BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic resulted in unique programmatic opportunities to test hypotheses related to the initiation of antiretroviral treatment (ART) and viral load (VL) suppression during a global health crisis, which would not otherwise have been possible. OBJECTIVES: To generate practice-relevant evidence on the impact of initiating ART pre-COVID-19 versus during the COVID-19 pandemic on HIV VL. METHOD: Logistic regression was performed on data covering 6596 persons with HIV whose VL data were available, out of 36 585 persons who were initiated on ART between 01 April 2019 and 30 March 2021. RESULTS: After controlling for covariates such as age, gender, duration on ART, tuberculosis status at the time of the last visit, and rural vs urban status, the odds of having a VL < 1000 copies/mL were significantly higher for clients who started ART during the COVID-19 pandemic than the year before COVID-19 (adjusted odds ratio [AOR]: 2.50; confidence interval [CI]: 1.55-4.01; P < 0.001). Odds of having a VL < 1000 copies/mL were also significantly higher among female participants than male (AOR: 1.23; CI: 1.02-1.48), among patients attending rural clinics compared to those attending urban clinics (AOR: 1.83; CI: 1.47-2.28), and in clients who were 15 years or older at the time of their last visit (AOR: 1.50; CI: 1.07-2.11. CONCLUSION: Viral loads did not deteriorate despite pandemic-induced changes in HIV services such as the expansion of multi-month dispensing (MMD), which may have played a protective role regardless of the general negative impacts of response to the COVID-19 crises on communities and individuals. What this study adds: This research capitalises on the natural experiment of COVID-19-related changes in HIV services and provides new practice-relevant research evidence..

OBJECTIVE: To examine the relationship between antibody status and various hypothesized risk factors for Toxoplasma gondiiinfection among two different Amerindian populations in eastern Panama. Following up on earlier research that we conducted, we now explore the role of dogs in the natural transmission of Toxoplasma,the role that dogs play in promoting transmission, the interactive effect of cats and dogs, and the accessibility of infective material to children. METHODS: In 1991, 10 Panamanian medical students conducted interviews and took blood samples from 760 Kuna and Embera children aged 2 through 12 years in the Upper Bayano River Basin and the San Blas Islands. Serologic assays were performed using direct agglutination. The data analyses in the 1990s included univariate, bivariate, and multivariate analyses, without regard to data on dogs. Further bivariate and multivariate analyses were performed in 2003 to examine the contribution of dogs. RESULTS: In communities with high Toxoplasmaantibody prevalence in children, logistic regression suggested that the factors predictive of antibody presence were: compacted soil floors of huts (P= 0.001), having a dog (P= 0.038), and the interviewer seeing a cat in the house (P= 0.049). Our results suggest that the villagers' dogs play a significant role in facilitating the transmission of Toxoplasma gondiito humans, most often in the presence of cats in the houses, and only in those communities with higher Toxoplasmas eroprevalence in children. CONCLUSIONS: Dogs may act as mechanical vectors, by rolling in foul-smelling substances and by ingesting fecal material. In areas of high Toxoplasma prevalence in children and where dogs and cats are plentiful, immunocompromised individuals and pregnant women should be warned of the possibility of acquiring Toxoplasma gondii from dogs as well as from soil contaminated by cats. People should be encouraged to wash their hands after contact with soil, dogs, or cats as well as before eating.

OBJETIVO: Examinar la relación entre la presencia o ausencia de anticuerpos y los diversos factores de riesgo hipotéticos asociados con la infección por Toxoplasma gondii en dos poblaciones amerindias diferentes del este de Panamá. Como secuela a una investigación preliminar, en este trabajo se explora el papel de los perros en la transmisión natural de Toxoplasma y en la facilitación de la transmisión, así como el efecto interactivo de los perros y gatos y el acceso de los niños a materiales infecciosos. MÉTODOS: En 1991, 10 estudiantes de medicina panameños llevaron a cabo entrevistas y les tomaron muestras de sangre a 760 niños kunas y emberas de 2 a 12 años de edad en la cuenca superior del río Bayano y en las islas de San Blas. Se hicieron pruebas serológicas mediante aglutinación directa. Todos los datos, menos los de los perros, se estudiaron mediante análisis unifactorial, bifactorial y multifactorial. En 2003 se efectuaron nuevos análisis bifactoriales y multifactoriales para examinar la contribución de los perros. RESULTADOS: En comunidades con una alta prevalencia de anticuerpos contra Toxoplasma en niños, la regresión logística indicó que los siguientes factores tenían valor pronóstico en relación con la presencia de anticuerpos: pisos de tierra compacta en las chozas (P = 0,001), tener perro (P = 0,038), y que el investigador hubiera visto un gato dentro de la vivienda (P = 0,049). Según nuestros resultados, los perros de los habitantes de las aldeas desempeñan un papel importante en la facilitación de la transmisión de Toxoplasma gondii a los seres humanos, la mayor parte de las veces en presencia de gatos dentro de la vivienda y solamente en comunidades con una alta seroprevalencia de Toxoplasma en niños. CONCLUSIONES: Los perros pueden ser vectores mecánicos debido a su hábito de revolcarse en sustancias fétidas y de comer heces. En zonas donde la prevalencia de Toxoplasma en niños es alta y donde hay muchos perros y gatos, a las personas inmunodeprimidas y las mujeres embarazadas se les debe advertir del peligro de infectarse con Toxoplasma gondii por contacto con perros o con tierra contaminada por gatos. Se debe alentar a las personas a lavarse las manos después de tocar tierra, perros o gatos y antes de comer.