ABSTRACT INTRODUCTION a research ethics system is essential to protect the rights of research participants. The challenges posed by the COVID-19 pandemic to conduct research ethically to produce rapid results have demonstrated the need to strengthen this system. The objective of this study was to describe the state of the research ethics system of the Provinces of Argentina and the adaptations made due to the pandemic. METHOD: a survey was conducted with provincial research ethics committees or similar areas within the Ministries of Health of the provinces responsible for the oversight of research ethics review under their jurisdiction. RESULTS sixteen of the 17 provinces surveyed responded. 93.7% of the provincial committees review human research and have standard operating procedures (SOPs). 68.7% register the research ethics committees (REC) in their jurisdiction. Seventy-five percent accredit RECs and 68.7% supervise them. 100% have a registry of health research in the jurisdiction, only 56.2% have public access. 81.2% carry out training activities. 100% adapted the SOPs to evaluate studies on COVID-19. DISCUSSION the results show consolidated provincial systems. Transparency in research needs to be strengthened through public registration of research. Possibilities for improvement were identified to propose future actions.

RESUMEN INTRODUCCIÓN un sistema de evaluación ética de las investigaciones en seres humanos es esencial para proteger los derechos de los participantes. Los desafíos impuestos por la pandemia de la COVID-19 para conducir investigaciones éticas que produzcan resultados con rapidez demuestran la necesidad de fortalecerlo. El objetivo de este estudio fue describir el estado de situación de los sistemas de evaluación ética de las provincias de Argentina y las adaptaciones realizadas por la pandemia. MÉTODOS se realizó una encuesta a los comités provinciales de ética en investigación o áreas similares de los ministerios de Salud que ejercen la vigilancia sobre la evaluación ética de las investigaciones de su jurisdicción. RESULTADOS respondieron 16 de las 17 provincias encuestadas. El 93,7% de los comités provinciales evalúa investigaciones en seres humanos y tiene procedimientos operativos estandarizados (POE). El 68,7% lleva un registro de los comités de ética en investigación (CEI) de su jurisdicción. Un 75% acredita a los CEI y un 68,7% los supervisa. El 100% tiene un registro de las investigaciones en salud; en 56,2% de los casos este registro es público. Del total, 81,2% realizan actividades de capacitación. El 100% adaptó los POE para evaluar estudios sobre la COVID-19. DISCUSIÓN los resultados muestran sistemas provinciales consolidados. Se requiere fortalecer la transparencia en la investigación mediante el registro público de las investigaciones. Se identificaron posibilidades de mejora para proponer acciones a futuro.

BACKGROUND The eco-epidemiological status of Chagas disease in the Monte Desert ecoregion of western Argentina is largely unknown. We investigated the environmental and socio-demographic determinants of house infestation with Triatoma infestans, bug abundance, vector infection with Trypanosoma cruzi and host-feeding sources in a well-defined rural area of Lavalle Department in the Mendoza province. METHODS Technical personnel inspected 198 houses for evidence of infestation with T. infestans, and the 76 houses included in the current study were re-inspected. In parallel with the vector survey, an environmental and socio-demographic survey was also conducted. Univariate risk factor analysis for domiciliary infestation was carried out using Firth penalised logistic regression. We fitted generalised linear models for house infestation and bug abundance. Blood meals were tested with a direct ELISA assay, and T. cruzi infection was determined using a hot-start polymerase chain reaction (PCR) targeting the kinetoplast minicircle (kDNA-PCR). FINDINGS The households studied included an aged population living in precarious houses whose main economic activities included goat husbandry. T. infestans was found in 21.2% of 198 houses and in 55.3% of the 76 re-inspected houses. Peridomestic habitats exhibited higher infestation rates and bug abundances than did domiciles, and goat corrals showed high levels of infestation. The main host-feeding sources were goats. Vector infection was present in 10.2% of domiciles and 3.2% of peridomiciles. Generalised linear models showed that peridomestic infestation was positively and significantly associated with the presence of mud walls and the abundance of chickens and goats, and bug abundance increased with the number of all hosts except rabbits. MAIN CONCLUSIONS We highlight the relative importance of specific peridomestic structures (i.e., goat corrals and chicken coops) associated with construction materials and host abundance as sources of persistent bug infestation driving domestic colonisation. Environmental management strategies framed in a community-based programme combined with improved insecticide spraying and sustained vector surveillance are needed to effectively suppress local T. infestans populations.

Resumo: A aplicação de inseticida residual ainda é a principal medida para suprimir a infestação domiciliar por triatomíneos, vetores da doença de Chagas. Enquanto os aspersores manuais acionados por compressão têm sido utilizados tradicionalmente na América Latina, o programa de controle vetorial da Província de Mendoza, Argentina, introduziu o uso de um equipamento aspersor montado em veículo, aparentemente com vantagem em relação ao aspersor manual. Realizamos um estudo randomizado de intervenção para avaliar a efetividade e os componentes selecionados do desempenho dos dois equipamentos. Avaliamos a infestação por Triatoma infestans em 76 domicílios previamente infestados a 0, 1, 4 e 12 meses pós-intervenção. As infestações foram reduzidas substancialmente, sem diferença significativa entre as duas técnicas. As infestações finais eram limitadas ao peridomicílio. O equipamento montado em veículo levava menos tempo para completar a aplicação, comparado com o equipamento manual, mas os dois tratamentos tiveram desempenho semelhante e deixaram de suprimir completamente as infestações. As principais vantagens do equipamento montado em veículo foram redução do esforço físico, principalmente em condições adversas em campo, e potenciais ganhos em termos de cobertura de borrifação por unidade de tempo.

Abstract: Residual insecticide spraying still is the main tool used to suppress house infestations with Chagas disease vectors. While manual compression sprayers (MCS) have traditionally been used in Latin America, Mendoza's vector control program from Argentina introduced the use of a modified motorized vehicle-mounted sprayer (VMS) with apparent advantages over MCS. We conducted a randomized intervention trial to evaluate the effectiveness and selected components of the performance of MCS and VMS. We assessed house infestation by Triatoma infestans in 76 previously-infested houses at 0, 1, 4 and 12 months postintervention. Infestations were reduced substantially, with no significant differences between treatments. End-point infestations were restricted to peridomiciles. Although VMS required less time to complete the house spraying than MCS, both treatments had similar performance and did not suppress infestations completely. The main relative advantages of VMS were a reduced physical effort, especially under harsh field conditions, and potential gains in spray coverage per unit of time.

Resumen: El empleo de insecticida residual es todavía la principal herramienta para suprimir la infestación domiciliaria por triatominos, vectores de la enfermedad de Chagas. Mientras los aspersores manuales activados por compresión han sido utilizados tradicionalmente en América Latina, el programa de control vectorial de la provincia de Mendoza, Argentina, introdujo el uso de un equipamiento aspersor montado en un vehículo, aparentemente con ventajas respecto al aspersor manual. Realizamos un ensayo de intervención aleatorizado para evaluar la efectividad y los componentes seleccionados del desempeño de los dos equipamientos. Evaluamos la infestación por Triatoma infestans en 76 vivendas, previamente infestados a 0, 1, 4 y 12 meses tras la intervención. Las infestaciones se redujeron substancialmente, sin diferencia significativa entre las dos técnicas. Las infestaciones finales se limitaban al peridomicilio. El equipamiento montado en el vehículo llevaba menos tiempo para completar la aplicación, comparado con el equipamiento manual, pero los dos tratamientos tuvieron un desempeño semejante y dejaron de suprimir completamente las infestaciones. Las principales ventajas del equipamiento montado en vehículo fueron: la reducción del esfuerzo físico, principalmente en condiciones adversas en el campo, y potenciales beneficios en términos de cobertura de pulverización por unidad de tiempo.

Resumo: A aplicação de inseticida residual ainda é a principal medida para suprimir a infestação domiciliar por triatomíneos, vetores da doença de Chagas. Enquanto os aspersores manuais acionados por compressão têm sido utilizados tradicionalmente na América Latina, o programa de controle vetorial da Província de Mendoza, Argentina, introduziu o uso de um equipamento aspersor montado em veículo, aparentemente com vantagem em relação ao aspersor manual. Realizamos um estudo randomizado de intervenção para avaliar a efetividade e os componentes selecionados do desempenho dos dois equipamentos. Avaliamos a infestação por Triatoma infestans em 76 domicílios previamente infestados a 0, 1, 4 e 12 meses pós-intervenção. As infestações foram reduzidas substancialmente, sem diferença significativa entre as duas técnicas. As infestações finais eram limitadas ao peridomicílio. O equipamento montado em veículo levava menos tempo para completar a aplicação, comparado com o equipamento manual, mas os dois tratamentos tiveram desempenho semelhante e deixaram de suprimir completamente as infestações. As principais vantagens do equipamento montado em veículo foram redução do esforço físico, principalmente em condições adversas em campo, e potenciais ganhos em termos de cobertura de borrifação por unidade de tempo.

Abstract: Residual insecticide spraying still is the main tool used to suppress house infestations with Chagas disease vectors. While manual compression sprayers (MCS) have traditionally been used in Latin America, Mendoza's vector control program from Argentina introduced the use of a modified motorized vehicle-mounted sprayer (VMS) with apparent advantages over MCS. We conducted a randomized intervention trial to evaluate the effectiveness and selected components of the performance of MCS and VMS. We assessed house infestation by Triatoma infestans in 76 previously-infested houses at 0, 1, 4 and 12 months postintervention. Infestations were reduced substantially, with no significant differences between treatments. End-point infestations were restricted to peridomiciles. Although VMS required less time to complete the house spraying than MCS, both treatments had similar performance and did not suppress infestations completely. The main relative advantages of VMS were a reduced physical effort, especially under harsh field conditions, and potential gains in spray coverage per unit of time.

Resumen: El empleo de insecticida residual es todavía la principal herramienta para suprimir la infestación domiciliaria por triatominos, vectores de la enfermedad de Chagas. Mientras los aspersores manuales activados por compresión han sido utilizados tradicionalmente en América Latina, el programa de control vectorial de la provincia de Mendoza, Argentina, introdujo el uso de un equipamiento aspersor montado en un vehículo, aparentemente con ventajas respecto al aspersor manual. Realizamos un ensayo de intervención aleatorizado para evaluar la efectividad y los componentes seleccionados del desempeño de los dos equipamientos. Evaluamos la infestación por Triatoma infestans en 76 vivendas, previamente infestados a 0, 1, 4 y 12 meses tras la intervención. Las infestaciones se redujeron substancialmente, sin diferencia significativa entre las dos técnicas. Las infestaciones finales se limitaban al peridomicilio. El equipamiento montado en el vehículo llevaba menos tiempo para completar la aplicación, comparado con el equipamiento manual, pero los dos tratamientos tuvieron un desempeño semejante y dejaron de suprimir completamente las infestaciones. Las principales ventajas del equipamiento montado en vehículo fueron: la reducción del esfuerzo físico, principalmente en condiciones adversas en el campo, y potenciales beneficios en términos de cobertura de pulverización por unidad de tiempo.

Introduction. Highly active antiretroviral therapy (HAART) has been administered to children infected with human immunodeficiency virus (HIV) since 1996. This kind of therapy is effective in achieving viral suppression and stopping disease progression but prolonged administration increases the risk of toxic effects, favours the onset of viral resistance and leads to decreased adherence. The aim of the present study was to determine prognostic factors among clinical, immunological and virological parameters at the beginning of HAART. Population and methods. We performed a prospective-retrospective observational analysis of a cohort or 564 HIV+ children assisted in Hospitals of Buenos Aires and Rosario, Argentina, treated with HAART since 1998 (media of treatment: 46.78 months. Range: 2-91 months). Patients were divided in groups according to age (younger or older than one year), and outcome (favourable or unfavourable). Stage, CD4 lymphocytes percentage, CD4 lymphocyte cell count and viral load at the beginning of treatment were analyzed with outcome by means of χ² tests, and logistic regression. Results. No differences were observed on the percentage of CD4 T cells and viral load at baseline, between children under one year of age with good (n= 79) or bad outcomes (n= 4). Among older children (450 with good outcome, 31 with unfavourable), the following were identified as predictors of bad outcome: HAART initiation during stage C (p= 0.006), CD4 T-cell percentage below 15 percent (p< 0.001) and CD4 absolute value below 500 cells/mm³ (p= 0.003). Conclusions. Children older than one year will have better outcome when HAART is initiated before stage C, with more than 15% CD4 or more than 500 cells/mm³.

Introducción. Desde 1996, los niños infectados por el virus de la inmunodeficiencia humana reciben tratamientos antirretrovirales denominados de gran actividad (TARGA). El inicio tardío puede restarle eficacia; la administración prolongada aumenta el riesgo de episodios adversos y desarrollo de resistencia, y dificulta la adherencia. Nuestro objetivo fue establecer si existe relación entre los parámetros clínicos, inmunológicos y virológicos al inicio del tratamiento TARGA, y la evolución de los pacientes. Población, material y métodos. Estudio retrospectivo-prospectivo observacional de una cohorte de niños VIH positivos tratados con TARGA a partir de 1998 (n= 564) en hospitales de Buenos Aires y Rosario (promedio de tratamiento: 46,78 meses. Intervalo: 2-91 meses). Se los agrupó según edad (menor o mayor de un año) y evolución (favorable o desfavorable). Se correlacionaron el estadio clínico, porcentaje de linfocitos CD4 y carga viral al comienzo del tratamiento con la evolución. Resultados. No hubo diferencias entre porcentaje y recuento de CD4 y carga viral al inicio entre los niños menores de un año con buena (n= 79) o mala evolución (n: 4). Entre los niños mayores (450 con buena evolución, 31 con evolución desfavorable), fueron predictores de mala evolución al iniciar TARGA, el compromiso clínico grave (estadio C) (p= 0,006), CD4 menor 15% (p< 0,001) y recuento de CD4 menor de 500 células/mm³ (p= 0,003). Conclusiones. Los niños mayores de un año tienen mejor pronóstico cuando empiezan tratamiento en estadios previos al C, con CD4 > 15% o más de 500 células CD4/mm³.