Marcela Gomez-Suarez

Background/Objectives: Despite the availability of safe and highly effective human papillomavirus (HPV) vaccines, vaccination coverage remains below global targets in many low- and middle-income countries. School-based HPV prevention campaigns represent a promising strategy to promote adolescent engagement in preventive health behaviors; however, little is known about the factors of adolescents’ intention to participate in these initiatives, particularly in Latin America. This study aimed to identify factors of adolescents’ intention to participate in a school-based HPV prevention campaign in Bogotá, Colombia. Methods: A cross-sectional study was conducted among 125 adolescents aged 11–17 years. Sociodemographic characteristics, HPV-related knowledge, exposure to HPV-related information on social media, and intention to receive HPV vaccination were assessed as potential factors of participation. Associations with intention to participate were estimated using Poisson regression with robust variance, and adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 52.8% of adolescents reported an intention to participate in a school-based HPV prevention campaign. Exposure to HPV-related information on social media showed the strongest positive association with participation (aPR = 1.80; 95% CI: 1.25–2.58), followed by accurate knowledge of the recommended age for HPV vaccination (aPR = 1.68; 95% CI: 1.10–2.57), religious practice (aPR = 1.67; 95% CI: 1.23–2.27), and intention to receive HPV vaccination (aPR = 1.49; 95% CI: 1.01–2.21). Conclusions: These findings identify factors associated with adolescents’ intention to participate in school-based HPV prevention campaigns. Integrating evidence-based digital communication with practical HPV education may inform strategies to promote adolescent engagement. Future studies should determine whether these factors predict actual participation and implementation outcomes.

Background: Cancer diagnosis in Colombia faces delays and regional inequities, particularly in rural and underserved areas where access to subspecialist pathology is limited. General pathologists in these contexts frequently manage complex oncological cases with limited expert support, which may increase diagnostic uncertainty and professional burden. Methods: A concurrent mixed-methods design was applied within the GLORIA (Globalization of a telepathology network with artificial intelligence applications) project framework. Quantitative data were collected from a national survey distributed to ASOCOLPAT-registered pathologists ( n = 57). Qualitative data were obtained through conversational interviews with general pathologists from six small and mid-sized laboratories ( n = 11). Findings: Most participants reported needing subspecialist support for complex oncological cases (100%) and reported high emotional stress (86%), mainly associated with diagnostic uncertainty, legal responsibility, and excessive workload. Consultation response times differed across contexts, ranging from 1 to 7 days in Bogotá to more than 30 days in small cities. While 86% reported familiarity with telepathology, 63.2% had never used it in routine practice; however, 94% believed slide scanners could improve diagnostic timeliness. Qualitative findings identified recurrent themes related to administrative authorization barriers, logistical delays, professional isolation, and the perceived value of telepathology for timely expert feedback and learning. Interpretation: This baseline assessment suggests that telepathology implementation in Colombia must address not only technical readiness but also structural barriers in referral workflows and the professional needs of general pathologists, including timely feedback, shared responsibility, and learning opportunities.

Cancer continues to be a significant public health challenge in Latin America and the Caribbean (LAC), marked by rising incidence and mortality rates and a projection of increased burden by 2040. Despite the recognized importance of early diagnosis and treatment, the LAC region faces profound disparities in cancer care access due to socioeconomic, geographic, and educational barriers. These inequities are exacerbated by a lack of medical specialists, healthcare access limitations, and the distribution of resources, especially in rural areas. Social determinants of health (SDH) such as income level, educational attainment, and geographic location further contribute to delayed diagnoses and poor treatment outcomes. Addressing these barriers, recent initiatives emphasize strategies like telepathology networks, health education programs, and the establishment of cancer support networks to improve early diagnosis and quality of care. This review explores these SDH-based disparities in cancer care within LAC, examining innovative approaches aimed at reducing health inequities and improving outcomes for underserved populations. Through targeted interventions, the article highlights the critical need for policies promoting equitable access to cancer care as a fundamental public health objective in LAC.

Introduction: chronic childhood malnutrition (CCMN) is a global issue affecting millions of children, especially in middle-income and low-income countries. This phenomenon, resulting from a variety of factors, carries serious sequelae on a child´s growth, and physical and cognitive development. Addressing this problem by analyzing the social determinants of health (SDH), provides a broad view of the need of impacting each of these factors. Lack of accessing essential nutrients linked to factors such as poverty, discrimination and social inequalities have a direct impact on child nutrition. The problem is aggravated by living conditions, especially in rural areas, where access to basic services such as drinking water and sanitation is limited. Objective: to analyze the SDH present in vulnerable urban communities in Bogotá, related to CCMN. Discussion and conclusion: understanding these determinants is fundamental to tackle this problem and design comprehensive public policies considering the complete territorial and social reality in combating child malnutrition. However, assuming this great challenge requires comprehensive actions addressing inequalities, from poverty to ethnic identity, ensuring equal opportunities, access to health and nutrition services, and community empowerment promotion.

Introducción: la esclerosis múltiple (EM) es una enfermedad crónica que afecta principalmente a la población joven, además que su diagnóstico y tratamiento tardío generan una alta discapacidad y deterioro en la calidad de vida. La evidencia sobre el uso y la utilidad de las herramientas de salud móvil (mHealth) para el diagnóstico y seguimiento de la EM no ha sido ampliamente explorada, generando un vacío de conocimiento. Por ello, el objetivo de este estudio fue analizar la utilidad de estas herramientas como apoyo en la sospecha diagnóstica y el seguimiento de pacientes con EM. Materiales y métodos: esta fue una revisión de la literatura con una estrategia de búsqueda en: Pubmed, Scopus, ScienceDirect y Web of Science, utilizando términos MeSH. Además, se realizó la selección de artículos siguiendo el flujograma Prisma, y como criterio de inclusión, se revisaron artículos sobre el uso y la aplicación de herramientas tecnológicas en el diagnóstico y seguimiento de pacientes con EM. Resultados: se incluyeron 10 artículos a nivel global que evaluaron a 10?581 participantes, de los cuales 9110 tuvieron un diagnóstico de EM, provenientes de Estados Unidos y Europa, donde el desenlace fue la oportunidad diagnóstica y el seguimiento en calidad de vida. Las mHealth incorporadas evaluaron subjetiva y objetivamente datos clínicos, permitiendo caracterizar factores de riesgo, signos y síntomas, características clínicas y sociodemográficas, entre otras, estableciendo parámetros de diagnóstico temprano. Discusión: las mHealth han demostrado en países desarrollados su utilidad para el diagnóstico temprano, tratamiento y pronóstico de la EM, además de ser innovadoras y efectivas para mejorar la gestión, dada su capacidad de monitorización y seguimiento de datos clínicos. Esta utilidad podría representar enormes beneficios para poblaciones de países en vías de desarrollo. Conclusiones: las mHealth en EM son útiles como apoyo diagnóstico, ya que reducen el tiempo diagnóstico, son aplicables en monitorización e identificación de la sintomatología, orientando a mejores tratamientos y seguimiento.

Purpose: The aim of this study was to review the scientific evidence and describe the ocular treatment-emergent adverse events (TEAEs) related to pharmacological treatment in patients with multiple sclerosis. Methods: A systematic review of literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines in the MEDLINE, LILACS, EMBASE, and COCHRANE databases. Articles were filtered based on title and abstract considering the selection criteria and subsequently filtered by full-text reading. The resulting articles were evaluated using the Joanna Briggs Institute Quality Tools. Study characteristics and results were extracted and presented in structured tables to conduct a narrative synthesis. Results: A total of 2852 published articles were extracted using our strategy. After removing duplicates, 2841 articles were screened based on title and abstract, 102 articles were evaluated using quality tools, and 69 articles were filtered by full-text reading. Through this search strategy, 60 articles met all the inclusion criteria and seven articles, through a search update conducted in the same manner, were included. This resulted in 67 articles meeting the inclusion criteria, of which 11 were experimental and 56 were observational. The therapies related to ocular TEAEs were alemtuzumab, amantadine, fingolimod, steroids, CTLA-4 Ig, estriol, interferon β, natalizumab, hyperbaric oxygen, rituximab, siponimod, teriflunomide, and tovaxin. Fingolimod and siponimod were commonly associated with macular edema, interferon β was associated with retinopathy, alemtuzumab was associated with thyroid eye disease, amantadine was associated with corneal edema, and steroids were associated with acute retinal necrosis. Opportunistic infections were also found, and there was one life-threatening case. Conclusions: Our search revealed different methodological assessments of the topic. However, longitudinal studies regarding ocular TEAEs related to multiple sclerosis therapy are necessary to provide evidence-based recommendations, especially in understudied regions such as Latin America and Africa. Physicians should monitor ocular symptoms in patients being treated for multiple sclerosis and consider an interdisciplinary approach. Systematic review registration: PROSPERO ID CRD42020106886

With the evolution in prevention, diagnosis, and treatment of HIV/AIDS, ending the infection as a public health threat worldwide has become a real possibility included within the United Nations Sustainable Development Goal Project 2030. However, some countries and even entire regions are not on track to reach this target due to increased new infections in young populations. Young women (15–24 years) represent 48% of the new HIV cases globally. Research shows these women have significant unmet sexual and reproductive health (SRH) needs, with high rates of unplanned pregnancies, increased HIV perinatal transmission (HIV-PT) risk, and higher maternal morbidity and mortality. Granting access to SRH services based on rights for women living with HIV is a cost-effective alternative to reducing new infections in children by promoting respect for women’s reproductive options. This chapter addresses the role of SRH services based on rights for women living with HIV within HIV-PT. It also summarizes the new “Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV”; designed by the World Health Organization as a global recommendation for SRH programs and services that promote gender equality and human rights for women living with HIV.

Introduction: Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC.Methods: Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta‐analysis was not considered appropriate given the level of heterogeneity of the studies.Results: A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non‐permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV.Conclusions: This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.

To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia. An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared. For every 10,000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening. The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.