The World Health Organization has called for the global elimination of cervical cancer. While high income countries have made significant progress, the incidence and mortality due to cervical cancer is unacceptably high in low and middle income countries (LMIC). Jamaica is an upper middle income country with cervical cancer incidence and mortality of 21.6/100,000 and 13.6/100,000 person years respectively compared to 14.9/100,000 and 7.6/100,000 person years in Latin America and the Caribbean. Jamaica's pathway to reducing the burden of cervical cancer highlights challenges and opportunities for other LMIC. High prevalence of HPV infection (54% women attending primary care clinics), low levels of cervical cancer screening (<50% women 15 to 54 years old screened in the last 3 years) and suboptimal uptake of HPV vaccination (approximately 30%) are persistent barriers to achieving this goal. Lessons learned from the response to the human immunodeficiency virus (HIV) epidemic confirm the need for serious political commitment by global and national leaders, meaningful engagement of stakeholders and innovative strategies to improve uptake of HPV vaccination and cervical cancer screening. Commitment of technical and financial resources are critical for establishing robust cancer registries and strengthening monitoring and evaluation systems in LMIC.

Objectives. To describe the clinical presentation of chikungunya virus (CHIKV) illness in adults during the 2014 outbreak in Jamaica and to determine the predictive value of the case definition. Methods. A cross-sectional study was conducted using clinical data from suspected cases of CHIKV that were reported to the Ministry of Health in April – December 2014. In addition, charts were reviewed of all individuals over 15 years of age with suspected CHIKV based on a diagnosis of CHIKV or “acute viral illness” that presented to four major health centers in Jamaica during the week prior to and the peak week of the epidemic. Data abstracted from these charts using a modified CHIKV Case Investigation Form included demographics, clinical findings, and laboratory tests. Results. In 2014, the Ministry of Health of Jamaica received 4 447 notifications of CHIKV infection. PCR testing was conducted on 137 suspected CHIKV cases (56 men and 81 women; median age 28 years) and was positive for 89 (65%) persons. In all, 205 health charts were identified that met the selection criteria (51 men and 154 women, median age 43 years). The most commonly reported symptoms were arthralgia (86%) and fever (76%). Of those who met the epidemiologic case definition for CHIKV as defined by the Pan American Health Organization, only 34% had this diagnosis recorded. Acute viral illness was the most frequently recorded diagnosis (n = 79; 58%). Conclusions. Broader case definitions for acute CHIKV illness may be needed to identify suspected cases during an outbreak. Standardized data collection forms and validation of case definitions may be useful for future outbreaks.

Background Adequate coverage of target populations ensures that desired outcomes, such as increased survival of people living with HIV, are achieved. However, estimates of coverage and impact of HIV programmes using available data are limited by the complex natural history of HIV, underreporting of cases and inadequate information systems. Methods Jamaica's national HIV estimates were generated using the 2009 version of the UNAIDS estimation and projection package (EPP) and Spectrum. National data used included sentinel surveillance data on antenatal clinic attendees (1986–2005 and 2007), distribution of antiretroviral regimes for prevention of mother-to-child transmission, distribution of antiretroviral therapy (ART) among adults and ART distribution in subpopulations (eg, men who have sex with men (MSM) and sex workers). Surveys of MSM (2007), sex worker (2001, 2005, 2008), STI clinic attendees (1990–2002) and inmates (2006) also provided inputs. Results In 2009, Jamaica's HIV prevalence was estimated at 1.7% (range 1.1–2.5) and 31 000 (range 20 000–43 000) adults (>15 years) were living with HIV. The number of adults in need of treatment was 15 000 (range 11 000–19 000) and approximately 2100 new infections occurred in 2009. The EPP/Spectrum estimates were generally consistent with locally available data. However, the number of persons with advanced HIV targeted by the national treatment programme was significantly lower than Spectrum's estimated target population. Conclusion EPP/Spectrum can provide important data for national HIV programme planning. Improved monitoring and evaluation systems will provide quality data and result in more robust estimates.

This study evaluates a simple clinical audit tool for assessing quality of care and blood pressure control among persons with hypertension in primary care clinics. A systematic random sampling of persons with diabetes mellitus (DM) and hypertension (HTN) attending five health centers in Kingston, Jamaica, was conducted. A modified Ministry of Health paper-based audit tool captured quality of care and outcome indicators (blood pressure and glycemic control). Additional chart audits were conducted by a physician and nurse to assess reliability. One hundred and forty-nine charts were audited between January and September 2017. One hundred and thirty-eight persons (92.6%) had hypertension (27 men and 111 women); 77 persons (51.7%) had DM (14 men and 63 women). The median age was 64 years old. Approximately two-thirds of persons with HTN and DM had electrolytes, lipid profile, and ECG done within the last year. One-fifth of persons with hypertension (18.5% men and 19.8% women, P = 1.000) had adequate blood pressure control with greater control among persons with HTN only compared to persons with both DM and HTN. Poor glycemic control was recorded for 69% of persons with DM (57% men and 71% women, P = .297). Moderate to substantial inter-rater agreement was observed for quality of care indicators. Our findings confirmed that hypertension and glycemic control are inadequate among persons attending primary care clinics in Jamaica's capital city. Simplified clinical audits can provide important quality of care and outcome indicators without losing the meaningfulness of the data collected.

The clinical spectrum of Coronavirus 2019 (COVID-19) includes acute COVID-19, long covid and multisystem inflammatory syndrome in children and adults (MISC/A). The rapid roll-out of COVID-19 vaccination has the potential to affect the clinical presentation of COVID-19 and case reports document rare occurrences of MIS-A after COVID-19 infection and recent vaccination with m-RNA vaccines. We describe 2 cases of MIS-A after COVID-19 infection and recent vaccination with ChAdOx1 nCoV-19.