Changes in the behaviour of health-care workers (HCWs) are required to improve adherence to infection prevention and control (IPC) guidelines. Despite heavy investment in strategies to change behaviour, effectiveness has not been adequately assessed. We did a systematic review to assess the effectiveness and sustainability of interventions to change IPC behaviour and assessed exploratory literature for barriers to and facilitators of behaviour change. 21 studies published from 1999 to 2011 met our inclusion criteria: seven intervention studies and 14 exploratory studies.

Antiviral drug resistance is a crucial factor that frequently determines the success of long-term therapy for chronic hepatitis B. The development of resistance to nucleos(t)ide analogues has been associated with exacerbations in liver disease and increased risk of emergence of multidrug resistance. The selection of a potent nucleos(t)ide analogue with a high barrier to resistance as a first-line therapy, such as entecavir or tenofovir, provides the best chance of achieving long-term treatment goals and should be used wherever possible.

Operational research in low-income countries has a key role in filling the gap between what we know from research and what we do with that knowledge—the so-called know–do gap, or implementation gap. Planned research that does not tangibly affect policies and practices is ineffective and wasteful, especially in settings where resources are scarce and disease burden is high. Clear parameters are urgently needed to measure and judge the success of operational research. We define operational research and its relation with policy and practice, identify why operational research might fail to affect policy and practice, and offer possible solutions to address these shortcomings.

In The Lancet Infectious Diseases, Oliver Cornely and colleagues1 report that fidaxomicin is non-inferior to vancomycin in treatment of patients in Europe, Canada, and the USA infected with Clostridium difficile. Of 216 patients given fidaxomicin in the per-protocol population, 198 (91·7%) achieved clinical cure, as did 213 (90·6%) of 235 given vancomycin (one-sided 97·5% CI −4·3%). Fidaxomicin had a lower risk of recurrence than did vancomycin after successful symptom resolution in the modified intention-to-treat population (12·7% vs 26·9%; p=0·0002).

Fidaxomicin could be an alternative treatment for infection with C difficile, with similar efficacy and safety to vancomycin.

In The Lancet Infectious Diseases, Hiroshi Imamura and colleagues1 report data from a randomised controlled trial of antimicrobial prophylaxis in patients having distal gastrectomy for cancer. Patients were randomly assigned to receive 1 g of cefazolin before the incision only or an additional dose once after closure and twice daily for 2 days after surgery. The rates of surgical-site infection were much the same between groups: 9% in the extended treatment group and 5% in the intraoperative alone group.

Elimination of postoperative antimicrobial prophylaxis did not increase the incidence of surgical-site infections after a gastrectomy. Therefore, this treatment is not recommended after gastric cancer surgery.

In The Lancet Infectious Diseases, Nitika Pant Pai and colleagues1 concluded, in a systematic review and meta-analysis, that a rapid point-of-care HIV test, Oraquick, had a slightly lower sensitivity for oral specimens (98·03%) than blood specimens (99·68%), but specificities were similar (99·74% vs 99·91%). Although the positive predictive values (PPVs) were similar (98·65% vs 98·50%) in high-prevalence settings (HIV prevalence >1%), they identified a lower PPV for oral specimens (88·55%) than blood specimens (97·65%) in lower-prevalence settings.

Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test.

In The Lancet Infectious Diseases, Mohamed Kharfan-Dabaja and colleagues describe a phase 2, placebo-controlled trial1 of a therapeutic cytomegalovirus DNA vaccine (TransVax; Vical, San Diego, CA, USA) for patients undergoing haemopoietic stem-cell transplantation. Occurrence and duration of episodes of cytomegalovirus viraemia were significantly reduced when cytomegalovirus-seropositive patients, who are at highest risk for cytomegalovirus disease, received up to four doses of the vaccine. The results of this study are exciting, particularly in view of the frustrating failures of previous trials.

We show proof of concept for an immunotherapeutic cytomegalovirus vaccine (TransVax) for clinically significant viraemia in the HSCT setting. The reported safety and efficacy outcomes support further development in a phase 3 trial, notwithstanding a lack of significant reduction in the use of cytomegalovirus-specific antiviral therapy compared with placebo in this phase 2 trial.

Malaria can have devastating consequences for pregnant women and their developing fetuses. The lack of information on the effect of malaria in the first trimester has been previously identified as an important knowledge gap in estimating the burden of malaria in pregnancy.1 Similarly, few data are available on the safety in early pregnancy of the artemisinin class of compounds, alone or as combination therapies,2 the most effective antimalarials to date. Although extrapolation of animal reprotoxicology data to human beings is ambiguous, it suggests that artemisinin derivatives could cause birth defects or pregnancy loss when used in the early first trimester of pregnancy.

A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.

BCG has been given to over 3 billion people since the early part of the 20th century. Although the vaccine is effective, its use was implemented before clinical-trial design had reached its current sophistication, and before sensitive in-vitro techniques of assessing cellular immune responses were available. Recent studies and reinterpretation of previous trials have helped to clarify the true efficacy of BCG against both infection with and disease caused by Mycobacterium tuberculosis, while large cohort studies have provided an accurate side-effect profile in recipients with HIV infection.

Vaccination of school-age children without previous tuberculin testing can reduce the incidence of tuberculosis and could reduce the costs of tuberculosis control. Restriction of BCG vaccination to the first year of life is not in the best interests of the public nor of programmes for tuberculosis control.

In The Lancet Infectious Diseases, Raph Hamers and colleagues1 report an increased likelihood of virological failure after the first year of standard first-line non-nucleoside transcriptase inhibitor-based antiretroviral therapy (ART) in patients who have a drug resistance mutation for at least one drug in the regimen. Moreover, they show that the risk of acquired HIV drug resistance is higher in people with pretreatment drug resistance than in those without. Although not entirely surprising, this study provides the first documentation of this finding in an African setting.

At least three fully active antiretroviral drugs are needed to ensure an optimum response to first-line regimens and to prevent acquisition of drug resistance. Improved access to alternative combinations of antiretroviral drugs in sub-Saharan Africa is warranted.