Antiretroviral Treatment As Prevention In African Hiv 1 Serodiscordant Couples

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Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples

Author : Andrew Mujugira
Publisher :
ISBN 13 :
Total Pages : 78 pages
Book Rating : 4.:/5 (957 download)

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Book Synopsis Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples by : Andrew Mujugira

Download or read book Antiretroviral Treatment as Prevention in African HIV-1 Serodiscordant Couples written by Andrew Mujugira and published by . This book was released on 2016 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt: The studies described in this dissertation examine the relationship between use of antiretroviral therapy (ART) and biologic and behavioral factors related to HIV-1 transmission risk in stable heterosexual HIV-1 serodiscordant African couples. ART is recommended for all HIV-1 infected persons, regardless of CD4 count, to reduce HIV-1 related morbidity, mortality and risk of transmission to uninfected partners. ART is a cornerstone of combination HIV-1 prevention, and optimizing use of ART, both for treatment and prevention, is an urgent public health priority. The complementary prospective studies presented in this dissertation were secondary analyses of data from the Partners PrEP Study, a randomized clinical trial of daily oral pre-exposure prophylaxis (PrEP) to decrease HIV-1 acquisition among HIV-1 uninfected members of serodiscordant couples in Kenya and Uganda. This work includes prospective studies of: 1) correlates of failure to achieve plasma viral suppression and virologic rebound after initial suppression, 2) frequency, magnitude and correlates of seminal HIV-1 RNA shedding in men initiating ART, 3) residual HIV-1 transmission risk during the first 6 months of ART, and 4) sexual risk behavior before and after ART. Younger age was associated with delayed ART initiation, failure to achieve viral suppression, and increased risk of virologic rebound after initial suppression. Seminal HIV-1 RNA shedding was infrequent and present at low levels in HIV-1 infected African men with suppressed blood HIV-1 RNA. There were no HIV-1 transmission events on suppressive ART. We observed residual HIV-1 transmission risk during the first 6-months of ART, prior to complete viral suppression in blood and genital secretions. Importantly, substantial risk compensation did not occur following ART initiation among HIV-1 infected persons with known uninfected partners. Results from this dissertation contribute further evidence of the effectiveness of ART for HIV-1 prevention, and provide reassurance that HIV-1 transmission risk declines after starting ART. As treatment guidelines evolve from wait-and-treat to test-and-treat, scaling up access to HIV-1 testing, improving linkage and retention in care, and achieving high ART coverage and complete viral suppression at individual and population levels are essential to achieving zero new HIV-1 infections and zero AIDS-related deaths.

New Approaches to HIV Prevention in African HIV Serodiscordant Couples

Author : Kathryn G. Curran
Publisher :
ISBN 13 :
Total Pages : 118 pages
Book Rating : 4.:/5 (89 download)

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Book Synopsis New Approaches to HIV Prevention in African HIV Serodiscordant Couples by : Kathryn G. Curran

Download or read book New Approaches to HIV Prevention in African HIV Serodiscordant Couples written by Kathryn G. Curran and published by . This book was released on 2013 with total page 118 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation informs the future implementation of HIV prevention for HIV serodiscordant couples in Africa. The research objectives include: 1) reviewing effective HIV prevention interventions, 2) evaluating the use of daily short message service (SMS, i.e. text message) surveys to measure sex and pre-exposure prophylaxis (PrEP) adherence, and 3) examining the acceptability of initiation of antiretroviral therapy (ART) at higher CD4 counts, a powerful HIV prevention tool. After the necessary first step of HIV testing and counseling, HIV serodiscordant couples may be offered appropriate HIV prevention interventions, including condoms, male circumcision, treatment of sexually transmitted infections, and two recent biomedical strategies: initiation of ART by the HIV-infected partner and PrEP by the HIV-uninfected partner. Importantly, the widespread implementation and effectiveness of HIV prevention interventions requires understanding and encouraging behaviors for acceptance, adherence, and correct use. We conducted a prospective study of HIV-related behaviors and qualitative research to answer key implementation questions regarding the feasibility of PrEP and acceptability of early ART among HIV serodiscordant couples. Within a clinical trial of PrEP, we evaluated the use of daily SMS surveys to examine patterns in sexual behavior and PrEP use. Daily SMS data collection was acceptable, obtained high response rates, and provided an assessment of temporal patterns of HIV risk behaviors and PrEP use over a 60-day period. Participants were more likely to adhere to daily PrEP doses when they were sexually-active, PrEP use was not associated with unprotected sex, and anticipating sex was difficult. In addition, HIV risk behaviors were reported on more days through daily SMS surveys compared to monthly interviewer-administered questionnaires, highlighting the potential of SMS to collect more accurate self-reported data. SMS may offer a new method for measuring and promoting behaviors related to HIV risk and adherence as well as enhancing communication between patients and providers. Qualitative research with HIV serodiscordant couples familiar with HIV prevention methodologies highlighted common perceived advantages and concerns related to early initiation of ART, and an important conceptualization of ART as the "final stage" before dying. This negative meaning of ART initiation poses a challenge to acceptance of early ART and indicates that new messages regarding ART initiation are needed. These new messages should emphasize the benefits of HIV prevention and maintaining good health; acknowledge concerns such as side effects and life-long adherence; and ultimately, portray a positive image of individuals on ART. Social and behavioral factors, in particular sustained adherence as well as individual and community acceptance, will be fundamental to successful implementation of early ART and PrEP and should remain a focus of HIV prevention and treatment

Antiretroviral Therapy Initiation for Treatment and Prevention in East Africa

Author : Andrew Mujugira
Publisher :
ISBN 13 :
Total Pages : 28 pages
Book Rating : 4.:/5 (88 download)

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Book Synopsis Antiretroviral Therapy Initiation for Treatment and Prevention in East Africa by : Andrew Mujugira

Download or read book Antiretroviral Therapy Initiation for Treatment and Prevention in East Africa written by Andrew Mujugira and published by . This book was released on 2013 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: In serodiscordant couples, provision of antiretroviral therapy (ART) to the HIV-infected partner significantly decreases risk of sexual HIV transmission of HIV. The World Health Organization has recently issued guidelines recommending ART initiation, regardless of CD4 count, for HIV-infected members of serodiscordant couples to prevent HIV transmission to the uninfected partner. We conducted a prospective cohort study among 1998 HIV-infected individuals with known HIV-uninfected partners who were enrolled in the Partners PrEP Study, an HIV prevention clinical trial in Kenya and Uganda. The primary objective was to assess ART initiation in those who became ART-eligible during study follow-up. The cumulative probabilities of initiating ART at 6, 12, and 24 months after referral were 60.8%, 78.8% and 91.5%, respectively. Approximately 40% of HIV-infected partners had not initiated ART six months after initial referrals. Higher CD4 (p0.001), asymptomatic HIV disease (p=0.04), and alcohol use (p=0.001) were significant predictors of ART initiation. To evaluate whether HIV-infected persons would be interested in earlier ART (CD4 350 cells/ [mu] L) for HIV prevention, as recommended by the WHO, we conducted a cross-sectional study among an additional 571 East African HIV-infected individuals in serodiscordant partnerships. The objective of the study was to determine whether fertility intentions were correlated with a greater likelihood to initiate early ART for prevention. We found that HIV-infected partners with fertility intentions were nearly twice as likely to express interest in early ART for HIV prevention (adjusted odds ratio [AHR] 1.83, p=0.02) than those without fertility intentions. Younger age (p

Disease Control Priorities, Third Edition (Volume 6)

Author : King K. Holmes
Publisher : World Bank Publications
ISBN 13 : 1464805253
Total Pages : 1027 pages
Book Rating : 4.4/5 (648 download)

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Book Synopsis Disease Control Priorities, Third Edition (Volume 6) by : King K. Holmes

Download or read book Disease Control Priorities, Third Edition (Volume 6) written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

HIV Treatment and Prevention in KwaZulu-Natal, South Africa: Individual, Couple, and Household Effects of Antiretroviral Therapy

Author : Catherine E. Oldenburg
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (951 download)

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Book Synopsis HIV Treatment and Prevention in KwaZulu-Natal, South Africa: Individual, Couple, and Household Effects of Antiretroviral Therapy by : Catherine E. Oldenburg

Download or read book HIV Treatment and Prevention in KwaZulu-Natal, South Africa: Individual, Couple, and Household Effects of Antiretroviral Therapy written by Catherine E. Oldenburg and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Using the Africa Centre for Population Health's demographic and HIV surveillance program, a population-based open cohort that has been conducting annual surveillance since 2000, this dissertation evaluates the effectiveness of ART in a real-world setting at multiple levels, including for individuals, within couples, and in households. First, this dissertation analyzes the effect of ART uptake in serodiscordant couples in the risk of HIV acquisition by the uninfected partner. Second, the effectiveness of immediate eligibility for ART on household-level HIV acquisition is assessed. Finally, the effect of immediate ART eligibility and uptake on survival in HIV-infected individuals is examined using two causal modeling approaches.

Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples

Download Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples PDF Online Free

Author : World Health Organization
Publisher :
ISBN 13 : 9789241501972
Total Pages : 66 pages
Book Rating : 4.5/5 (19 download)

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Book Synopsis Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples by : World Health Organization

Download or read book Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples written by World Health Organization and published by . This book was released on 2012 with total page 66 pages. Available in PDF, EPUB and Kindle. Book excerpt: "New WHO guidelines recommend offering HIV testing and counselling to couples, wherever HIV testing and counselling is available, including in antenatal clinics. For couples where only one partner is HIV positive, the guidelines recommend offering antiretroviral therapy to the HIV positive partner, regardless of his/her own immune status (CD4 count), to reduce the likelihood of HIV transmission to the HIV negative partner. Today, only 40% of people with HIV globally know their HIV status. Up to 50% of HIV-positive people in on-going relationships have HIV-negative partners (i.e. they are in serodiscordant relationships). Of those HIV-positive individuals who know their status, many have not disclosed their HIV status to their partners, nor do they know their partners' HIV status. Consequently, a significant number of new infections occur within serodiscordant couples. CHTC offers couples the opportunity to test, receive their results and mutually disclose their status in an environment where support is provided by a counsellor/health worker. A range of prevention, treatment and support options can then be discussed and decided upon together, depending on the status of each partner. Recent evidence confirms the benefit of early ART for people with a CD4 count above 350 cells/μL in preventing transmission to HIV-negative partners. In order to benefit from such opportunities, couples should be supported to test together and disclose their status to each other and access prevention, care and treatment services."--Publisher description.

Antiretroviral Treatment in Sub-Saharan Africa

Author : Tizazu Fetene
Publisher : African Books Collective
ISBN 13 : 9994455788
Total Pages : 230 pages
Book Rating : 4.9/5 (944 download)

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Book Synopsis Antiretroviral Treatment in Sub-Saharan Africa by : Tizazu Fetene

Download or read book Antiretroviral Treatment in Sub-Saharan Africa written by Tizazu Fetene and published by African Books Collective. This book was released on 2013-05-13 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: The introduction of antiretroviral therapy (ART) in middle and low income countries is arguably one of the most meaningful outcomes recorded in the fight against HIV and AIDS. A record number of some 6.2 million people living with HIV and AIDS are reported to be benefiting from the treatment, which is reported to have risen by 19 per cent between 2010 and 2011 and as a result of this, the region has also enjoyed a significant decline in AIDS mortality. This volume is the outcome of the call for abstracts put out by OSSREA in 2011 for senior researchers, social scientists and practitioners to write scientific articles on issues surrounding ARVs. The volume contains eight chapters organized into four sections: ART and quality of life; Adherence to ART; Traditional medicine and ART; and Sexual behaviour of ART attendants. The chapters are contributed by Academics and researchers from three different African countries: four from Ethiopia, two from Uganda and two from Zimbabwe.

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence

Author : World Health Organization. Department of Mental Health and Substance Abuse
Publisher : World Health Organization
ISBN 13 : 9241547545
Total Pages : 133 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence by : World Health Organization. Department of Mental Health and Substance Abuse

Download or read book Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence written by World Health Organization. Department of Mental Health and Substance Abuse and published by World Health Organization. This book was released on 2009 with total page 133 pages. Available in PDF, EPUB and Kindle. Book excerpt: "These guidelines were produced by the World Health Organization (WHO), Department of Mental Health and Substance Abuse, in collaboration with the United Nations Office on Drugs and Crime (UNODC) a Guidelines Development Group of technical experts, and in consultation with the International Narcotics Control Board (INCB) secretariat and other WHO departments. WHO also wishes to acknowledge the financial contribution of UNODC and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to this project. " - p. iv

Understanding Risk Factors for HIV-1 Infectiousness and Transmission

Author : Erin M. Kahle
Publisher :
ISBN 13 :
Total Pages : 119 pages
Book Rating : 4.:/5 (881 download)

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Book Synopsis Understanding Risk Factors for HIV-1 Infectiousness and Transmission by : Erin M. Kahle

Download or read book Understanding Risk Factors for HIV-1 Infectiousness and Transmission written by Erin M. Kahle and published by . This book was released on 2013 with total page 119 pages. Available in PDF, EPUB and Kindle. Book excerpt: The studies described in this dissertation focus on clinical and biologic factors associated with increased HIV-1 infectiousness among heterosexual HIV-1 serodiscordant couples. The specific aims include 1) evaluating whether specific characteristics of HIV-1 serodiscordant couples could be used to defined a higher-risk subgroup for targeted prevention research, 2) assessing the prevalence of unreported antiretroviral therapy (ART) in HIV-1 infected participants enrolling in an HIV-1 prevention trial, 3) determining whether HIV-1 subtype C is associated with increased HIV-1 transmission, and 4) assessing whether immune activation is associated with increased HIV-1 transmission. The identification of a composite set of predictors for HIV-1 transmission is applicable to the design of efficient prevention programs targeting high-risk subpopulations to maximize limited prevention resources. We developed a risk score for identifying a high-risk subpopulation of HIV-1 serodiscordant couples which will provide greater predictive ability in identifying HIV-1 transmission risk than individual risk predictors (i.e. viral load, unprotected sex). A well-developed and validated risk scoring tool, such as ours, is a valuable addition to HIV-1 prevention intervention research in order to reduce sample size, decrease cost of study and provide more efficient recruitment. Biologic factors, including both viral and host characteristics, may be associated with increased HIV-1 infectiousness. HIV-1 subtype, specifically subtype C, has been suggested as a factor in differential HIV-1 transmission between populations, although no epidemiologic evidence supports this conclusion. We compared HIV-1 subtype C and non-C subtypes and found no significant difference in risk of HIV-1 transmission in a multinational population in sub-Saharan Africa. In an analysis of cytokines as markers for immune activation, we found elevated IL-10 and IP-10 concentrations to be associated with increased HIV-1 transmission and acquisition, suggesting a potential biologic mechanism in both HIV-1 infected and susceptible partners. HIV-1 serodiscordant couples cohorts offer unique opportunities to assess correlates of HIV-1 infectiousness, as transmissions can be directly measured within partnerships. The application of our study findings will provide more efficient methods for identifying target populations and a better understanding of the virologic and immunologic mechanisms of HIV-1 infectiousness.

Safer Conception Among HIV-1 Sero-discordant Couples in East Africa

Author : Kerry Nugent Hancuch
Publisher :
ISBN 13 :
Total Pages : 19 pages
Book Rating : 4.:/5 (957 download)

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Book Synopsis Safer Conception Among HIV-1 Sero-discordant Couples in East Africa by : Kerry Nugent Hancuch

Download or read book Safer Conception Among HIV-1 Sero-discordant Couples in East Africa written by Kerry Nugent Hancuch and published by . This book was released on 2016 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt: Context: Supporting people affected by HIV-1 in achieving their reproductive goals while minimizing the risk of HIV-1 transmission is a public health imperative. Background: For HIV-1 serodiscordant couples, HIV-1 exposure and risk of transmission to the uninfected partner and unborn children is heightened during pregnancy attempts but safer conception strategies can mitigate risk. Understanding couples’ choices and experiences with safer conception can be useful for programmatic recommendations as safer conception programs are scaled up. Methods: 1013 high-risk, heterosexual HIV-1 serodiscordant couples from Kenya and Uganda were followed for two years in an open-label delivery study of integrated pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART), the Partners Demonstration Project. Annually, we assessed participant experience with safer conception strategies. Multivariate logistic regression was used to characterize women who reported ever having used a safer conception strategy during their first annual visit. Results: 859 couples were included in analysis. 66% of couples had HIV-infected women and 86% desired future children. The median age for women was 27 (interquartile range: 23-32). At the first annual visit, 32% of women reported use of a safer conception strategy ever in their life: 14% reported using ART, 16% PrEP, 3% self-insemination, and 2% STI treatment. Women who reported discussing their fertility desires with their male partners (adjusted odds ratio (aOR) = 1.91, 95% confidence interval (CI) 1.26-2.589), had no living children at the time of study enrollment (aOR = 1.71, 95% CI 1.14-2.57), and were HIV-uninfected (aOR = 1.56, 95% CI 1.11-2.20) were more likely to report having used at least one safer conception strategy. Conclusions: HIV-1 prevention counseling for serodiscordant couples should integrate opportunities for couples to share their fertility desires and discuss preferences for safer conception strategies.

Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection

Author : World Health Organization
Publisher :
ISBN 13 : 9789241549684
Total Pages : 429 pages
Book Rating : 4.5/5 (496 download)

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Book Synopsis Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection by : World Health Organization

Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda

Download Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda PDF Online Free

Author : Megan Claire Dillavou
Publisher :
ISBN 13 :
Total Pages : 108 pages
Book Rating : 4.:/5 (17 download)

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Book Synopsis Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda by : Megan Claire Dillavou

Download or read book Individual and Couple-level Risk Factors Associated with HIV Transmission, Family Planning, and ART Initiation in an Open Cohort of Heterosexual HIV-1 Serodiscordant Couples in Rwanda written by Megan Claire Dillavou and published by . This book was released on 2016 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the factors of heterosexual HIV-1 serodiscordant couples that lead to risky behaviors for HIV transmission are essential in controlling the HIV epidemic in sub-Saharan Africa. Predictors of HIV transmission within stable discordant couples and trends in family planning over time, as well as predictors of ART initiation provide important information for future studies and prevention and treatment program development. This dissertation evaluates these aspects of HIV-1 serodiscordant couple transmission in an ART naive 10-year observational cohort in Kigali, Rwanda. The first study evaluated the incident HIV-1 infections and the predictors of HIV-1 transmission in ART na?ve HIV-1 heterosexual serodiscordant couples. Eighty-three partner linked incident HIV-1 infections occurred in the cohort with 37 in women (IR=2.2/100 CY; 95%CI: 1.53.299) and 46 in men (IR=2.49/100 CY; 95%CI: 1.83-3.33). In the adjusted final model of linked HIV infection in females, baseline VL (aHR 2.33; 95%CI: 1.28-4.24), female genital inflammation (cHR 4.77; 95%CI: 1.72-13.21), and having unprotected sex with study partner since last visit (cHR 3.29; 95%CI: 1.27-8.51) were significant predictors. Predictors of linked incident HIV-1 infection in males included baseline VL (aHR 2.14; 95%CI: 1.50-3.07), female genital inflammation (aHR 3.91; 95%CI: 1.71-8.94), any unprotected sex with study partner since previous visit (aHR 3.56; 95%CI: 1.48-8.56), and presence of sperm on a wet prep (aHR 3.35; 95%CI: 0.99-11.36). These findings support the need to include sexual partners in the assessment of risk and target risk reduction strategies. The second study described pregnancy and analyzed predictors of women ever using hormonal contraception (HC) by HIV status. Overall pregnancy incidence rate was 12.7/100 PY (95%CI: 11.3-14.1) while in M-F+ couples it was 13.2/100 PY (95%CI: 11.3-15.3) and 12.1/100 PY (95%CI: 10.2-14.1) in M+F- couples. 34% of HIV positive women, 26% of HIV- women who did not seroconvert, and 25% of HIV- women who seroconverted had used hormonal contraception at point during the study. In adjusted analyses, being younger (aRR 0.97; 95%CI: 0.95-0.99), ability to read Kinyarwandan easily (aRR 1.28; 95%CI: 1.06-1.55), and no STI in the past year (aRR 0.80; 95%CI: 0.67-0.95) was associated with ever HC use in HIV+ women. Among HIV negative women who did not seroconvert, HC ever use was associated with younger age (aRR 0.98; 95%CI: 0.96-1.0) and not being pregnant at baseline (aRR 0.72; 95%CI: 0.55-0.94). Across HIV groups, injectable methods were the most frequently used type of hormonal contraception at last visit and during most of study follow-up. The overall low uptake of hormonal contraception and high pregnancy rates in both HIV + and HIV- women suggest the need for more effective and widely accessible safer conception methods. The third study evaluated predictors of time to ART initiation, stratified by gender of seropositive partner. Of the 1837 couples (882 M+F- / 955 M-F+), 30% had an HIV positive partner initiate ART. Of those, 39% had a seropositive male partner (M+F-) and 61% had a seropositive female partner (M-F+). Shorter time to ART initiation in M+F- couples was predicted by baseline viral load (aHR1.54; 95%CI:1.01-2.34), while both baseline viral load (aHR1.43; 95%CI:1.02-2.02) and baseline WHO stage IV (aHR 4.85; 95%CI:1.45-16.26) predicted earlier time to ART initiation in M-F+ couples. As expected, clinical values were the main predictors of time to ART initiation. In conclusion, partner and partnership characteristics play an important in risk of HIV-1 acquisition and transmission in heterosexual serodiscordant couples. Family planning and fertility desires are particularly complex and important risk factors that may change over time for serodiscordant couples. These findings can help improve the targeted HIV prevention, safer conception and family planning services, and ART treatment programs focusing on sustained viral load suppression among heterosexual serodiscordant couples in Africa.

Just Die Quietly, Domestic Violence and Women's Vulnerability to HIV in Uganda

Author : Lisa Karanja
Publisher : Human Rights Watch
ISBN 13 :
Total Pages : 79 pages
Book Rating : 4./5 ( download)

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Book Synopsis Just Die Quietly, Domestic Violence and Women's Vulnerability to HIV in Uganda by : Lisa Karanja

Download or read book Just Die Quietly, Domestic Violence and Women's Vulnerability to HIV in Uganda written by Lisa Karanja and published by Human Rights Watch. This book was released on 2003 with total page 79 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Ethics and Drug Resistance: Collective Responsibility for Global Public Health

Author : Euzebiusz Jamrozik
Publisher : Springer
ISBN 13 : 9783030278762
Total Pages : 448 pages
Book Rating : 4.2/5 (787 download)

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Book Synopsis Ethics and Drug Resistance: Collective Responsibility for Global Public Health by : Euzebiusz Jamrozik

Download or read book Ethics and Drug Resistance: Collective Responsibility for Global Public Health written by Euzebiusz Jamrozik and published by Springer. This book was released on 2021-08-21 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Open Access volume provides in-depth analysis of the wide range of ethical issues associated with drug-resistant infectious diseases. Antimicrobial resistance (AMR) is widely recognized to be one of the greatest threats to global public health in coming decades; and it has thus become a major topic of discussion among leading bioethicists and scholars from related disciplines including economics, epidemiology, law, and political theory. Topics covered in this volume include responsible use of antimicrobials; control of multi-resistant hospital-acquired infections; privacy and data collection; antibiotic use in childhood and at the end of life; agricultural and veterinary sources of resistance; resistant HIV, tuberculosis, and malaria; mandatory treatment; and trade-offs between current and future generations. As the first book focused on ethical issues associated with drug resistance, it makes a timely contribution to debates regarding practice and policy that are of crucial importance to global public health in the 21st century.

Obstetric Care

Author : Martin Olsen
Publisher : Cambridge University Press
ISBN 13 : 1108515665
Total Pages : 540 pages
Book Rating : 4.1/5 (85 download)

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Book Synopsis Obstetric Care by : Martin Olsen

Download or read book Obstetric Care written by Martin Olsen and published by Cambridge University Press. This book was released on 2017-10-04 with total page 540 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gain a critical understanding of obstetrics, and a thorough knowledge base of modern management techniques, with this accessible textbook. While acting as a stand-alone text on obstetric care, this volume also forms part of a three-volume set - all authored by leading authorities - on the entirety of obstetric and gynecologic practice. Obstetric Care's topics are based on academic objectives of experts in the field. This textbook offers tailored support for new residents and experienced physicians alike. Obstetric Care is invaluable for wide-ranging yet concise reference material, and provides evidence based care recommendations for specific patient conditions. The chapters in this textbook are based on the objectives of the Committee for Resident Education in Obstetrics and Gynecology; the book offers outstanding modern management techniques across the obstetrics specialty, making it a go-to for reference and comprehensive study.

Evaluating Individual and Couple-level Risk Factors Associated with HIV Acquisition in HIV Serodiscordant Couples in Zambia: Alcohol Use, Fertility Desire, and HIV Acquisition from Outside Partners in an Open Cohort in Zambia

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Author : Dvora Leah Davey
Publisher :
ISBN 13 :
Total Pages : 93 pages
Book Rating : 4.:/5 (17 download)

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Book Synopsis Evaluating Individual and Couple-level Risk Factors Associated with HIV Acquisition in HIV Serodiscordant Couples in Zambia: Alcohol Use, Fertility Desire, and HIV Acquisition from Outside Partners in an Open Cohort in Zambia by : Dvora Leah Davey

Download or read book Evaluating Individual and Couple-level Risk Factors Associated with HIV Acquisition in HIV Serodiscordant Couples in Zambia: Alcohol Use, Fertility Desire, and HIV Acquisition from Outside Partners in an Open Cohort in Zambia written by Dvora Leah Davey and published by . This book was released on 2016 with total page 93 pages. Available in PDF, EPUB and Kindle. Book excerpt: The high prevalence of serodiscordant relationships coupled with the high risk of transmission within those relationships across sub-Saharan African countries makes these couples a target for HIV prevention efforts. The development of appropriate and effective interventions for HIV prevention in serodiscordant couples must be based on accurate assessments of sexual risk behaviors, substance use, and fertility desires. My dissertation evaluates HIV acquisition and transmission in heterosexual HIV serodiscordant couples in Lusaka, Zambia. My first study analyzed the role that alcohol use plays on sexual behavior and HIV acquisition in Zambian serodiscordant couples. Men who reported heavy drinking was associated with increased odds of having =>1 outside sexual partnership (adjusted odds ratio [aOR]=2.02; 95% CI=1.58, 2.57), and condomless sex with main partner in the past 3-months (aOR=1.61; 95% CI=1.28, 2.04). Women's heavy drinking was associated with increased odds of having =>1 outside partner (aOR=1.89, 95% CI=1.35, 2.64), and condomless sex with main partner in past 3-months (aOR=1.54; 95% CI=1.31, 1.82). Women who reported being drunk daily or almost daily was associated with increased HIV acquisition (aHR=3.71; 95% CI=0.90, 15.25). Men who reported being drunk weekly or daily/almost daily was associated with increased HIV acquisition (aHR=1.72; 95% CI= 1.01, 2.93), and transmission (aHR=1.42; 95% CI=0.97, 2.10). My second study evaluated the incidence and predictors of HIV acquisition from an outside partner in serodiscordant couples in Zambia. Forty-five unlinked HIV infections occurred among women (1.85 per 100-couple-years [CY]) and 55 unlinked HIV infections occurred among men (1.82 per 100 CY). Risk of female unlinked infection was associated with baseline female alcohol consumption (aHR=5.44; 95% CI: 1.03, 28.73), recent genital ulcers and/or genital inflammation (aHR=6.09; 95% CI: 2.72, 13.64 and aHR=11.92; 95% CI: 5.60, 25.37, respectively). Risk of male unlinked HIV infection was associated with reporting being drunk weekly or daily/almost daily at baseline (aHR=3.52; 95% CI=1.19, 10.46), recent genital inflammation (aHR=8.52; 95% CI: 3.82, 19.03), genital ulceration (aHR=4.27; 95% CI: 2.05, 8.89), self-reporting =>1 outside partner (aHR=3.36; 95% CI: 1.53, 7.37). My third study evaluated the effect of fertility desires on HIV acquisition among HIV serodiscordant couples in Zambia. Among a sub-set of 1,029 serodiscordant couples, 311 agreed that they wanted a child in the future (30.4%), and 368 agreed they did not want a child or did not know (36.0%), and 344 couples disagreed about having a child (33.6%), of which in 212 couples (61.6% of disagreeing couples) the man wanted a child but the woman did not, and in 132 couples (38.3% of disagreeing couples) the woman wanted a child but the man did not. The adjusted risk ratio for woman's HIV acquisition was 2.06 (95% CI=1.40, 3.03) among women who wanted a child, 1.75 (95% CI=1.07, 2.87) for men who wanted a child in the next 12-months, and 2.55 (95% CI=1.32, 4.93) among couples who agreed that they wanted a child compared to couples who agreed they did not want a child. In conclusion, heavy alcohol use plays an important role in linked and unlinked HIV acquisition and transmission in serodiscordant couples. The strongest predictors of unlinked infection in serodiscordant relationships were alcohol use, genital inflammation and ulceration prior to infection. Further, women were particularly vulnerable when they or their partner wanted to have a child. These findings will help improve the implementation of HIV prevention and safer conception services among heterosexual serodiscordant couples in Southern Africa and beyond.

Handbook of Antimicrobial Resistance

Author : Matthias Gotte
Publisher : Springer
ISBN 13 : 9781493906932
Total Pages : 0 pages
Book Rating : 4.9/5 (69 download)

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Book Synopsis Handbook of Antimicrobial Resistance by : Matthias Gotte

Download or read book Handbook of Antimicrobial Resistance written by Matthias Gotte and published by Springer. This book was released on 2018-02-12 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: While many volumes have been written about various aspects of antimicrobial resistance, this book is a comprehensive reference work. All manifestations of resistance are addressed: viral; bacterial, parasitical and fungal are given dedicated sections. The underlining molecular mechanisms, which depend not only on the microbe but on the specific drug (target), are highly diverse. This work discusses and compares the biological, biochemical and structural aspects of resistance and its evolution.