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

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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

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.

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.

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.

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.

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.

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.

A Guide to the Clinical Care of Women with HIV

Author : Jean R. Anderson
Publisher : DIANE Publishing Inc.
ISBN 13 : 9780160726118
Total Pages : 636 pages
Book Rating : 4.7/5 (261 download)

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Book Synopsis A Guide to the Clinical Care of Women with HIV by : Jean R. Anderson

Download or read book A Guide to the Clinical Care of Women with HIV written by Jean R. Anderson and published by DIANE Publishing Inc.. This book was released on 2005 with total page 636 pages. Available in PDF, EPUB and Kindle. Book excerpt: NOTE: NO FURTHER DISCOUNT FOR THIS PRODUCT ITEM -OVERSRTOCK SALE-- Significantly reduced price. Edited by Jean R. Anderson. This guide addresses the health care needs unique to women with HIV. It targets clinicians who provide primary care to women as well as those seeking an understanding of how to take care of women with HIV/AIDS. This guide includes tables, figures, color plates, resources, references, and indices. This 2005 edition includes new chapters on international issues and nutrition. Edge indexed."

The Global HIV Epidemics among Sex Workers

Author : Deanna Kerrigan
Publisher : World Bank Publications
ISBN 13 : 0821397753
Total Pages : 344 pages
Book Rating : 4.8/5 (213 download)

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Book Synopsis The Global HIV Epidemics among Sex Workers by : Deanna Kerrigan

Download or read book The Global HIV Epidemics among Sex Workers written by Deanna Kerrigan and published by World Bank Publications. This book was released on 2012-12-01 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: A global economic analysis of HIV infection amongst sex workers, finding that evidence based and rights affirming interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be cost effective and deliver significant returns on investment.

Risk Factors Analysis of Longitudinal Viral Dynamics and Immunological Responses Among HIV-discordant Couples

Author : Xiaoyue Wang
Publisher :
ISBN 13 :
Total Pages : 50 pages
Book Rating : 4.:/5 (18 download)

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Book Synopsis Risk Factors Analysis of Longitudinal Viral Dynamics and Immunological Responses Among HIV-discordant Couples by : Xiaoyue Wang

Download or read book Risk Factors Analysis of Longitudinal Viral Dynamics and Immunological Responses Among HIV-discordant Couples written by Xiaoyue Wang and published by . This book was released on 2018 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: In their 2011 paper “Prevention of HIV-1 infection with Early Antiretroviral Therapy” (Cohen, et al, New England Journal of Medicine, 2011), an interim analysis was performed for the HPTN 052 Study to address both personal and public health benefits from early antiretroviral therapy (ART) among HIV-infected patients and their HIV-uninfected partners. It was found that at least 96% of genetically linked infections caused by human immunodeficiency virus type I (HIV-1) in serodiscordant couples were prevented by ART [1]. Furthermore, as described in their 2016 paper “Antiretroviral Therapy for the Prevention of HIV-1 Transmission” ((Cohen, et al, New England Journal of Medicine, 2016), offering the antiretroviral therapy to all patients with HIV-1 infection including 5 years of follow-up proves the durability of ART for the prevention of HIV-1 transmission comparing early and delayed ART. As a result, they conclude that the early initiation of ART results in meaningful decrease in genetically linked HIV-1 infections in sexual partners [2]. In this thesis, we intend to perform risk factors analyses to identify key prognostic factors that are associated with the longitudinal progression of viral dynamics and immunological response, reflected by viral loads and CD4+ counts, respectively, via repeated measurements analysis with Linear Mixed-Effects Models and Generalized Estimating Equations (GEE), for the HIV-infected patients receiving early and delayed ART for the HPTN 052 Study. Such analyses provide more insights into how HIV-1 viral dynamics and patient’s immunological response are progressing over time, when the patients are experiencing or yet to experience HIV disease symptoms with ART [2]. After performing all the analyses, it was found that it is better to use Antiretroviral therapy as early as possible based on multivariate analyses for both immediate arm and delayed arm. In addition, we also found that baseline CD4 count, baseline viral load and region are the key risk factors when predicting how the CD4 count and viral load change over time in either immediate arm or delayed arm.

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

Evaluating Risk Factors and Synergistic Effects of Two Common HIV-1 Coinfections

Author : Aaron F. Bochner
Publisher :
ISBN 13 :
Total Pages : 85 pages
Book Rating : 4.:/5 (19 download)

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Book Synopsis Evaluating Risk Factors and Synergistic Effects of Two Common HIV-1 Coinfections by : Aaron F. Bochner

Download or read book Evaluating Risk Factors and Synergistic Effects of Two Common HIV-1 Coinfections written by Aaron F. Bochner and published by . This book was released on 2018 with total page 85 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: HIV-1 coinfections have long been suspected of catalyzing the HIV-1 epidemic by increasing HIV-1 transmission or acquisition risk. The geographical distribution of coinfections may explain why some regions have been more heavily impacted by HIV-1. The primary objective of this dissertation was to expand our understanding of two common HIV-1 coinfections that have been hypothesized to increase the risk of HIV-1 transmission and acquisition: schistosomiasis and trichomoniasis. The specific aims of this dissertation were 1) Identify correlates of T. vaginalis infection within a population of HIV-1 serodiscordant heterosexual couples, 2) Estimate the association between schistosomiasis and HIV-1 acquisition, 3) Evaluate the impact of schistosome coinfection on HIV-1 set-point genital viral load levels, and 4) Evaluate the association between schistosome coinfection and HIV-1 set-point plasma viral load levels. Methods: To conduct these analyses, we used data from four cohort studies: the Partners in Prevention HSV/HIV Transmission Study, the Couples Observational Study, the Partners PrEP Study, and the Mombasa Cohort. All analyses utilized data from multiple cohorts. For all cohorts, a large amount of individual-level information was collected, including characteristics associated with HIV-1 acquisition risk and the prevalence of coinfections, permitting thorough adjustment for possible confounding factors. Results and Conclusions: Correlates of T. vaginalis infection: In a cross-sectional analysis of 8,155 HIV-1 serodiscordant couples, the strongest predictor of a prevalent T. vaginalis infection was having an infected sexual partner. Thus, concurrent treatment of sexual partners is critical to prevent reinfection. Among women, having a circumcised male partner was associated with reduced T. vaginalis risk while bacterial vaginosis (detected via Nugent Score) was associated with an increased risk, so expanding male circumcision programs and bacterial vaginosis treatment has the potential to reduce the prevalence of trichomoniasis. Schistosomiasis and HIV-1 acquisition risk: In nested case-control analyses including 575 HIV-1 seroconverters and 1,675 controls, S. mansoni infection was not associated with an increased the risk of HIV-1 acquisition. In addition, S. haematobium infection was not associated with a statistically significant increase in HIV-1 acquisition risk, though our result suggested that women with S. haematobium could face a moderate increased risk of HIV-1 acquisition. Schistosomiasis and set point HIV-1 RNA viral loads: Schistosomiasis was not associated with increased plasma HIV-1 viral loads. Our results do not support the hypothesis that schistosome coinfection increases the rate of HIV-1 disease progression. Schistosomiasis and genital HIV-1 RNA viral loads: Schistosomiasis was not associated with increased genital HIV-1 viral loads. Our results do not support the hypothesis that schistosome coinfection increases HIV-1 transmission risk.

Preventing HIV Among Young People in Southern and Eastern Africa

Author : Kaymarlin Govender
Publisher : Routledge
ISBN 13 : 0429870752
Total Pages : 273 pages
Book Rating : 4.4/5 (298 download)

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Book Synopsis Preventing HIV Among Young People in Southern and Eastern Africa by : Kaymarlin Govender

Download or read book Preventing HIV Among Young People in Southern and Eastern Africa written by Kaymarlin Govender and published by Routledge. This book was released on 2020-12-30 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides an overview of the current epidemiology of the HIV epidemic among young people in Eastern and Southern Africa (ESA) and examines the efforts to confront and reduce the high level of new HIV infections amongst young people. Taking a multi-dimensional approach to prevention, the contributors discuss the many challenges facing these efforts, in view of the slow progress in curbing the incidence of HIV amongst young people, focusing particularly on the structural and social drivers of HIV. Through an examination of these issues, chapters in this book provide valuable insights on how to mitigate HIV risk among young people and what can be regarded as the catalysts to mounting credible policy and programmatic responses required to achieve epidemic control in the region. The contributors draw on examples from a range of primary and secondary data sources to illustrate promising practices and challenges in HIV prevention, demonstrating links between conceptual approaches to prevention and lessons learnt from implementation projects in the region. Bringing together social scientists and public health experts who are actively engaged in finding effective solutions, the book discusses ‘which interventions works’, ‘why they work’, and the limitations and gaps in our knowledge to curb the pandemic amongst young people. As such it is an important read for researchers focusing on HIV/AIDS and public health. The Open Access version of this book, available at https://www.taylorfrancis.com/books/e/10.4324/9780429462818 has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license.

Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV

Author : World Health Organization
Publisher : World Health Organization
ISBN 13 : 9241549998
Total Pages : 144 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV by : World Health Organization

Download or read book Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV written by World Health Organization and published by World Health Organization. This book was released on 2017-02-20 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: he starting point for this guideline is the point at which a woman has learnt that she is living with HIV and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities as well as from the health-care institutions where they seek care particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes. This guideline is meant to help countries to more effectively and efficiently plan develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.

Re-thinking Sexualities in Africa

Author : Signe Arnfred
Publisher : Nordic Africa Institute
ISBN 13 : 9789171065131
Total Pages : 284 pages
Book Rating : 4.0/5 (651 download)

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Book Synopsis Re-thinking Sexualities in Africa by : Signe Arnfred

Download or read book Re-thinking Sexualities in Africa written by Signe Arnfred and published by Nordic Africa Institute. This book was released on 2004 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: "This volume sets out to investigate critically existing lines of thought about sexuality in Africa, while also creating space for alternative approaches"--P. [4] of cover.

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

Methodological Challenges in Biomedical HIV Prevention Trials

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309114306
Total Pages : 270 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Methodological Challenges in Biomedical HIV Prevention Trials by : Institute of Medicine

Download or read book Methodological Challenges in Biomedical HIV Prevention Trials written by Institute of Medicine and published by National Academies Press. This book was released on 2008-06-13 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: The number of people infected with HIV or living with AIDS is increasing at unprecedented rates as various scientists, organizations, and institutions search for innovative solutions to combating and preventing the disease. At the request of the Bill & Melinda Gates Foundation, Methodological Challenges in Biomedical HIV Prevention Trials addresses methodological challenges in late-stage nonvaccine biomedical HIV prevention trials with a specific focus on microbicide and pre-exposure prophylaxis trials. This book recommends a number of ways to improve the design, monitoring, and analysis of late-stage clinical trials that evaluate nonvaccine biomedical interventions. The objectives include identifying a beneficial method of intervention, enhancing quantification of the impact, properly assessing the effects of using such an intervention, and reducing biases that can lead to false positive trial results. According to Methodological Challenges in Biomedical HIV Prevention Trials, the need to identify a range of effective, practical, and affordable preventive strategies is critical. Although a large number of promising new HIV prevention strategies and products are currently being tested in late-stage clinical trials, these trials face a myriad of methodological challenges that slow the pace of research and limit the ability to identify and fully evaluate effective biomedical interventions.

Challenges in Infectious Diseases

Author : I.W. Fong
Publisher : Springer Science & Business Media
ISBN 13 : 1461444969
Total Pages : 326 pages
Book Rating : 4.4/5 (614 download)

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Book Synopsis Challenges in Infectious Diseases by : I.W. Fong

Download or read book Challenges in Infectious Diseases written by I.W. Fong and published by Springer Science & Business Media. This book was released on 2012-09-06 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: This next volume in the series will provide up to date Information and discussion on future approach to control several challenging Infectious Disease worldwide. The past decade has been highlighted by numerous advances in research of medical scientific knowledge. medical technology and the biological and diagnostic techniques-but somewhat less dramatic changes or improvement in management of medical conditions. This volume will address some of the emerging issues, challenges, and controversies in Infectious Diseases.