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1.
BMC Res Notes. 2017 Feb 16;10(1):101. doi: 10.1186/s13104-017-2423-1.

Perceptions and experiences of pregnant women about routine HIV testing and counselling in Ghimbi town, Ethiopia: a qualitative study.

Author information

  • 1Department of Public Health, College of Medicine and Health Sciences, Wollo University, P. O. Box 1145, Dessie, Ethiopia. israelmitiku@yahoo.com.
  • 2School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Abstract

BACKGROUND:

Ethiopia has implemented routine HIV testing and counselling using a provider initiated HIV testing ('opt-out' approach) to achieve high coverage of testing and prevention of mother-to-child transmission of HIV. However, women's perceptions and experiences with this approach have not been well studied. We conducted a qualitative study to explore pregnant women's perceptions and experiences of routine HIV testing and counselling in Ghimbi town, Ethiopia, in May 2013. In-depth interviews were held with 28 women tested for HIV at antenatal clinics (ANC), as well as four health workers involved in routine HIV testing and counselling. Data were analyzed using the content analysis approach.

RESULTS:

We found that most women perceived routine HIV testing and counselling beneficial for women as well as unborn babies. Some women perceived HIV testing as compulsory and a prerequisite to receive delivery care services. On the other hand, health workers reported that they try to emphasise the importance HIV testing during pre-test counselling in order to gain women's acceptance. However, both health workers and ANC clients perceived that the pre-test counselling was limited.

CONCLUSIONS:

Routine HIV testing and counselling during pregnancy is well acceptable among pregnant women in the study setting. However, there is a sense of obligation as women felt the HIV testing is a pre-requisite for delivery services. This may be related to the limited pre-test counselling. There is a need to strengthen pre-test counselling to ensure that HIV testing is implemented in a way that ensures pregnant women's autonomy and maximize opportunities for primary prevention of HIV.

KEYWORDS:

HIV; Opt-out; Pre-test counselling; Qualitative; Routine

PMID:
28209187
PMCID:
PMC5314483
DOI:
10.1186/s13104-017-2423-1
[PubMed - indexed for MEDLINE]
Free PMC Article
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2.
N Engl J Med. 2017 Feb 16;376(7):699-700. doi: 10.1056/NEJMc1616287.

Antiretroviral Therapy for Perinatal HIV Prevention.

Author information

  • 1Johns Hopkins University School of Medicine, Baltimore, MD. mgfowler@mujhu.org
  • 2Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
  • 3Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
PMID:
28199813
DOI:
10.1056/NEJMc1616287
[PubMed - indexed for MEDLINE]
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3.
BMC Res Notes. 2017 Feb 10;10(1):90. doi: 10.1186/s13104-017-2416-0.

Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya.

Author information

  • 1Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya. wnjoroge@kemri-wellcome.org.
  • 2Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya.
  • 3Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK.
  • 4Center for Global Health and Development, Boston University School of Public Health, 85 East Concord Street, Boston, MA, 02118, USA.
  • 5Ministry of Health, Division of eHealth, Nairobi, Kenya.

Abstract

BACKGROUND:

The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area.

RESULTS:

A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials.

CONCLUSION:

This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

KEYWORDS:

Evaluation; Health equity; Health information systems; Kenya; Telemedicine; eHealth; mHealth

PMID:
28183341
PMCID:
PMC5301342
DOI:
10.1186/s13104-017-2416-0
[PubMed - indexed for MEDLINE]
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5.
Medicine (Baltimore). 2017 Feb;96(6):e6041. doi: 10.1097/MD.0000000000006041.

Pairwise diversity and tMRCA as potential markers for HIV infection recency.

Author information

  • 1aDivision of Medical Virology, Stellenbosch University, Tygerberg, South Africa bBotswana-Harvard AIDS Institute Partnership, Gaborone, Botswana cAfrica Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Republic of South Africa dHarvard T.H. Chan School of Public Health, Boston, MA, USA eNational Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa fResearch Department of Infection, University College London, London, United Kingdom gCollege of Health Sciences, University of KwaZulu-Natal, Durban, Republic of South Africa hDivision of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

Intrahost human immunodeficiency virus (HIV)-1 diversity increases linearly over time. We assessed the extent to which mean pairwise distances and the time to the most recent common ancestor (tMRCA) inferred from intrahost HIV-1C env sequences were associated with the estimated time of HIV infection. Data from a primary HIV-1C infection study in Botswana were used for this analysis (N = 42). A total of 2540 HIV-1C env gp120 variable loop region 1 to conserved region 5 (V1C5) of the HIV-1 envelope gp120 viral sequences were generated by single genome amplification and sequencing, with an average of 61 viral sequences per participant and 11 sequences per time point per participant. Raw pairwise distances were calculated for each time point and participant using the ape package in R software. The tMRCA was estimated using phylogenetic inference implemented in Bayesian Evolutionary Analysis by Sampling Trees v1.8.2. Pairwise distances and tMRCA were significantly associated with the estimated time since HIV infection (both P < 0.001). Taking into account multiplicity of HIV infection strengthened these associations. HIV-1C env-based pairwise distances and tMRCA can be used as potential markers for HIV recency. However, the tMRCA estimates demonstrated no advantage over the pairwise distances estimates.

PMID:
28178146
PMCID:
PMC5313003
DOI:
10.1097/MD.0000000000006041
[PubMed - indexed for MEDLINE]
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6.
Infect Dis Poverty. 2017 Feb 7;6(1):21. doi: 10.1186/s40249-016-0233-7.

Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

Author information

  • 1Institute of Resource Governance and Social Change, Jl. R. W. Monginsidi II, No. 2, Kel. Kelapa Lima, Kec. Kelapa Lima, Kupang, Nusa Tenggara Timur, Indonesia.
  • 2National Food Reserve Agency, P.O. Box 5384, Dar es Salaam, Tanzania.
  • 3Binus University International, Jl. Hang Lekir I No. 6, Senayan, Jakarta, 10270, Indonesia.
  • 4Discipline of Public Health, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia. lillian.mwanri@flinders.edu.au.

Abstract

BACKGROUND:

The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them.

METHODS:

This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010.

RESULTS:

The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local NGO) and the local government respectively.

CONCLUSIONS:

The current study identified challenges that adoptive families as well as the AIDS-orphaned children themselves faced in Mbeya Rural District, Tanzania. Recognition of these issues highlights the need for targeted interventions to address the underlying social determinants of human immunodeficiency virus or HIV and AIDS in affected populations in order to prevent further imposition of social, cultural and economic disadvantages on families that provide care for AIDS-orphaned children and the children themselves. These findings may prove useful in provoking discussions that may lead to HIV/AIDS prevention and the development of broader mitigation strategies to alleviate the impact of this scourge on families and communities in rural Tanzania, and in similar settings across the world.

KEYWORDS:

AIDS; AIDS-orphaned children; Adoptive families; Coping strategies; HIV; Mbeya Rural District; Tanzania

PMID:
28173857
PMCID:
PMC5297121
DOI:
10.1186/s40249-016-0233-7
[PubMed - indexed for MEDLINE]
Free PMC Article
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7.
Afr J Prim Health Care Fam Med. 2016 Dec 2;8(1):e1-e8. doi: 10.4102/phcfm.v8i1.1240.

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care.

Author information

  • 1Centre for Rural Health, University of KwaZulu-Natal. Haskins@ukzn.ac.za.

Abstract

BACKGROUND:

In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.

AIM:

This study describes provision of services for mothers and babies aged under 1 year.

SETTING:

Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.

METHODS:

All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother-baby pairs receiving well-child services, where these services were provided and by whom.

RESULTS:

Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.

CONCLUSIONS:

Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.

PMID:
28155320
PMCID:
PMC5153411
[PubMed - indexed for MEDLINE]
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8.
Afr J Prim Health Care Fam Med. 2016 Nov 29;8(1):e1-e8. doi: 10.4102/phcfm.v8i1.1230.

Weight status and associated factors among HIV infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa.

Author information

  • 1Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo. felistas.mashinya@ul.ac.za.

Abstract

BACKGROUND:

Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD).

AIM:

The study determined weight status and associated factors in people with HIV infection receiving ART.

SETTING:

Rural primary health care clinics in Dikgale, Limpopo province, South Africa.

METHODS:

A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m2). Data on ART duration were extracted from patients' files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques.

RESULTS:

Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, p = 0.001) and male gender (OR: 0.29, p = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, p = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis.

CONCLUSION:

A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.

PMID:
28155318
PMCID:
PMC5153409
[PubMed - indexed for MEDLINE]
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9.
Afr J Prim Health Care Fam Med. 2016 Oct 31;8(1):e1-e5. doi: 10.4102/phcfm.v8i1.1210.

Vitamin D status, hypertension and body mass index in an urban black community in Mangaung, South Africa.

Author information

  • 1Department of Nutrition and Dietetics, University of the Free State. nutrition@ufs.ac.za.

Abstract

BACKGROUND:

A strong relationship exists between hypertension and body weight. Research has linked both higher blood pressure and body weight with lower vitamin D status.

OBJECTIVE:

This study assessed the vitamin D status of a low-income, urban, black community in South Africa, to examine whether serum levels of 25-hydroxy vitamin D [25(OH)D] are associated with hypertension and body mass index (BMI).

METHODS:

Data collected from 339 adults (25-64 years) from the Assuring Health for All in the Free State (AHA-FS) study were analysed. Variables measured include serum 25(OH)D, blood pressure, weight and height to determine BMI, and HIV status.

RESULTS:

Mean 25(OH)D level was 38.4 ± 11.2 ng/mL for the group; 43.5 ± 11.8 ng/mL and 37.0 ± 10.6 ng/mL for males and females, respectively. Approximately 40% of the participants were HIV-positive and 63.4% hypertensive. Based on BMI, 11.8% were underweight, 33.0% normal weight, 23.0% overweight and 32.1% obese. HIV status showed no correlation with 25(OH)D levels when controlling for BMI. Poor inverse relationships were found between BMI and 25(OH)D (p = 0.01), and between mean arterial blood pressure and 25(OH)D (p = 0.05). When controlling for BMI, no correlation was found between 25(OH)D and the prevalence of hypertension or mean arterial blood pressure.

CONCLUSION:

Approximately 96% of participants had an adequate vitamin D status, which could be attributed to latitude, sunny conditions and expected high levels of sun exposure because of living conditions. Results confirmed a poor inverse relationship between vitamin D status and hypertension, which seems to be dependent on BMI.

PMID:
28155313
PMCID:
PMC5105600
[PubMed - indexed for MEDLINE]
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10.
Afr J Prim Health Care Fam Med. 2016 Oct 31;8(1):e1-e6. doi: 10.4102/phcfm.v8i1.1171.

Confirmation of factors that influence antiretroviral regimen change and the subsequent patient outcomes at a Regional Hospital in rural KwaZulu-Natal.

Author information

  • 1Madadeni Hospital, School of Health Sciences, University of KwaZulu-Natal. soorjuv@gmail.com.

Abstract

BACKGROUND:

Treatment failure (TF) and adverse drug reactions (ADRs) are the main indications for antiretroviral therapy (ART) regimen change. Identification of factors influencing regimen change and subsequent health outcomes of patients after regimen change is essential in providing a sustainable and effective antiretroviral roll-out campaign.

AIM:

To confirm the factors that influence antiretroviral regimen change and to evaluate patient outcomes post regimen change.

METHODS:

A retrospective chart analysis of 269 HIV-infected non-pregnant patients (age &gt;18 years), who underwent an antiretroviral (ARV) regimen change and were followed up for approximately one year since initiation, was undertaken at a Provincial Hospital ARV Clinic in KwaZulu-Natal, from January 2008 to December 2012.

RESULTS:

Of the 269 patients, there were 200 females (75%). Most patients were between the ages 30 and 44 (57.6%). Only five patients had coexisting tuberculosis (TB) infection (2%). The most common first-line ART regimen to be changed was stavudine (D4T)/lamivudine(3TC)/ efavirenz(EFV) n = 111(41%). The most common regimen patients were changed to was tenofovir (TDF)/3TC/EFV n = 89(33%). Stavudine was the most commonly substituted drug (35.5%). Lipodystrophy was the most common ADR (56.8%). ADR was the indication for ART regimen change in 175 patients (65%), whilst TF accounted for ART regimen change in 94 patients (35%). Immunological success (CD4 counts) was shown after regimen change (374.21 ± 243.16 vs. 456.09 ± 250.07, CI: 0.95, p &lt; 0.001). Undetectable viral loads were measured in 172/205 (83.9%) patients post regimen change.

CONCLUSION:

ADRs were the main cause for antiretroviral regimen change. Stavudine was the most substituted drug with lipodystrophy being the most common side effect. Coexisting TB infection did not influence regimen change. Immunological and virological success was shown after regimen modification.

PMID:
28155312
PMCID:
PMC5105599
[PubMed - indexed for MEDLINE]
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11.
MMWR Morb Mortal Wkly Rep. 2017 Feb 3;66(4):104-106. doi: 10.15585/mmwr.mm6604a3.

Changes in the Disparity of HIV Diagnosis Rates Among Black Women - United States, 2010-2014.

Author information

  • 1Division of HIV/AIDS Prevention, CDC.

Abstract

In 2015, black women represented 61% of human immunodeficiency virus (HIV) diagnoses among women (1). HIV diagnosis rates among women declined during 2010-2014 (1); however, whether the decline resulted in a decrease in the disparities between black women and Hispanic and white women was unknown. To assess whether a change in disparities occurred, CDC used three different measures of disparity: 1) the absolute rate difference (the difference between the group with the lowest rate and the group with the highest rate) (2); 2) the diagnosis disparity ratio* (the ratio of the difference between the group rate and the overall population rate to the overall rate); and 3) the Index of Disparity (the average of the differences between rates for specific groups and the total rate divided by the total rate, expressed as a percentage) (3). The absolute rate difference between black women and white women decreased annually, from 36.9 in 2010 to 28.3 in 2014. The diagnosis disparity ratio for black women decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010-2011, and then decreased each year during 2012-2014. Although disparities still exist, these findings indicate improvement. Expanding access to biomedical and behavioral interventions and research guided by social and structural determinants frameworks could close the remaining gap.

PMID:
28151925
DOI:
10.15585/mmwr.mm6604a3
[PubMed - indexed for MEDLINE]
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12.
MMWR Morb Mortal Wkly Rep. 2017 Feb 3;66(4):97-103. doi: 10.15585/mmwr.mm6604a2.

HIV Care Outcomes Among Blacks with Diagnosed HIV - United States, 2014.

Author information

  • 1Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC.

Abstract

Since the release of the National HIV/AIDS Strategy (NHAS) (1) and the establishment of the federal Human Immunodeficiency Virus (HIV) Care Continuum Initiative (2), federal efforts have accelerated to improve and increase HIV testing, care, and treatment and to reduce HIV-related disparities in the United States. National HIV Surveillance System (NHSS)* data are used to monitor progress toward reaching NHAS goals, and recent data indicate that blacks have lower levels of care and viral suppression than do persons of other racial and ethnic groups (3). Among persons with HIV infection diagnosed through 2012 who were alive at year-end 2013, 68.1% of blacks received any HIV medical care compared with 74.4% of whites (3). CDC used NHSS data to describe HIV care outcomes among blacks who received a diagnosis of HIV. Among blacks with HIV infection diagnosed in 2014, 21.9% had infection classified as HIV stage 3 (acquired immunodeficiency syndrome [AIDS]) at the time of diagnosis compared with 22.5% of whites; 71.6% of blacks were linked to care within 1 month after diagnosis compared with 79.0% of whites. Among blacks with HIV infection diagnosed through 2012 who were alive on December 31, 2013, 53.5% were receiving continuous HIV medical care compared with 58.2% of whites; 48.5% of blacks achieved viral suppression compared with 62.0% of whites. Intensified efforts and implementation of effective interventions and public health strategies that increase engagement in care and viral suppression among blacks (1,4) are needed to achieve NHAS goals.

PMID:
28151924
DOI:
10.15585/mmwr.mm6604a2
[PubMed - indexed for MEDLINE]
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13.
Medicine (Baltimore). 2017 Feb;96(5):e5991. doi: 10.1097/MD.0000000000005991.

Reproductive history before and after HIV diagnosis: A cross-sectional study in HIV-positive women in Spain.

Author information

  • 1aRed de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III bCIBER de Epidemiología y Salud Pública (CIBERESP) cHospital Universitario La Fe, Valencia dHospital Universitario Ramón y Cajal, Madrid eHospital Universitario San Pedro-CIBIR, Logroño fHospital Universitario de Alicante, Alicante gHospital Universitario de Canarias, Tenerife hHospital Universitario Donostia, Donostia iHospital Universitario Reina Sofia, Murcia jUniversidad de Alcalá, Alcalá de Henares, Madrid, Spain kCity University of New York School of Public Health at Hunter College, New York, USA.

Abstract

The aim of this study is to examine the reproductive history of human immunodeficiency virus (HIV)-positive women, before and after HIV diagnosis, to describe the characteristics of women with pregnancies after HIV diagnosis, and to assess the prevalence of mother-to-child transmission.A cross-sectional study was performed among women within reproductive ages (18-49) selected from the cohort in the Spanish AIDS Research Network (CoRIS). A descriptive analysis of the pregnancy outcomes was made according to women's serostatus at the moment of pregnancy and association of women's characteristics with having pregnancy after HIV diagnosis was evaluated using logistic regression models.Overall, 161 women were interviewed; of them, 86% had been pregnant at least once and 39% after HIV diagnosis. There were 347 pregnancies, 29% of them occurred after HIV diagnosis and in these, 20% were miscarriages and 29% were voluntary termination of pregnancy. There were 3 cases of mother-to-child transmission among the 56 children born from HIV-positive mothers; in these cases, women were diagnosed during delivery. Having a pregnancy after HIV diagnosis was more likely when the younger women were at the time of diagnosis: odds ratio (OR) = 1.29 (95% confidence interval 0.40-4.17) for 25 to 29 years old, OR = 0.59 (0.15-2.29) for 30 to 34 years old, OR = 0.14 (0.03-0.74) for ≥35 years old, compared with those <25 years at diagnosis, who were diagnosed for ≥5 years (OR = 5.27 [1.71-16.18]), who received antiretroviral treatment at some point (OR = 9.38 [1.09-80.45]), and who received information on reproductive health (OR = 4.32 [1.52-12.26]).An important number of pregnancies occurred after HIV diagnosis, reflecting a desire for motherhood in these women. Reproductive and sexual health should be tackled in medical follow-ups.

PMID:
28151893
PMCID:
PMC5293456
DOI:
10.1097/MD.0000000000005991
[PubMed - indexed for MEDLINE]
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14.
N Engl J Med. 2017 Feb 2;376(5):501-502. doi: 10.1056/NEJMc1611639.

Multidrug-Resistant HIV-1 Infection despite Preexposure Prophylaxis.

Author information

  • 1Maple Leaf Medical Clinic, Toronto, ON, Canada dknox@mlmedical.com.
  • 2University of Colorado Anschutz Medical Campus, Aurora, CO.
  • 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
  • 4St. Michael's Hospital, Toronto, ON, Canada.
PMID:
28146652
DOI:
10.1056/NEJMc1611639
[PubMed - indexed for MEDLINE]
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15.
BMC Res Notes. 2017 Jan 31;10(1):74. doi: 10.1186/s13104-017-2404-4.

Performance of point-of-care urine test in diagnosing tuberculosis suspects with and without HIV infection in selected peripheral health settings of Addis Ababa, Ethiopia.

Author information

  • 1Medical Microbiology and Immunology Unit, Institute of Biomedical Sciences, Mekelle University, PO. Box: 1871, Mekelle, Ethiopia. selamniguse@gmail.com.
  • 2College of Health Sciences, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia.
  • 3School of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • 4HIV/AIDS and TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.

Abstract

BACKGROUND:

There are few rapid point-of-care tests (POCT) for tuberculosis (TB) for use in resource-constrained settings with high levels of human immunodeficiency virus (HIV). This hinders early tuberculosis (TB) treatment. This cross-sectional study evaluates the recently developed urine Determine tuberculosis lipoarabinomannan (TB LAM) antigen test. A total of 122 participants with signs and symptoms of TB, including 21 (17.1%) participants positive for HIV, were enrolled from September 2011 to March 2012 at three selected health centers in Addis Ababa, Ethiopia. Blood, sputum and urine samples were collected. Löwenstein-Jensen (LJ) solid culture was used as a gold standard to evaluate the performance of the Determine TB LAM antigen test. Data were analyzed using STATA (Statacorp LP, USA).

RESULTS:

Of the 122 participants with suspected TB, 35 (28.7%) had TB confirmed bacteriologically by LJ culture. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Determine TB LAM (for both HIV-positive and HIV-negative participants) was 37.1% (95% CI 21.5-55.1), 97.7% (95% CI 91.9-99.7), 86.7% (95% CI 59.5-98.3) and 79.4% (95% CI 70.5-86.6), respectively. However, in participants who were co-infected with TB and HIV, sensitivity, specificity, PPV and NPV were 55.6% (95% CI 21.2-86.3), 100% (95% CI 73.5-100), 100% (95% CI 47.8-100) and 75.0% (95% CI 47.6-92.7). Moreover, the level of immunosuppression of the HIV-infected TB patients was found to have a significant association with the performance of Determine TB LAM (χ2 = 7.89, p = 0.002).

CONCLUSIONS:

The Determine TB LAM test is a potential alternative in peripheral health settings for TB diagnosis in patients who are co-infected with HIV, with advanced immunosuppression.

KEYWORDS:

Lipoarabinomannan; Performance; Point-of-care

PMID:
28137314
PMCID:
PMC5282652
DOI:
10.1186/s13104-017-2404-4
[PubMed - indexed for MEDLINE]
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16.
Biomed Res Int. 2017;2017:2641259. doi: 10.1155/2017/2641259. Epub 2017 Jan 4.

Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination.

Author information

  • 1Guangdong Provincial Center for Skin Disease & STI Control, Guangzhou, Guangdong 510091, China.
  • 2School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510085, China; Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia.

Abstract

Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM (p for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population.

PMID:
28133605
PMCID:
PMC5241445
DOI:
10.1155/2017/2641259
[PubMed - indexed for MEDLINE]
Free PMC Article
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17.
BMC Res Notes. 2017 Jan 26;10(1):65. doi: 10.1186/s13104-017-2392-4.

Dynamic changes in biomarkers in acute human immunodeficiency virus infections: a case report.

Author information

  • 1Shanghai Dermatology Hospital, Shanghai, 200050, China. weiming_gu2003@aliyun.com.
  • 2School of Public Health, Fudan University, Shanghai, 200032, China.
  • 3Shanghai Dermatology Hospital, Shanghai, 200050, China.

Abstract

BACKGROUND:

The highest incidence of human immunodeficiency virus infection in China is among men who have sex with men. This case report aims to describe the dynamic changes in biomarkers in an acute human immunodeficiency virus infection of a Han Chinese man who has sex with men, and to illustrate the possibility of using these biomarkers for the early detection of human immunodeficiency virus infection in Chinese hospital settings.

CASE PRESENTATION:

The 25-year-old Han Chinese male patient presented himself with an 8-day history of symptoms and signs of upper respiratory viral infections to a sexually transmitted infection clinic of a hospital setting in Shanghai. The viral load of human immunodeficiency virus, p24 antigen-antibody complex, and lymphocyte subsets of blood samples were repeatedly measured over the next 39 days. The human immunodeficiency virus from serum was genotyped. This patient was diagnosed as a human immunodeficiency virus infection, and the viral genotype was CRF 01_AE. The onset of the symptoms and signs was 12 days after his last reported unprotected intercourse with a human immunodeficiency virus -infected man. The patient had detectable levels of p24 antigen at his first visit, 20 days after infection, and the HIV viral load was at the highest point (8 × 106 copies/ml). A low concentration of antibody to HIV was observed in the patient's serum 10 days after his 1st visit (30 days after infection). The confirmation of human immunodeficiency virus infection by Western blot assays was made at day 20 after his 1st visit (40 days after infection).

CONCLUSIONS:

Symptoms of acute human immunodeficiency virus infection are non-specific. Specific laboratory markers appear shortly after HIV infections. The first biomarker detected from serum is the viral RNA and p24 antigen, followed by HIV-specific antibody. The results suggest that there are urgent needs for both human immunodeficiency virus antigen and antibody testing in routine medical practice, and that human immunodeficiency virus RNA testing should be recommended to detect early infection. Ethics approval was obtained from the Ethics Board of the Shanghai Dermatology Hospital.

KEYWORDS:

Acute infection; Antibody testing; Biomarkers; China; HIV case report; Men who have sex with men; p24 antigen

PMID:
28126023
PMCID:
PMC5270311
DOI:
10.1186/s13104-017-2392-4
[PubMed - indexed for MEDLINE]
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18.
BMC Res Notes. 2017 Jan 26;10(1):70. doi: 10.1186/s13104-017-2390-6.

Seroprevalence of Toxoplasma gondii and associated risk factors among HIV-infected women within reproductive age group at Mizan Aman General Hospital, Southwest Ethiopia: a cross sectional study.

Author information

  • 1Department of Parasitology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. ayalewjejaw@yahoo.com.
  • 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Abstract

BACKGROUND:

Toxoplasmosis is serious in the case of immune suppression and prenatal transmission. In immunocompromised hosts, it is manifested primarily as a life-threatening condition, toxoplasmic encephalitis. Congenital toxoplasmosis results in abortion or congenitally acquired disorders which primarily affect the central nervous system. This study assessed seroprevalence of Toxoplasma gondii (T. gondii) infection and associated factors among HIV-infected women within the reproductive age group (18-49 years) at Mizan Aman General Hospital, Southwest Ethiopia. An institution based cross-sectional study was conducted from February 01 to May 30, 2015. Systematic random sampling technique was employed for participant selection. Enzyme linked immuno sorbent assay was used to test for T. gondii from venous blood specimens. Participants were interviewed using structured questionnaire for different variables. Descriptive statistics, binary and multivariable logistic regression analyses were performed during data analysis. P value of less than 0.05 was considered statistically significant.

RESULTS:

A total of 270 HIV-infected women within the reproductive age group were included in the study. Mean age of the respondents was 31 years (SD = ±6.5). Of the total study participants, 255 (94.4%), 95% CI (91.6, 97.2%) were found to be seropositive for T. gondii anti-immunoglobulin G (IgG) antibody, and 6 (2.2%), 95% CI (1.3, 3.1%) for anti-immunoglobulin M (IgM). All the anti-IgM positive samples were also positive for IgG. Multivariate analysis showed that; age within 28-37 years (Adjusted Odds Ratio [AOR] 2.58, 95% CI 1.01, 6.60), level of education with unable or only able to read and write (AOR = 4.46, 95% CI 1.20, 16.60), and substance abuse (AOR = 4.49, 95 CI 1.60, 12.55) were significantly associated with seropositivity of T. gondii infection.

CONCLUSIONS:

Seroprevalence of toxoplasmosis among the HIV-infected women in the childbearing age group in Mizan Aman was high. Age, educational status and drug addiction were identified as factors associated with T. gondii infection. Education of HIV-infected women about the transmission and prevention methods of T. gondii infection is important. Besides, studies on incidence of toxoplasmosis in newborns and infants are recommended.

KEYWORDS:

Ethiopia; HIV-infected women; Seroprevalence; Toxoplasma gondii

PMID:
28126016
PMCID:
PMC5270335
DOI:
10.1186/s13104-017-2390-6
[PubMed - indexed for MEDLINE]
Free PMC Article
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19.
Infect Dis Poverty. 2017 Jan 9;6(1):2. doi: 10.1186/s40249-016-0223-9.

Prevalence of and risk factors associated with Cryptosporidium infection in an underdeveloped rural community of southwest China.

Yang Y1,2,3, Zhou YB4,5,6, Xiao PL1,2,3, Shi Y1,2,3, Chen Y7, Liang S8,9, Yihuo WL10, Song XX1,2,3, Jiang QW1,2,3.

Author information

  • 1School of Public Health, Fudan University, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
  • 2Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
  • 3Center for Tropical Disease Research, Fudan University, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
  • 4School of Public Health, Fudan University, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China. z_yibiao@hotmail.com.
  • 5Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China. z_yibiao@hotmail.com.
  • 6Center for Tropical Disease Research, Fudan University, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China. z_yibiao@hotmail.com.
  • 7School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
  • 8Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, 2055 Mowry Road, Gainesville, FL, 32611, USA.
  • 9Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, 32611, USA.
  • 10Puge Center for Disease Prevention and Control, 6 Qingnian Road, Puge County, Sichuan, 615300, China.

Abstract

BACKGROUND:

Cryptosporidium spp. is an important intestinal protozoan causing diarrhea in humans, livestock, and wild animals. Cryptosporidium infection remains a major public health issue, but its epidemiology in humans is still unclear, particularly in rural China. This study was designed to determine the prevalence of and risk factors associated with Cryptosporidium infection in a rural southwestern Chinese community.

METHODS:

A community-based cross-sectional survey was conducted among 687 residents of a small town in a Yi autonomous prefecture of southwest China in 2014. Blood samples were examined using a broad set of quality-controlled diagnostic methods for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection. Univariable and multivariable analyses were performed to determine the risk factors associated with Cryptosporidium infection.

RESULTS:

The majority of the participants were Yi people with poor living conditions and unsatisfactory hygiene habits, and the study area was of very low socioeconomic status. Of the 615 individuals included in the analysis, 14 (2.3%) were HIV positive, 51 (8.3%) were infected with HBV, and 74 (12.0%) had Cryptosporidium infection. The prevalences of HIV/HBV, HIV/Cryptosporidium, and HBV/Cryptosporidium co-infections were 0.3%, 0.3%, and 1.8%, respectively. The prevalence of HBV infection was higher in individuals with Cryptosporidium infection (χ 2   = 5.00, P = 0.03). Owning livestock or poultry was an important risk factor for Cryptosporidium infection (aOR = 2.27, 95% CI: 1.01-5.08, P < 0.05). Cryptosporidium infection was significantly associated with HBV infection (aOR = 3.42, 95% CI: 1.47-7.92, P < 0.01), but not with HIV infection (aOR = 0.57, 95% CI: 0.07-4.39, P = 0.59).

CONCLUSIONS:

The prevalence of Cryptosporidium infection was high in the rural area of southwestern China that was investigated, and there was a significant association between HBV infection and Cryptosporidium infection. Further investigations are needed to determine the significance of Cryptosporidium infection in patients infected with HBV.

KEYWORDS:

China; Cryptosporidium; Hepatitis B virus; Human immunodeficiency virus; Prevalence; Risk factors; Rural areas

PMID:
28126012
PMCID:
PMC5267368
DOI:
10.1186/s40249-016-0223-9
[PubMed - indexed for MEDLINE]
Free PMC Article
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20.
MMWR Morb Mortal Wkly Rep. 2017 Jan 27;66(3):80-83. doi: 10.15585/mmwr.mm6603a3.

Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age - United States, 2013-2014.

Author information

  • 1Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

Abstract

Pelvic inflammatory disease (PID) is a clinical syndrome of the female reproductive tract characterized by inflammation of the endometrium, fallopian tubes, or peritoneum (1). PID occurs when microorganisms ascend from the vagina or cervix to the fallopian tubes and other upper genital tract structures (1). PID can result from untreated bacterial infections, including chlamydia and gonorrhea, and can lead to infertility, ectopic pregnancy, and chronic pelvic pain (1). Because there is no single diagnostic test for PID, clinicians rely on nonspecific signs and symptoms for diagnosis. The purpose of these analyses was to assess the burden of self-reported PID in a nationally representative sample using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle. Starting in 2013, NHANES female participants aged 18-44 years were asked about a lifetime history of PID diagnosis. Based on these data, the estimated prevalence of self-reported lifetime PID was 4.4% in sexually experienced women of reproductive age (18-44 years). The prevalence of self-reported lifetime PID was highest in women at increased risk, such as women reporting a previous sexually transmitted infection (STI) diagnosis. Stratified by race/ethnicity and having a previous STI diagnosis, non-Hispanic black (black) and non-Hispanic white (white) women reporting a previous STI diagnosis had nearly equal self-reported lifetime PID prevalence (10.0% versus 10.3%). However, the lifetime prevalence of PID among black women was 2.2 times that among white women if no previous STI was diagnosed (6.0% versus 2.7%). These findings suggest that PID is prevalent and associated with previous STI diagnoses; therefore, it is important for clinicians to screen female patients for chlamydia and gonorrhea to reduce the incidence of PID.

PMID:
28125569
DOI:
10.15585/mmwr.mm6603a3
[PubMed - indexed for MEDLINE]
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