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Delany-Moretlwe S, Smith E, Myer L, Ahmed K, Nkala B, Maboa R, Gama C, Sibiya S, Sebe M, Brumskine W, Bekker LG, Nchabeleng M, Lombard C, Gray G, Rees H. FACTS 001: Characteristics of Participants Enrolled in a Phase III Randomised Controlled Trial of Tenofovir Gel for Prevention of HIV-1 and HSV-2. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5637.abstract] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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127
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Burgess JS, Reddy K, Ramchuran P, Dott C, Palanee T, Rees H. Streamlining Operational Processes by Building a Centralized HIV Clinical Research Centre. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5571.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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128
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Ramchuran P, Reddy K, Ramalo P, Maseko N, Vuma A, Gama L, Sibeko S, Duba N, Rees H, Palanee T. Pre-screening Strategies to Enhance Accrual and Retention in the ASPIRE Trial at the Wits Reproductive Health and HIV Institute, Johannesburg. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5147.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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129
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Reddy K, Rees H, Palanee T. WhatsApp!: Use of Mobile Technology in Optimizing ASPIRE Study Retention and Adherence at the Wits Reproductive Health and HIV Institute, Johannesburg. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5041.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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130
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Reddy K, Rees H, Palanee T. Bridging the Gap: Uniting Participants and Staff for Improved ASPIRE Study Metrics at Wits Reproductive Health and HIV Institute in Hillbrow. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5177.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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131
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Eakle R, Manthata G, Stadler J, Mbogua J, Sibanyoni M, Venter WF, Rees H. Preparing for PrEP & Immediate Treatment: Focus Group Discussions in Advance of a Demonstration Project in South Africa. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5606.abstract] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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132
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Mudhune S, Delany-Moretlwe S, Baron D, Pato S, Stadler J, Ngcobo N, Khunwane M, Makgopa S, Malefo M, Ntjana H, Nkompela T, Sibisi G, Ikaneng T, Seemise K, Mdanda S, Manenzhe K, Morolo M, Gray G, Rees H. Motivating, Measuring and Monitoring Adherence in the FACTS 001 Tenofovir Gel Microbicide Study. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5355.abstract] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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133
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Gafos M, Crook A, Pool R, Mzimela MA, Morar N, Vallely A, Abaasa A, Palanee T, Mweemba O, Ramjee G, Francis S, Kamali A, Rees H, Chisembele M, Mccormack S. Exploring Post-coital Intravaginal Cleansing Practices among Women Enrolled in the Microbicides Development Programme MDP 301 Clinical Trial. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5008.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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134
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Terris-Prestholt F, Quaife M, Delany-Moretlwe S, Rees H, Watts C, Vickerman P. The Better it Is, the More it Will Be Used - The Synergistic Relationship between Product Efficacy, Level of Uptake and Overall Impact. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5129.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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135
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Cohen SS, Naidoo I, Martin R, Maduna N, Moloelang M, Ndzamela N, Kasango C, Tlagadi A, Stockenstrom G, Tabata NP, Dlungwana T, Gumede S, Phaahla MA, Ismail Z, Rammutla E, Delany-Moretlwe S, Gray G, Rees H, Nhlangulela L. Setting Up and Oversight of Local Clinical Trial Site Laboratories with Limited Resources: A Case Study of South Africa's FACTS 001 Study. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5483.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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136
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Dott C, Reddy K, Palanee T, Rees H. Cost Benefit Analysis of the Centralisation of Pharmacy Services in a Multi-study Clinical Research Site in Hillbrow, Johannesburg. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5612.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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137
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Reddy K, Ramchuran P, Maseko N, Vuma A, Gama L, Sibeko S, Duba N, Rees H, Palanee T. Strategies to Improve Male Involvement and Partner Support in the ASPIRE Trial: The Hillbrow Experience. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5006.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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138
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Pato S, Baron D, Nkala B, Mzizi P, Mdluli J, Mosewu I, Kanyiki L, Lembethe D, Mabude Z, Moate R, Ngema I, Malamatsho R, Dlamini C, Delany-Moretlwe S, Gray G, Rees H. Assessing GPP in Action: How FACTS 001 Formalised the Implementation of Stakeholder Engagement in a Large-scale Prevention Trial. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5092.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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139
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Jones A, Cremin I, Abdullah F, Idoko J, Cherutich P, Kilonzo N, Rees H, Hallett T, O'Reilly K, Koechlin F, Schwartlander B, de Zalduondo B, Kim S, Jay J, Huh J, Piot P, Dybul M. Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention. Lancet 2014; 384:272-9. [PMID: 24740087 DOI: 10.1016/s0140-6736(13)62230-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.
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Nachega JB, Uthman OA, del Rio C, Mugavero MJ, Rees H, Mills EJ. Addressing the Achilles' heel in the HIV care continuum for the success of a test-and-treat strategy to achieve an AIDS-free generation. Clin Infect Dis 2014; 59 Suppl 1:S21-7. [PMID: 24926028 PMCID: PMC4141496 DOI: 10.1093/cid/ciu299] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mathematical models and recent data from ecological, observational, and experimental studies show that antiretroviral therapy (ART) is effective for both treatment and prevention of HIV, validating the treatment as prevention (TasP) approach. Data from a variety of settings, including resource-rich and -limited sites, show that patient attrition occurs at each stage of the human immunodeficiency virus (HIV) treatment cascade, starting with the percent unaware of their HIV infection in a population and linkage to care after diagnosis, assessment of ART readiness, receipt of ART, and finally long-term virologic suppression. Therefore, in order to implement TasP, we must first define practical and effective linkage to care, acceptability of treatment, and adherence and retention monitoring strategies, as well as the cost-effectiveness of such strategies. Ending this pandemic will require the combination of political will, resources, and novel effective interventions that are not only feasible and cost effective but also likely to be used in combination across successive steps on the HIV treatment cascade.
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Crook AM, Ford D, Gafos M, Hayes R, Kamali A, Kapiga S, Nunn A, Chisembele M, Ramjee G, Rees H, McCormack S. Injectable and oral contraceptives and risk of HIV acquisition in women: an analysis of data from the MDP301 trial. Hum Reprod 2014; 29:1810-7. [PMID: 24838704 PMCID: PMC4093991 DOI: 10.1093/humrep/deu113] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION Do injectable and oral contraceptives increase the risk of human immunodeficiency virus (HIV) acquisition in women? SUMMARY ANSWER After adjusting for confounders, evidence of a significantly increased risk of HIV remained for women using injectable depo-medroxyprogesterone (DMPA) (hazard ratio = 1.49, 95% confidence interval (1.06–2.08)) but not for injectable norethisterone-enanthate (Net-En) or oral contraceptive pills (OC). WHAT IS KNOWN ALREADY An association between the use of some types of hormonal contraception (HC) methods and an increased risk of HIV, possibly through changes in the genital tract environment and alterations in the immune response, has been previously observed, although not consistently. A recent systematic review of these studies has highlighted the need for more definitive evidence. STUDY DESIGN, SIZE, DURATION A secondary data analysis of the MDP301 phase 3 microbicide trial was conducted to estimate the effects of use of different methods of HC on the risk of HIV acquisition in women. HIV-negative women (n = 8663) with a median age of 28 years were included in the analysis; 382 HIV seroconverted by 52 weeks follow-up; 10% of women-years were lost to follow-up before 52 weeks. PARTICIPANTS/MATERIALS, SETTING, METHODS Contraceptive use was reported at each 4-weekly visit. Cox proportional hazards (PH) models were used to estimate the effects of baseline and current use of injectable DMPA, injectable Net-En and OC compared with no HC, on the risk of HIV, adjusting for baseline and time-updated covariates. Causal effects for 52 weeks of HC use compared with no HC were estimated in a weighted Cox model, censoring women at deviation from baseline HC use (or non-use) or pregnancy. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, 2499 (29%) women were on DMPA, 1180 (14%) on Net-En, and 1410 (16%) on OC; 3574 (40%) not on HC, started HC in follow-up. Adjusted hazard ratios (HR) for baseline HC use, compared with no HC, were 1.38 (95% confidence interval (CI) 1.07–1.78) for DMPA; 1.18 (0.86–1.62) for Net-En and 0.97 (0.68–1.38) for OC. The estimated causal effects of DMPA and Net-En over 52 weeks were: HR = 1.49 (95% CI 1.06–2.08) and HR = 1.31 (95% CI 0.62–1.61), respectively. LIMITATIONS, REASONS FOR CAUTION A main limitation of the study was that it was a secondary analysis of data from a study that was not designed to investigate this question. Despite our best efforts, we cannot exclude residual confounding to explain the effect of DMPA. WIDER IMPLICATIONS OF THE FINDINGS The results of this study should be reviewed by the World Health Organization to determine whether current recommendations on the use of DMPA in settings with high HIV prevalence require modification. STUDY FUNDING/COMPETING INTEREST(S) MDP is a partnership of African and European academic/government institutions with commercial organizations, which is funded by the UK Government (DFID and MRC), with support from IPM and EDCTP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: None.
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Dochez C, Bogers JJ, Verhelst R, Rees H. HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine 2014; 32:1595-601. [DOI: 10.1016/j.vaccine.2013.10.081] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/24/2013] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
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143
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Heffron R, Donnell D, Kiarie J, Rees H, Ngure K, Mugo N, Were E, Celum C, Baeten JM. A prospective study of the effect of pregnancy on CD4 counts and plasma HIV-1 RNA concentrations of antiretroviral-naive HIV-1-infected women. J Acquir Immune Defic Syndr 2014; 65:231-6. [PMID: 24442226 PMCID: PMC3898601 DOI: 10.1097/qai.0000000000000013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In HIV-1-infected women, CD4 count declines occur during pregnancy, which has been attributed to hemodilution. However, for women who have not initiated antiretroviral therapy, it is unclear if CD4 declines are sustained beyond pregnancy and accompanied by increased viral levels, which could indicate an effect of pregnancy on accelerating HIV-1 disease progression. METHODS In a prospective study among 2269 HIV-1-infected antiretroviral therapy-naive women from 7 African countries, we examined the effect of pregnancy on HIV-1 disease progression. We used linear mixed models to compare CD4 counts and plasma HIV-1 RNA concentrations between pregnant, postpartum, and nonpregnant periods. RESULTS Women contributed 3270 person-years of follow-up, during which time 476 women became pregnant. In adjusted analysis, CD4 counts were an average of 56 (95% confidence interval: 39 to 73) cells/mm lower during pregnant compared with nonpregnant periods and 70 (95% confidence interval: 53 to 88) cells/mm lower during pregnant compared with postpartum periods; these results were consistent when restricted to the subgroup of women who became pregnant. Plasma HIV-1 RNA concentrations were not different between pregnant and nonpregnant periods (P = 0.9) or pregnant and postpartum periods (P = 0.3). Neither CD4 counts nor plasma HIV-1 RNA levels were significantly different in postpartum compared with nonpregnant periods. CONCLUSIONS CD4 count declines among HIV-1-infected women during pregnancy are temporary and not sustained in postpartum periods. Pregnancy does not have a short-term impact on plasma HIV-1 RNA concentrations.
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Broutet N, Fruth U, Deal C, Gottlieb SL, Rees H. Vaccines against sexually transmitted infections: the way forward. Vaccine 2014; 32:1630-7. [PMID: 24480024 DOI: 10.1016/j.vaccine.2014.01.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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145
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146
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Dodet B, Durrheim DN, Rees H. Rabies: underused vaccines, unnecessary deaths. Vaccine 2014; 32:2017-9. [PMID: 24434045 DOI: 10.1016/j.vaccine.2013.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/04/2013] [Accepted: 12/13/2013] [Indexed: 12/25/2022]
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147
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Terris-Prestholt F, Foss AM, Cox AP, Heise L, Meyer-Rath G, Delany-Moretlwe S, Mertenskoetter T, Rees H, Vickerman P, Watts CH. Cost-effectiveness of tenofovir gel in urban South Africa: model projections of HIV impact and threshold product prices. BMC Infect Dis 2014; 14:14. [PMID: 24405719 PMCID: PMC3899035 DOI: 10.1186/1471-2334-14-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 12/24/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa. METHODS The estimated 'per sex-act' HIV and HSV-2 efficacies were imputed from CAPRISA 004. A dynamic HIV/STI transmission model, parameterised and fitted to Gauteng (HIV prevalence of 16.9% in 2008), South Africa, was used to estimate the impact of gel use over 15 years. Uptake was assumed to increase linearly to 30% over 10 years, with gel use in 72% of sex-acts. Full economic programme and averted HIV treatment costs were modelled. Cost per DALY averted is estimated and a microbicide price that equalises its cost-effectiveness to that of male circumcision is estimated. RESULTS Using plausible assumptions about product introduction, we predict that tenofovir gel use could lead to a 12.5% and 4.9% reduction in HIV and HSV-2 incidence respectively, by year 15. Microbicide introduction is predicted to be highly cost-effective (under $300 per DALY averted), though the dose price would need to be just $0.12 to be equally cost-effective as male circumcision. A single dose or highly effective (83% HIV efficacy per sex-act) regimen would allow for more realistic threshold prices ($0.25 and $0.33 per dose, respectively). CONCLUSIONS These findings show that an effective coitally-dependent microbicide could reduce HIV incidence by 12.5% in this setting, if current condom use is maintained. For microbicides to be in the range of the most cost-effective HIV prevention interventions, product costs will need to decrease substantially.
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Iosub R, Herbert R, Rees H. EPA-0802 - Service evaluation report: Overview of the use of antipsychotic long-acting injections (lais) in north bristol recovery service (nbrs). Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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149
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Delany-Moretlwe S, Bello B, Kinross P, Oliff M, Chersich M, Kleinschmidt I, Rees H. HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey. Int J STD AIDS 2013; 25:428-38. [DOI: 10.1177/0956462413512803] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We estimated the prevalence of HIV and assessed correlates of HIV infection in long-distance truck drivers in South Africa. Between October 2003 and July 2004, 1900 long-distance truck drivers aged ≥18 years consented to interview and for testing for HIV. Participants were selected from a 10% stratified random sample of registered truck depots. A proximate-determinants framework was used to assess the hierarchical relationship between risk factors and HIV infection using logistic regression. HIV prevalence was 26% (95% confidence interval 24% to 28%). In multivariate analyses, HIV infection was associated with spending 2–4 weeks on the road (adjusted odds ratio 1.4; 95% confidence interval 1.1 to 1.9). There was modest evidence of a dose-response relationship between time on the road and HIV risk. Mobility increased risk by creating conditions for unsafe sex and reducing access to health services. Targeted HIV interventions for long-distance truck drivers are needed.
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Heffron RA, Donnell D, Mugo N, Celum C, Rees H, Ngure K, Were E, Kiarie J, Baeten JM. P3.200 Effect of Pregnancy on HIV-1 Disease Progression Among Antiretroviral-Naive HIV-1 Infected Women. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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