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Kloek M, Bulstra CA, van Noord L, Al‐Hassany L, Cowan FM, Hontelez JAC. HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e26022. [PMID: 36419343 PMCID: PMC9684687 DOI: 10.1002/jia2.26022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Developing effective targets, policies and services for key populations requires estimations of population sizes and HIV prevalence across countries and regions. We estimated the relative and absolute HIV prevalence among men who have sex with men (MSM), transgender women and men, and male and transgender sex workers (MSW and TGSW) in sub-Saharan African countries using peer-reviewed literature. METHODS We performed a systematic review of peer-reviewed studies assessing HIV prevalence in MSM, transgender women and men, MSW and TGSW in sub-Saharan Africa between 2010 and 2021, following PRISMA guidelines. We searched Embase, Medline Epub, Africa Index Medicus, Africa Journal Online, Web of Science and Google Scholar. We calculated HIV prevalence ratios (PRs) between the study prevalence, and the geospatial-, sex, time and age-matched general population prevalence. We extrapolated results for MSM and transgender women to estimate HIV prevalence and the number living with HIV for each country in sub-Saharan Africa using pooled review results, and regression approximations for countries with no peer-reviewed data. RESULTS AND DISCUSSION We found 44 articles assessing HIV prevalence in MSM, 10 in transgender women, five in MSW and zero in transgender men and TGSW. Prevalence among MSM and transgender women was significantly higher compared to the general population: PRs of 11.3 [CI: 9.9-12.9] for MSM and 8.1 [CI: 6.9-9.6] for transgender women in Western and Central Africa, and, respectively, 1.9 [CI: 1.7-2.0] and 2.1 [CI: 1.9-2.4] in Eastern and Southern Africa. Prevalence among MSW was significantly higher in both Nigeria (PR: 12.4 [CI: 7.3-21.0]) and Kenya (PR: 8.6 [CI: 4.6-15.6]). Extrapolating our findings for MSM and transgender women resulted in an estimated HIV prevalence of 15% or higher for about 60% of all sub-Saharan African countries for MSM, and for all but two countries for transgender women. CONCLUSIONS HIV prevalence among MSM and transgender women throughout sub-Saharan Africa is alarmingly high. This high prevalence, coupled with the specific risks and vulnerabilities faced by these populations, highlights the urgent need for risk-group-tailored prevention and treatment interventions across the sub-continent. There is a clear gap in knowledge on HIV prevalence among transgender men, MSW and TGSW in sub-Saharan Africa.
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Affiliation(s)
- Mariëlle Kloek
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Caroline A. Bulstra
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands,Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
| | - Laura van Noord
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Lina Al‐Hassany
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Frances M. Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe,Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Jan A. C. Hontelez
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands,Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
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102
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Thindwa D, Mwalukomo TS, Msefula J, Jambo KC, Brown C, Kamng’ona A, Mwansambo C, Ojal J, Flasche S, French N, Heyderman RS, Swarthout TD. Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi. AIDS 2022; 36:2045-2055. [PMID: 35983828 PMCID: PMC10503545 DOI: 10.1097/qad.0000000000003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors. METHODS Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage. RESULTS Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex. CONCLUSION Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
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Affiliation(s)
- Deus Thindwa
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Programme
| | - Thandie S. Mwalukomo
- School of Life Sciences and Allied Health Professions, Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Programme
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Arox Kamng’ona
- School of Life Sciences and Allied Health Professions, Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - John Ojal
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- KEMRI-Wellcome Research Programme, Geographic Medicine Centre, Kilifi, Kenya
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil French
- Institute of Infection, Veterinary and Ecological Science, Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool
| | - Robert S. Heyderman
- Division of Infection and Immunity, Research Department of Infection, NIHR Mucosal Pathogens Research Unit, University College London, London, UK
| | - Todd D. Swarthout
- Malawi-Liverpool-Wellcome Programme
- Division of Infection and Immunity, Research Department of Infection, NIHR Mucosal Pathogens Research Unit, University College London, London, UK
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103
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Moturi AK, Suiyanka L, Mumo E, Snow RW, Okiro EA, Macharia PM. Geographic accessibility to public and private health facilities in Kenya in 2021: An updated geocoded inventory and spatial analysis. Front Public Health 2022; 10:1002975. [PMID: 36407994 PMCID: PMC9670107 DOI: 10.3389/fpubh.2022.1002975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To achieve universal health coverage, adequate geographic access to quality healthcare services is vital and should be characterized periodically to support planning. However, in Kenya, previous assessments of geographic accessibility have relied on public health facility lists only, assembled several years ago. Here, for the first time we assemble a geocoded list of public and private health facilities in 2021 and make use of this updated list to interrogate geographical accessibility to all health providers. Methods Existing health provider lists in Kenya were accessed, merged, cleaned, harmonized, and assigned a unique geospatial location. The resultant master list was combined with road network, land use, topography, travel barriers and healthcare-seeking behavior within a geospatial framework to estimate travel time to the nearest (i) private, (ii) public, and (iii) both (public and private-PP) health facilities through a travel scenario involving walking, bicycling and motorized transport. The proportion of the population within 1 h and outside 2-h was computed at 300 × 300 spatial resolution and aggregated at subnational units used for decision-making. Areas with a high disease prevalence for common infections that were outside 1-h catchment (dual burden) were also identified to guide prioritization. Results The combined database contained 13,579 health facilities, both in the public (55.5%) and private-for-profit sector (44.5%) in 2021. The private health facilities' distribution was skewed toward the urban counties. Nationally, average travel time to the nearest health facility was 130, 254, and 128 min while the population within 1-h was 89.4, 80.5, and 89.6% for the public, private and PP health facility, respectively. The population outside 2-h were 6% for public and PP and 11% for the private sector. Mean travel time across counties was heterogeneous, while the population within 1-h ranged between 38 and 100% in both the public sector and PP. Counties in northwest and southeast Kenya had a dual burden. Conclusion Continuous updating and geocoding of health facilities will facilitate an improved understanding of healthcare gaps for planning. Heterogeneities in geographical access continue to persist, with some areas having a dual burden and should be prioritized toward reducing health inequities and attaining universal health coverage.
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Affiliation(s)
- Angela K. Moturi
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Laurissa Suiyanka
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Eda Mumo
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Bick AJ, Skosana SB, Avenant C, Hapgood JP. Variability and quantification of serum medroxyprogesterone acetate levels. Steroids 2022; 187:109100. [PMID: 35964796 PMCID: PMC9884996 DOI: 10.1016/j.steroids.2022.109100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023]
Abstract
Quantification of serum progestin levels in clinical contraceptive studies is now routinely performed to understand progestin pharmacokinetics and to correct for unreliable self-reporting of contraceptive use by study participants. Many such studies are focussed on the three-monthly progestin-only intramuscular (IM) injectable contraceptive depot medroxyprogesterone acetate (DMPA-IM). Methods commonly used to measure serum MPA levels include liquid chromatography coupled to mass spectrometry (LC/MS) and radioimmunoassay (RIA); however, RIA methods have not been used in recent years. We review the available literature and find that these methods vary widely in terms of use of organic solvent extraction, use of derivitization and choice of organic solvent and chromatography columns. There is a lack of standardization of LC/MS methodology, including a lack of detailed extraction protocols. Limited evidence suggests that RIA, without organic solvent extraction, likely over-estimates progestin levels. Maximum MPA concentrations in the first two weeks post-injection show wide inter-individual and inter-study variation, regardless of quantification method used. Standardization of quantification methods and sampling time post-injection is required to improve interpretation of clinical data, in particular the side effects arising at different times depending on the pharmacokinetic profile unique to injectable contraceptives.
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Affiliation(s)
- Alexis J Bick
- Department of Molecular and Cell Biology, University of Cape, Cape Town, South Africa
| | - Salndave B Skosana
- Department of Molecular and Cell Biology, University of Cape, Cape Town, South Africa
| | - Chanel Avenant
- Department of Molecular and Cell Biology, University of Cape, Cape Town, South Africa
| | - Janet P Hapgood
- Department of Molecular and Cell Biology, University of Cape, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
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Liu Y, Xu C, Liu F, Shen F, Zhang B, Zhang J, Xiao G, Wang N, Lin N, Zhou S, Wang H, Du Q. Spatiotemporal variation in the blood lead levels of Chinese children with the environmental Kuznets curve trend. Heliyon 2022; 8:e11609. [DOI: 10.1016/j.heliyon.2022.e11609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/10/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
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Emphasising Organisational Routine: A Qualitative Study of Patient and Health Professional Experiences of Inpatient Oncology Care. Healthcare (Basel) 2022; 10:healthcare10112145. [DOI: 10.3390/healthcare10112145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although the experience of hospitalisation for cancer management has been widely researched, such research from the African sub-continent is limited. Objective: This study explored experiences of patient care in a tertiary, inpatient oncology setting in urban South Africa, from the point of view of patients and health professionals. Methods: In-depth interviews and focus groups were conducted with participants. Participants included oncology inpatients, oncologists, nurses and nursing management (N = 46) at an oncology unit in Johannesburg, South Africa. Data were analysed by a multidisciplinary research group using reflexive thematic analysis principles. Results: Our results suggest that barriers to establishing effective organisational routines included communication breakdowns between patients and healthcare providers, a lack of predictability in interactions with doctors, deficient access to information and diminished confidence in nurses. Conclusions: Oncology inpatients may not feel in control of their circumstances, in part due to lacking routine in the hospital setting. Ironically, nurses, who are often at the frontline of patient management, appear to be underutilised or disabled by the healthcare system as conveyors of information. Implications for practice: Robust organisational routines for oncology inpatients may be a good mechanism for allaying uncertainty and conferring a sense of control. Nursing staff, as the individuals with the most direct patient contact, could be instrumental in nurturing organisational routines towards improving patient perceptions of care.
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Penile Squamous Cell Carcinomas in Sub-Saharan Africa and Europe: Differential Etiopathogenesis. Cancers (Basel) 2022; 14:cancers14215284. [PMID: 36358704 PMCID: PMC9654935 DOI: 10.3390/cancers14215284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
Penile squamous cell carcinomas (PSCC) are classified by the World Health Organization into two categories based on their relationship with the human papillomavirus (HPV): HPV-associated and HPV-independent. We compared a cohort of PSCC from Mozambique, a sub-Saharan country in southeast Africa with a high prevalence of HPV and HIV infection, and Spain, a country in southwestern Europe with a low prevalence of HPV and HIV, to study the distribution of the etiopathogenic categories of these tumors in both sites. A total of 79 PSCC were included in the study (28 from Mozambique and 51 from Spain). All cases underwent HPV-DNA polymerase chain reaction (PCR) testing, genotyping, and immunohistochemistry for p16 and p53. Any PSCC showing either p16 overexpression or HPV-DNA in PCR analysis was considered HPV-associated. Overall, 40/79 (50.6%) tumors were classified as HPV-associated and 39 (49.4%) as HPV-independent. The two sites showed marked differences: 25/28 (89.3%) tumors from Mozambique and only 15/51 (29.4%) from Spain were HPV-associated (p < 0.001). HPV16 was the most frequent HPV type identified in 64.0% (16/25) of the HPV-associated tumors from Mozambique, and 60.0% (9/15) from Spain (p = 0.8). On average, patients from Mozambique were almost two decades younger than those from Spain (mean age 50.9 ± 14.9 and 69.2 ± 13.3, respectively [p < 0.001]). In conclusion, significant etiopathogenic differences between PSCC in Mozambique and Spain were observed, with a remarkably high prevalence of HPV-associated tumors in Mozambique and a relatively low prevalence in Spain. These data may have important consequences for primary prevention of PSCC worldwide.
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Li L, Guo X, Zhang X, Zhao L, Li L, Wang Y, Xie T, Yin Q, Jing Q, Hu T, Li Z, Wu R, Zhao W, Xin SX, Shi B, Liu J, Xia S, Peng Z, Yang Z, Zhang F, Chen XG, Zhou X. A unified global genotyping framework of dengue virus serotype-1 for a stratified coordinated surveillance strategy of dengue epidemics. Infect Dis Poverty 2022; 11:107. [PMID: 36224651 PMCID: PMC9556283 DOI: 10.1186/s40249-022-01024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dengue is the fastest spreading arboviral disease, posing great challenges on global public health. A reproduceable and comparable global genotyping framework for contextualizing spatiotemporal epidemiological data of dengue virus (DENV) is essential for research studies and collaborative surveillance. METHODS Targeting DENV-1 spreading prominently in recent decades, by reconciling all qualified complete E gene sequences of 5003 DENV-1 strains with epidemiological information from 78 epidemic countries/areas ranging from 1944 to 2018, we established and characterized a unified global high-resolution genotyping framework using phylogenetics, population genetics, phylogeography, and phylodynamics. RESULTS The defined framework was discriminated with three hierarchical layers of genotype, subgenotype and clade with respective mean pairwise distances 2-6%, 0.8-2%, and ≤ 0.8%. The global epidemic patterns of DENV-1 showed strong geographic constraints representing stratified spatial-genetic epidemic pairs of Continent-Genotype, Region-Subgenotype and Nation-Clade, thereby identifying 12 epidemic regions which prospectively facilitates the region-based coordination. The increasing cross-transmission trends were also demonstrated. The traditional endemic countries such as Thailand, Vietnam and Indonesia displayed as persisting dominant source centers, while the emerging epidemic countries such as China, Australia, and the USA, where dengue outbreaks were frequently triggered by importation, showed a growing trend of DENV-1 diffusion. The probably hidden epidemics were found especially in Africa and India. Then, our framework can be utilized in an accurate stratified coordinated surveillance based on the defined viral population compositions. Thereby it is prospectively valuable for further hampering the ongoing transition process of epidemic to endemic, addressing the issue of inadequate monitoring, and warning us to be concerned about the cross-national, cross-regional, and cross-continental diffusions of dengue, which can potentially trigger large epidemics. CONCLUSIONS The framework and its utilization in quantitatively assessing DENV-1 epidemics has laid a foundation and re-unveiled the urgency for establishing a stratified coordinated surveillance platform for blocking global spreading of dengue. This framework is also expected to bridge classical DENV-1 genotyping with genomic epidemiology and risk modeling. We will promote it to the public and update it periodically.
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Affiliation(s)
- Liqiang Li
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xiang Guo
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Xiaoqing Zhang
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Lingzhai Zhao
- Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, Guangdong, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yuji Wang
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Tian Xie
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Qingqing Yin
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Qinlong Jing
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Tian Hu
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Ziyao Li
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Rangke Wu
- School of Foreign Studies, Southern Medical University, Guangzhou, 510515, China
| | - Wei Zhao
- BSL-3 Laboratory (Guangdong), School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Sherman Xuegang Xin
- Laboratory of Biophysics, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Benyun Shi
- School of Computer Science and Technology, Nanjing Tech University, Nanjing, 211816, China
| | - Jiming Liu
- Department of Computer Science, Hong Kong Baptist University, Kowloon, Hong Kong, 999077, China
| | - Shang Xia
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhiqiang Peng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China
| | - Fuchun Zhang
- Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, 510060, Guangdong, China.
| | - Xiao-Guang Chen
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China.
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Xiaohong Zhou
- Institute of Tropical Medicine, Southern Medical University, Guangzhou, 510515, China.
- Key Laboratory of Prevention and Control for Emerging Infectious Diseases of Guangdong Higher Institutes, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Pathogen Biology, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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Nshimirimana C, Vuylsteke B, Smekens T, Benova L. HIV testing uptake and determinants among adolescents and young people in Burundi: a cross-sectional analysis of the Demographic and Health Survey 2016-2017. BMJ Open 2022; 12:e064052. [PMID: 36229150 PMCID: PMC9562752 DOI: 10.1136/bmjopen-2022-064052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess HIV testing uptake and its determinants among adolescents and young adults. DESIGN Cross-sectional design involving analysis of 2016 Demographic and Health Survey data. SETTING Nationally representative survey of Burundi. PARTICIPANTS A total of 7218 young women and 2860 young men were included. PRIMARY AND SECONDARY OUTCOME We estimated the proportion of adolescent (15-19 years) and young adult (20-24 years) women and men who had tested for HIV and received results in the 12 months preceding the survey. Multivariable logistic models for determining predictors of HIV testing uptake were fitted among respondents aged 15-24 regardless of sexual activity in the 12 months before the survey and separately among a subset that reporting having had sex in the 12 months preceding the survey. RESULTS An estimated 27.1% (95% CI 25.8% to 28.4%) women and 16.6% (95% CI 15.1% to 18.1%) men had tested for HIV and received results in the 12 months preceding the survey. The proportion was more than twice as high among those aged 20-24 years compared with 15-19 years, among both sexes. In multivariable analysis, older age (20-24 years) was associated with HIV testing (adjusted OR (aOR): 1.62, 95% CI 1.38 to 1.91) among women; (aOR: 1.78, 95% CI 1.32 to 2.40) among men. Higher educational level (aOR: 1.40, 95% CI 1.11 to 1.76) was significantly associated with HIV testing uptake among women. Male circumcision status, condom use, number of sex partners, history of STIs were not associated with HIV testing among the subset that reported having had sex in the 12 months preceding the survey. CONCLUSION Despite the interventions implemented to reach the 90-90-90 UNAIDS goals, HIV testing among youth in Burundi was low. Youth-friendly health centres should be part of strategies to stimulate young people to increase uptake of HIV preventive services in Burundi.
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Affiliation(s)
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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van Heerden A, Ntinga X, Lippman SA, Leslie HH, Steward WT. Understanding the factors that impact effective uptake and maintenance of HIV care programs in South African primary health care clinics. Arch Public Health 2022; 80:221. [PMID: 36210476 PMCID: PMC9548388 DOI: 10.1186/s13690-022-00975-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasingly urgent gap in knowledge regarding the translation of effective HIV prevention and care programming into scaled clinical policy and practice. Challenges limiting the translation of efficacious programming into national policy include the paucity of proven efficacious programs that are reasonable for clinics to implement and the difficulty in moving a successful program from research trial to scaled programming. This study aims to bridge the divide between science and practice by exploring health care providers' views on what is needed to implement new HIV programs within existing HIV care. METHODS We conducted 20 in-depth interviews with clinic managers and clinic program implementing staff and five key informant interviews with district health managers overseeing programming in the uMgungundlovu District of KwaZulu-Natal Province, South Africa. Qualitative data were analyzed using a template approach. A priori themes were used to construct templates of relevance, including current care context for HIV and past predictors of successful implementation. Data were coded and analyzed by these templates. RESULTS Heath care providers identified three main factors that impact the integration of HIV programming into general clinical care: perceived benefits, resource availability, and clear communication. The perceived benefits of HIV programs hinged on the social validation of the program by early adopters. Wide program availability and improved convenience for providers and patients increased perceived benefit. Limited staffing capacity and a shortage of space were noted as resource constraints. Programs that specifically tackled these constraints through clinic decongestion were reported as being the most successful. Clear communication with all entities involved in clinic-based programs, some of which include external partners, was noted as central to maximizing program function and provider uptake. CONCLUSIONS Amid the COVID-19 pandemic, new programs are continuously being developed for implementation at the primary health care level. A better understanding of the factors that facilitate and prevent programmatic success will improve public health outcomes. Implementation is likely to be most successful when programs capitalize on endorsements from early adopters, tackle resource constraints, and foster greater communication among partners responsible for implementation.
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Affiliation(s)
- Alastair van Heerden
- grid.417715.10000 0001 0071 1142Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, 3201 KZN South Africa ,grid.11951.3d0000 0004 1937 1135SAMRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Xolani Ntinga
- grid.417715.10000 0001 0071 1142Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, Sweetwaters, Pietermaritzburg, 3201 KZN South Africa
| | - Sheri A. Lippman
- grid.266102.10000 0001 2297 6811Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA USA ,grid.11951.3d0000 0004 1937 1135MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hannah H. Leslie
- grid.266102.10000 0001 2297 6811Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA USA
| | - Wayne T. Steward
- grid.266102.10000 0001 2297 6811Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA USA
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Nalubega S, Osuwat LO, Agyeiwaa PB, Evans C, Matovu JB. The practice of pilot/feasibility studies in informing the conduct of HIV related clinical trials in sub-Saharan Africa: A scoping review. Contemp Clin Trials Commun 2022; 29:100959. [PMID: 35865280 PMCID: PMC9294242 DOI: 10.1016/j.conctc.2022.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Pilot/feasibility studies represent a fundamental phase of the research process and play a vital role in the preliminary planning of a full size HIV clinical trial. Published HIV clinical trial protocols were reviewed to establish the extent to which the proposed HIV clinical trials are informed by a prior pilot/feasibility study. Methods The JBI methodology for scoping reviews was followed. Six databases were systematically searched to identify articles for inclusion. Results Thirty two (32) published HIV study protocols were included. Articles were in the English language and were published in the past 10 years (2011-2020). The review results showed that the majority of HIV-related clinical trials in sub-Saharan Africa were not informed by pilot/feasibility studies. The results further indicated that the number of HIV clinical trials informed by a pilot/feasibility study have been on the increase in the 8 years' period since 2012, a trend that indicates positive uptake of pilot studies in HIV related studies. A few select countries (South Africa, Uganda, Zimbabwe, Malawi and Kenya) comprised more than 70% of all clinical trials that were informed by a pilot/feasibility study, conducted in sub Saharan Africa. Conclusions Although there is an increasing interest among researchers to integrate pilot/feasibility studies in HIV related research, limited countries in sub-Saharan Africa appear to have embraced this trend. Strategies that can motivate researchers to engage in a culture of incorporating pilot/feasibility studies in HIV related research should be implemented.
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Affiliation(s)
- Sylivia Nalubega
- School of Health Sciences, Soroti University, Soroti, Uganda
- Corresponding author. Soroti University, School of Health Sciences, Department of Nursing, Uganda.
| | | | - Poku Brenda Agyeiwaa
- School of Sociology and Socio Policy, University of Nottingham, Nottingham, United Kingdom
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- University of Nottingham Center for Evidence Based Healthcare, United Kingdom
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Soogun AO, Kharsany ABM, Zewotir T, North D, Ogunsakin E, Rakgoale P. Spatiotemporal Variation and Predictors of Unsuppressed Viral Load among HIV-Positive Men and Women in Rural and Peri-Urban KwaZulu-Natal, South Africa. Trop Med Infect Dis 2022; 7:232. [PMID: 36136643 PMCID: PMC9502339 DOI: 10.3390/tropicalmed7090232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
Unsuppressed HIV viral load is an important marker of sustained HIV transmission. We investigated the prevalence, predictors, and high-risk areas of unsuppressed HIV viral load among HIV-positive men and women. Unsuppressed HIV viral load was defined as viral load of ≥400 copies/mL. Data from the HIV Incidence District Surveillance System (HIPSS), a longitudinal study undertaken between June 2014 to June 2016 among men and women aged 15−49 years in rural and peri-urban KwaZulu-Natal, South Africa, were analysed. A Bayesian geoadditive regression model which includes a spatial effect for a small enumeration area was applied using an integrated nested Laplace approximation (INLA) function while accounting for unobserved factors, non-linear effects of selected continuous variables, and spatial autocorrelation. The prevalence of unsuppressed HIV viral load was 46.1% [95% CI: 44.3−47.8]. Predictors of unsuppressed HIV viral load were incomplete high school education, being away from home for more than a month, alcohol consumption, no prior knowledge of HIV status, not ever tested for HIV, not on antiretroviral therapy (ART), on tuberculosis (TB) medication, having two or more sexual partners in the last 12 months, and having a CD4 cell count of <350 cells/μL. A positive non-linear effect of age, household size, and the number of lifetime HIV tests was identified. The higher-risk pattern of unsuppressed HIV viral load occurred in the northwest and northeast of the study area. Identifying predictors of unsuppressed viral load in a localized geographic area and information from spatial risk maps are important for targeted prevention and treatment programs to reduce the transmission of HIV.
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Affiliation(s)
- Adenike O. Soogun
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
- School of Laboratory Medicine & Medical Science, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Temesgen Zewotir
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Delia North
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ebenezer Ogunsakin
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Perry Rakgoale
- Department of Geography, School of Agriculture, Earth, and Environmental Science, University of KwaZulu-Natal, Durban 4001, South Africa
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Okyere J, Ayebeng C, Owusu BA, Dickson KS. Prevalence and factors associated with hypertension among older people living with HIV in South Africa. BMC Public Health 2022; 22:1684. [PMID: 36064661 PMCID: PMC9446744 DOI: 10.1186/s12889-022-14091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background People living with HIV (PLHIV) are experiencing increased life expectancy mostly due to the success of anti-retroviral therapy. Consequently, they face the threat of chronic diseases attributed to ageing including hypertension. The risk of hypertension among PLHIV requires research attention particularly in South Africa where the prevalence of HIV is highest in Africa. We therefore examined the prevalence and factors associated with hypertension among older people living with HIV in South Africa. Methods We analysed cross-sectional data on 514 older PLHIV. Data were extracted from the WHO SAGE Well-Being of Older People Study (WOPS) (2011–2013). The outcome variable was hypertension status. Data was analysed using STATA Version 14. Chi-square and binary logistic regression were performed. The results were presented in odds ratio with its corresponding confidence interval. Results The prevalence of hypertension among PLHIV was 50.1%. Compared to PLHIV aged 50–59, those aged 60–69 [OR = 2.2; CI = 1.30,3.84], 70–79 years [OR = 2.8; CI = 1.37,5.82], and 80 + [OR = 4.9; CI = 1.68,14.05] had higher risk of hypertension. Females were more likely [OR = 5.5; CI = 2.67,11.12] than males to have hypertension. Persons ever diagnosed with stroke were more likely [OR = 3.3; CI = 1.04,10.65] to have hypertension when compared to their counterparts who have never been diagnosed with stroke. Compared to PLHIV who had no clinic visits, those who visited the clinic three to six times [OR = 5.3; CI = 1.35,21.01], or more than six times [OR = 5.5; CI = 1.41,21.41] were more likely to have hypertension. Conclusion More than half of South African older PLHIV are hypertensive. The factors associated with hypertension among older PLHIV are age, sex, ever diagnosed with stroke and number of times visited the clinic. Integration of hypertension management and advocacy in HIV care is urgently needed in South Africa in order to accelerate reductions in the prevalence of hypertension among older PLHIV, as well as enhance South Africa’s capacity to attain the Sustainable Development Goal target 3.3.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. .,Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Harrison SR, Jordan AM. Chronic disease care integration into primary care services in sub-Saharan Africa: a 'best fit' framework synthesis and new conceptual model. Fam Med Community Health 2022; 10:e001703. [PMID: 36162864 PMCID: PMC9516220 DOI: 10.1136/fmch-2022-001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To examine the relevance of existing chronic care models to the integration of chronic disease care into primary care services in sub-Saharan Africa and determine whether additional context-specific model elements should be considered. DESIGN 'Best fit' framework synthesis comprising two systematic reviews. First systematic review of existing chronic care conceptual models with construction of a priori framework. Second systematic review of literature on integrated HIV and diabetes care at a primary care level in sub-Saharan Africa, with thematic analysis carried out against the a priori framework. New conceptual model constructed from a priori themes and new themes. Risk of bias of included studies was assessed using CASP and MMAT. ELIGIBILITY CRITERIA Conceptual models eligible for inclusion in construction of a priori framework if developed for a primary care context and described a framework for long-term management of chronic disease care. Articles eligible for inclusion in second systematic review described implementation and evaluation of an intervention or programme to integrate HIV and diabetes care into primary care services in SSA. INFORMATION SOURCES PubMed, Embase, CINAHL Plus, Global Health and Global Index Medicus databases searched in April 2020 and September 2022. RESULTS Two conceptual models of chronic disease care, comprising six themes, were used to develop the a priori framework. The systematic review of primary research identified 16 articles, within which all 6 of the a priori framework themes, along with 5 new themes: Improving patient access, stigma and confidentiality, patient-provider partnerships, task-shifting, and clinical mentoring. A new conceptual model was constructed from the a priori and new themes. CONCLUSION The a priori framework themes confirm a need for co-ordinated, longitudinal chronic disease care integration into primary care services in sub-Saharan Africa. Analysis of the primary research suggests integrated care for HIV and diabetes at a primary care level is feasible and new themes identified a need for a contextualised chronic disease care model for sub-Saharan Africa.
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Affiliation(s)
- Simon R Harrison
- Biomedical Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Aileen M Jordan
- Biomedical Sciences, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
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Kauhl B, Vietzke M, König J, Schönfelder M. Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:7. [PMID: 39177711 PMCID: PMC11281746 DOI: 10.1007/s43999-022-00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/21/2022] [Indexed: 08/24/2024]
Abstract
BACKGROUND The disease management program (DMP) for type 2 Diabetes Mellitus (T2DM) is the largest DMP in Germany. Our goal was to analyze regional differences in unenrollment rates, suggest areas for intervention and provide background information, which population groups in which locations are currently not enrolled in the DMP for T2DM. METHODS In this study, we used data of the 1.7 mil. insurants of the AOK Nordost health insurance. For the visualization of enrollment potential, we used the Besag-York-Mollie model (BYM). The spatial scan statistic (SaTScan) was used to detect areas of unusually high rates of unenrolled diabetics to prioritize areas for intervention. To explore sociodemographic associations, we used Bayesian spatial global regression models. A Spatially varying coefficient model (SVC) revealed in how far the detected associations vary over space. RESULTS The proportion of diabetics currently not enrolled in the DMP T2DM was 36.8% in 2019 and varied within northeastern Germany. Local clusters were detected mainly in Mecklenburg-West-Pomerania and Berlin. The main sociodemographic variables associated with unenrollment were female sex, younger age, being unemployed, foreign citizenship, small household size and the proportion of persons commuting to work outside their residential municipality. The SVC model revealed important spatially varying effects for some but not all associations. CONCLUSION Lower socioeconomic status and foreign citizenship had an ubiquitous effect on not being enrolled. The DMP T2DM therefore does currently not reach those population groups, which have a higher risk for secondary diseases and possible avoidable hospitalizations. Logically, future interventions should focus on these groups. Our methodology clearly suggests areas for intervention and points out, which population group in which locations should be specifically approached.
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Affiliation(s)
- B Kauhl
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany.
| | - M Vietzke
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - J König
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - M Schönfelder
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
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Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38:10.7196/SAJCC.2022.v38i2.527. [PMID: 36284926 PMCID: PMC9536494 DOI: 10.7196/sajcc.2022.v38i2.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. OBJECTIVES This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. METHODS A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). RESULTS Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. CONCLUSION This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. CONTRIBUTIONS OF THE STUDY This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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Mahaye N, Musee N. Effects of Two Antiretroviral Drugs on the Crustacean Daphnia magna in River Water. TOXICS 2022; 10:toxics10080423. [PMID: 36006102 PMCID: PMC9416331 DOI: 10.3390/toxics10080423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Antiretroviral (ARVs) drugs are used to manage the human immunodeficiency virus (HIV) disease and are increasingly being detected in the aquatic environment. However, little is known about their effects on non-target aquatic organisms. Here, Daphnia magna neonates were exposed to Efavirenz (EFV) and Tenofovir (TFV) ARVs at 62.5–1000 µg/L for 48 h in river water. The endpoints assessed were mortality, immobilization, and biochemical biomarkers (catalase (CAT), glutathione S-transferase (GST), and malondialdehyde (MDA)). No mortality was observed over 48 h. Concentration- and time-dependent immobilization was observed for both ARVs only at 250–1000 µg/L after 48 h, with significant immobilization observed for EFV compared to TFV. Results for biochemical responses demonstrated that both ARVs induced significant changes in CAT and GST activities, and MDA levels, with effects higher for EFV compared to TFV. Biochemical responses were indicative of oxidative stress alterations. Hence, both ARVs could potentially be toxic to D. magna.
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Diress G, Adane S, Linger M, Merchaw A, Mengist B. Individual and community-level determinates of risky sexual behaviors among sexually active unmarried men: A multilevel analysis of 2016 Ethiopian Demographic and Health Survey. PLoS One 2022; 17:e0270083. [PMID: 35862425 PMCID: PMC9302804 DOI: 10.1371/journal.pone.0270083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In Ethiopia, HIV/AIDS continues to be a major public health problem mostly due to the high prevalence of risky sexual behaviors. However, research on risky sexual behavior and its determinants among unmarried men (never married, widowed, and divorced) who are highly vulnerable to risky sexual behavior was limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and its determinants among non-married men using a nationally representative sample. METHODS The analysis was done on 5680 sexually active unmarried men aged 15-59 years using data from the 2016 Ethiopia Demographic Health Survey (EDHS). The main outcome variable was risky sexual behavior which defined as having at least one of the following: multiple sexual partners; initiation of sex before the age of 18 years; inconsistent condom use in the last 12 months; alcohol consumption at last sex. Multivariable generalized linear mixed-effects regression was employed to identify variables associated with risky sexual behavior. RESULT The overall magnitude of risky sexual behavior was 26.9% (95% CI; 25.7, 28.0). Currently employed (AOR = 2.49, 95% CI = 1.64-3.77), history of HIV testing (AOR = 2.51, 95% C = 1.95-3.23), drinking alcohol almost every day (AOR = 5.49, 95 CI = 2.73-11.02), and using Internet daily (AOR = 1.99, 95% CI = 1.06-3.74) increase the odds of risky sexual behavior. Whereas, primary education (AOR = 0.44, 95% CI = 0.32-0.61), secondary education level (AOR = 0.46, 95% CI = 0.29-0.72) and a high proportion of community-level media exposure (AOR = 0.42, 95% CI = 0.12-0.75) decrease the odds of risky sexual behavior. CONCLUSION In general, a significant proportion of sexually active unmarried men in Ethiopia have practiced risky sexual behavior. An intervention should be designed which are against the factors found to increase the odds of risky sexual behavior to reduce the incidence of HIV and other sexually transmitted infections.
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Affiliation(s)
- Gedefaw Diress
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Seteamlak Adane
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Melese Linger
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Abebe Merchaw
- School of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Belayneh Mengist
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Achia T, Cervantes IF, Stupp P, Musingila P, Muthusi J, Waruru A, Schmitz M, Bronson M, Chang G, Bore J, Kingwara L, Mwalili S, Muttunga J, Gitonga J, De Cock KM, Young P. Methods for conducting trends analysis: roadmap for comparing outcomes from three national HIV Population-based household surveys in Kenya (2007, 2012, and 2018). BMC Public Health 2022; 22:1337. [PMID: 35831818 PMCID: PMC9281165 DOI: 10.1186/s12889-022-13633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For assessing the HIV epidemic in Kenya, a series of independent HIV indicator household-based surveys of similar design can be used to investigate the trends in key indicators relevant to HIV prevention and control and to describe geographic and sociodemographic disparities, assess the impact of interventions, and develop strategies. We developed methods and tools to facilitate a robust analysis of trends across three national household-based surveys conducted in Kenya in 2007, 2012, and 2018. METHODS We used data from the 2007 and 2012 Kenya AIDS Indicator surveys (KAIS 2007 and KAIS 2012) and the 2018 Kenya Population-based HIV Impact Assessment (KENPHIA 2018). To assess the design and other variables of interest from each study, variables were recoded to ensure that they had equivalent meanings across the three surveys. After assessing weighting procedures for comparability, we used the KAIS 2012 nonresponse weighting procedure to revise normalized KENPHIA weights. Analyses were restricted to geographic areas covered by all three surveys. The revised analysis files were then merged into a single file for pooled analysis. We assessed distributions of age, sex, household wealth, and urban/rural status to identify unexpected changes between surveys. To demonstrate how a trend analysis can be carried out, we used continuous, binary, and time-to-event variables as examples. Specifically, temporal trends in age at first sex and having received an HIV test in the last 12 months were used to demonstrate the proposed analytical approach. These were assessed with respondent-specific variables (age, sex, level of education, and marital status) and household variables (place of residence and wealth index). All analyses were conducted in SAS 9.4, but analysis files were created in Stata and R format to support additional analyses. RESULTS This study demonstrates trends in selected indicators to illustrate the approach that can be used in similar settings. The incidence of early sexual debut decreased from 11.63 (95% CI: 10.95-12.34) per 1,000 person-years at risk in 2007 to 10.45 (95% CI: 9.75-11.2) per 1,000 person-years at risk in 2012 and to 9.58 (95% CI: 9.08-10.1) per 1,000 person-years at risk in 2018. HIV-testing rates increased from 12.6% (95% CI: 11.6%-13.6%) in 2007 to 56.1% (95% CI: 54.6%-57.6%) in 2012 but decreased slightly to 55.6% [95% CI: 54.6%-56.6%) in 2018. The decrease in incidence of early sexual debut could be convincingly demonstrated between 2007 and 2012 but not between 2012 and 2018. Similarly, there was virtually no difference between HIV Testing rates in 2012 and 2018. CONCLUSIONS Our approach can be used to support trend comparisons for variables in HIV surveys in low-income settings. Independent national household surveys can be assessed for comparability, adjusted as appropriate, and used to estimate trends in key indicators. Analyzing trends over time can not only provide insights into Kenya's progress toward HIV epidemic control but also identify gaps.
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Affiliation(s)
- Thomas Achia
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya.
| | | | - Paul Stupp
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Musingila
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Jacques Muthusi
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Anthony Waruru
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mary Schmitz
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Megan Bronson
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gregory Chang
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Bore
- Kenya National Bureau of Statistics, Nairobi, Kenya
| | | | - Samuel Mwalili
- Department of Statistics and Actuarial Science, Jomo Kenyatta University, Juja, Kenya
| | | | | | - Kevin M De Cock
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peter Young
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Gelibo T, Lulseged S, Eshetu F, Abdella S, Melaku Z, Ajiboye S, Demissie M, Solmo C, Ahmed J, Getaneh Y, Kaydos-Daniels SC, Abate E. Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017–2018). PLoS One 2022; 17:e0271221. [PMID: 35819961 PMCID: PMC9491827 DOI: 10.1371/journal.pone.0271221] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
The design and evaluation of national HIV programs often rely on aggregated
national data, which may obscure localized HIV epidemics. In Ethiopia, even
though the national adult HIV prevalence has decreased, little information is
available about local areas and subpopulations. To inform HIV prevention efforts
for specific populations, we identified geographic locations and drivers of HIV
transmission. We used data from adults aged 15–64 years who participated in the
Ethiopian Population-based HIV Impact Assessment survey (October 2017–April
2018). Location-related information for the survey clusters was obtained from
the 2007 Ethiopia population census. Spatial autocorrelation of HIV prevalence
data were analyzed via a Global Moran’s I test. Geographically weighted
regression analysis was used to show the relationship of covariates. The finding
indicated that uncircumcised men in certain hotspot towns and divorced or
widowed individuals in hotspot woredas/towns might have contributed to the
average increase in HIV prevalence in the hotspot areas. Hotspot analysis
findings indicated that, localized, context-specific intervention efforts
tailored to at-risk populations, such as divorced or widowed women or
uncircumcised men, could decrease HIV transmission and prevalence in urban
Ethiopia.
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Affiliation(s)
- Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
- * E-mail:
| | - Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Frehywot Eshetu
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Saro Abdella
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Solape Ajiboye
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Atlanta, GA, United States of
America
| | - Minilik Demissie
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Chelsea Solmo
- ICAP at Columbia University, New York, New York, United States of
America
| | - Jelaludin Ahmed
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Yimam Getaneh
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Susan C. Kaydos-Daniels
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Ebba Abate
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
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Moraga P, Baker L. rspatialdata: a collection of data sources and tutorials on downloading and visualising spatial data using R. F1000Res 2022; 11:770. [PMID: 36016994 PMCID: PMC9363973 DOI: 10.12688/f1000research.122764.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
Abstract
Spatial and spatio-temporal data are used in a wide range of fields including environmental, health and social disciplines. Several packages in the statistical software R have been recently developed as clients for various databases to meet the growing demands for easily accessible and reliable spatial data. While documentation on how to use many of these packages exist, there is an increasing need for a one stop repository for tutorials on this information. In this paper, we present rspatialdata a website that provides a collection of data sources and tutorials on downloading and visualising spatial data using R. The website includes a wide range of datasets including administrative boundaries of countries, Open Street Map data, population, temperature, vegetation, air pollution, and malaria data. The goal of the website is to equip researchers and communities with the tools to engage in spatial data analysis and visualisation so that they can address important local issues, such as estimating air pollution, quantifying disease burdens, and evaluating and monitoring the United Nation’s sustainable development goals.
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Affiliation(s)
- Paula Moraga
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955-6900, Saudi Arabia
| | - Laurie Baker
- College of the Atlantic, 105 Eden St, Bar Harbor, ME, 04609, USA
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123
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Dzinza R, Ngwira A. Comparing parametric and Cox regression models using HIV/AIDS survival data from a retrospective study in Ntcheu district in Malawi. J Public Health Res 2022; 11:22799036221125328. [PMID: 36185416 PMCID: PMC9523851 DOI: 10.1177/22799036221125328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The study was designed to compare parametric and Cox regression survival models. It was also aimed at determining risk factors of death due to HIV/AIDS. Design and methods: The models were fitted to time from ART initiation to death due to HIV/AIDS while using data that was collected from 6670 patients records who registered for ART from 2007 to 2012 at Ntcheu district hospital in Malawi. The best fitting model was used to determine risk factors of death due to HIV/AIDS. Results: The exponential and Gompertz model competed very well with the Cox regression. Patients in WHO clinical stage 4 (HR = 1.69, p-value <0.001) and males (HR = 1.74, p-value <0.001) were associated with increased hazard of death than those in WHO clinical stage 3 and females. Patients with high body mass index (HR = 0.82, p-value <0.001) were associated with lower hazard of death than those with lower body mass index. Conclusions: Parametric models may perform as good as the Cox regression and the plausibility of all models needs to be investigated to use the correct model for accurate inferences. Furthermore, strategies to limit deaths due to HIV/AIDS should initiate ART early before WHO clinical stage 4 and males should receive special attention. The strategies should also aim at improving the body mass index of patients.
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Affiliation(s)
- Rabson Dzinza
- Mathematics and Statistics Department, Nalikule College of Education, Lilongwe, Malawi
| | - Alfred Ngwira
- Basic Sciences Department, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
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Gapare CR, El-Zein M, Patel H, Tope P, Franco EL. Ecological analysis of correlates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Cancer Epidemiol Biomarkers Prev 2022; 31:1804-1811. [PMID: 35700009 DOI: 10.1158/1055-9965.epi-22-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth leading cause of death among women worldwide, with 85% of the burden falling on low- to middle- income countries. We studied the correlates of cervical cancer incidence and mortality, and case-fatality in Sub-Saharan Africa. METHODS Country-level data on 16 putative cervical cancer correlates for 37 Sub-Saharan African countries were collected from publicly available data sources. We performed univariate and multiple (stepwise) linear regression analyses to identify correlates of cervical cancer incidence and mortality, and case-fatality. RESULTS In univariate analyses, incidence and mortality rates were significantly correlated with contraceptive use, penile cancer incidence, and human immunodeficiency virus prevalence. Incidence rates were also correlated with literacy rates, whereas mortality rates were correlated with the proportion of rural population and screening coverage. Multiple regression analyses showed contraceptive use (p=0.009) and penile cancer incidence (p=0.004) as associated with cervical cancer incidence. Penile cancer incidence (p=9.77 x 10-5) and number of medical doctors (p=0.0433) were associated with mortality. The goodness of fit of the incidence and mortality models was moderate at best, explaining 49% and 37% of variability in the data, respectively. However, the case-fatality model had the best fit explaining most of the variation (adjusted R2=0.948; p=6.822 x 10-16). CONCLUSIONS To reduce the burden of cervical cancer in Sub-Saharan Africa, it would be important to design multimodal interventions that not only target screening and HPV vaccination, but also focus on cervical cancer correlates. IMPACT Identifying contextual factors associated with cervical cancer in this region could inform targeted interventions.
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Folayan MO, Abeldaño Zuñiga RA, Virtanen JI, El Tantawi M, Abeldaño GF, Ishabiyi AO, Jafer M, Al-Khanati NM, Quadri MFA, Yousaf MA, Ellakany P, Nzimande N, Ara E, Khalid Z, Lawal FB, Lusher J, Popoola BO, Idigbe I, Khan ATA, Ayanore MA, Gaffar B, Osamika BE, Aly NM, Ndembi N, Nguyen AL. Associations between COVID-19 testing status, non-communicable diseases and HIV status among residents of sub-Saharan Africa during the first wave of the pandemic. BMC Infect Dis 2022; 22:535. [PMID: 35692050 PMCID: PMC9188915 DOI: 10.1186/s12879-022-07498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study determined if non-communicable disease status, HIV status, COVID-19 status and co-habiting were associated with COVID-19 test status in sub-Saharan Africa. METHODS Data of 5945 respondents age 18-years-old and above from 31 countries in sub-Saharan Africa collected through an online survey conducted between June and December 2020, were extracted. The dependent variable was COVID-19 status (testing positive for COVID-19 and having symptoms of COVID-19 but not getting tested). The independent variables were non-communicable disease status (hypertension, diabetes, cancer, heart conditions, respiratory conditions, depression), HIV positive status, COVID-19 status (knowing a close friend who tested positive for COVID-19 and someone who died from COVID-19) and co-habiting (yes/no). Two binary logistic regression models developed to determine associations between the dependent and independent variables were adjusted for age, sex, employment, sub region and educational status. RESULTS Having a close friend who tested positive for COVID-19 (AOR:6.747), knowing someone who died from COVID-19 infection (AOR:1.732), and living with other people (AOR:1.512) were significantly associated with higher odds of testing positive for COVID-19 infection, while living with HIV was associated with significantly lower odds of testing positive for COVID-19 infection (AOR:0.284). Also, respondents with respiratory conditions (AOR:2.487), self-reported depression (AOR:1.901), those who had a close friend who tested positive for COVID-19 infection (AOR:2.562) and who knew someone who died from COVID-19 infection (AOR:1.811) had significantly higher odds of having symptoms of COVID-19 infection but not getting tested. CONCLUSION Non-communicable diseases seem not to increase the risk for COVID-19 positive test while cohabiting seems to reduce this risk. The likelihood that those who know someone who tested positive to or who died from COVID-19 not getting tested when symptomatic suggests there is poor contact tracing in the region. People with respiratory conditions and depression need support to get tested for COVID-19.
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Affiliation(s)
- Morenike O Folayan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria.
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Postgraduate Department, University of Sierra Sur, Oaxaca, Mexico
| | - Jorma I Virtanen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Medicine, University of Sierra Sur, Oaxaca, Mexico
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Dental Public Health, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Biology, Virtual University of Pakistan, Lahore, Pakistan
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulraman Bin Faisal University, Dammam, Saudi Arabia
| | - Ntombifuthi Nzimande
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Economic and Social Geography, Faculty of Science and Informatics, University of Szeged, 6722, Szeged, Hungary
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Government College for Women, Moulana Azad Road, Srinagar, Kashmir (J&K), India
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Sciences, University of Genoa, 16132, Genoa, Italy
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Regent's University London, London, UK
| | - Bamidele O Popoola
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Child Oral Health, University of Ibadan, Ibadan, Nigeria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- School of Biological Sciences, University of the Punjab, New Campus, Lahore, 54590, Punjab, Pakistan
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Psychology, Miami University, Oxford, OH, USA
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Nicaise Ndembi
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Africa Centres for Disease Control and Prevention, African Union Commission, Roosevelt Street, Addis Ababa, Ethiopia
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Ile-Ife, Nigeria
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Mapping HIV prevalence in Nigeria using small area estimates to develop a targeted HIV intervention strategy. PLoS One 2022; 17:e0268892. [PMID: 35675346 PMCID: PMC9176772 DOI: 10.1371/journal.pone.0268892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Although geographically specific data can help target HIV prevention and treatment strategies, Nigeria relies on national- and state-level estimates for policymaking and intervention planning. We calculated sub-state estimates along the HIV continuum of care in Nigeria. Design Using data from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) (July–December 2018), we conducted a geospatial analysis estimating three key programmatic indicators: prevalence of HIV infection among adults (aged 15–64 years); antiretroviral therapy (ART) coverage among adults living with HIV; and viral load suppression (VLS) rate among adults living with HIV. Methods We used an ensemble modeling method called stacked generalization to analyze available covariates and a geostatistical model to incorporate the output from stacking as well as spatial autocorrelation in the modeled outcomes. Separate models were fitted for each indicator. Finally, we produced raster estimates of each indicator on an approximately 5×5-km grid and estimates at the sub-state/local government area (LGA) and state level. Results Estimates for all three indicators varied both within and between states. While state-level HIV prevalence ranged from 0.3% (95% uncertainty interval [UI]: 0.3%–0.5%]) to 4.3% (95% UI: 3.7%–4.9%), LGA prevalence ranged from 0.2% (95% UI: 0.1%–0.5%) to 8.5% (95% UI: 5.8%–12.2%). Although the range in ART coverage did not substantially differ at state level (25.6%–76.9%) and LGA level (21.9%–81.9%), the mean absolute difference in ART coverage between LGAs within states was 16.7 percentage points (range, 3.5–38.5 percentage points). States with large differences in ART coverage between LGAs also showed large differences in VLS—regardless of level of effective treatment coverage—indicating that state-level geographic targeting may be insufficient to address coverage gaps. Conclusion Geospatial analysis across the HIV continuum of care can effectively highlight sub-state variation and identify areas that require further attention in order to achieve epidemic control. By generating local estimates, governments, donors, and other implementing partners will be better positioned to conduct targeted interventions and prioritize resource distribution.
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127
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Nguyen VK, Eaton JW. Trends and country-level variation in age at first sex in sub-Saharan Africa among birth cohorts entering adulthood between 1985 and 2020. BMC Public Health 2022; 22:1120. [PMID: 35659216 PMCID: PMC9167540 DOI: 10.1186/s12889-022-13451-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Debuting sexual intercourse marks exposure to pregnancy or fatherhood and sexually transmitted infections (STIs), including HIV. In sub-Saharan Africa (SSA), sexual debut varies according to cultural, religious, and economic factors, and encouraging delay has been a longstanding component of behavioural HIV prevention strategies. Age at first sex (AFS) is routinely collected in national household surveys, but data are affected by reporting biases, limiting utility to monitor trends and guide sexual health interventions. METHODS We collated individual-level data from nationally-representative household surveys to analyse timing and national trends in AFS in 42 SSA countries. We used a log-skew-logistic distribution to characterize the time to AFS in a Bayesian spatio-temporal model, providing estimates of the sexual debut rate by sex, age, time, and country. We statistically adjusted for reporting biases by comparing AFS reported by the same birth cohorts in multiple survey rounds, allowing different reporting biases by sex and country. RESULTS Median AFS in 2015 ranged from 15.8 among Angolan women to 25.3 among men in Niger. AFS was younger for women than men in 37/40 countries. The gap was largest for Sahel region countries and minimal in southern African countries. The distribution of female AFS was asymmetric with half debuting sex in an age range of 3.9 years [IQR 3.4-5.0 across countries]. Median AFS increased slightly between 1985 and 2020, ranging 0.84 years [IQR 0.11-1.55] and 0.79 [IQR -0.23-1.98] for females and males, respectively. The gender gap changed little over time in most countries. Female teens often reported higher AFS compared to when asked in their late twenties while male teens reported lower AFS; both sexes recalled a higher AFS in older ages compared to their thirties. CONCLUSIONS AFS increased slightly in most SSA countries, but changes were modest relative to large and persistent variation between countries and sexes, indicating relatively entrenched socio-cultural practices around sexual debut. Sexual health, family planning, and HIV/STI prevention services should adapt to local practices rather than focusing interventions to change AFS. These estimates for rates of sexual debut provide data to guide programmatic prioritization and implementation of sexual health services.
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Affiliation(s)
- Van Kính Nguyen
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, St. Mary's Hospital Campus, Norfolk Place, London, W2 1PG, UK.
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, St. Mary's Hospital Campus, Norfolk Place, London, W2 1PG, UK
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128
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Epidemiology of Kaposi’s sarcoma in sub-Saharan Africa. Cancer Epidemiol 2022; 78:102167. [DOI: 10.1016/j.canep.2022.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 12/24/2022]
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129
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Nyitray AG, Masunaga K, Nyoni J, Ross MW. Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012. Int J STD AIDS 2022; 33:672-679. [PMID: 35531601 PMCID: PMC9189599 DOI: 10.1177/09564624221094456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022]
Abstract
Background: Anal cancer is primarily caused by high-risk human papillomavirus (hrHPV), is associated with HIV infection, and has a very high incidence among men who have sex with men (MSM). We assessed prevalence of hrHPV, and factors associated with hrHPV in anal canal specimens collected in Dar es Salaam, Tanzania from HIV-positive and HIV-negative MSM. Methods: MSM were recruited using respondent-driven sampling in this cross-sectional study. The primary outcome in this ancillary analysis of 116 MSM was prevalence of HPV-16 and other hrHPV types. Prevalence ratios (PR) estimated the association between hrHPV and HIV-negative participants' demographics, sexual behaviour and sexually transmitted infections. Results: Median age was 23 years and 33.6% of participants were HIV-positive. HrHPV and HPV-16 prevalence was 54.3% and 17.2%, respectively, with HPV-16 prevalence highest among HIV-positive MSM identifying as gay (36.1%) and lowest among HIV-negative MSM identifying as bisexual (2.9%). Having two or more receptive anal sex partners in the past month was associated with hrHPV (PR 3.20, 95%CI 1.69-6.07, vs. 0 partners) among HIV-negative MSM.Conclusions: HrHPV prevalence was high among MSM in Dar es Salaam and highest among HIV-positive MSM identifying as gay. These estimates may be used to support HPV vaccination and screening initiatives.
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Affiliation(s)
- Alan G Nyitray
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioural Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ka ` imi ` aina Masunaga
- Department of Developmental and Surgical Sciences, University of Minnesota Physicians, Minnesota Children’s Hospital, MN, USA
| | - Joyce Nyoni
- Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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130
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Rydzak CE, Lima AS, Meirelles GS. Endemic Thoracic Infections in Sub-Saharan Africa. Radiol Clin North Am 2022; 60:461-479. [DOI: 10.1016/j.rcl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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131
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Naigino R, Makumbi F, Mukose A, Buregyeya E, Arinaitwe J, Musinguzi J, Kiene SM, Wanyenze RK. Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda. AIDS Behav 2022; 26:1684-1694. [PMID: 34714435 DOI: 10.1007/s10461-021-03520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/26/2022]
Abstract
The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1-45 days since delivery) and highest (88.2%) in the delayed postpartum period (151-183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31-0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40-0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08-1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10-11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65-2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.
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Affiliation(s)
- Rose Naigino
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Kagee A. The need for psychosocial oncology research in sub-Saharan Africa: a review of the terrain. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221093842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cancer is a major cause of morbidity and mortality in many sub-Saharan African countries, but the field of psycho-oncology is underdeveloped. This article reviews the literature on psychosocial oncology in sub-Saharan African with a view to developing a research and practice agenda in the field. The search engines used were Google Scholar, Psych Info, Web of Science, and PubMed and articles were focused on but not limited to the past 10 years. The search terms were ‘Africa, psycho-oncology, psychosocial oncology, mental health, and cancer’. The review is structured as follows: cancer surveillance in sub-Saharan African, behavioural risk factors, cancer screening, and psychosocial issues related to various types of cancers. Psychological reactions in the context of cancer including adjustment, depression, and anxiety disorders are also discussed. It is suggested that sub-Saharan African countries require appropriate funding to support improved systems of surveillance and implementation of cancer registries. Public health and behavioural interventions are needed to increase the awareness of cervical cancer and preventive health-seeking behaviour among high-risk women. Restrictive laws on opioids need to be reconsidered and behavioural health campaigns to control obesity, limit salt intake, and increase awareness of the risks of ultra-violet light are necessary to reduce the incidence of various cancers. Psychosocial support is necessary to ameliorate depressed mood, anxiety, and anticipation and fear of death among persons living with cancer and their families in sub-Saharan Africa. To this end, the training of practitioners to strengthen psychosocial aspects of care, especially palliative care, is a priority.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
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"Validation of the D:A:D Chronic Kidney Disease Risk Score Incorporating Proteinuria in People Living with HIV in Harare, Zimbabwe". J Acquir Immune Defic Syndr 2022; 90:562-566. [PMID: 35413019 DOI: 10.1097/qai.0000000000003002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to validate the D:A:D risk score for chronic kidney disease (CKD) in people living with HIV (PLWH) in a cohort from Harare, Zimbabwe. Additionally, we aimed to evaluate proteinuria as a predictive variable in the risk score model, being the first study to do so. DESIGN Data from PLWH attending a clinic in Harare was evaluated. Those with a baseline estimated glomerular filtration rate >60ml/min/1.73m2 and at least two subsequent eGFR measurements were included. A modified version of the D:A:D risk score model was applied to categorise participants as 'low', 'medium' and 'high-risk' of progression to CKD. Potential predictors of renal impairment were assessed by logistic regression in univariate and multivariate models. Proteinuria was evaluated in a nested model using D:A:D risk categories. RESULTS 2793 participants were included. 40 participants (1.4% of the cohort) progressed to CKD during the median follow-up time of 4.2 years. Progression rates were 1%, 3% and 12% in the low, medium, and high-risk groups respectively. Proteinuria data was available for 2251 participants. Presence of proteinuria was strongly associated with progression to CKD [OR 7.8, 95% CI 3.9-15.7], and its inclusion in the risk score improved the discrimination of the model with the c-statistic increasing from 0.658 to 0.853). CONCLUSION A modified version of the D:A:D CKD risk score performed well in predicting CKD events among this Sub-Saharan African cohort of people living with HIV. Inclusion of proteinuria into the risk score model significantly improved predictability.
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Finlay J, Lambert T, Krahn J, Meyer G, Singh AE, Caine V. Incentive-Based Human Immunodeficiency Virus Screening in Low- and Middle-Income Countries: A Systematic Review. Sex Transm Dis 2022; 49:274-283. [PMID: 34654770 DOI: 10.1097/olq.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The majority of new human immunodeficiency virus (HIV) infections that occur worldwide are in sub-Saharan Africa. While recent gains have been made in many low- and middle-income countries (LMICs), substantial disparities in sexually transmitted and blood-borne infections (STBBI) screening and treatment still exist between LMIC and high-income countries. In addition to increasing STBBI screening uptake, providing incentives for STBBI screening may decrease perceived stigma associated with STBBI screening. METHODS Our review was conducted as part of a larger systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidance from the Cochrane Handbook for Systematic Reviews of Interventions. This review focuses on incentivized STBBI screening in LMIC; high-income countries were excluded. Articles were excluded if their primary focus was on children and youth (younger than 16 years), results retrieval, treatment, behavioral change only, behavior intention, treatment adherence, or provider incentive. RESULTS The search yielded 6219 abstracts. The search and selection criteria included all STBBI; however, only articles examining incentivized HIV screening met our inclusion criteria. Five articles representing 4 distinct studies from South Africa, Uganda, and Zimbabwe were included, all of which focused on incentivized HIV screening. Populations screened included the following: men, first-time testers, population-based surveillance program families, and insurance health plan members. Incentive structures varied widely and incentives were mainly food vouchers, lottery prizes, or household items. CONCLUSIONS Our review was conducted to determine if patient incentives increase STBBI test uptake in LMIC. Overall, incentives were associated with an increase in HIV screening uptake. Most studies included focused solely on men. There is a significant void in understanding STBBI incentive-based screening outside of this context and in complex populations who should be targeted in incentivized HIV screening. Incentives appear most effective when developed specific to context and target population. Further research is needed to analyze incentivized screening across similar study designs, to evaluate long-term effectiveness, and to explore the ethical implications of incentivized care.
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Affiliation(s)
| | - Teresa Lambert
- From the Alberta Health Services Edmonton Sexually Transmitted Infection Clinic, Edmonton
| | - Jessica Krahn
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Garret Meyer
- From the Alberta Health Services Edmonton Sexually Transmitted Infection Clinic, Edmonton
| | | | - Vera Caine
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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135
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Ofili MA, Idemudia ES, Olawa BD. Recruitment managers’ emotional intelligence and employment discrimination against people living with HIV/AIDS: The mediating role of stigma. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.2989/16073614.2021.2017175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michael A. Ofili
- Faculty of Humanities, North-West University, Mahikeng, South Africa
| | | | - Babatola D. Olawa
- Lifestyle Disease Entity, Mafikeng Campus, North-West University, Mahikeng South Africa
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136
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How do women prepare for pregnancy in a low-income setting? Prevalence and associated factors. PLoS One 2022; 17:e0263877. [PMID: 35286337 PMCID: PMC8920258 DOI: 10.1371/journal.pone.0263877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
Background Despite growing evidence of pregnancy preparation benefits, there is little knowledge on how women in developing countries prepare for pregnancy and factors influencing their preparedness for pregnancy. Here, we determine how women in Malawi prepare for pregnancy and factors associated with pregnancy preparation. Methods We used data from a previous cohort study comprising 4,244 pregnant mothers, recruited between March and December 2013 in Mchinji district, Malawi. Associations of pregnancy preparation with socio-demographic and obstetric factors were tested for using mixed effects ordinal regression, with the likelihood ratio and Wald’s tests used for variable selection and independently testing the associations. Results Most mothers (63.9%) did not take any action to prepare for their pregnancies. For those who did (36.1%), eating more healthily (71.9%) and saving money (42.8%) were the most common forms of preparation. Mothers who were married (adjusted odds-ratio (AOR 7.77 (95% CI [5.31, 11.25]) or with no or fewer living children were more likely to prepare for pregnancy (AOR 4.71, 95% CI [2.89,7.61]. Mothers with a period of two to three years (AOR 2.51, 95% CI [1.47, 4.22]) or at least three years (AOR 3.67, 95%CI [2.18, 6.23]) between pregnancies were more likely to prepare for pregnancy than women with first pregnancy or shorter intervals. On the other hand, teenage and older (≥ 35 years old) mothers were less likely to prepare for pregnancy (AOR 0.61, 95%CI [0.47, 0.80]) and AOR 0.49 95%CI [0.33, 0.73], respectively). Conclusion While preconception care may not be formally available in Malawi, our study has revealed that over a third of mothers took some action to prepare for pregnancy before conception. Although this leaves around two thirds of women who did not make any form of pregnancy preparation, our findings form a basis for future research and development of a preconception care package that suits the Malawian context.
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Xi X, Spencer SEF, Hall M, Grabowski MK, Kagaayi J, Ratmann O. Inferring the sources of HIV infection in Africa from deep‐sequence data with semi‐parametric Bayesian Poisson flow models. J R Stat Soc Ser C Appl Stat 2022. [DOI: 10.1111/rssc.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaoyue Xi
- Department of MathematicsImperial College London LondonUK
| | | | - Matthew Hall
- Big Data Institute, Nuffield Department of MedicineUniversity of Oxford OxfordUK
| | - M. Kate Grabowski
- Department of PathologyJohns Hopkins University BaltimoreMDUSA
- Rakai Health Sciences Program KalisizoUganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program KalisizoUganda
- Makerere University School of Public Health KampalaUganda
| | - Oliver Ratmann
- Department of MathematicsImperial College London LondonUK
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138
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Nduva GM, Otieno F, Kimani J, Wahome E, McKinnon LR, Cholette F, Majiwa M, Masika M, Mutua G, Anzala O, Graham SM, Gelmon L, Price MA, Smith AD, Bailey RC, Baele G, Lemey P, Hassan AS, Sanders EJ, Esbjörnsson J. Quantifying rates of HIV-1 flow between risk groups and geographic locations in Kenya: A country-wide phylogenetic study. Virus Evol 2022; 8:veac016. [PMID: 35356640 PMCID: PMC8962731 DOI: 10.1093/ve/veac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022] Open
Abstract
In Kenya, HIV-1 key populations including men having sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW) are thought to significantly contribute to HIV-1 transmission in the wider, mostly heterosexual (HET) HIV-1 transmission network. However, clear data on HIV-1 transmission dynamics within and between these groups are limited. We aimed to empirically quantify rates of HIV-1 flow between key populations and the HET population, as well as between different geographic regions to determine HIV-1 'hotspots' and their contribution to HIV-1 transmission in Kenya. We used maximum-likelihood phylogenetic and Bayesian inference to analyse 4058 HIV-1 pol sequences (representing 0.3 per cent of the epidemic in Kenya) sampled 1986-2019 from individuals of different risk groups and regions in Kenya. We found 89 per cent within-risk group transmission and 11 per cent mixing between risk groups, cyclic HIV-1 exchange between adjoining geographic provinces and strong evidence of HIV-1 dissemination from (i) West-to-East (i.e. higher-to-lower HIV-1 prevalence regions), and (ii) heterosexual-to-key populations. Low HIV-1 prevalence regions and key populations are sinks rather than major sources of HIV-1 transmission in Kenya. Targeting key populations in Kenya needs to occur concurrently with strengthening interventions in the general epidemic.
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Affiliation(s)
- George M Nduva
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Frederick Otieno
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Elizabeth Wahome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Lyle R McKinnon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella 4013, South Africa
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Canada
| | - Maxwell Majiwa
- Kenya Medical Research Institute/Center for Global Health Research, KEMRI-CGHR, P.O. Box 20778-00202, Kisumu, Kenya
| | - Moses Masika
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Gaudensia Mutua
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Omu Anzala
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Department of Epidemiology, University of Washington, Office of the Chair, UW Box # 351619, Seattle, DC, USA
| | - Larry Gelmon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Matt A Price
- IAVI Global Headquarters, 125 Broad Street, 9th Floor, New York, NY 10004, USA
- Department of Epidemiology and Biostatistics, University of California, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd Floor, San Francisco, CA 94158-2549, USA
| | - Adrian D Smith
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Robert C Bailey
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA
| | - Guy Baele
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Philippe Lemey
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Amin S Hassan
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
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Orel E, Esra R, Estill J, Thiabaud A, Marchand-Maillet S, Merzouki A, Keiser O. Prediction of HIV status based on socio-behavioural characteristics in East and Southern Africa. PLoS One 2022; 17:e0264429. [PMID: 35239697 PMCID: PMC8893684 DOI: 10.1371/journal.pone.0264429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION High yield HIV testing strategies are critical to reach epidemic control in high prevalence and low-resource settings such as East and Southern Africa. In this study, we aimed to predict the HIV status of individuals living in Angola, Burundi, Ethiopia, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Zambia and Zimbabwe with the highest precision and sensitivity for different policy targets and constraints based on a minimal set of socio-behavioural characteristics. METHODS We analysed the most recent Demographic and Health Survey from these 10 countries to predict individual's HIV status using four different algorithms (a penalized logistic regression, a generalized additive model, a support vector machine, and a gradient boosting trees). The algorithms were trained and validated on 80% of the data, and tested on the remaining 20%. We compared the predictions based on the F1 score, the harmonic mean of sensitivity and positive predictive value (PPV), and we assessed the generalization of our models by testing them against an independent left-out country. The best performing algorithm was trained on a minimal subset of variables which were identified as the most predictive, and used to 1) identify 95% of people living with HIV (PLHIV) while maximising precision and 2) identify groups of individuals by adjusting the probability threshold of being HIV positive (90% in our scenario) for achieving specific testing strategies. RESULTS Overall 55,151 males and 69,626 females were included in the analysis. The gradient boosting trees algorithm performed best in predicting HIV status with a mean F1 score of 76.8% [95% confidence interval (CI) 76.0%-77.6%] for males (vs [CI 67.8%-70.6%] for SVM) and 78.8% [CI 78.2%-79.4%] for females (vs [CI 73.4%-75.8%] for SVM). Among the ten most predictive variables for each sex, nine were identical: longitude, latitude and, altitude of place of residence, current age, age of most recent partner, total lifetime number of sexual partners, years lived in current place of residence, condom use during last intercourse and, wealth index. Only age at first sex for male (ranked 10th) and Rohrer's index for female (ranked 6th) were not similar for both sexes. Our large-scale scenario, which consisted in identifying 95% of all PLHIV, would have required testing 49.4% of males and 48.1% of females while achieving a precision of 15.4% for males and 22.7% for females. For the second scenario, only 4.6% of males and 6.0% of females would have had to be tested to find 55.7% of all males and 50.5% of all females living with HIV. CONCLUSIONS We trained a gradient boosting trees algorithm to find 95% of PLHIV with a precision twice higher than with general population testing by using only a limited number of socio-behavioural characteristics. We also successfully identified people at high risk of infection who may be offered pre-exposure prophylaxis or voluntary medical male circumcision. These findings can inform the implementation of new high-yield HIV tests and help develop very precise strategies based on low-resource settings constraints.
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Affiliation(s)
- Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rachel Esra
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Amaury Thiabaud
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Aziza Merzouki
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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140
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Pedersen CK, Zimani P, Frendø M, Spindler NJ, Chidziva C, von Buchwald C, Jensen RG. Prevalence and causes of paediatric hearing loss in a rural province of Zimbabwe: A cross-sectional study. Int J Pediatr Otorhinolaryngol 2022; 154:111044. [PMID: 35091201 DOI: 10.1016/j.ijporl.2022.111044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/09/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hearing loss (HL) in childhood is a significant disability with severe consequences for educational, cognitive, and social-emotional success. Nevertheless, prevalence estimates for HL in Sub-Saharan Africa (SSA) are based on scarce data. Therefore, we aimed to estimate the prevalence of HL in a sample of primary school children from a rural province of Zimbabwe. METHODS A cross-sectional study was performed on primary school children aged 4-13 years from a rural Zimbabwean province. In the quietest room available, participants underwent audiometry, video otoscopy, and tympanometry. Hearing loss was defined as a pure-tone average > 25 dB. Risk factors of hearing loss were evaluated via a questionnaire. Furthermore, to enable comparison with similar studies, HL prevalence was calculated according to two other commonly used definitions. RESULTS A total of 451 pupils were included, of which 10.6% (95% CI 7.8-13.5) met the study criteria for HL. Conductive HL (95.1%) was nineteen times more prevalent than sensorineural HL (4.9%). Otitis media was the underlying cause in 40% of all cases of HL. The prevalence of clinically significant HL varied depending on the definition applied, i.e., 0.4% (95% CI -0.2-1.0) in the worst World Health Organisation category as opposed to 4.2% (95% CI 2.4-4.1) in the worst American Speech-Hearing Association category. CONCLUSIONS Hearing loss was common in this sample of primary school children from a rural province in Zimbabwe.
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Affiliation(s)
- Christian K Pedersen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark.
| | | | - Martin Frendø
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark.
| | - Nicklas Juel Spindler
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark.
| | | | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark.
| | - Ramon G Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark.
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Cuadros DF, de Oliveira T, Gräf T, Junqueira DM, Wilkinson E, Lemey P, Bärnighausen T, Kim HY, Tanser F. The role of high-risk geographies in the perpetuation of the HIV epidemic in rural South Africa: A spatial molecular epidemiology study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000105. [PMID: 36962341 PMCID: PMC10021703 DOI: 10.1371/journal.pgph.0000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
In this study, we hypothesize that HIV geographical clusters (geospatial areas with significantly higher numbers of HIV positive individuals) can behave as the highly connected nodes in the transmission network. Using data come from one of the most comprehensive demographic surveillance systems in Africa, we found that more than 70% of the HIV transmission links identified were directly connected to an HIV geographical cluster located in a peri-urban area. Moreover, we identified a single central large community of highly connected nodes located within the HIV cluster. This module was composed by nodes highly connected among them, forming a central structure of the network that was also connected with the small sparser modules located outside of the HIV geographical cluster. Our study supports the evidence of the high level of connectivity between HIV geographical high-risk populations and the entire community.
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Affiliation(s)
- Diego F. Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, United States of America
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, OH, United States of America
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Science, Department of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Tiago Gräf
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Gonçalo Moniz, Salvador, Brazil
| | - Dennis M. Junqueira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Science, Department of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eduan Wilkinson
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- School of Laboratory Medicine and Medical Science, Department of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Philippe Lemey
- Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, Leuven, Belgium
| | - Till Bärnighausen
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Heidelberg Institute for Public Health, University of Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Hae-Young Kim
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Frank Tanser
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Sweileh WM. Post-exposure prophylaxis against blood-borne viral infections among health care workers: A bibliometric analysis. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:419-431. [PMID: 35213392 DOI: 10.3233/jrs-210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health care workers face a wide range of chemical, physical, and biological occupational hazards in their jobs. OBJECTIVE The present study aimed to investigate research trends on post-exposure prophylaxis (PEP) against blood-borne viral infections among health care workers. METHOD Keywords related to health care workers, PEP, and blood-borne viruses were entered in the Scopus database for the period from 1950 to 27 January 2022. RESULTS The search query returned 271 papers. The earliest publication was in 1984. The Pan African Medical Journal ranked first (n = 8, 3.0%), followed by the Infection Control and Hospital Epidemiology and Journal of Hospital Infection with 6 (2.2%) papers for each. One hundred ninety-one journals took part in publishing the retrieved papers. Authors from 63 different countries took part in publishing the retrieved papers. The United States (US) ranked first (n = 53, 19.6%) followed by India (n = 26, 9.6%). The United States Centers for Disease Control and Prevention contributed the most (n = 9, 3.3%) and ranked first in the top active institutions. The mean number of authors per paper was 4.4 and the mean number of citations per paper was 17.0. The most frequent author keywords focused on PEP, health care workers, occupational exposure, HIV, hepatitis B, anti-retroviral and needle-stick injuries. Research themes in the retrieved papers focused on knowledge/attitude/practice and management and epidemiology of occupational exposure and PEP. There was a limited number of research publications in this field. CONCLUSION Research activity in this field needs to be strengthened in low- and middle-income countries through reporting and training of HCWs.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine E-mail:
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Mweemba C, Hangoma P, Fwemba I, Mutale W, Masiye F. Estimating district HIV prevalence in Zambia using small-area estimation methods (SAE). Popul Health Metr 2022; 20:8. [PMID: 35183216 PMCID: PMC8858531 DOI: 10.1186/s12963-022-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.
Methods
We estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.
Results
The results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.
Conclusions
HIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
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Cocker D, Sammarro M, Chidziwisano K, Elviss N, Jacob ST, Kajumbula H, Mugisha L, Musoke D, Musicha P, Roberts AP, Rowlingson B, Singer AC, Byrne RL, Edwards T, Lester R, Wilson C, Hollihead B, Thomson N, Jewell CP, Morse T, Feasey N. Drivers of Resistance in Uganda and Malawi (DRUM): a protocol for the evaluation of One-Health drivers of Extended Spectrum Beta Lactamase (ESBL) resistance in Low-Middle Income Countries (LMICs). Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17581.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to investigate how human behaviour, water, sanitation, and hygiene (WASH) practices, environmental contamination, and antibiotic usage in both urban and rural settings interact to contribute to transmission of ESBL E. coli and ESBL K. pneumoniae between humans, animals, and the environment. Here we present the protocol for the Drivers of Resistance in Uganda and Malawi (DRUM) Consortium, in which we will collect demographic, geospatial, clinical, animal husbandry and WASH data from a total of 400 households in Uganda and Malawi. Longitudinal human, animal and environmental sampling at each household will be used to isolate ESBL E. coli and ESBL K. pneumoniae. This will be complimented by a Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) survey and structured observations to understand the contextual and psychosocial drivers of regional WASH practices. Bacterial isolates and plate sweeps will be further characterised using a mixture of short-,long-read and metagenomic whole-genome sequencing. These datasets will be integrated into agent-based models to describe the transmission of EBSL resistance in Uganda and Malawi and allow us to inform the design of interventions for interrupting transmission of ESBL-bacteria.
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Adeagbo OA, Seeley J, Gumede D, Xulu S, Dlamini N, Luthuli M, Dreyer J, Herbst C, Cowan F, Chimbindi N, Hatzold K, Okesola N, Johnson C, Harling G, Subedar H, Sherr L, McGrath N, Corbett L, Shahmanesh M. Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis. BMJ Open 2022; 12:e048780. [PMID: 35165105 PMCID: PMC8845207 DOI: 10.1136/bmjopen-2021-048780] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal. METHODS Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach. RESULTS Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake. CONCLUSION Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
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Affiliation(s)
- Oluwafemi Atanda Adeagbo
- Department of Health Promotion, Education & Behaviour, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
- Department of Sociology, University of Johannesburg, Auckland Park, South Africa
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Janet Seeley
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Dumsani Gumede
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Sibongiseni Xulu
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Nondumiso Dlamini
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Manono Luthuli
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Jaco Dreyer
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Carina Herbst
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - F Cowan
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- CeSHHAR Zimbabwe, Harare, Zimbabwe
| | - Natsayi Chimbindi
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | | | - Nonhlanhla Okesola
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
| | - Cheryl Johnson
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Guy Harling
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Lorraine Sherr
- University College London Faculty of Population Health Sciences, London, UK
| | - Nuala McGrath
- Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, UK
| | - Liz Corbett
- Infectious and Tropical Diseases, LSHTM, London, UK
| | - Maryam Shahmanesh
- Social Science & Research Ethics Unit, Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice. M. Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Yonga AM, Kiss L, Onarheim KH. A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa. BMC Public Health 2022; 22:220. [PMID: 35114964 PMCID: PMC8815228 DOI: 10.1186/s12889-022-12619-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Intimate partner violence (IPV) affects more than one in three women in sub-Saharan Africa (SSA). It is associated with both pregnancy and HIV, adversely affecting women in this region. This is the first systematic examination of the effects of IPV on HIV-positive (HIV+) pregnant women in SSA. Methods A systematic review of the literature on HIV+ pregnant women experiencing IPV in SSA was carried out. Searches were carried out in PubMed, Web of Science and African Journals Online databases. Articles published between January 2010 and June 2020, in English, were included. Data extraction included details on study locations, study design, study participants and the study outcome variables (depression, IPV, medication adherence, postpartum unsafe sex, and HIV disclosure). Results Fourteen studies (ten cross-sectional studies, four cohort studies) were included. Results indicate a high prevalence of IPV amongst pregnant women with HIV in SSA (18.0 to 63.1%). The results suggest an association between HIV-positive status and consequences of IPV during pregnancy, particularly mental health effects, such as depression symptoms and suicidal ideation. HIV-related stigma has a key role within the relationship between HIV and IPV during pregnancy. One study described that the presence of IPV reduces adherence to Prevention of Mother-To-Child Transmission (PMTCT) medication. Three studies reported no association between HIV positive status or HIV status disclosure and IPV during pregnancy. Discussion/conclusions The systematic review confirms interconnections between IPV and HIV seropositivity amongst pregnant women in SSA. Importantly, stigma, social isolation and poor mental health hinder help-seeking, disclosure, and treatment adherence among HIV+ pregnant women exposed to IPV in SSA. As a result, the potential of community interventions to tackle issues associated with IPV in HIV-positive pregnant women in this area should be explored in research, policy, and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12619-w.
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Affiliation(s)
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK.,Gender Violence & Health Centre, Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristine Husøy Onarheim
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Roberts DA, Cuadros D, Vandormael A, Gareta D, Barnabas RV, Herbst K, Tanser F, Akullian A. Predicting the Risk of Hiv-1 Acquisition in Rural South Africa Using Geospatial Data. Clin Infect Dis 2022; 75:1224-1231. [PMID: 35100612 PMCID: PMC9525068 DOI: 10.1093/cid/ciac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Accurate human immunodeficiency virus (HIV) risk assessment can guide optimal HIV prevention. We evaluated the performance of risk prediction models incorporating geospatial measures. Methods We developed and validated HIV risk prediction models in a population-based cohort in South Africa. Individual-level covariates included demographic and sexual behavior measures, and geospatial covariates included community HIV prevalence and viral load estimates. We trained models on 2012–2015 data using LASSO Cox models and validated predictions in 2016–2019 data. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. We compared the spatial distribution of predicted risk to that of high incidence areas (≥ 3/100 person-years). Results Our analysis included 19 556 individuals contributing 44 871 person-years and 1308 seroconversions. Incidence among the highest predicted risk quintile using the full model was 6.6/100 person-years (women) and 2.8/100 person-years (men). Models using only age group and geospatial covariates had similar performance (women: AUROC = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). Geospatial models more accurately identified high incidence regions than individual-level models; 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. Conclusions Geospatial models with no individual measures other than age group predicted HIV risk nearly as well as models that included detailed behavioral data. Geospatial models may help guide HIV prevention efforts to individuals and geographic areas at highest risk.
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Affiliation(s)
- D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Diego Cuadros
- Department of Geography, University of Cincinnati, Cincinnati, USA
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Ruanne V Barnabas
- Department of Epidemiology, University of Washington, Seattle, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa
| | - Adam Akullian
- Department of Global Health, University of Washington, Seattle, USA.,Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, USA
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149
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Adeola AO, Forbes PBC. Antiretroviral Drugs in African Surface Waters: Prevalence, Analysis, and Potential Remediation. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2022; 41:247-262. [PMID: 34033688 DOI: 10.1002/etc.5127] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/24/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
The sources, ecotoxicological impact, and potential remediation strategies of antiretroviral drugs (ARVDs) as emerging contaminants in surface waters are reviewed based on recent literature. The occurrence of ARVDs in water bodies raises concern because many communities in Africa depend on rivers for water resources. Southern Africa is a potential hotspot regarding ARVD contamination due to relatively high therapeutic application and detection thereof in water bodies. Efavirenz and nevirapine are the most persistent in effluents and are prevalent in surface water based on environmental concentrations. Whereas the highest concentration of efavirenz reported in Kenya was 12.4 µg L-1 , concentrations as high as 119 and 140 µg L-1 have been reported in Zambia and South Africa, respectively. Concentrations of ARVDs ranging from 670 to 34 000 ng L-1 (influents) and 540 to 34 000 ng L-1 (effluents) were determined in wastewater treatment plants in South Africa, compared with Europe, where reported concentrations range from less than limit of detection (LOD) to 32 ng L-1 (influents) and less than LOD to 22 ng L-1 (effluents). The present African-based review suggests the need for comprehensive toxicological and risk assessment of these emerging pollutants in Africa, with the intent of averting environmental hazards and the development of sustainable remediation strategies. Environ Toxicol Chem 2022;41:247-262. © 2021 SETAC.
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Affiliation(s)
- Adedapo O Adeola
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield, Pretoria, South Africa
| | - Patricia B C Forbes
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield, Pretoria, South Africa
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150
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Jones BI, Freedman A, Thomas MJ, Villalba-Mendez C, Sathia L, Flanagan D, Francis S, Currie CJ. Comorbid diseases and conditions in people with HIV in the UK. Curr Med Res Opin 2022; 38:277-285. [PMID: 34761727 DOI: 10.1080/03007995.2021.2003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aimed to characterize the risk of people living with HIV (PLHIV) in the UK progressing to pre-specified HIV-associated comorbidities, compared with matched, HIV-negative controls. METHODS Primary and secondary care records from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) were used to identify PLHIV, and a matched cohort from the HIV-negative population. Kaplan Meier curves and Cox proportional hazard models were used to evaluate the risk of developing comorbidities including central nervous system (CNS) disorders, end-stage renal disease, osteoporosis, diabetes, cardiovascular disease (CVD), hypertension, stroke and cancer. RESULTS A total of 2945 PLHIV were matched to a cohort of 5890 HIV-negative controls. PLHIV demonstrated an increased hazard ratio (HR) for time to development of incident sleep disorders, depression, osteoporosis, stroke, cancer and renal disease when compared with their matched HIV-negative control. The HRs for anxiety, hypertension, diabetes and CVD were not significantly increased. CONCLUSIONS PLHIV in the UK were at a higher risk of developing a number of comorbid conditions, highlighting the need for regular attendance of health reviews such as the annual health reviews recommended by the British HIV Associations (BHIVA) quality standard for care, which are currently not uniformly conducted.
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Affiliation(s)
| | - Andrew Freedman
- Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | | | - Craig J Currie
- Global Epidemiology, Pharmatelligence, Cardiff, UK
- Division of Population Medicine, School of Medicine, Cardiff University, UK
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