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Siyadatpanah A, Norouzi R, Mirzaei F, Haghirosadat BF, Nissapatorn V, Mitsuwan W, Nawaz M, Pereira ML, Hosseini SA, Montazeri M, Majdizadeh M, Almeida RS, Hemati M, Wilairatana P, Coutinho HDM. Green synthesis of nano-liposomes containing Bunium persicum and Trachyspermum ammi essential oils against Trichomonasvaginalis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:150-162. [PMID: 35864068 DOI: 10.1016/j.jmii.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/11/2022] [Accepted: 06/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trichomonas vaginalis, a parasitic flagellated protozoan, is one of the main non-viral sexually transmitted diseases worldwide. Treatment options for trichomoniasis are limited to nitroimidazole compounds. However, resistance to these drugs has been reported, which requires the development of new anti-Trichomonas agents that confer suitable efficacy and less toxicity. METHODS In the present work, we assessed the effectiveness of the liposomal system containing essential oils of Bunium persicum and Trachyspermum ammi against T. vaginalis in vitro. The chemical composition of B. persicum and T. ammi were analyzed using gas chromatography-mass spectrometry (GC-MS). Liposomal vesicles were prepared with phosphatidylcholine) 70%) and cholesterol)30%) using the thin-film method. The essential oils of B. persicum and T. ammi were loaded into the liposomes using the inactive loading method. Liposomal vesicles were made for two plants separately. Their physicochemical features were tested using Zeta-Sizer, AFM and SEM. The anti-Trichomonas activity was determined after 12 and 24 h of parasite cultures in TYI-S-33 medium. RESULTS After 12 and 24 h of administration, the IC50 of the B. persicum essential oil nano-liposomes induced 14.41 μg/mL and 45.19 μg/mL, respectively. The IC50 of T. ammi essential oil nano-liposomes induced 8.08 μg/mL and 25.81 μg/mL, respectively. CONCLUSIONS These data suggested that nano-liposomes of the essential oils of B. persicum and T. ammi may be a promising alternative to current treatments for Trichomonas infection.
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Affiliation(s)
- Abolghasem Siyadatpanah
- Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand, Iran; Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
| | - Roghayeh Norouzi
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran.
| | - Farzaneh Mirzaei
- Department of Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Bibi Fatemeh Haghirosadat
- Medical Nanotechnology & Tissue Engineering Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand.
| | - Watcharapong Mitsuwan
- Akkhraratchakumari Veterinary College, And Research Center of Excellence in Innovation of Essential Oil, Walailak University, Nakhon Si Thammarat, Thailand.
| | - Muhammad Nawaz
- Department of Nano-Medicine Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia.
| | - Maria Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal.
| | | | - Mahbobeh Montazeri
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mohammad Majdizadeh
- Cellular and Molecular Biology, Department of Nano-Biotechnology, Nano-Biotech Foresight Company, Science & Technology Park of Yazd, Yazd, Iran.
| | - Ray S Almeida
- Department of Biological Chemistry, Regional University of Cariri - URCA, Crato, Brazil.
| | - Mahdie Hemati
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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2
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Cantisani C, Rega F, Ambrosio L, Grieco T, Kiss N, Meznerics FA, Bánvölgyi A, Vespasiani G, Arienzo F, Rossi G, Soda G, Pellacani G. Syphilis, the Great Imitator-Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1339. [PMID: 36674095 PMCID: PMC9859468 DOI: 10.3390/ijerph20021339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as "The Great Imitator". Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett's sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.
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Affiliation(s)
- Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Federica Rega
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Luca Ambrosio
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Teresa Grieco
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Norbert Kiss
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary
| | - Giordano Vespasiani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Rossi
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
| | - Giuseppe Soda
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy
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Rotsaert A, Nöstlinger C, Van Landeghem E, Vanbaelen T, Wouters E, Buffel V, Scheerder G, Schim van der Loeff M, Vuylsteke B, Reyniers T. Pre-Exposure Prophylaxis Users' Attitudes About Sexually Transmitted Infections and Its Influence on Condom Use: A Mixed-Method Study in Belgium. AIDS Patient Care STDS 2022; 36:483-492. [PMID: 36484763 DOI: 10.1089/apc.2022.0172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Incidence rates of sexually transmitted infections (STIs) are rising among men who have sex with men (MSM). Since the rollout of HIV pre-exposure prophylaxis (PrEP), promoting condom use to prevent the spread of STIs has become more challenging. Using a mixed-method design, we explored MSM PrEP users' attitudes toward STIs, condoms, and condom use with nonsteady partners to prevent STIs. We triangulated data from 22 in-depth interviews conducted at a large HIV/STI clinic between August 2021 and January 2022 and an online survey among 326 PrEP users between September 2020 and January 2022. Interviews were analyzed iteratively using a thematic analysis approach. We used bivariate and multi-variate ordered logistic regression to analyze the online survey data. Themes identified in the qualitative data influencing condom use decisions to prevent STIs were as follows: (1) awareness (i.e., perceived severity of and susceptibility to STIs, condom counseling), (2) motivation (i.e., concerns about STIs, sexual pleasure and protection of own health), and (3) perceived social norms and practices (e.g., reduced condom use at community level). Overall, 10.7% of survey respondents consistently used condoms with nonsteady partners. Survey respondents who reported high or moderate levels of willingness to use condoms to prevent acquiring STIs were significantly more likely to use condoms for anal sex with nonsteady partners; those who initiated PrEP 6-12 months ago were less likely to use condoms. We found a wide variation in attitudes toward condom use for the prevention of STIs among MSM using PrEP. We recommend client-centered approaches, taking into account PrEP users' values and priorities toward STI prevention to help reduce the spread of STIs.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Veerle Buffel
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Gert Scheerder
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Infection and Immunity (AII), Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Neilan AM, DeMonte JB, Foote JHA, Karalius B, Patel K, Kapogiannis BG, Rudy BJ, Huszti H, Fernandez MI, Hudgens MG, Ciaranello AL. Rates of Sexually Transmitted Infection Diagnoses Among US Youth With Perinatally and Nonperinatally Acquired HIV. Sex Transm Dis 2022; 49:223-230. [PMID: 34711773 PMCID: PMC8820772 DOI: 10.1097/olq.0000000000001578] [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: 01/24/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Of new sexually transmitted infections (STIs) in the United States, 50% occur among youth aged 15 to 24 years. Previous studies among youth with HIV (YHIV) do not distinguish STI trends among individuals with perinatally (YPHIV) and nonperinatally (YNPHIV) acquired HIV. METHODS Among 3 Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) studies conducted between 2009 and 2015, we estimated incident diagnoses of trichomonal, bacterial, viral, and overall STIs stratified by sex assigned at birth, mode of HIV acquisition (perinatal [YPHIV] and nonperinatal [YNPHIV]), age (13-17 and 18-24 years), CD4 count (<200, 200-499, and ≥500/μL), and HIV viral load (VL) (<400 and ≥400 copies/mL). RESULTS Among 3131 YHIV, across the 3 studies, mean (SD) age was 20.6 (2.6) years, 888 (28%) were female, 2498 (80%) had nonperinatal HIV acquisition recorded, and 2298 (73%) were African American/Black. Mean follow-up was 0.9 (0.3) years. Compared with YPHIV, YNPHIV spent less person-time with VL <400 copies/mL (47% vs. 53%) and more time off antiretroviral therapy (49% vs. 15%), and had higher overall STI rates (males, 65.9 vs. 8.5/100 person-years [PY]; females, 54.7 vs. 17.2/100 PY). Among YPHIV, bacterial STIs were higher during person-time spent with VL ≥400 vs. <400 copies/mL (male YPHIV, 10.9 vs. 0.6/100 PY; female YPHIV, 11.2 vs. 2.9/100 PY); no difference was observed among YNPHIV, which may be due to concurrent acquisition of HIV and other STIs and limited follow-up. CONCLUSIONS Compared with YPHIV, YNPHIV spent less time on antiretroviral therapy and virologically suppressed; YNPHIV also had higher STI diagnosis rates. Very high STI diagnosis rates among YHIV, including among those without virologic suppression, highlight the importance of youth-focused efforts to support durable virologic suppression and identify and treat STIs.
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Affiliation(s)
- Anne M. Neilan
- From the Division of General Academic Pediatrics, Department of Pediatrics
- Division of Infectious Diseases
- Medical Practice Evaluation Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Justin B. DeMonte
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Julia H. A. Foote
- Medical Practice Evaluation Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | - Brad Karalius
- Department of Epidemiology and Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Kunjal Patel
- Department of Epidemiology and Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Bill G. Kapogiannis
- Maternal and Pediatric Infectious Diseases Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Bret J. Rudy
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Heather Huszti
- Department of Pediatrics and Division of Psychology, Children’s Hospital of Orange County, Orange, CA
| | | | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrea L. Ciaranello
- Division of Infectious Diseases
- Medical Practice Evaluation Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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Wand H, Ramjee G, Reddy T. Quantifying Vulnerabilities of Single Women and Sexually Transmitted Infections in South Africa (2002-2016): Is It Getting Better (or Worse)? ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3237-3245. [PMID: 34664154 DOI: 10.1007/s10508-021-01998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
Curable sexually transmitted infections (STIs) affect millions of people across the world. Besides unacceptably high HIV rates, South Africa also has the highest burden of STIs in the world. The aim of the study was to investigate temporal changes in STI incidence rates using the data from ~ 10,000 women who enrolled in several HIV prevention trials, KwaZulu-Natal, South Africa (2002-2016). We particularly focused on the changes in distribution of the most influential factors and their population-level impacts on STI incidence rates over time. Characteristics of the women were compared across the study periods: 2002-2004, 2005-2008, 2009-2011, and 2012-2016. Besides multivariable Cox regression models, population attributable risks were calculated for the significant factors. Despite the significant progress in prevention, testing, and treatment programs, infection rates increased substantially from 13.6 to 20.0 per 100 person-year over the study period. Our findings provided a compelling evidence for single/non-cohabiting South African women to be the most vulnerable population who consistently and substantially contributed to increasing STI rates during the 15 years of study duration (PAR%: 44%-47%). We also highlighted the impact of women's lack of knowledge related to their partner, using injectable contraceptives, less parity, and baseline STI positivity which were increased substantially over time. Our findings suggest that a significant proportion of STIs could be prevented by targeting single/non-cohabiting. These results may provide guidance in developing more effective STI prevention programs by targeting women at highest risk of infections and delivering more realistic messages.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, KwaZulu-Natal, 3630, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, KwaZulu-Natal, 3630, South Africa
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Mugo PM, Agutu CA, Wahome E, Juma M, Nzioka J, Mohamed K, Mumba T, Shally M, Fauz I, Omar A, Rinke de Wit TF, van der Elst EM, Graham SM, Sanders EJ. Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017. Wellcome Open Res 2021; 4:127. [PMID: 33884308 PMCID: PMC8042516 DOI: 10.12688/wellcomeopenres.15401.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.
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Affiliation(s)
- Peter M. Mugo
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clara A. Agutu
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Margaret Juma
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Khamisi Mohamed
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mahmoud Shally
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise M. van der Elst
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan M. Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Headington, UK
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7
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Wand H, Ramjee G, Reddy T. Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa. Int J STD AIDS 2021; 32:600-608. [PMID: 33769896 DOI: 10.1177/0956462420968998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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In Support of the Publicly Funded Sexually Transmitted Infections Specialty Clinic-ASTDA Position Statement. Sex Transm Dis 2021; 47:503-505. [PMID: 32520881 DOI: 10.1097/olq.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Mugo PM, Agutu CA, Wahome E, Juma M, Nzioka J, Mohamed K, Mumba T, Shally M, Fauz I, Omar A, Rinke de Wit TF, van der Elst EM, Graham SM, Sanders EJ. Trends and predictors of HIV positivity and time since last test at voluntary counselling and testing encounters among adults in Kilifi, Kenya, 2006-2017. Wellcome Open Res 2021; 4:127. [PMID: 33884308 PMCID: PMC8042516 DOI: 10.12688/wellcomeopenres.15401.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/12/2023] Open
Abstract
Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of first-time testing (FTT), late retesting (previous test more than one year ago for GP or three months for KP), and test positivity at three voluntary counselling and testing (VCT) centres in coastal Kenya. Methods: Routine VCT data covering 2006-2017 was collected from three VCT centres in Kilifi County. We analysed HIV testing history and test results from encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 24,728 test encounters (32% FTT), we observed declines in HIV positivity (proportion of encounters where the result was positive) among GP men, GP women, first-time testers and MSM but not among FSW. The proportion of encounters for FTT and late retesting decreased for both GP and KP but remained much higher in KP than GP. HIV positivity was higher at FTT and late retesting encounters; at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment and sexually transmitted infection (STI) symptoms. HIV positivity was lower in GP men, never married clients and those less than 35 years of age. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: HIV positive test results were most common at encounters with first-time testers and late re-testers. While the proportion of encounters at which late retesting was reported decreased steadily over the period reviewed, efforts are needed to increase retesting among the most at-risk populations.
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Affiliation(s)
- Peter M. Mugo
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clara A. Agutu
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Margaret Juma
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Khamisi Mohamed
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mahmoud Shally
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise M. van der Elst
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan M. Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Headington, UK
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10
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Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, Baggaley R, Mathers B, Verster A, Grulich AE. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:39-56. [PMID: 33217341 DOI: 10.1016/s2468-1253(20)30303-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. METHODS We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. FINDINGS Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). INTERPRETATION HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. FUNDING World Health Organization.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Sahar Bajis
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Prevalence of HIV infection and bacteriologically confirmed tuberculosis among individuals found at bars in Kampala slums, Uganda. Sci Rep 2020; 10:13438. [PMID: 32778729 PMCID: PMC7417543 DOI: 10.1038/s41598-020-70472-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
Individuals found at bars in slums have several risk factors for HIV and tuberculosis (TB). To determine the prevalence of HIV and TB among individuals found at bars in slums of Kampala, Uganda, we enrolled adults found at bars that provided written informed consent. Individuals with alcohol intoxication were excluded. We performed HIV testing using immunochromatographic antibody tests (Alere Determine HIV-1/2 and Chembio HIV 1/2 STAT-PAK). TB was confirmed using the Xpert MTB/RIF Ultra assay, performed on single spot sputum samples. We enrolled 272 participants from 42 bars in 5 slums. The prevalence of HIV and TB was 11.4% (95% CI 8.1–15.8) and 15 (95% CI 6–39) per 1,000 population respectively. Predictors of HIV were female sex (aOR 5.87, 95% CI 2.05–16.83), current cigarette smoking (aOR 3.23, 95% CI 1.02–10.26), history of TB treatment (aOR 10.19, 95% CI 3.17–32.82) and CAGE scores of 2–3 (aOR 3.90, 95% CI 1.11–13.70) and 4 (aOR 4.77, 95% CI 1.07–21.35). The prevalence of HIV and TB was twice and four times the national averages respectively. These findings highlight the need for concurrent programmatic screening for both HIV and TB among high risk populations in slums.
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12
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Secco AA, Akselrod H, Czeresnia J, Levy M, Byrne M, Monroe A, Lucar J, Horberg M, Castel AD, Doshi R, Rivasplata H, Squires L, Parenti D, Benator D. Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort. Sex Transm Infect 2020; 96:89-95. [PMID: 31907326 DOI: 10.1136/sextrans-2019-054216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs. METHODS We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as incare viral load (ICVL) and percentage with all viral loads less than the limit of detection (%<LLOD) by year (2012-2016) among those with incident STIs. RESULTS From 2012 to 2016, the incidence of STIs increased: chlamydia from 2.1 to 3.4 cases/100 person-years (p=0.0006), gonorrhoea from 2.1 to 4.0 (p<0.0001), syphilis from 1.7 to 2.6 (p=0.0042) and any STI episode from 5.3 to 8.8 (p<0.0001). STI incidence rates increased for those aged 18-34 (from 13.2 to 23.2 cases/100 person-years, p<0.0001), cisgender men (from 6.5 to 11.5, p<0.0001), non-Hispanic whites (from 8.6 to 16.1, p=0.0003) and men who have sex with men (from 9.3 to 15.7, p<0.0001). During 2012-2016, the ICVL among those with incident STIs improved from 108 to 19 copies/mL and %<LLOD from 23.6% to 55.1%. However, even in 2016, younger participants, cisgender and transgender women, non-Hispanic blacks and Hispanics had higher ICVLs and lower %<LLOD. CONCLUSIONS Rates of incident STIs rose among persons in care for HIV in Washington, DC, with improved but not optimal measures of HIV viral suppression. These findings inform focused interventions towards preventing STI transmission and ending the HIV epidemic.
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Affiliation(s)
- Alessandra Anna Secco
- Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA .,Infectious Diseases Section, DC VA Medical Center, Washington, District of Columbia, USA
| | - Hana Akselrod
- Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jonathan Czeresnia
- Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Matthew Levy
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Morgan Byrne
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Anne Monroe
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Jose Lucar
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael Horberg
- Department of Infectious Diseases, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Amanda Derryck Castel
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Rupali Doshi
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA.,HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Heather Rivasplata
- Infectious Diseases Section, DC VA Medical Center, Washington, District of Columbia, USA
| | - Leah Squires
- Infectious Diseases Section, DC VA Medical Center, Washington, District of Columbia, USA.,Department of Psychology, DC VA Medical Center, Washington, District of Columbia, USA
| | - David Parenti
- Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Debra Benator
- Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Infectious Diseases Section, DC VA Medical Center, Washington, District of Columbia, USA
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13
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Wayal S, Reid D, Weatherburn P, Blomquist P, Fabiane S, Hughes G, Mercer CH. Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom. HIV Med 2019; 20:523-533. [PMID: 31124278 PMCID: PMC6771985 DOI: 10.1111/hiv.12753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In the UK, men who have sex with men (MSM) bear a disproportionate sexually transmitted infection (STI) burden. We investigated MSM's STI knowledge; whether their STI testing behaviour met national guidelines (annually if sexually active; 3-monthly if engaging in STI risk behaviours); and the relationship between STI testing in the last 3 months, STI knowledge and STI risk behaviours by HIV status. METHODS Sexually active (in the last year) men aged > 15 years who were UK residents and were recruited from gay-orientated online dating platforms completed an anonymous online survey about STI knowledge, STI risk behaviours, and STI testing (March-May 2017). This included 11 true statements about STIs. Respondents scored 1 for each statement they 'knew', with those scoring < 6 overall treated as having 'poor' STI knowledge. Descriptive and multivariable analyses were conducted, separately by HIV status, to test our hypothesis and calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS Compared to HIV-positive men (n = 489), the proportion of HIV-negative/unknown-status men (n = 3157) with 'poor' STI knowledge was significantly higher (46.4% versus 22.9% for HIV-positive men) and the proportion with STI testing in the last 12 months was lower (71.6% versus 87.2%, respectively). In the last 3 months, 56.9% of HIV-negative/unknown-status and 74.1% of HIV-positive men reported STI risk behaviours, of whom 45.8% and 55.1%, respectively, had been tested for STIs during this time. Among HIV-negative/unknown-status men, those reporting STI risk behaviours were more likely (AOR 1.52; 95% CI 1.26-1.84) and those with poor STI knowledge less likely (AOR 0.73; 95% CI 0.61-0.89) to have been tested during the last 3 months. However, neither factor was independently associated with 3-monthly testing among HIV-positive men. CONCLUSIONS Improving STI knowledge, especially among HIV-negative/unknown-status men, and promoting frequent STI testing among men engaging in STI risk behaviours are vital to address the poor sexual health of MSM.
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Affiliation(s)
- S Wayal
- Institute for Global HealthUniversity College LondonLondonUK
- HIV & STI DepartmentCentre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
| | - D Reid
- HIV & STI DepartmentCentre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
- Sigma Research, Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUK
| | - P Weatherburn
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
- Sigma Research, Public Health, Environments and SocietyLondon School of Hygiene & Tropical MedicineLondonUK
| | - P Blomquist
- HIV & STI DepartmentCentre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
| | - S Fabiane
- Institute for Global HealthUniversity College LondonLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
| | - G Hughes
- HIV & STI DepartmentCentre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
| | - CH Mercer
- Institute for Global HealthUniversity College LondonLondonUK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU)in Blood Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical MedicineLondonUK
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14
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Mugo PM, Agutu CA, Wahome E, Juma M, Nzioka J, Mohamed K, Mumba T, Shally M, Fauz I, Omar A, Rinke de Wit TF, van der Elst EM, Graham SM, Sanders EJ. Trends and predictors of new HIV diagnosis and time since last test at testing encounters among adults in Kilifi, Kenya, 2006-2017. Wellcome Open Res 2019; 4:127. [PMID: 33884308 PMCID: PMC8042516 DOI: 10.12688/wellcomeopenres.15401.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 11/12/2023] Open
Abstract
Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of new HIV diagnosis, first-time testing (FTT), and late retesting (previous test more than one year ago for GP or three months for KP). Methods: Data was collected routinely at three voluntary counselling and testing (VCT) centres in Kilifi County between 2006 and 2017. We analysed test encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 25,670 test encounters (32% FTT), we observed significant declines in HIV positivity (proportion of encounters with a new HIV diagnosis) among GP men, GP women, and first-time testers, but not among MSM and FSW. FTT and late retesting decreased for both GP and KP, but remained much higher in KP than GP. In 2017, less than 20% of KP were testing quarterly as recommended. HIV positivity was higher at FTT and late retesting encounters (relative to on-time retesting); at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment, sexually transmitted infection (STI) symptoms, or no religious affiliation. HIV positivity was lower in GP men and younger clients. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: New HIV diagnoses were most common among first-time testers and late re-testers. While late retesting decreased steadily over the period reviewed, achievement of the county's 90% HIV diagnosis target will require redoubled efforts to increase retesting among the most at risk populations.
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Affiliation(s)
- Peter M. Mugo
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clara A. Agutu
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Margaret Juma
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joseph Nzioka
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Khamisi Mohamed
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mahmoud Shally
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Tobias F. Rinke de Wit
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elise M. van der Elst
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan M. Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI) -Wellcome Trust Research Programme, Kilifi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Headington, UK
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