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Aravantinou M, Plagianos M, Kokogho A, Adebajo S, Nowak RG, Shoyemi E, Ekeh C, Lombardi K, Peel SA, Baral SD, Crowell TA, Derby N, Teleshova N, Martinelli E. Herpes Simplex Virus Type 2 Prevalence and Association with Inflammatory Cytokines Among Sexual and Gender Minorities Living With and Without HIV-1 from Lagos, Nigeria. AIDS Res Hum Retroviruses 2023; 39:485-494. [PMID: 36825536 PMCID: PMC10510689 DOI: 10.1089/aid.2022.0070] [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] [Indexed: 02/25/2023] Open
Abstract
Herpes simplex virus type 2 (HSV-2) is common globally and contributes significantly to the risk of acquiring HIV-1, yet these two sexually transmitted infections have not been sufficiently characterized for sexual and gender minorities (SGM) across Sub-Saharan Africa. To help fill this gap, we performed a retrospective study using plasma and serum samples from 183 SGM enrolled at the Lagos site of the TRUST/RV368 cohort in Nigeria, assayed them for HSV-2 antibodies with the Kalon ELISA and plasma cytokines and chemokines with Luminex, and correlated the findings with HIV-1 viral loads (VLs) and CD4 counts. We found an overall HSV-2 prevalence of 36.6% (49.5% and 23.9% among SGM with and without HIV-1, respectively, p < .001). Moreover, HSV-2-positive status was associated with high circulating concentrations of CCL11 among antiretroviral therapy-treated (p = .031) and untreated (p = .015) participants, and with high concentrations of CCL2 in the untreated group (p = .004), independent of VL. Principal component analysis revealed a strong association of cytokines with HIV-1 VL independent of HSV-2 status. In conclusion, our study finds that HSV-2 prevalence among SGM with HIV-1 is twice as high than HSV-2 prevalence among SGM without HIV-1 in Lagos and suggests that this is associated with higher levels of certain systemic cytokines. Additional work is needed to further characterize the relationship between HSV-2 and HIV-1 in SGM and help develop targeted therapies for coinfected individuals.
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Affiliation(s)
- Meropi Aravantinou
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Marlena Plagianos
- Center for Biomedical Research, Population Council, New York, New York, USA
| | | | - Sylvia Adebajo
- Center for International Health Education and Biosecurity (CIHEB), University of Maryland, Baltimore, Maryland, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, USA
| | | | | | - Kara Lombardi
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Sheila A. Peel
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nina Derby
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Natalia Teleshova
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Elena Martinelli
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, Ensminger AL, Kamuingona R, Andjamba H, Nshimyimana B, Manyando M, Massetti GM. Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6376. [PMID: 37510608 PMCID: PMC10378761 DOI: 10.3390/ijerph20146376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Likang Xu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Rachel Coomer
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Private Bag, Windhoek 12029, Namibia
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pragna Patel
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Alison L. Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Brigitte Nshimyimana
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Molisa Manyando
- US Agency for International Development, Washington, DC 20004, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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3
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How much could long-acting PrEP cost in South Africa? THE LANCET HIV 2022; 9:e814-e815. [DOI: 10.1016/s2352-3018(22)00293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022]
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4
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Okiring J, Getahun M, Gutin SA, Lebu S, Lee J, Maeri I, Eyul P, Bukusi EA, Cohen CR, Neilands TB, Ssali S, Charlebois ED, Camlin CS. Sexual partnership concurrency and age disparities associated with sexually transmitted infection and risk behavior in rural communities in Kenya and Uganda. Int J Infect Dis 2022; 120:158-167. [PMID: 35472527 PMCID: PMC9984205 DOI: 10.1016/j.ijid.2022.04.038] [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: 12/23/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk. METHODS Data were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates. RESULTS Partner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46-9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89-4.31; women: aOR=2.99, 95% CI: 1.52-5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54-6.37). CONCLUSION Findings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships.
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Affiliation(s)
- Jaffer Okiring
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, P.O. Box 7475, Kampala, Uganda
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Sarah A Gutin
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Sarah Lebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Joi Lee
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, P.O. Box 7475, Kampala, Uganda
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA; Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Pool Road, Kampala, Uganda
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA; Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
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5
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Amone-P'Olak K. Prevalence, distribution and attributable risks of adverse childhood experiences in different family types: A survey of young adults in Botswana. CHILD ABUSE & NEGLECT 2022; 126:105513. [PMID: 35144077 DOI: 10.1016/j.chiabu.2022.105513] [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: 04/10/2021] [Revised: 11/15/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although adverse childhood experiences (ACEs) are often associated with poor outcomes in adulthood, little is known about its distribution in various family types, especially in low- and middle-income countries. OBJECTIVE We assessed the prevalence, distribution, and attributable risks of ACEs in different family types in early adults. METHODS Using data from 483 young adults (18-25 years of age), we assessed the prevalence and distribution of ACEs and employed binary logistic regressions to quantify the attributable risk of ACEs in different family types: nuclear (reference), single-mother, separated/divorced, and extended family types. We compared respondents without reports of ACEs (reference) to those reporting different numbers of ACEs (1 or more, 2 or more, 3 or more, 4 or more and 5 or more) to assess attributable risks of ACEs in different family types. RESULTS Out of the 483 participants, (female = 262 [53.3%]), 26.7% reported no ACEs, 21.1% reported 1 ACE, 13.3% reported 2 ACEs, and 38.9% reported 3 or more ACEs. Two hundred thirty-two (48%) and 153 (31.7%) students reported that they were from a nuclear and single-mother family types, respectively. Overall, there were higher densities of ACEs in single-mother and separated/divorced compared to nuclear family type. Compared to nuclear family type, the attributable risks of ACEs for single-mother family type ranged from 2.85 (95% Confidence Intervals (CI) 1.65) to 4.13 (95% CI: 1.92-8.91) and for separate/divorced family type ranging from 3.69 (95% CI: 1.72) to 6.32 (95% CI: 2.40-16.64). CONCLUSIONS The odds of ACEs differ with family types and were markedly pronounced in single-mother and separated/divorced compared to nuclear family types. Interventions to mitigate the effects of ACEs should be targeted at family types with a high density of ACEs. Professionals should design programmes targeting single-mother, separated/divorced and extended family types to alleviate the negative effects of childhood adversity.
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Affiliation(s)
- Kennedy Amone-P'Olak
- Department of Psychology, Faculty of Social Sciences, Kyambogo University, Uganda.
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6
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Hughes SM, Levy CN, Calienes FL, Martinez KA, Selke S, Tapia K, Chohan BH, Oluoch L, Kiptinness C, Wald A, Ghosh M, Hardy L, Ngure K, Mugo NR, Hladik F, Roxby AC. Starting to have sexual intercourse is associated with increases in cervicovaginal immune mediators in young women: a prospective study and meta-analysis. eLife 2022; 11:78565. [PMID: 36281966 PMCID: PMC9596159 DOI: 10.7554/elife.78565] [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: 03/11/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Adolescent girls and young women (AGYW) are at high risk of sexually transmitted infections (STIs). It is unknown whether beginning to have sexual intercourse results in changes to immune mediators in the cervicovaginal tract that contribute to this risk. Methods: We collected cervicovaginal lavages from Kenyan AGYW in the months before and after first penile-vaginal sexual intercourse and measured the concentrations of 20 immune mediators. We compared concentrations pre- and post-first sex using mixed effect models. We additionally performed a systematic review to identify similar studies and combined them with our results by meta-analysis of individual participant data. Results: We included 180 samples from 95 AGYW, with 44% providing only pre-first sex samples, 35% matched pre and post, and 21% only post. We consistently detected 19/20 immune mediators, all of which increased post-first sex (p<0.05 for 13/19; Holm-Bonferroni-adjusted p<0.05 for IL-1β, IL-2, and CXCL8). Effects remained similar after excluding samples with STIs and high Nugent scores. Concentrations increased cumulatively over time after date of first sex, with an estimated doubling time of about 5 months. Our systematic review identified two eligible studies, one of 93 Belgian participants, and the other of 18 American participants. Nine immune mediators were measured in at least two-thirds of studies. Meta-analysis confirmed higher levels post-first sex for 8/9 immune mediators (p<0.05 for six mediators, most prominently IL-1α, IL-1β, and CXCL8). Conclusions: Cervicovaginal immune mediator concentrations were higher in women who reported that they started sexual activity. Results were consistent across three studies conducted on three different continents. Funding: This research was funded by R01 HD091996-01 (ACR), by P01 AI 030731-25 (Project 1) (AW), R01 AI116292 (FH), R03 AI154366 (FH) and by the Center for AIDS Research (CFAR) of the University of Washington/Fred Hutchinson Cancer Research Center AI027757.
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Affiliation(s)
- Sean M Hughes
- Department of Obstetrics and Gynecology, University of WashingtonSeattleUnited States
| | - Claire N Levy
- Department of Obstetrics and Gynecology, University of WashingtonSeattleUnited States
| | - Fernanda L Calienes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterSeattleUnited States
| | - Katie A Martinez
- Department of Obstetrics and Gynecology, University of WashingtonSeattleUnited States
| | - Stacy Selke
- Department of Laboratory Medicine & Pathology, University of WashingtonSeattleUnited States
| | - Kenneth Tapia
- Department of Global Health, University of WashingtonSeattleUnited States
| | - Bhavna H Chohan
- Department of Global Health, University of WashingtonSeattleUnited States,Centre for Virus Research, Kenya Medical Research InstituteNairobiKenya
| | - Lynda Oluoch
- Centre for Clinical Research, Kenya Medical Research InstituteNairobiKenya
| | | | - Anna Wald
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterSeattleUnited States,Department of Laboratory Medicine & Pathology, University of WashingtonSeattleUnited States,Department of Medicine, University of WashingtonSeattleUnited States,Department of Epidemiology, University of WashingtonSeattleUnited States
| | - Mimi Ghosh
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington UniversityWashingtonUnited States
| | - Liselotte Hardy
- Department of Clinical Sciences, Unit of Tropical Bacteriology, Institute of Tropical MedicineAntwerpBelgium
| | - Kenneth Ngure
- Department of Global Health, University of WashingtonSeattleUnited States,Department of Community Health, Jomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Nelly R Mugo
- Department of Global Health, University of WashingtonSeattleUnited States,Centre for Clinical Research, Kenya Medical Research InstituteNairobiKenya
| | - Florian Hladik
- Department of Obstetrics and Gynecology, University of WashingtonSeattleUnited States,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterSeattleUnited States,Department of Medicine, University of WashingtonSeattleUnited States
| | - Alison C Roxby
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterSeattleUnited States,Department of Global Health, University of WashingtonSeattleUnited States,Department of Medicine, University of WashingtonSeattleUnited States,Department of Epidemiology, University of WashingtonSeattleUnited States
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7
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Hanass-Hancock J, Carpenter B, Reddy T, Nzuza A, Gaffoor Z, Goga A, Andrasik M. Participants' characteristics and motivations to screen for HIV vaccine and monoclonal antibody trials in KwaZulu-Natal, South Africa. Trials 2021; 22:897. [PMID: 34895272 PMCID: PMC8665490 DOI: 10.1186/s13063-021-05792-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/03/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HIV is one of the greatest public health challenges in South Africa. Potential HIV vaccines and antibodies are thought to be cost-effective biomedical HIV prevention methods and are currently under investigation in phase I, II, and III trials. Consequently, current and future clinical trials need to ensure sufficient recruitment and retention. To achieve this goal, clinical trial staff need to understand the socio-demographic and behavioural characteristics of people volunteering to screen for these trials and their reasons for volunteering. METHODS We conducted a secondary analysis of participant screening data across five vaccine and monoclonal antibody trials at four sites in KwaZulu-Natal, South Africa. Our study reviewed the demographic, behavioural, motivational, and health-related data from the case report forms and screening questionnaires. Descriptive statistics, chi-squared, and one-way ANOVA tests were used to analyse participants' characteristics and motivation to participate in HIV vaccine and monoclonal antibody trials. Analyses were conducted using R version 3.5.2. RESULTS Screening data from 1934 participants, including 79.2% of women, were obtained across all five trials (1034 enrolled, 900 screened out/declined). Screened participants predominately self-identified as black, heterosexual, cisgender women or men, many with lower educational backgrounds (43.9% did not complete secondary/high school), and several self-reported HIV-risk behaviours among themselves and their partners. 10.8% of the screened participants were living with HIV. Avoiding HIV risk was the main motivation to participate in clinical trials, followed by altruistic reasons such as a desire to help the community or helping to find a vaccine. DISCUSSION The current recruitment approach of these trials attracts heterosexual participants who seek to reduce HIV risk and support their community. Hence, the data suggest the need for and potential acceptance of continued ongoing HIV prevention efforts. Current trials attract participants with lower educational levels, which may be driven by the site locations, current community mobilisation strategies and research site opening hours. The sites could consider more flexible working hours to accommodate working participants and find ways to connect participants to educational support and opportunities to upgrade education levels for the current clientele. TRIAL REGISTRATION HVTN 100: A Safety and Immune Response Study of 2 Experimental HIV Vaccines, NCT02404311 . Registered on March 17, 2015. HVTN 111: Safety and Immune Response to a Clade C DNA HIV Vaccine, NCT02997969. Registered on December 16, 2016. HVTN 108: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults, NCT02915016. Registered on September 22, 2016. HVTN 702: Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa, NCT02968849. Registered on November 1, 2016. HVTN 703/HPTN 081: Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women, NCT02568215 . Registered on October 1, 2015.
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Affiliation(s)
- Jill Hanass-Hancock
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa. .,University of KwaZulu Natal School of Health Science, Durban, South Africa.
| | - Bradley Carpenter
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa.,University of KwaZulu Natal School of Health Science, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Research Unit, Seattle, USA
| | - Ayanda Nzuza
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa
| | - Zakir Gaffoor
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Ameena Goga
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Michele Andrasik
- HIV Vaccine Trials Network, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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8
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Madeen EP, Maldarelli F, Groopman JD. Environmental Pollutants, Mucosal Barriers, and Pathogen Susceptibility; The Case for Aflatoxin B 1 as a Risk Factor for HIV Transmission and Pathogenesis. Pathogens 2021; 10:1229. [PMID: 34684180 PMCID: PMC8537633 DOI: 10.3390/pathogens10101229] [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: 07/29/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
HIV transmission risk is dependent on the infectivity of the HIV+ partner and personal susceptibility risk factors of the HIV- partner. The mucosal barrier, as the internal gatekeeper between environment and self, concentrates and modulates the internalization of ingested pathogens and pollutants. In this review, we summarize the localized effects of HIV and dietary toxin aflatoxin B1 (AFB1), a common pollutant in high HIV burden regions, e.g., at the mucosal barrier, and evidence for pollutant-viral interactions. We compiled literature on HIV and AFB1 geographic occurrences, mechanisms of action, related co-exposures, personal risk factors, and HIV key determinants of health. AFB1 exposure and HIV sexual transmission hotspots geographically co-localize in many low-income countries. AFB1 distributes to sexual mucosal tissues generating inflammation, microbiome changes and a reduction of mucosal barrier integrity, effects that are risk factors for increasing HIV susceptibility. AFB1 exposure has a positive correlation to HIV viral load, a risk factor for increasing the infectivity of the HIV+ partner. The AFB1 exposure and metabolism generates inflammation that recruits HIV susceptible cells and generates chemokine/cytokine activation in tissues exposed to HIV. Although circumstantial, the available evidence makes a compelling case for studies of AFB1 exposure as a risk factor for HIV transmission, and a modifiable new component for combination HIV prevention efforts.
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Affiliation(s)
- Erin P. Madeen
- Department of Cancer Prevention, National Institute of Health, Shady Grove, MD 21773, USA
- HIV Dynamics and Replication Program, NCI-Frederick, Frederick, MD 21703, USA;
| | - Frank Maldarelli
- HIV Dynamics and Replication Program, NCI-Frederick, Frederick, MD 21703, USA;
| | - John D. Groopman
- Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
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HIV Incidence Among Women in Sub-Saharan Africa: A Time Trend Analysis of the 2000-2017 Period. J Assoc Nurses AIDS Care 2021; 32:662. [PMID: 33989245 DOI: 10.1097/jnc.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa.
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10
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Sex Work Is Associated With Increased Vaginal Microbiome Diversity in Young Women From Mombasa, Kenya. J Acquir Immune Defic Syndr 2021; 85:79-87. [PMID: 32433252 DOI: 10.1097/qai.0000000000002406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although nonoptimal vaginal bacteria and inflammation have been associated with increased HIV risk, the upstream drivers of these phenotypes are poorly defined in young African women. SETTING Mombasa, Kenya. METHODS We characterized vaginal microbiome and cytokine profiles of sexually active young women aged 14-24 years (n = 168) in 3 study groups: those engaging in formal sex work, in transactional sex, and nonsex workers. Vaginal secretions were collected using self-inserted SoftCup, and assayed for cytokines and vaginal microbiome through multiplex ELISA and 16S rRNA sequencing, respectively. Epidemiological data were captured using a validated questionnaire. RESULTS The median age of participants was 20 years (interquartile range: 18-22 years). Approximately two-thirds of young women (105/168) had vaginal microbial communities characterized by Gardnerella and/or Prevotella spp. dominance; a further 29% (49/168) were predominantly Lactobacillus iners. Microbiome clustering explained a large proportion of cytokine variation (>50% by the first 2 principal components). Age was not associated with vaginal microbial profiles in bivariable or multivariable analyses. Women self-identifying as sex workers had increased alpha (intraindividual) diversity, independent of age, recent sexual activity, HIV, and other sexually transmitted infections (beta = 0.47, 95% confidence interval: 0.05 to 0.90, P = 0.03). Recent sex (number of partners or sex acts last week, time since last vaginal sex) correlated with increased alpha diversity, particularly in participants who were not involved in sex work. CONCLUSION Nonoptimal vaginal microbiomes were common in young Kenyan women and associated with sex work and recent sexual activity, but independent of age. Restoring optimal vaginal microflora may represent a useful HIV prevention strategy.
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Mthiyane N, Harling G, Chimbindi N, Baisley K, Seeley J, Dreyer J, Zuma T, Birdthistle I, Floyd S, McGrath N, Tanser F, Shahmanesh M, Sherr L. Common mental disorders and HIV status in the context of DREAMS among adolescent girls and young women in rural KwaZulu-Natal, South Africa. BMC Public Health 2021; 21:478. [PMID: 33691665 PMCID: PMC7945212 DOI: 10.1186/s12889-021-10527-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 02/28/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND HIV affects many adolescent girls and young women (AGYW) in South Africa. Given the bi-directional HIV and mental health relationship, mental health services may help prevent and treat HIV in this population. We therefore examined the association between common mental disorders (CMD) and HIV-related behaviours and service utilisation, in the context of implementation of the combination DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) HIV prevention programme in rural uMkhanyakude district, KwaZulu-Natal. DREAMS involved delivering a package of multiple interventions in a single area to address multiple sources of HIV risk for AGYW. METHODS We analysed baseline data from an age-stratified, representative cohort of 13-22 year-old AGYW. We measured DREAMS uptake as a count of the number of individual-level or community-based interventions each participant received in the last 12 months. CMD was measured using the validated Shona Symptom Questionnaire, with a cut off score ≥ 9 indicating probable CMD. HIV status was ascertained through home-based serotesting. We used logistic regression to estimate the association between CMD and HIV status adjusting for socio-demographics and behaviours. RESULTS Probable CMD prevalence among the 2184 respondents was 22.2%, increasing steadily from 10.1% among 13 year-old girls to 33.1% among 22 year-old women. AGYW were more likely to report probable CMD if they tested positive for HIV (odds ratio vs. test negative: 1.88, 95% confidence interval: 1.40-2.53). After adjusting for socio-demographics and behaviours, there was evidence that probable CMD was more prevalent among respondents who reported using multiple healthcare-related DREAMS interventions. CONCLUSION We found high prevalence of probable CMD among AGYW in rural South Africa, but it was only associated with HIV serostatus when not controlling for HIV acquisition risk factors. Our findings highlight that improving mental health service access for AGYW at high risk for HIV acquisition might protect them. Interventions already reaching AGYW with CMD, such as DREAMS, can be used to deliver mental health services to reduce both CMD and HIV risks. There is a need to integrate mental health education into existing HIV prevention programmes in school and communities.
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Affiliation(s)
| | - Guy Harling
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- University of KwaZulu-Natal, Durban, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | | | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nuala McGrath
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Frank Tanser
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of Southampton, Southampton, UK
- University of Lincoln, Lincoln, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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Heri AB, Cavallaro FL, Ahmed N, Musheke MM, Matsui M. Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018. BMC Public Health 2021; 21:456. [PMID: 33676482 PMCID: PMC7937241 DOI: 10.1186/s12889-021-10472-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/19/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Zambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth. METHODS We carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013-14, and 2018). We calculated the percentage of women and men ages 15-24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months. RESULTS HIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20-24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30-1.84], among men; and aOR = 1.74 [1.40-2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32-1.88]) and in a union (aOR = 2.44 [1.83-3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82-17.19]). Education-based inequity was considerably widened among women than men by 2018. CONCLUSION HTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.
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Affiliation(s)
- Aimé Bitakuya Heri
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Francesca L Cavallaro
- Institute of Child Health, University College London, 30 Guilford St, Holborn, London, WC1N 1EH, UK
| | - Nurilign Ahmed
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Maurice Mubuyaeta Musheke
- Centre for Infectious Disease Research in Zambia, Plot # 34620, Off Alick Nkhata Road, Lusaka, Zambia
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
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Kesebonye WM, Amone-P’Olak K. The influence of father involvement during childhood on the emotional well-being of young adult offspring: a cross-sectional survey of students at a university in Botswana. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1177/0081246320962718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Africa is witnessing rapid changes in family structure with noticeable absence and non-involvement of fathers in child-rearing. This study investigated the influence of father involvement in child care on the emotional well-being of young adult offspring in a cross-sectional survey of 375 students (age: M = 21.05 ± 1.94) at a university in Botswana. The Positive Affect and Negative Affect Scale and the Perception of Father Involvement Scale were used to assess emotional well-being and fathers’ involvement, respectively. T-tests, analyses of variance, and regression analyses were used to compute subpopulation differences and the influence of father involvement on emotional well-being. Only 38% of the students lived in a household with both parents, 70% indicated that they have a father figure (biological father, stepfather, uncles, and grandfathers), whereas, 30% of the students indicated that they had had no father figure. The female gender (β = .17, 95% CI = [.07, .27]), father availability (β = .23, 95% CI = [.06, .39]), and responsibility (β = .22, 95% CI = [.07, .27]) significantly and independently predicted emotional well-being. Significant differences were observed between biological father figures and no father figures and between other father figures and no father figure regarding emotional well-being. Father involvement, particularly the domains of availability and responsibility and having a father figure during childhood are associated with better emotional well-being in offspring.
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Affiliation(s)
| | - Kennedy Amone-P’Olak
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
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14
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Cromarty R, Sigal A, Liebenberg LJ, Mckinnon LR, Abdool Karim SS, Passmore JAS, Archary D. Betamethasone induces potent immunosuppression and reduces HIV infection in a PBMC in vitro model. J Investig Med 2020; 69:28-40. [PMID: 33004468 PMCID: PMC7803916 DOI: 10.1136/jim-2020-001424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/15/2023]
Abstract
Genital inflammation is an established risk factor for increased HIV acquisition risk. Certain HIV-exposed seronegative populations, who are naturally resistant to HIV infection, have an immune quiescent phenotype defined by reduced immune activation and inflammatory cytokines at the genital tract. Therefore, the aim of this study was to create an immune quiescent environment using immunomodulatory drugs to mitigate HIV infection. Using an in vitro peripheral blood mononuclear cell (PBMC) model, we found that inflammation was induced using phytohemagglutinin and Toll-like receptor (TLR) agonists Pam3CSK4 (TLR1/2), lipopolysaccharide (LPS) (TLR4) and R848 (TLR7/8). After treatment with anti-inflammatory drugs, ibuprofen (IBF) and betamethasone (BMS), PBMCs were exposed to HIV NL4-3 AD8. Multiplexed ELISA was used to measure 28 cytokines to assess inflammation. Flow cytometry was used to measure immune activation (CD38, HLA-DR and CCR5) and HIV infection (p24 production) of CD4+ T cells. BMS potently suppressed inflammation (soluble cytokines, p<0.05) and immune activation (CD4+ T cells, p<0.05). BMS significantly reduced HIV infection of CD4+ T cells only in the LPS (0.98%) and unstimulated (1.7%) conditions (p<0.02). In contrast, IBF had minimal anti-inflammatory and immunosuppressive but no anti-HIV effects. BMS demonstrated potent anti-inflammatory effects, regardless of stimulation condition. Despite uniform immunosuppression, BMS differentially affected HIV infection according to the stimulation conditions, highlighting the complex nature of these interactions. Together, these data underscore the importance of interrogating inflammatory signaling pathways to identify novel drug targets to mitigate HIV infection.
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Affiliation(s)
- Ross Cromarty
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
| | - Alexander Sigal
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
- Max-Planck-Institute for Infection Biology, Berlin, Germany
| | - Lenine Julie Liebenberg
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Lyle Robert Mckinnon
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salim Safurdeen Abdool Karim
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jo-Ann Shelly Passmore
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Derseree Archary
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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15
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Kaufman MR, Grilo G, Williams A, Marea CX, Fentaye FW, Abebe Gebretsadik L, Yedenekal SA. The intersection of gender-based violence and risky sexual behaviour among university students in Ethiopia: a qualitative study. PSYCHOLOGY & SEXUALITY 2020; 11:198-211. [DOI: 10.1080/19419899.2019.1667418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michelle R. Kaufman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Graziele Grilo
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - AshlieM. Williams
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Goin DE, Pearson RM, Craske MG, Stein A, Pettifor A, Lippman SA, Kahn K, Neilands TB, Hamilton EL, Selin A, MacPhail C, Wagner RG, Gomez-Olive FX, Twine R, Hughes JP, Agyei Y, Laeyendecker O, Tollman S, Ahern J. Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors. Am J Epidemiol 2020; 189:422-432. [PMID: 31667490 PMCID: PMC7306677 DOI: 10.1093/aje/kwz238] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.
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Affiliation(s)
- Dana E Goin
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
- Bristol Biomedical Research Centre, National Institute for Health Research, Bristol, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Alan Stein
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Erica L Hamilton
- HIV Prevention Trials Network Leadership and Operations Center, Science Facilitation Department, FHI 360, Durham, North Carolina
| | - Amanda Selin
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Catherine MacPhail
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ryan G Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gomez-Olive
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Yaw Agyei
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Ahern
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
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Kate Grabowski M, Lessler J, Bazaale J, Nabukalu D, Nankinga J, Nantume B, Ssekasanvu J, Reynolds SJ, Ssekubugu R, Nalugoda F, Kigozi G, Kagaayi J, Santelli JS, Kennedy C, Wawer MJ, Serwadda D, Chang LW, Gray RH. Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda. Nat Commun 2020; 11:976. [PMID: 32080169 PMCID: PMC7033206 DOI: 10.1038/s41467-020-14636-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/18/2020] [Indexed: 01/11/2023] Open
Abstract
HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.
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Affiliation(s)
- Mary Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA.
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda.
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
| | - Jeremiah Bazaale
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Dorean Nabukalu
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Justine Nankinga
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Betty Nantume
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Avenue, New York, NY, 10032, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - David Serwadda
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
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Liebenberg LJP, McKinnon LR, Yende-Zuma N, Garrett N, Baxter C, Kharsany ABM, Archary D, Rositch A, Samsunder N, Mansoor LE, Passmore JAS, Abdool Karim SS, Abdool Karim Q. HPV infection and the genital cytokine milieu in women at high risk of HIV acquisition. Nat Commun 2019; 10:5227. [PMID: 31745084 PMCID: PMC6863918 DOI: 10.1038/s41467-019-13089-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/18/2019] [Indexed: 01/05/2023] Open
Abstract
Human papillomavirus (HPV) infection correlates with higher rates of HIV acquisition, but the underlying biological mechanisms are unclear. Here we study associations between HPV and HIV acquisition and relate these to vaginal cytokine profiles in an observational cohort of women at high risk of HIV infection (CAPRISA 004, n = 779) and with 74% HPV prevalence. We report here that HPV infection associates with a 2.5-fold increase in HIV acquisition risk in this population (95% CI: 1.2-5.3). Among 48 vaginal cytokines profiled, cytokines associated with HPV infection overlap substantially with cytokines associated with HIV risk, but are distinct from those observed in HPV negative women. Although our data do not establish a causative link between HPV status and the risk of HIV, we suggest that increasing HPV vaccination coverage may carry an additional benefit of reducing the risk of contracting HIV infection, particularly in regions with high HPV prevalence.
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Affiliation(s)
- Lenine J P Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa.
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Anne Rositch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Jo-Ann S Passmore
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM) and MRC-UCT Gynecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Columbia University, New York City, NY, USA
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19
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Brief Report: Age-Disparate Relationships and HIV Prevalence Among Never Married Women in Rakai, Uganda. J Acquir Immune Defic Syndr 2019; 79:430-434. [PMID: 30365449 DOI: 10.1097/qai.0000000000001832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Age-disparate relationships are associated with increased HIV prevalence. We determined whether the frequency of age-disparate relationships in never married women changed over time and whether they are associated with HIV prevalence in Rakai, Uganda. METHODS A total of 10,061 never married women, aged 15-49 years, in the Rakai Community Cohort Study provided information on the age of their male sexual partners from 1997 to 2013. Logistic regression was used to assess trends in age-disparate relationships (≥5 years) between never married women and their male partners. Log-binomial regression was used to estimate adjusted prevalence ratios (adjPR) of HIV prevalence associated with age-disparate relationships. RESULTS Two thousand nine hundred ninety-nine women (30%) had a male partner ≥5 years older, which remained stable over time. The prevalence of HIV among women in age-disparate relationships was 14%, 10% for women in relationships with men 0-4 years older (adjPR 1.36, 95% confidence interval: 1.22 to 1.53) not controlling women's age; however, after age adjustment, the impact of age-disparate relationships on HIV prevalence was attenuated. Age-disparate relationships were associated with increased HIV prevalence among women aged 15-17 years (adjPR 1.83, 95% confidence interval: 1.10 to 3.17), but not in other age groups. CONCLUSIONS The frequency of age-disparate relationships among never married women was unchanged over a 15-year period in Rakai, Uganda. Age-disparate relationships were associated with increased HIV prevalence among adolescents aged 15-17 years, but not older women.
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20
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Kilembe W, Inambao M, Sharkey T, Wall KM, Parker R, Himukumbwa C, Tichacek A, Malama K, Visoiu AM, Price M, Chomba E, Allen S. Single Mothers and Female Sex Workers in Zambia Have Similar Risk Profiles. AIDS Res Hum Retroviruses 2019; 35:814-825. [PMID: 31204869 DOI: 10.1089/aid.2019.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to compare reproductive health and high-risk behaviors in female sex workers (FSWs) and single mothers (SMs) in Zambia's two largest cities, Lusaka and Ndola. FSWs were invited from known community hot spots, and sexually active HIV- SMs were referred from infant vaccination services for free and anonymous screening and treatment for HIV and other sexually transmitted infections (STIs) and long acting reversible contraception. A subset completed an interviewer-administered survey. From 2012 to 2016, 1,893 women (1,377 FSWs and 516 HIV- SMs) responded to referrals. HIV prevalence was 50% in Lusaka and 33% in Ndola FSWs. Positive syphilis serology (rapid plasmin reagin) was found in 29%-31% of HIV+ FSWs and 9%-12% of HIV- FSWs and SMs. Trichomonas was more common in Ndola (11%-12%), compared with Lusaka (3%-7%). Antiretroviral therapy (ART) use among HIV+ FSWs was 9%-15%. In all groups, consistent condom use (8%-11%) and modern contraceptive use (35%-65%) were low. Low literacy and reported coercion at first sexual intercourse were common in both FSWs and SMs, as was alcohol use during sex among FSWs. Zambian FSWs and SMs have low condom use and high HIV/STI and unplanned pregnancy risk. Many FSWs and half of SMs are ≥25 years of age, and thus too old for HIV prevention services targeting "adolescent girls and young women" (aged 15-24). Tailored and targeted reproductive health services are needed to reduce HIV, STI, and unplanned pregnancy in these vulnerable women.
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Affiliation(s)
| | | | | | - Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, New York
| | - Elwyn Chomba
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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21
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Liu CM, Packman ZR, Abraham AG, Serwadda DM, Nalugoda F, Aziz M, Prodger JL, Kaul R, Kalibbala S, Gray RH, Price LB, Quinn TC, Tobian AA, Reynolds SJ. The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women. Open Forum Infect Dis 2019; 6:ofz328. [PMID: 31660406 DOI: 10.1093/ofid/ofz328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/11/2019] [Indexed: 11/14/2022] Open
Abstract
Background The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post-ART initiation. The vaginal microbiome was characterized by 16S rRNA gene-based sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA). Results Five vaginal CSTs were identified, which varied significantly by bacterial load (P < .01): CST-1 was characterized by Lactobacillus iners, CST-2 by Gardnerella, CST-3 by Gardnerella and Prevotella, CST-4 by Lactobacillus crispatus, and CST-5 was highly diverse. Vaginal microbiome composition also did not change significantly after ART initiation (P = .985). Immune reconstitution after ART initiation did not affect vaginal microbiome CST assignment (P = .722) or individual-level changes in bacterial load (log response ratio [interquartile range], -0.50 [-2.75 to 0.38] vs -0.29 [-2.03 to 1.42]; P = .40). Conclusions The vaginal microbiome of HIV-infected women was not affected by the initiation of ART or immune reconstitution in this observational study. Further research is needed to explore the long-term effects of ART treatment on the vaginal microbiome.
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Affiliation(s)
- Cindy M Liu
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Zoe R Packman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Maliha Aziz
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Jessica L Prodger
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Rakai Health Sciences Program, Kalisizo, Uganda
| | - Lance B Price
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Rakai Health Sciences Program, Kalisizo, Uganda
| | - Steven J Reynolds
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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22
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Effectiveness of a Health Behavioural Intervention Aimed at Reduction of Risky Sexual Behaviours among Young Men in the KwaZulu-Natal Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111938. [PMID: 31159277 PMCID: PMC6603881 DOI: 10.3390/ijerph16111938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022]
Abstract
Two studies evaluating the same behavioural intervention were conducted in two areas in the KwaZulu-Natal province of South Africa using a randomized pre-test post-test control group design for study 1 (peri-urban) and a pre-test post-test design without a control group for study 2 (rural). The intervention included discussions and skills training on: (1) notions of masculinity, manhood, and responsibility, (2) personal and sexual relationships, (3) general communication skills, and (4) alcohol and other substance use. The intervention was aimed at men between 18 and 35 years of age. Measures of attitude, subjective norms, perceived behavioural control and intention for condom use, human immunodeficiency virus (HIV) testing, reduction of alcohol and drug use, avoiding sex while intoxicated, and avoiding sex with intoxicated people were assessed using a facilitator-administered questionnaire. The results for study 1 showed that 4 of the 19 variables scored significantly different at baseline and that all 19 variables showed no significant changes between pre-test and post-test. For study 2, one significant difference was found for attitude towards avoiding sex when one is intoxicated. Overall, the intervention had minimal success with just one area of positive effect. Further development and testing of this programme is recommended before it can be considered for broader scale implementation.
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23
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Cockcroft A, Marokoane N, Kgakole L, Mhati P, Tswetla N, Sebilo I, Andersson N. Acceptability and challenges of introducing an educational audio-drama about gender violence and HIV prevention into schools in Botswana: an implementation review. AIDS Care 2019; 31:1397-1402. [PMID: 30909721 DOI: 10.1080/09540121.2019.1595521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Structural interventions for HIV prevention are typically complex and evaluation should include measurement of implementation. In a trial of a structural intervention for HIV prevention in Botswana we trained teachers to use an audio-drama about gender violence and HIV (BVV). We measured the use of BVV by the trained teachers, and the factors related. In three-day workshops we trained guidance teachers in primary and secondary schools to use the 8-episode BVV audio-drama, that covers gender, gender violence and HIV. One to two years later, two interviewers visited schools and administered an electronic questionnaire to the head teacher and to the BVV-trained teacher. Most teachers (70%, 72/103) had used the BVV materials and reported a positive response from students. Primary school teachers were less likely to have used BVV (adjusted odds ratio (ORa) 0.24, 95% cluster adjusted confidence interval (CIca) 0.07-0.88). Teachers in schools with a working MP3 player were more likely to have used BVV (ORa 3.75, 95% CIca 1.11-12.70). Implementation was much lower in one district (ORa 0.12, 95% CIca 0.04-0.36), related to language constraints. The main difficulty was lack of time, especially in primary schools. These findings could inform rollout of the BVV programme in schools. Abbreviations: BVV: Beyond Victims and Villains audio-drama; CI: Confidence interval; OR: Odds ratio.
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Affiliation(s)
- Anne Cockcroft
- CIET Trust Botswana , Gaborone , Botswana.,CIET/PRAM, Department of Family Medicine, McGill University , Montreal , Canada
| | | | | | - Puna Mhati
- CIET Trust Botswana , Gaborone , Botswana
| | | | - Ikko Sebilo
- Ministry of Health and Wellness, District Health Management Team , Tutume , Botswana
| | - Neil Andersson
- CIET/PRAM, Department of Family Medicine, McGill University , Montreal , Canada.,Centro de Investigacion de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero , Acapulco , Mexico
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24
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Pillay T, Sobia P, Olivier AJ, Narain K, Liebenberg LJP, Ngcapu S, Mhlongo M, Passmore JAS, Baxter C, Archary D. Semen IgM, IgG1, and IgG3 Differentially Associate With Pro-Inflammatory Cytokines in HIV-Infected Men. Front Immunol 2019; 9:3141. [PMID: 30728825 PMCID: PMC6351442 DOI: 10.3389/fimmu.2018.03141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022] Open
Abstract
Genital inflammation significantly increases the risk for HIV infection. The seminal environment is enriched in pro-inflammatory cytokines and chemokines. Here, we investigated the interplay between semen cytokines and humoral immunity to understand whether the characteristics of semen antibodies are associated with genital inflammation. In 36 HIV-infected and 40 HIV-uninfected mens' semen, HIV-specific antibodies (gp120, gp41, p66, and p24), immunoglobulin (Ig) subclasses, isotypes and cytokines, using multiplex assays, were measured. Semen IgG1, IgG3, and IgM were significantly higher in HIV-infected compared to HIV-uninfected men (p < 0.05). In HIV-uninfected men, pro-inflammatory cytokines IL-6, IL-8, and MCP-1 significantly correlated with IgG1 and total IgG (IgG1+IgG2+IgG3+IgG4) (both r≥0.55; p≤0.001). Total IgG in HIV-infected men correlated to HIV-specific antibodies in the semen irrespective of antiretroviral (ARV) use. In HIV-infected, ARV-treated men, p66 and gp41-specific antibodies were inversely correlated with IL-6 and MIP-1α (both r≥−0.65, p≤0.03). In HIV-infected, ARV-naïve men, p24 and gp120-specific antibodies correlated significantly with pro-inflammatory TNF-α (r≥0.44, p≤0.03), while p24 antibodies correlated significantly with chemokine MIP-1β (r = 0.45; p = 0.02). Local cytokines/chemokines were associated with the mucosal-specific Ig subclasses which likely effect specific antibody functions. Together, these data inform on mucosal-specific immunity that may be elicited in the male genital tract (MGT) in future vaccines and/or combination HIV prevention strategies.
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Affiliation(s)
- Thevani Pillay
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Parveen Sobia
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Abraham Jacobus Olivier
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Kapil Narain
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Lenine J P Liebenberg
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa
| | - Mesuli Mhlongo
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Jo-Ann S Passmore
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service (NHLS), Cape Town, South Africa.,Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Derseree Archary
- Centre for the AIDS Programme of Research In South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa
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25
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Abstract
OBJECTIVES To assess neurodevelopment of breastfed HIV-exposed uninfected (HEU) and breastfed HIV-unexposed children in the context of universal maternal antiretroviral therapy (ART). DESIGN Prospective study with antenatal enrolment and follow-up of breastfeeding HEU and HIV-unexposed mother-infant pairs through 12-18 months postpartum. SETTING Peri-urban community, Cape Town, South Africa. PARTICIPANTS HEU (n = 215) and HIV-unexposed (n = 306) children. MAIN OUTCOME MEASURES Cognitive, motor and language development at median 13 (interquartile range 12-14) months of age: continuous and dichotomous Bayley Scales of Infant and Toddler Development Third Edition (delay defined as composite score <85). RESULTS Incidence of preterm delivery (<37 weeks) was similar among HEU and HIV-unexposed children (11 vs. 9%, P = 0.31; median gestation 39 weeks); 48% were boys. Median breastfeeding duration was shorter among HEU vs. HIV-unexposed children (6 vs. 10 months). All HIV-infected mothers initiated lifelong ART (tenofovir-emtricitabine-efavirenz) antenatally. HEU (vs. HIV-unexposed) children had higher odds of cognitive delay [odds ratio (OR) 2.28 (95% confidence interval (CI) 1.13-4.60)] and motor delay [OR 2.10 (95% CI 1.03-4.28)], but not language delay, in crude and adjusted analysis. Preterm delivery modified this relationship for motor development: compared with term HIV-unexposed children, term HEU children had similar odds of delay, preterm HIV-unexposed children had five-fold increased odds of delay (adjusted OR 4.73, 95% CI 1.32; 16.91) and preterm HEU children, 16-fold increased odds of delay (adjusted OR 16.35, 95% CI 5.19; 51.54). CONCLUSION Young HEU children may be at increased risk for cognitive and motor delay despite universal maternal ART and breastfeeding; those born preterm may be particularly vulnerable.
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26
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McKinnon LR, Liebenberg LJ, Yende-Zuma N, Archary D, Ngcapu S, Sivro A, Nagelkerke N, Garcia Lerma JG, Kashuba AD, Masson L, Mansoor LE, Karim QA, Karim SSA, Passmore JAS. Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women. Nat Med 2018; 24:491-496. [PMID: 29480895 PMCID: PMC5893390 DOI: 10.1038/nm.4506] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/30/2018] [Indexed: 12/13/2022]
Abstract
Several clinical trials have demonstrated that antiretroviral (ARV) drugs, taken as pre-exposure prophylaxis (PrEP), can prevent HIV infection1, with the magnitude of protection ranging from -49 to 86%2–11. While these divergent outcomes are thought to be due primarily to product adherence12, biological factors likely contribute13. Despite selective recruitment of higher risk participants for prevention trials, HIV risk is heterogeneous, even within higher risk groups14–16. To determine whether this heterogeneity could influence PrEP outcomes, we undertook a post-hoc prospective analysis of the CAPRISA 004 tenofovir 1% gel trial (n=774), one of the first trials to demonstrate protection against HIV infection. Concentrations of nine pro-inflammatory cytokines were measured in cervicovaginal lavages at >2,000 visits, and a graduated cytokine score was used to define genital inflammation. In women without genital inflammation, tenofovir was 57% protective against HIV (95% CI: 7 to 80%), compared to 3% (95% CI: −104 to 54%) if genital inflammation was present. Among high gel adherers, tenofovir protection was 75% (95% CI: 25 to 92%) in women without inflammation compared to −10% (95% CI: −184 to 57%) in women with inflammation. Host immune predictors of HIV risk may modify the effectiveness of HIV prevention tools; reducing genital inflammation in women may augment HIV prevention efforts.
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Affiliation(s)
- Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Lenine J Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Nico Nagelkerke
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jose Gerardo Garcia Lerma
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela D Kashuba
- Eschelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindi Masson
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Epidemiology, Columbia University, New York, New York, USA
| | - Jo-Ann S Passmore
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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27
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Govender E, Mansoor L, MacQueen K, Abdool Karim Q. Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa. CULTURE, HEALTH & SEXUALITY 2017; 19:1268-1285. [PMID: 28423992 DOI: 10.1080/13691058.2017.1309682] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.
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Affiliation(s)
- Eliza Govender
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
- b Centre for Culture, Communication and Media Studies (CCMS), College of Humanities , University of KwaZulu-Natal , Durban , South Africa
| | - Leila Mansoor
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
| | - Kate MacQueen
- c Social and Behavioural Health Sciences, FHI 360 , Durham , NC , USA
| | - Quarraisha Abdool Karim
- a Centre for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal , Durban , South Africa
- d Department of Epidemiology , Columbia University , New York , NY , USA
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28
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Dong KL, Moodley A, Kwon DS, Ghebremichael MS, Dong M, Ismail N, Ndhlovu ZM, Mabuka JM, Muema DM, Pretorius K, Lin N, Walker BD, Ndung'u T. Detection and treatment of Fiebig stage I HIV-1 infection in young at-risk women in South Africa: a prospective cohort study. Lancet HIV 2017; 5:e35-e44. [PMID: 28978417 DOI: 10.1016/s2352-3018(17)30146-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND HIV incidence among young women in sub-Saharan Africa remains high and their inclusion in vaccine and cure efforts is crucial. We aimed to establish a cohort of young women detected during Fiebig stage I acute HIV infection in whom treatment was initiated immediately after diagnosis to advance research in this high-risk group. METHODS 945 women aged 18-23 years in KwaZulu-Natal, South Africa, who were HIV uninfected and sexually active consented to HIV-1 RNA testing twice a week and biological sampling and risk assessment every 3 months during participation in a 48-96 week life-skills and job-readiness programme. We analysed the effect of immediate combination antiretroviral therapy (ART) on viraemia and immune responses, sexual risk behaviour, and the effect of the socioeconomic intervention. FINDINGS 42 women were diagnosed with acute HIV infection between Dec 1, 2012, and June 30, 2016, (incidence 8·2 per 100 person-years, 95% CI 5·9-11·1), of whom 36 (86%) were diagnosed in Fiebig stage I infection with a median initial viral load of 2·97 log10 copies per mL (IQR 2·42-3·85). 23 of these 36 women started ART at a median of 1 day (1-1) after detection, which limited the median peak viral load to 4·22 log10 copies per mL (3·27-4·83) and the CD4 nadir to 685 cells per μL (561-802). ART also suppressed viral load (to <20 copies per mL) within a median of 16 days (12-26) and, in 20 (87%) of 23 women, prevented seroconversion, as shown with western blotting. 385 women completed the 48 week socioeconomic intervention, of whom 231 were followed up for 1 year. 202 (87%) of these 231 women were placed in jobs, returned to school, or started a business. INTERPRETATION Frequent HIV screening combined with a socioeconomic intervention facilitated sampling and risk assessment before and after infection. In addition to detection of acute infection and immediate treatment, we established a cohort optimised for prevention and cure research. FUNDING Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases, International AIDS Vaccine Initiative, Wellcome Trust, Howard Hughes Medical Institute.
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Affiliation(s)
- Krista L Dong
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA
| | - Amber Moodley
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Douglas S Kwon
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mary Dong
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Nasreen Ismail
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Zaza M Ndhlovu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jenniffer M Mabuka
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel M Muema
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Karyn Pretorius
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Nina Lin
- Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce D Walker
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; Infectious Disease Division, Massachusetts General Hospital, Boston, MA, USA; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; Institute for Medical Sciences and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Thumbi Ndung'u
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa; Max Planck Institute for Infection Biology, Berlin, Germany.
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29
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Gosmann C, Anahtar MN, Handley SA, Farcasanu M, Abu-Ali G, Bowman BA, Padavattan N, Desai C, Droit L, Moodley A, Dong M, Chen Y, Ismail N, Ndung'u T, Ghebremichael MS, Wesemann DR, Mitchell C, Dong KL, Huttenhower C, Walker BD, Virgin HW, Kwon DS. Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women. Immunity 2017; 46:29-37. [PMID: 28087240 DOI: 10.1016/j.immuni.2016.12.013] [Citation(s) in RCA: 424] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/20/2022]
Abstract
Elevated inflammation in the female genital tract is associated with increased HIV risk. Cervicovaginal bacteria modulate genital inflammation; however, their role in HIV susceptibility has not been elucidated. In a prospective cohort of young, healthy South African women, we found that individuals with diverse genital bacterial communities dominated by anaerobes other than Gardnerella were at over 4-fold higher risk of acquiring HIV and had increased numbers of activated mucosal CD4+ T cells compared to those with Lactobacillus crispatus-dominant communities. We identified specific bacterial taxa linked with reduced (L. crispatus) or elevated (Prevotella, Sneathia, and other anaerobes) inflammation and HIV infection and found that high-risk bacteria increased numbers of activated genital CD4+ T cells in a murine model. Our results suggest that highly prevalent genital bacteria increase HIV risk by inducing mucosal HIV target cells. These findings might be leveraged to reduce HIV acquisition in women living in sub-Saharan Africa.
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Affiliation(s)
- Christina Gosmann
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Melis N Anahtar
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Scott A Handley
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Mara Farcasanu
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA
| | - Galeb Abu-Ali
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Brittany A Bowman
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA
| | - Nikita Padavattan
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4001, South Africa
| | - Chandni Desai
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Lindsay Droit
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Amber Moodley
- Females Rising through Education, Support, and Health, Durban, KwaZulu-Natal, 4066, South Africa
| | - Mary Dong
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Females Rising through Education, Support, and Health, Durban, KwaZulu-Natal, 4066, South Africa
| | - Yuezhou Chen
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Nasreen Ismail
- HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4001, South Africa
| | - Thumbi Ndung'u
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; HIV Pathogenesis Programme, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4001, South Africa
| | - Musie S Ghebremichael
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Duane R Wesemann
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Caroline Mitchell
- Vincent Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Krista L Dong
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Females Rising through Education, Support, and Health, Durban, KwaZulu-Natal, 4066, South Africa
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Bruce D Walker
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02115, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Herbert W Virgin
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Douglas S Kwon
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Cambridge, MA 02139, USA; Harvard Medical School, Boston, MA 02115, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02115, USA.
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