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Wand H, Moodley J, Reddy T, Naidoo S. Geospatial correlations and variations in child mortality and stunting in South Africa: Evaluating distal vs structural determinants. Spat Spatiotemporal Epidemiol 2024; 50:100653. [PMID: 39181600 DOI: 10.1016/j.sste.2024.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/10/2024] [Accepted: 04/22/2024] [Indexed: 08/27/2024]
Abstract
South Africa has one of the highest child mortality and stunting rates in the world. Flexible geoadditive models were used to investigate the geospatial variations in child mortality and stunting in South Africa. We used consecutive rounds of national surveys (2008-2017). The child mortality declined from 31 % to 24 % over time. Lack of medical insurance, black ethnicity, low-socioeconomic conditions, and poor housing conditions were identified as the most significant correlates of child mortality. The model predicted degrees of freedom which was estimated as 19.55 (p < 0.001), provided compelling evidence for sub-geographical level variations in child mortality which ranged from 6 % to 35 % across the country. Population level impact of the distal characteristics on child mortality and stunting exceeded that of other risk factors. Geospatial analysis can help in monitoring trends in child mortality over time and in evaluating the impact of health interventions.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, 2052, New South Wales, Australia.
| | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa
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Malahleha M, Laher F, Dilraj A, Smith P, Gray GE, Grove D, Odhiambo JA, Andrasik MP, Grunenberg NA, Moodie Z, Huang Y, Borate BR, Gillespie KM, Allen M, Atujuna M, Singh N, Kalonji D, Meintjes G, Kotze P, Bekker LG, Janes H. Risk Factors Associated with HIV Acquisition in Males Participating in HIV Vaccine Efficacy Trials in South Africa. AIDS Behav 2023; 27:3027-3037. [PMID: 36929319 PMCID: PMC10386918 DOI: 10.1007/s10461-023-04025-z] [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] [Accepted: 02/09/2023] [Indexed: 03/17/2023]
Abstract
In South Africa, HIV acquisition risk has been studied less in people assigned male at birth. We studied the associations between risk behaviors, clinical features and HIV incidence amongst males in two South African HIV preventive vaccine efficacy trials. We used Cox proportional hazards models to test for associations between demographics, sexual behaviors, clinical variables and HIV acquisition among males followed in the HVTN 503 (n = 219) and HVTN 702 (n = 1611) trials. Most males reported no male sexual partners (99.09% in HVTN 503) or identified as heterosexual (88.08% in HVTN 702). Annual HIV incidence was 1.39% in HVTN 503 (95% CI 0.76-2.32%) and 1.33% in HVTN 702 (95% CI 0.80-2.07%). Increased HIV acquisition was significantly associated with anal sex (HR 6.32, 95% CI 3.44-11.62), transactional sex (HR 3.42, 95% CI 1.80-6.50), and non-heterosexual identity (HR 16.23, 95%CI 8.13-32.41) in univariate analyses and non-heterosexual identity (HR 14.99, 95% CI 4.99-45.04; p < 0.01) in multivariate analysis. It is appropriate that prevention efforts in South Africa, although focused on the severe epidemic in young women, also encompass key male populations, including men who have sex with men, but also men who engage in anal or transactional sex.
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Affiliation(s)
- Mookho Malahleha
- Setshaba Research Centre, Soshanguve, Tshwane, South Africa
- Synergy Biomed Research Institute, East London, Eastern Cape, South Africa
| | - Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Athmanundh Dilraj
- Setshaba Research Centre, Soshanguve, Tshwane, South Africa.
- Setshaba Research Centre, 2088 Block H, Soshanguve, Pretoria, 0152, South Africa.
| | - Philip Smith
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Doug Grove
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jackline A Odhiambo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michele P Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nicole A Grunenberg
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Bhavesh R Borate
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kevin M Gillespie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mary Allen
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Millicent Atujuna
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Nishanta Singh
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Dishiki Kalonji
- South African Medical Research Council, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Cape Town, South Africa
| | - Phillip Kotze
- Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Bezerra ALL, de Almeida PRB, Reis RK, Ferreira GRON, Sousa FDJDD, Gir E, Botelho EP. Human immunodeficiency virus epidemic scenery among brazilian women: a spatial analysis study. BMC Womens Health 2023; 23:463. [PMID: 37658362 PMCID: PMC10474736 DOI: 10.1186/s12905-023-02616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Approximately 37.7 million people worldwide are infected with human immunodeficiency virus (HIV). Although HIV detection among women, they still representing 53% of population living with the virus. Spatial analysis techniques are powerful tools for combating HIV allowing the association of the phenomenon with socioeconomic and political factors. Therefore, the main goal of this study was to spatially analyze HIV prevalence among Brazilian women from 2007 to 2020. METHODS ecological study was conducted using secondary databases of the Notifiable Diseases Information System (SINAN) for HIV and Acquired Immunodeficiency Syndrom (AIDS) in Brazilian women 15 years old and over. Age-adjusted HIV/AIDS incidence rates were analyzed using spatial distribution, autocorrelation, and spatiotemporal risk analysis techniques. RESULTS During the study period, 119,890 cases of HIV/AIDS were reported among Brazilian women. The southeastern region had a higher age-adjusted HIV/AIDS incidence than other Brazilian regions. Hotspot HIV/AIDS incidence rates decreased in all Brazil. Piauí, Paraná, and Minas Gerais were the only states with an increased number of cold spots. Previous spatiotemporal risk zones were observed in the states of São Paulo, Rio Grande do Sul, and Rio de Janeiro. Belém was a risk zone with a later spatiotemporal risk. CONCLUSIONS The efficiency of public policies fighting HIV has not been uniform among municipalities, although HIV/AIDS cases have decreased among Brazilian women. The social determinants of health in each municipality should be considered when local health authorities implement policies. Women empowerment should be promoted, and access to preventive, diagnostic, and treatment healthcare places should be expanded and guaranteed.
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Affiliation(s)
- Ana Luisa Lemos Bezerra
- Nursing Graduate Program, Universidade Federal do Pará, Rua Augusto Correia, 01 - Setor Saúde, Guamá - Belém, Pará, 66075-110, Brazil
| | - Paula Regina Barbosa de Almeida
- Nursing Graduate Program, Universidade Federal do Pará, Rua Augusto Correia, 01 - Setor Saúde, Guamá - Belém, Pará, 66075-110, Brazil
| | - Renata Karina Reis
- Escola de Enfermagem de Ribeirão Preto. Graduate Program in Fundamental Nursing, Universidade de São Paulo, Av.Bandeirantes, Ribeirão Preto, 3900, 14040-902, SP, Brazil
| | | | - Fabianne de Jesus Dias de Sousa
- Nursing Graduate Program, Universidade Federal do Pará, Rua Augusto Correia, 01 - Setor Saúde, Guamá - Belém, Pará, 66075-110, Brazil
| | - Elucir Gir
- Escola de Enfermagem de Ribeirão Preto. Graduate Program in Fundamental Nursing, Universidade de São Paulo, Av.Bandeirantes, Ribeirão Preto, 3900, 14040-902, SP, Brazil
| | - Eliã Pinheiro Botelho
- Nursing Graduate Program, Universidade Federal do Pará, Rua Augusto Correia, 01 - Setor Saúde, Guamá - Belém, Pará, 66075-110, Brazil.
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Ugwu CLJ, Ncayiyana JR. Spatial disparities of HIV prevalence in South Africa. Do sociodemographic, behavioral, and biological factors explain this spatial variability? Front Public Health 2022; 10:994277. [PMID: 36438270 PMCID: PMC9692089 DOI: 10.3389/fpubh.2022.994277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background In 2021, an estimated 38 million people were living with human immunodeficiency virus (HIV) globally, with over two-thirds living in African regions. In South Africa, ~20% of South African adults are living with HIV. Accurate estimation of the risk factors and spatial patterns of HIV risk using individual-level data from a nationally representative sample is invaluable for designing geographically targeted intervention and control programs. Methods Data were obtained from the 2016 South Africa Demographic and Health Survey (SDHS16). The study involved all men and women aged 15 years and older, who responded to questions and tested for HIV in the SDHS. Generalized additive models (GAMs) were fitted to our data with a nonparametric bivariate smooth term of spatial location parameters (X and Y coordinates). The GAMs were used to assess the spatial disparities and the potential contribution of sociodemographic, biological, and behavioral factors to the spatial patterns of HIV prevalence in South Africa. Results A significantly highest risk of HIV was observed in east coast, central and north-eastern regions. South African men and women who are widowed and divorced had higher odds of HIV as compared to their counterparts. Additionally, men and women who are unemployed had higher odds of HIV as compared to the employed. Surprisingly, the odds of HIV infection among men residing in rural areas were 1.60 times higher (AOR 1.60, 95% CI 1.12, 2.29) as compared to those in urban areas. But men who were circumcised had lower odds of HIV (AOR 0.73, 95% CI 0.52, 0.98), while those who had STI in the last 12 months prior to the survey had higher odds of HIV (AOR 1.76, 95% CI 1.44, 3.68). Conclusion Spatial heterogeneity in HIV risk persisted even after covariate adjustment but differed by sex, suggesting that there are plausible unobserved influencing factors contributing to HIV uneven variation. This study's findings could guide geographically targeted public health policy and effective HIV intervention in South Africa.
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Affiliation(s)
| | - Jabulani R. Ncayiyana
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
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Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Guure C, Afagbedzi S, Torpey K. Willingness to take and ever use of pre-exposure prophylaxis among female sex workers in Ghana. Medicine (Baltimore) 2022; 101:e28798. [PMID: 35119051 PMCID: PMC8812709 DOI: 10.1097/md.0000000000028798] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/19/2022] [Indexed: 01/04/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a drug taken by people who are human immunodeficiency virus (HIV) negative and at increased risk of acquiring HIV. It's an effective intervention for HIV prevention. This study seeks to report on the prevalence and determinants of willingness to take and ever use of PrEP among female sex workers (FSW) in Ghana.The data analyzed was obtained from the Integrated Bio-behavioral Surveillance Survey conducted across the 16 regions of Ghana in 2020. Analysis was only performed on FSW who were tested negative to HIV and were sexually active. All included variables were described using medians, percentages, and graphs. Bayesian adjusted odds ratios and 95% credible intervals were estimated using a Bayesian generalized linear model via the binomial family of distributions under the logit link function.Of the 5107 FSW with complete data on willingness to use PrEP, 2737 (53.59%) reported their willingness to take PrEP. Out of the 998 respondents who have ever heard of PrEP only 64 (6.39%) have ever used PrEP. The median age of the respondents was 25 years. People with no comprehensive knowledge of HIV and acquired immunodeficiency syndrome as well as those who entered into the FSW business at age less than 25 years; 946 (34.56%) and 2181 (79.65%) respectively were more willing to take PrEP. FSW from 6 out of the 16 regions of Ghana have never used PrEP. A statistically significant difference between those who entered the sex work at age less than 25 years and those within 25 to 34 years was observed. About 23% of FSWs who had been screened for Sexually Transmitted Infections were more likely to take PrEP.Respondents with lesser age and no comprehensive knowledge of HIV were more willing to take PrEP. The willingness to accept PrEP among FSWs in Ghana is modest. However, utilization is low. Advocacy or intervention programs are required to improve uptake of PrEP.
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Affiliation(s)
- Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Seth Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
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Puplampu AE, Afagbedzi S, Dery S, Puplampu DA, Guure C. Determinants of Higher-Risk Sexual Behavior in Some Selected African Countries. SCIENTIFICA 2021; 2021:8089293. [PMID: 34527387 PMCID: PMC8437602 DOI: 10.1155/2021/8089293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although higher-risk sexual behavior (H-RSB) is a major contributor to the rapid rising rate of new HIV infections, there exists paucity of comprehensive evidence across the sub-Saharan African region. The purpose of this study was to determine the prevalence of H-RSB and its determinants across sub-Saharan Africa to inform policy. METHOD Data were obtained from the Demographic and Health Survey (DHS) of ten sub-Saharan African (SSA) countries with their three most current DHS surveys from 2000 to 2016. Only participants who ever had sexual encounters in their lifetime were included in the study. Weighted adjusted Cox regression with robust variance and constant time was used to investigate disparities of H-RSB among the ten SSA countries. Relationships between sociodemographic, socioeconomic, knowledge, mass media, and H-RSB were investigated. RESULTS The trend and prevalence of higher-risk sexual behavior show that Lesotho experienced a decreasing trend of the prevalence of H-RSB from 8.92 in period one to 6.42 in period three. Ghana experienced a marginal increase from 6.22 in period one to 6.76 in period two and then to 6.43 in the third period. However, Malawi, Zambia, and Zimbabwe obtained a marginal increasing trend in the prevalence of H-RSB from period one to three: 2.75 to 3.74, 4.33 to 6.24, and 6.11 to 7.99, respectively. Meanwhile, the prevalence of H-RSB in Namibia and Uganda decreased in period two to 1.84 and 5.76 but increased in period three to 2.01 and 6.83, respectively. Generally, determinants of H-RSB among the countries include age, sex, religious affiliation, marital status, educational level, employment status, economic status, age at first sex, and status of circumcision. CONCLUSION Trend of relatively high prevalence of H-RSB has been found across majority of the countries with key sociodemographic factors influencing H-RSB. Therefore, different targeted interventional approaches are needed in all the countries to help reduce H-RSB and the overall HIV incidence. If issues regarding sexual behavior and sexual health are not addressed adequately, H-RSB can negate all the appreciable efforts aimed at ending the HIV pandemic by 2030.
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Affiliation(s)
| | - Seth Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Dzifa Adimle Puplampu
- Center for Climate Change and Sustainable Studies, University of Ghana, Legon, Accra, Ghana
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
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