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Cuadros DF, Huang Q, Musuka G, Dzinamarira T, Moyo BK, Mpofu A, Makoni T, DeWolfe Miller F, Bershteyn A. Moving beyond hotspots of HIV prevalence to geospatial hotspots of UNAIDS 95-95-95 targets in sub-Saharan Africa. Lancet HIV 2024; 11:e479-e488. [PMID: 38852597 DOI: 10.1016/s2352-3018(24)00102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 06/11/2024]
Abstract
The HIV epidemic in sub-Saharan Africa displays a varied geographical distribution, with particular regions termed as HIV hotspots due to a higher prevalence of infection. Addressing these hotspots is essential for controlling the epidemic. However, these regions, influenced by historical factors, challenge standard interventions. Legacy effects-the lasting impact of past events-play a substantial role in the persistence of these hotspots. To address this challenge of the standard interventions, we propose a shift towards the UNAIDS 95-95-95 targets. Spatial analysis of HIV viral load and antiretroviral therapy coverage can provide a more comprehensive perspective on the epidemic's dynamics. Studies in Zambia and Zimbabwe, using this approach, have revealed disparities in HIV care metrics across regions. By focusing on the UNAIDS 95-95-95 targets, more effective control strategies can be designed, with consideration of both historical and current factors. This approach would offer a solution-oriented strategy, emphasising tailored interventions based on specific regional needs.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA.
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
| | | | - Brian K Moyo
- HIV and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Tatenda Makoni
- Zimbabwe Network for People Living with HIV (ZNNP+), Harare, Zimbabwe
| | - F DeWolfe Miller
- Department of Tropical Medicine and Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, HI, USA
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Yu ST, Wang P, Kabudula CW, Gareta D, Harling G, Houle B. Local Network Interaction as a Mechanism for Wealth Inequality. Nat Commun 2024; 15:5322. [PMID: 38909070 PMCID: PMC11193797 DOI: 10.1038/s41467-024-49607-0] [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: 08/15/2023] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
Given limited institutional resources, low-income populations often rely on social networks to improve their socioeconomic outcomes. However, it remains in question whether small-scale social interactions could affect large-scale economic inequalities in under-resourced contexts. Here, we leverage population-level data from one of the poorest South African settings to construct a large-scale, geographically defined, inter-household social network. Using a multilevel network model, we show that having social ties in close geographic proximity is associated with stable household asset conditions, while geographically distant ties correlate to changes in asset allocation. Notably, we find that localised network interactions are associated with an increase in wealth inequality at the regional level, demonstrating how macro-level inequality may arise from micro-level social processes. Our findings highlight the importance of understanding complex social connections underpinning inter-household resource dynamics, and raise the potential of large-scale social assistance programs to reduce disparities in resource-ownership by accounting for local social constraints.
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Affiliation(s)
- Shao-Tzu Yu
- Office of Population Research, Princeton University, Princeton, NJ, USA.
- School of Demography, The Australian National University, Canberra, ACT, Australia.
| | - Peng Wang
- Centre for Transformative Innovation, Swinburne University of Technology, Melbourne, Australia
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faulty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Guy Harling
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faulty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, Durban, South Africa
- Institute for Global Health, University College London, London, UK
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Brian Houle
- School of Demography, The Australian National University, Canberra, ACT, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faulty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA
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Tran J, Hathaway CL, Broshkevitch CJ, Palanee-Phillips T, Barnabas RV, Rao DW, Sharma M. Cost-effectiveness of single-visit cervical cancer screening in KwaZulu-Natal, South Africa: a model-based analysis accounting for the HIV epidemic. Front Oncol 2024; 14:1382599. [PMID: 38720798 PMCID: PMC11077327 DOI: 10.3389/fonc.2024.1382599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Women living with human immunodeficiency virus (WLHIV) face elevated risks of human papillomavirus (HPV) acquisition and cervical cancer (CC). Coverage of CC screening and treatment remains low in low-and-middle-income settings, reflecting resource challenges and loss to follow-up with current strategies. We estimated the health and economic impact of alternative scalable CC screening strategies in KwaZulu-Natal, South Africa, a region with high burden of CC and HIV. Methods We parameterized a dynamic compartmental model of HPV and HIV transmission and CC natural history to KwaZulu-Natal. Over 100 years, we simulated the status quo of a multi-visit screening and treatment strategy with cytology and colposcopy triage (South African standard of care) and six single-visit comparator scenarios with varying: 1) screening strategy (HPV DNA testing alone, with genotyping, or with automated visual evaluation triage, a new high-performance technology), 2) screening frequency (once-per-lifetime for all women, or repeated every 5 years for WLHIV and twice for women without HIV), and 3) loss to follow-up for treatment. Using the Ministry of Health perspective, we estimated costs associated with HPV vaccination, screening, and pre-cancer, CC, and HIV treatment. We quantified CC cases, deaths, and disability-adjusted life-years (DALYs) averted for each scenario. We discounted costs (2022 US dollars) and outcomes at 3% annually and calculated incremental cost-effectiveness ratios (ICERs). Results We projected 69,294 new CC cases and 43,950 CC-related deaths in the status quo scenario. HPV DNA testing achieved the greatest improvement in health outcomes, averting 9.4% of cases and 9.0% of deaths with one-time screening and 37.1% and 35.1%, respectively, with repeat screening. Compared to the cost of the status quo ($12.79 billion), repeat screening using HPV DNA genotyping had the greatest increase in costs. Repeat screening with HPV DNA testing was the most effective strategy below the willingness to pay threshold (ICER: $3,194/DALY averted). One-time screening with HPV DNA testing was also an efficient strategy (ICER: $1,398/DALY averted). Conclusions Repeat single-visit screening with HPV DNA testing was the optimal strategy simulated. Single-visit strategies with increased frequency for WLHIV may be cost-effective in KwaZulu-Natal and similar settings with high HIV and HPV prevalence.
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Affiliation(s)
- Jacinda Tran
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - Christine Lee Hathaway
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Cara Jill Broshkevitch
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ruanne Vanessa Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Division of Infectious Diseases, Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Darcy White Rao
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA, United States
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Urade Y, Cassimjee Z, Dayal C, Chiba S, Ajayi A, Davies M. Epidemiology and referral patterns of patients living with chronic kidney disease in Johannesburg, South Africa: A single centre experience. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003119. [PMID: 38635562 PMCID: PMC11034980 DOI: 10.1371/journal.pgph.0003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Chronic kidney disease (CKD) is a significant contributor to the global burden of non-communicable disease. Early intervention may facilitate slowing down of progression of CKD; recognition of at-risk patient groups may improve detection through screening. We retrospectively reviewed the clinical records of 960 patients attending a specialist nephrology outpatient clinic during the period 1 January 2011-31 December 2021. A significant proportion (47.8%) of patients were referred with established CKD stage G4 or G5. Non-national immigration status, previous diagnosis with diabetes, and advancing age were associated with late referral; antecedent diagnosis with HIV reduced the odds of late referral. Black African patients comprised most of the sample cohort and were younger at referral and more frequently female than other ethnicities; non-nationals were younger at referral than South Africans. Hypertension-associated kidney disease was the leading ascribed aetiological factor for CKD (40.7% of cases), followed by diabetic kidney disease (DKD) (19%), glomerular disease (12.5%), and HIV-associated kidney disease (11.8%). Hypertension-related (25.9%) and diabetic (10.7%) kidney diseases were not uncommon in people living with HIV. Advancing age and male sex increased the likelihood of diagnosis with hypertensive nephropathy, DKD and obstructive uropathy; males were additionally at increased risk of HIV-associated kidney disease and nephrotoxin exposure, as were patients of Black African ethnicity. In summary, this data shows that hypertension, diabetes, and HIV remain important aetiological factors in CKD in the South African context. Despite the well-described risk of CKD in these disorders, referral to nephrology services occurs late. Interventions and policy actions targeting at-risk populations are required to improve referral practices.
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Affiliation(s)
- Yusuf Urade
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Zaheera Cassimjee
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Chandni Dayal
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Division of Nephrology, Helen Joseph Hospital, Johannesburg, Gauteng, South Africa
| | - Sheetal Chiba
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Division of Nephrology, Helen Joseph Hospital, Johannesburg, Gauteng, South Africa
| | - Adekunle Ajayi
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Division of Nephrology, Helen Joseph Hospital, Johannesburg, Gauteng, South Africa
| | - Malcolm Davies
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Division of Nephrology, Helen Joseph Hospital, Johannesburg, Gauteng, South Africa
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Kim HY, Inghels M, Mathenjwa T, Shahmanesh M, Seeley J, Matthews P, Wyke S, McGrath N, Adeagbo O, Gareta D, Yapa HM, Zuma T, Dobra A, Blandford A, Bärnighausen T, Tanser F. Effect of a male-targeted digital decision support application aimed at increasing linkage to HIV care among men: Findings from the HITS cluster randomized clinical trial in rural South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304373. [PMID: 38562824 PMCID: PMC10984030 DOI: 10.1101/2024.03.15.24304373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Linkage to HIV care remains suboptimal among men. We investigated the effectiveness of a male-targeted HIV-specific decision support app, Empowering People through Informed Choices for HIV (EPIC-HIV), on increasing linkage to HIV care among men in rural South Africa. Methods Home-Based Intervention to Test and Start (HITS) was a multi-component cluster-randomized controlled trial among 45 communities in uMkhanyakude, KwaZulu-Natal. The development of EPIC-HIV was guided by self-determination theory and human-centered intervention design to increase intrinsic motivation to seek HIV testing and care among men. EPIC-HIV was offered in two stages: EPIC-HIV 1 at the time of home-based HIV counseling and testing (HBHCT), and EPIC-HIV 2 at 1 month after positive HIV diagnosis. Sixteen communities were randomly assigned to the arms to receive EPIC-HIV, and 29 communities to the arms without EPIC-HIV. Among all eligible men, we compared linkage to care (initiation or resumption of antiretroviral therapy after >3 months of care interruption) at local clinics within 1 year of a home visit, which was ascertained from individual clinical records. Intention-to-treat analysis was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., financial incentives) and clustering at the community level. We also conducted a satisfaction survey for EPIC-HIV 2. Results Among all 13,894 eligible men (i.e., ≥15 years and resident in the 45 communities), 20.7% received HBHCT, resulting in 122 HIV-positive tests. Among these, 54 men linked to care within 1 year after HBHCT. Additionally, of the 13,765 eligible participants who did not receive HBHCT or received HIV-negative results, 301 men linked to care within 1 year. Overall, only 13 men received EPIC-HIV 2. The proportion of linkage to care did not differ in the arms assigned to EPIC-HIV compared to those without EPIC-HIV (adjusted risk ratio=1.05; 95% CI:0.86-1.29). All 13 men who used EPIC-HIV 2 reported the app was acceptable, user-friendly, and useful for getting information on HIV testing and treatment. Conclusion Reach was low although acceptability and usability of the app was very high among those who engaged with it. Enhanced digital support applications could form part of interventions to increase knowledge of HIV treatment for men. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.
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Kim HY, Inghels M, Mathenjwa T, Shahmanesh M, Seeley J, Matthews P, McGrath N, Adeagbo O, Gareta D, Yapa HM, Zuma T, Dobra A, Bärnighausen T, Tanser F. The impact of a conditional financial incentive on linkage to HIV care: Findings from the HITS cluster randomized clinical trial in rural South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304278. [PMID: 38562873 PMCID: PMC10984055 DOI: 10.1101/2024.03.15.24304278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction HIV elimination requires innovative approaches to ensure testing and immediate treatment provision. We investigated the effectiveness of conditional financial incentives on increasing linkage to HIV care in a 2×2 factorial cluster randomized controlled trial-Home-Based Intervention to Test and Start (HITS) - in rural South Africa. Methods Of 45 communities in uMkhanyakude, KwaZulu-Natal, 16 communities were randomly assigned to the arms to receive financial incentives for home-based HIV counseling and testing (HBHCT) and linkage to care within 6 weeks (R50 [US$3] food voucher each) and 29 communities to the arms without financial incentives. We examined linkage to care (i.e., initiation or resumption of antiretroviral therapy after >3 months of care interruption) at local clinics within 6 weeks of a home visit, the eligibility period to receive the second financial incentive. Linkage to care was ascertained from individual clinical records. Intention-to-treat analysis (ITT) was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., male-targeted HIV-specific decision support app) and clustering of standard errors at the community level. Results Among 13,894 eligible men (i.e., ≥15 years and resident in the 45 communities), 20.7% received HBHCT, which resulted in 122 HIV-positive tests. Of these, 27 linked to care within 6 weeks of HBHCT. Additionally, of eligible men who did not receive HBHCT, 66 linked to care. In the ITT analysis, the proportion of linkage to care among men did not differ in the arms which received financial incentives and those without financial incentives (adjusted Risk Ratio [aRR]=0.78, 95% CI: 0.51-1.21). Among 19,884 eligible women, 29.1% received HBHCT, which resulted in 375 HIV-positive tests. Of these, 75 linked to care. Among eligible women who did not receive HBHCT, 121 linked to care within 6 weeks. Women in the financial incentive arms had a significantly higher probability of linkage to care, compared to those in the arms without financial incentives (aRR=1.50; 95% CI: 1.03-2.21). Conclusion While a small once-off financial incentive did not increase linkage to care among men during the eligibility period of 6 weeks, it significantly improved linkage to care among women over the same period. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.
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Kileel EM, Zheng A, Bor J, Fox MP, Crowther NJ, George JA, Khoza S, Rosen S, Venter WDF, Raal F, Hibberd P, Brennan AT. Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis. AIDS Behav 2024; 28:591-608. [PMID: 38300475 PMCID: PMC10876721 DOI: 10.1007/s10461-023-04248-0] [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: 12/02/2023] [Indexed: 02/02/2024]
Abstract
Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.
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Affiliation(s)
- Emma M Kileel
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Amy Zheng
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyabonga Khoza
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Frederick Raal
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Monod M, Brizzi A, Galiwango RM, Ssekubugu R, Chen Y, Xi X, Kankaka EN, Ssempijja V, Abeler-Dörner L, Akullian A, Blenkinsop A, Bonsall D, Chang LW, Dan S, Fraser C, Golubchik T, Gray RH, Hall M, Jackson JC, Kigozi G, Laeyendecker O, Mills LA, Quinn TC, Reynolds SJ, Santelli J, Sewankambo NK, Spencer SEF, Ssekasanvu J, Thomson L, Wawer MJ, Serwadda D, Godfrey-Faussett P, Kagaayi J, Grabowski MK, Ratmann O. Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda. Nat Microbiol 2024; 9:35-54. [PMID: 38052974 PMCID: PMC10769880 DOI: 10.1038/s41564-023-01530-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023]
Abstract
HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep-sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Uganda. We observed 1,117 individuals in the incidence cohort and 1,978 individuals in the transmission cohort. HIV viral suppression increased more rapidly in women than men, however incidence declined more slowly in women than men. We found that age-specific transmission flows shifted: whereas HIV transmission to girls and women (aged 15-24 years) from older men declined by about one-third, transmission to women (aged 25-34 years) from men that were 0-6 years older increased by half in 2003 to 2018. Based on changes in transmission flows, we estimated that closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018. This study suggests that HIV programmes to increase HIV suppression in men are critical to reduce incidence in women, close gender gaps in infection burden and improve men's health in Africa.
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Affiliation(s)
- Mélodie Monod
- Department of Mathematics, Imperial College London, London, UK
| | - Andrea Brizzi
- Department of Mathematics, Imperial College London, London, UK
| | | | | | - Yu Chen
- Department of Mathematics, Imperial College London, London, UK
| | - Xiaoyue Xi
- Department of Mathematics, Imperial College London, London, UK
| | - Edward Nelson Kankaka
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Research Department, Rakai Health Sciences Program, Rakai, Uganda
| | - Victor Ssempijja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
- Statistics Department, Rakai Health Sciences Program, Rakai, Uganda
| | | | | | | | - David Bonsall
- Wellcome Centre for Human Genomics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shozen Dan
- Department of Mathematics, Imperial College London, London, UK
| | - Christophe Fraser
- Big Data Institute, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, University of Oxford, Oxford, UK
- Sydney Infectious Diseases Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Hall
- Big Data Institute, University of Oxford, Oxford, UK
| | - Jade C Jackson
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A Mills
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Thomas C Quinn
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Santelli
- Population and Family Health and Pediatrics, Columbia Mailman School of Public Health, New York, NY, USA
| | - Nelson K Sewankambo
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Thomson
- Big Data Institute, University of Oxford, Oxford, UK
| | - Maria J Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Peter Godfrey-Faussett
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - M Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, UK.
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Moodley Y, Asare K, Tanser F, Tomita A. Maternal exposure to heat and its association with miscarriage in rural KwaZulu-Natal, South Africa: A population-based cohort study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241259171. [PMID: 39066467 PMCID: PMC11282531 DOI: 10.1177/17455057241259171] [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: 02/23/2023] [Revised: 04/21/2024] [Accepted: 05/16/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND We sought to improve the current understanding of how climate change impacts women's reproductive health in sub-Saharan Africa. OBJECTIVES We investigated the relationship between maternal heat exposure and miscarriage (pregnancy ending before 20 weeks gestation) in a South African setting. DESIGN Population-based cohort study. METHODS Our study involved data for pregnancies collected via a health and demographic surveillance system in rural KwaZulu-Natal, South Africa between 2012 and 2016. Data from the South African Weather Service were used to compute maternal exposure to heat during the following time windows for each pregnancy: during the month preceding conception (T1) and during the week preceding the study outcome (either a miscarriage or no miscarriage, T2). Heat exposure was operationalized as a continuous variable and defined as the number of days that a mother was exposed to a mean daily temperature of > 26.6°C (A "hot day," equivalent to a mean daily temperature of > 80°F) during T1 or T2. Binary logistic regression was used to investigate the relationship between maternal heat exposure and miscarriage. RESULTS A total of 105/3477 pregnancies included in our analysis ended in miscarriage (3.0%). Each additional hot day during T1 was associated with a 26% higher odds of miscarriage (odds ratio: 1.26; 95% confidence interval: 1.15-1.38). No significant associations were observed between maternal heat exposure during T2 and the odds of miscarriage (odds ratio: 0.94, 95% confidence interval: 0.73-1.20). The relationship between maternal heat exposure during T1 and the odds of miscarriage was J-shaped. CONCLUSION There is a clear relationship between maternal heat exposure during the month preceding conception and miscarriage in our sub-Saharan African setting. Given the lack of feasible strategies to reduce pregnancy loss associated with prevailing high temperatures in sub-Saharan Africa, progressive climate change will likely exacerbate existing challenges for women's reproductive health in this region.
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Affiliation(s)
- Yoshan Moodley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, South Africa
- Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kwabena Asare
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, KwaZulu-Natal, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation, School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa
| | - Andrew Tomita
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Congella, South Africa
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Ebogo-Belobo JT, Kenmoe S, Mbongue Mikangue CA, Tchatchouang S, Robertine LF, Takuissu GR, Ndzie Ondigui JL, Bowo-Ngandji A, Kenfack-Momo R, Kengne-Ndé C, Mbaga DS, Menkem EZ, Kame-Ngasse GI, Magoudjou-Pekam JN, Kenfack-Zanguim J, Esemu SN, Tagnouokam-Ngoupo PA, Ndip L, Njouom R. Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020. World J Crit Care Med 2023; 12:264-285. [PMID: 38188451 PMCID: PMC10768416 DOI: 10.5492/wjccm.v12.i5.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health. AIM To review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation. METHODS The study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test. RESULTS A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3). CONCLUSION The review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.
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Affiliation(s)
- Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | | | | | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala 00237, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde 00237, Cameroon
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11
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Jarolimova J, Chidumwa G, Chimbindi N, Okesola N, Dreyer J, Smit T, Seeley J, Harling G, Copas A, Baisley K, Shahmanesh M, Herbst (C, McGrath N, Zuma T, Khoza T, Behuhuma N, Bassett IV, Sherr L. Prevalence of Curable Sexually Transmitted Infections in a Population-Representative Sample of Young Adults in a High HIV Incidence Area in South Africa. Sex Transm Dis 2023; 50:796-803. [PMID: 37944161 PMCID: PMC10655853 DOI: 10.1097/olq.0000000000001871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Recent population-representative estimates of sexually transmitted infection (STI) prevalence in high HIV burden areas in southern Africa are limited. We estimated the prevalence and associated factors of 3 STIs among adolescents and young adults (AYA) in rural South Africa. METHODS Between March 2020 and May 2021, a population-representative sample of AYA aged 16 to 29 years were randomly selected from a Health and Demographic Surveillance Site in rural KwaZulu-Natal, South Africa, for a 2 × 2 factorial randomized controlled trial. Participants in 2 intervention arms were offered baseline testing for gonorrhea, chlamydia, and trichomoniasis using GeneXpert. Prevalence estimates were weighted for participation bias, and logistic regression models were used to assess factors associated with STIs. RESULTS Of 2323 eligible AYA, 1743 (75%) enrolled in the trial. Among 863 eligible for STI testing, 814 (94%) provided specimens (median age of 21.8 years, 52% female, and 71% residing in rural areas). Population-weighted prevalence estimates were 5.0% (95% confidence interval [CI], 4.2%-5.8%) for gonorrhea, 17.9% (16.5%-19.3%) for chlamydia, 5.4% (4.6%-6.3%) for trichomoniasis, and 23.7% (22.2%-25.3%) for any STI. In multivariable models, female sex (adjusted odds ratio [aOR], 2.24; 95% CI, 1.48-3.09) and urban/periurban (vs. rural) residence (aOR, 1.48; 95% CI, 1.02-2.15) were associated with STIs; recent migration was associated with lower odds of STI (aOR, 0.37; 95% CI, 0.15-0.89). Among those with an STI, 53 (31.0%) were treated within 7 days; median time to treatment was 11 days (interquartile range, 6-77 days). CONCLUSIONS We identified a high prevalence of curable STIs among AYA in rural South Africa. Improved access to STI testing to enable etiologic diagnosis and rapid treatment is needed.
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Affiliation(s)
| | - Glory Chidumwa
- Africa Health Research Institute, KwaZulu-Natal
- Wits Reproductive Health & HIV Institute (Wits Health Consortium), University of the Witswatersrand, Johannesburg, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal
- University College London, London, United Kingdom
- University of KwaZulu-Natal, Durban, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal
| | | | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal
- University of KwaZulu-Natal, Durban, South Africa
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal
- University College London, London, United Kingdom
- University of KwaZulu-Natal, Durban, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Copas
- University College London, London, United Kingdom
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal
- University College London, London, United Kingdom
- University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal
- University of KwaZulu-Natal, Durban, South Africa
- University of Southampton, Southampton
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal
- University College London, London, United Kingdom
- University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Ingrid V. Bassett
- From the Massachusetts General Hospital, Boston, MA
- Africa Health Research Institute, KwaZulu-Natal
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12
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Monod M, Brizzi A, Galiwango RM, Ssekubugu R, Chen Y, Xi X, Kankaka EN, Ssempijja V, Dörner LA, Akullian A, Blenkinsop A, Bonsall D, Chang LW, Dan S, Fraser C, Golubchik T, Gray RH, Hall M, Jackson JC, Kigozi G, Laeyendecker O, Mills LA, Quinn TC, Reynolds SJ, Santelli J, Sewankambo NK, Spencer SE, Ssekasanvu J, Thomson L, Wawer MJ, Serwadda D, Godfrey-Faussett P, Kagaayi J, Grabowski MK, Ratmann O. Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.16.23287351. [PMID: 36993261 PMCID: PMC10055554 DOI: 10.1101/2023.03.16.23287351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Uganda. We observed 1,117 individuals in the incidence cohort and 1,978 individuals in the transmission cohort. HIV viral suppression increased more rapidly in women than men, however incidence declined more slowly in women than men. We found that age-specific transmission flows shifted, while HIV transmission to girls and women (aged 15-24 years) from older men declined by about one third, transmission to women (aged 25-34 years) from men that were 0-6 years older increased by half in 2003 to 2018. Based on changes in transmission flows, we estimated that closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018. This study suggests that HIV programs to increase HIV suppression in men are critical to reduce incidence in women, close gender gaps in infection burden and improve men's health in Africa.
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13
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Currie DW, West CA, Patel HK, Favaloro J, Asiimwe F, Ndagije F, Silver R, Mugurungi O, Shang J, Ndongmo CB, Williams DB, Dzinotyiweyi E, Waruru A, Pasipamire M, Nuwagaba-Biribonwoha H, Dlamini S, McLeod N, Kayirangwa E, Rwibasira G, Minchella PA, Auld AF, Nyirenda R, Getaneh Y, Hailemariam AH, Tondoh-Koui I, Kohemun N, Mgomella GS, Njau PF, Kirungi WL, Dalhatu I, Stafford KA, Bodika SM, Ussery F, McCracken S, Stupp P, Brown K, Duong YT, Parekh BS, Voetsch AC. Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015-2019. Emerg Infect Dis 2023; 29:2325-2334. [PMID: 37877591 PMCID: PMC10617335 DOI: 10.3201/eid2911.230703] [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: 10/26/2023] Open
Abstract
Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15-49 years of age who had sex during the previous year and used a recent infection testing algorithm to distinguish recent from long-term infections. We collected risk factor information via participant interviews and assessed correlates of recent infection using multinomial logistic regression, incorporating each survey's complex sampling design. Compared with HIV-negative persons, persons with higher odds of recent HIV infection were women, were divorced/separated/widowed, had multiple recent sex partners, had a recent HIV-positive sex partner or one with unknown status, and lived in communities with higher HIV viremia prevalence. Prevention programs focusing on persons at higher risk for HIV and their sexual partners will contribute to reducing HIV incidence.
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14
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Medina-Marino A, Sibanda N, Putt M, Joseph Davey D, Smith P, Thirumurthy H, Bekker LG, Buttenheim A. Improving HIV testing, linkage, and retention in care among South African men through U=U messaging: A study protocol for two sequential hybrid type 1 effectiveness- implementation randomized controlled trials. RESEARCH SQUARE 2023:rs.3.rs-3349696. [PMID: 37886512 PMCID: PMC10602079 DOI: 10.21203/rs.3.rs-3349696/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Increasing HIV testing and treatment coverage among people living with HIV (PLHIV) is essential for achieving global AIDS epidemic control. However, compared to women, cis-gender heterosexual men living with HIV are significantly less likely to know their HIV status, initiate anti-retroviral therapy (ART) and achieve viral suppression. This is particularly true in South Africa, where men are also at increased risk of mortality resulting from AIDS-related illnesses. While there is growing knowledge of Treatment as Prevention or the concept Undetectable=Untransmittable (U=U) among PLHIV in Western and high-income countries, the reach and penetration of the U=U message in sub-Saharan Africa remains limited, and few studies have evaluated the impact of accessible and relatable U=U messages on ART initiation and adherence. To address these gaps, rigorous evaluations of interventions that incorporate U=U messages are needed, especially among men in high prevalence settings. METHODS Building on our U=U messages that we previously developed for men using behavioral economics insights and a human-centered design, we will conduct two sequential hybrid type 1 effectiveness-implementation trials to evaluate the impact of U=U messages on men's uptake of community-based HIV testing and ART initiation (Trial 1), and retention in care and achievement of viral suppression (Trial 2). A cluster randomized trial will be implemented for Trial 1, with HIV testing service site-days randomized to U=U or standard-of-care (SoC) messages inviting men to test for HIV. An individual-level randomized control trial will be implemented for Trial 2, with men initiating ART at six government clinics randomized to receive U=U counselling or SoC treatment adherence messaging. We will incorporate a multi-method evaluation to inform future implementation of U=U messaging interventions. The study will be conducted in the Buffalo City Metro Health District of the Eastern Cape Province and in the Cape Town Metro Health District in the Western Cape Province in South Africa. DISCUSSION These trials are the first to rigorously evaluate the impact of U=U messaging on HIV testing uptake, ART initiation and achievement of viral suppression among African men. If effective, these messaging interventions can shape global HIV testing, treatment and adherence counselling guidelines and practices.
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15
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Young R, Ssekasanvu J, Kagaayi J, Ssekubugu R, Kigozi G, Reynolds SJ, Wawer MJ, Nonyane BAS, Nantume B, Quinn TC, Tobian AAR, Santelli J, Chang LW, Kennedy CE, Paina L, Anglewicz PA, Serwadda D, Nalugoda F, Grabowski MK. HIV incidence among non-migrating persons following a household migration event: a population-based, longitudinal study in Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.23.23295865. [PMID: 37808671 PMCID: PMC10557776 DOI: 10.1101/2023.09.23.23295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda. Methods We used four survey rounds of data collected from July 2011-May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study, an open, population-based cohort. Non-migrants were individuals with no evidence of migration between surveys or at the prior survey. The primary exposure, household migration, was assessed using census data and defined as ≥1 household member migrating in or out of the house from another community between surveys (∼18 months). Incident HIV cases tested positive following a negative result at the preceding visit. Incidence rate ratios (IRR) with 95% confidence intervals were estimated using Poisson regression with generalized estimating equations and robust standard errors. Analyses were stratified by gender, migration into or out of the household, and the relationship between non-migrants and migrants (i.e., any household migration, spouse, child). Findings Overall, 11,318 non-migrants (5,674 women) were followed for 37,320 person-years. 28% (6,059/21,370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified in non-migrating household members. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV. However, HIV incidence among men was significantly higher when the spouse had recently migrated in (adjIRR:2·12;95%CI:1·05-4·27) or out (adjIRR:4·01;95%CI:2·16-7·44) compared to men with no spousal migration. Women with in- and out-migrant spouses also had higher HIV incidence, but results were not statistically significant. Interpretation HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses. Funding National Institutes of Health, US Centers for Disease Control and Prevention. Research in context We searched PubMed for studies focused on HIV acquisition, prevalence or sexual behaviors among non-migrants who lived with migrants in sub-Saharan Africa (SSA) using search terms such as "HIV", "Emigration and Immigration", "family", "spouses", "household", "parents", and "children". Despite high levels of migration and an established association with HIV risk in SSA, there is limited data on the broader societal impacts of migration on HIV acquisition risk among non-migrant populations directly impacted by it.There has been only one published study that has previously evaluated impact of migration on HIV incidence among non-migrating persons in sub-Saharan Africa. This study, which exclusively assessed spousal migration, was conducted in Tanzania more than two decades earlier prior to HIV treatment availability and found that non-migrant men with long-term mobile partners were more than four times as likely to acquire HIV compared to men who had partners that were residents. To the best of our knowledge, this is the first study to examine the effect of non-spousal migration, including any household migration and child migration, on HIV incidence among non-migrants. Added value of this study In this study, we used data from the Rakai Community Cohort Study (RCCS), a population-based HIV surveillance cohort to measure the impact of migration on HIV incidence for non-migrant household members. The RCCS captures HIV incident events through regular, repeat HIV testing of participants and migration events through household censuses. Our study adds to the current literature by examining the general effect of migration in the household on HIV incidence in addition to child, and spousal migration. Using data from over 11,000 non-migrant individuals, we found that spousal, but not other types of household migration, substantially increased HIV risk among non-migrants, especially among men. Taken together, our results suggest that spousal migration may be associated with an increased risk of HIV acquisition in the period surrounding and immediately after spousal migration. Implications of all the available evidence Our findings suggest that spousal migration in or out of the household is associated with greater HIV incidence. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for men with migrant spouses.
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Randera-Rees S, Clarence Safari W, Gareta D, Herbst K, Baisley K, Grant AD. Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa. Wellcome Open Res 2023; 6:169. [PMID: 37767058 PMCID: PMC10521066 DOI: 10.12688/wellcomeopenres.16702.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Methods: Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014-December 2017 and no HIV-related visits; and HIV-unknown otherwise. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0-36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6-25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6-13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. Conclusion: In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.
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Affiliation(s)
- Safiyya Randera-Rees
- Africa Health Research Institute, KwaZulu Natal, South Africa
- National Health Laboratory Services, Johannesburg, 2192, South Africa
| | - Wende Clarence Safari
- Africa Health Research Institute, KwaZulu Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu Natal, South Africa
- DSI-MRC, South African Population Research Infrastructure Network, KwaZulu Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu Natal, South Africa
- DSI-MRC, South African Population Research Infrastructure Network, KwaZulu Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu Natal, South Africa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Alison D. Grant
- Africa Health Research Institute, KwaZulu Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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17
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Busang J, Zuma T, Herbst C, Okesola N, Chimbindi N, Dreyer J, Mtshali N, Smit T, Ngubane S, Hlongwane S, Gumede D, Jalazi A, Mdluli S, Bird K, Msane S, Danisa P, Hanekom W, Lebina L, Behuhuma N, Hendrickson C, Miot J, Seeley J, Harling G, Jarolimova J, Sherr L, Copas A, Baisley K, Shahmanesh M. Thetha Nami ngithethe nawe (Let's Talk): a stepped-wedge cluster randomised trial of social mobilisation by peer navigators into community-based sexual health and HIV care, including pre-exposure prophylaxis (PrEP), to reduce sexually transmissible HIV amongst young people in rural KwaZulu-Natal, South Africa. BMC Public Health 2023; 23:1553. [PMID: 37582746 PMCID: PMC10428543 DOI: 10.1186/s12889-023-16262-x] [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: 04/12/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality and incidence. Effective ART based prevention has not translated into population-level impact in southern Africa due to sub-optimal coverage among youth. We aim to investigate the effectiveness, implementation and cost effectiveness of peer-led social mobilisation into decentralised integrated HIV and sexual reproductive health (SRH) services amongst adolescents and young adults in KwaZulu-Natal (KZN). METHODS We are conducting a type 1a hybrid effectiveness/implementation study, with a cluster randomized stepped-wedge trial (SWT) to assess effectiveness and a realist process evaluation to assess implementation outcomes. The SWT will be conducted in 40 clusters in rural KZN over 45 months. Clusters will be randomly allocated to receive the intervention in period 1 (early) or period 2 (delayed). 1) Intervention arm: Resident peer navigators in each cluster will approach young men and women aged 15-30 years living in their cluster to conduct health, social and educational needs assessment and tailor psychosocial support and health promotion, peer mentorship, and facilitate referrals into nurse led mobile clinics that visit each cluster regularly to deliver integrated SRH and differentiated HIV prevention (HIV testing, UTT for those positive, and PrEP for those eligible and negative). Standard of Care is UTT and PrEP delivered to 15-30 year olds from control clusters through primary health clinics. There are 3 co-primary outcomes measured amongst cross sectional surveys of 15-30 year olds: 1) effectiveness of the intervention in reducing the prevalence of sexually transmissible HIV; 2) uptake of universal risk informed HIV prevention intervention; 3) cost of transmissible HIV infection averted. We will use a realist process evaluation to interrogate the extent to which the intervention components support demand, uptake, and retention in risk-differentiated biomedical HIV prevention. DISCUSSION The findings of this trial will be used by policy makers to optimize delivery of universal differentiated HIV prevention, including HIV pre-exposure prophylaxis through peer-led mobilisation into community-based integrated adolescent and youth friendly HIV and sexual and reproductive health care. TRIAL REGISTRATION ClinicalTrials.gov Identifier-NCT05405582. Registered: 6th June 2022.
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Affiliation(s)
- Jacob Busang
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okesola
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nelisiwe Mtshali
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | | | - Dumsani Gumede
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Ashley Jalazi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | | | - Kristien Bird
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sithembile Msane
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Priscilla Danisa
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Willem Hanekom
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Limakatso Lebina
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - Ngundu Behuhuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Cheryl Hendrickson
- University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jacqui Miot
- University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Guy Harling
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, Durban, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Kathy Baisley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.
- Institute for Global Health, University College London, London, UK.
- University of KwaZulu-Natal, Durban, South Africa.
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Makofane K, Kim H, Tchetgen Tchetgen E, Bassett MT, Berkman L, Adeagbo O, McGrath N, Seeley J, Shahmanesh M, Yapa HM, Herbst K, Tanser F, Bärnighausen T. Impact of family networks on uptake of health interventions: evidence from a community-randomized control trial aimed at increasing HIV testing in South Africa. J Int AIDS Soc 2023; 26:e26142. [PMID: 37598389 PMCID: PMC10440100 DOI: 10.1002/jia2.26142] [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: 09/05/2022] [Accepted: 06/21/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION While it is widely acknowledged that family relationships can influence health outcomes, their impact on the uptake of individual health interventions is unclear. In this study, we quantified how the efficacy of a randomized health intervention is shaped by its pattern of distribution in the family network. METHODS The "Home-Based Intervention to Test and Start" (HITS) was a 2×2 factorial community-randomized controlled trial in Umkhanyakude, KwaZulu-Natal, South Africa, embedded in the Africa Health Research Institute's population-based demographic and HIV surveillance platform (ClinicalTrials.gov # NCT03757104). The study investigated the impact of two interventions: a financial micro-incentive and a male-targeted HIV-specific decision support programme. The surveillance area was divided into 45 community clusters. Individuals aged ≥15 years in 16 randomly selected communities were offered a micro-incentive (R50 [$3] food voucher) for rapid HIV testing (intervention arm). Those living in the remaining 29 communities were offered testing only (control arm). Study data were collected between February and November 2018. Using routinely collected data on parents, conjugal partners, and co-residents, a socio-centric family network was constructed among HITS-eligible individuals. Nodes in this network represent individuals and ties represent family relationships. We estimated the effect of offering the incentive to people with and without family members who also received the offer on the uptake of HIV testing. We fitted a linear probability model with robust standard errors, accounting for clustering at the community level. RESULTS Overall, 15,675 people participated in the HITS trial. Among those with no family members who received the offer, the incentive's efficacy was a 6.5 percentage point increase (95% CI: 5.3-7.7). The efficacy was higher among those with at least one family member who received the offer (21.1 percentage point increase (95% CI: 19.9-22.3). The difference in efficacy was statistically significant (21.1-6.5 = 14.6%; 95% CI: 9.3-19.9). CONCLUSIONS Micro-incentives appear to have synergistic effects when distributed within family networks. These effects support family network-based approaches for the design of health interventions.
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Affiliation(s)
- Keletso Makofane
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaUnited States
| | - Hae‐Young Kim
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
| | - Eric Tchetgen Tchetgen
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaUnited States
- Department of Statistics and Data Science, The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mary T. Bassett
- FXB Center for Health and Human RightsHarvard UniversityBostonMassachusettsUSA
| | - Lisa Berkman
- Harvard Center for Population and Development StudiesHarvard UniversityCambridgeUnited States
| | | | - Nuala McGrath
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
- Department of Social Statistics and DemographyUniversity of SouthamptonSouthamptonUK
| | - Janet Seeley
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Maryam Shahmanesh
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
| | - H. Manisha Yapa
- Kirby Institute for Infection and ImmunityUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kobus Herbst
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
| | - Frank Tanser
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
- Centre for Epidemic Response and Innovation, School for Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- School of Nursing and Public HealthUniversity of Kwa‐Zulu NatalDurbanSouth Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of Kwa‐Zulu NatalDurbanSouth Africa
| | - Till Bärnighausen
- Africa Health Research InstituteKwa‐Zulu NatalSouth Africa
- Heidelberg Institute of Global Health, Faculty of Medicine and University HospitalUniversity of HeidelbergHeidelbergGermany
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19
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Kileel EM, Zheng A, Bor J, Fox MP, Crowther NJ, George JA, Khoza S, Rosen S, Venter WD, Raal F, Hibberd P, Brennan AT. Does engagement in HIV care affect screening, diagnosis, and control of noncommunicable diseases in sub-Saharan Africa? A systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.30.23285196. [PMID: 36778439 PMCID: PMC9915817 DOI: 10.1101/2023.01.30.23285196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may also provide opportunities to increase access to NCD services in under-resourced environments. We sought to investigate whether reported use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and/or control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV (PLWH) in sub-Saharan Africa (SSA). Design Systematic review and meta-analysis. Methods We searched 10 electronic literature databases for studies published between 01 January 2011 and 31 December 2022 using a comprehensive search strategy. We sought studies reporting on screening, diagnosis, treatment, and/or control of NCDs of interest by ART use among non-pregnant adults with HIV ≥16 years of age in SSA. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. Results Twenty-six studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART, were included. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR: 1.07; 95% CI: 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR: 2.10, 95% CI: 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Conclusion Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.
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Affiliation(s)
- Emma M Kileel
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amy Zheng
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Siyabonga Khoza
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem Df Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick Raal
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Zaalberg A, Minnee E, Mayayo-Peralta I, Schuurman K, Gregoricchio S, van Schaik TA, Hoekman L, Li D, Corey E, Janssen H, Lieftink C, Prekovic S, Altelaar M, Nelson PS, Beijersbergen RL, Zwart W, Bergman A. A genome-wide CRISPR screen in human prostate cancer cells reveals drivers of macrophage-mediated cell killing and positions AR as a tumor-intrinsic immunomodulator. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.06.543873. [PMID: 37333335 PMCID: PMC10274642 DOI: 10.1101/2023.06.06.543873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The crosstalk between prostate cancer (PCa) cells and the tumor microenvironment plays a pivotal role in disease progression and metastasis and could provide novel opportunities for patient treatment. Macrophages are the most abundant immune cells in the prostate tumor microenvironment (TME) and are capable of killing tumor cells. To identify genes in the tumor cells that are critical for macrophage-mediated killing, we performed a genome-wide co-culture CRISPR screen and identified AR, PRKCD, and multiple components of the NF-κB pathway as hits, whose expression in the tumor cell are essential for being targeted and killed by macrophages. These data position AR signaling as an immunomodulator, and confirmed by androgen-deprivation experiments, that rendered hormone-deprived tumor cells resistant to macrophage-mediated killing. Proteomic analyses showed a downregulation of oxidative phosphorylation in the PRKCD- and IKBKG-KO cells compared to the control, suggesting impaired mitochondrial function, which was confirmed by electron microscopy analyses. Furthermore, phosphoproteomic analyses revealed that all hits impaired ferroptosis signaling, which was validated transcriptionally using samples from a neoadjuvant clinical trial with the AR-inhibitor enzalutamide. Collectively, our data demonstrate that AR functions together with the PRKCD and the NF-κB pathway to evade macrophage-mediated killing. As hormonal intervention represents the mainstay therapy for treatment of prostate cancer patients, our findings may have direct implications and provide a plausible explanation for the clinically observed persistence of tumor cells despite androgen deprivation therapy.
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21
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Callander D, McManus H, Gray RT, Grulich AE, Carr A, Hoy J, Donovan B, Fairley CK, Holt M, Templeton DJ, Liaw ST, McMahon JH, Asselin J, Petoumenos K, Hellard M, Pedrana A, Elliott J, Keen P, Costello J, Keane R, Kaldor J, Stoové M, Guy R. HIV treatment-as-prevention and its effect on incidence of HIV among cisgender gay, bisexual, and other men who have sex with men in Australia: a 10-year longitudinal cohort study. Lancet HIV 2023; 10:e385-e393. [PMID: 37068498 DOI: 10.1016/s2352-3018(23)00050-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Although HIV treatment-as-prevention reduces individual-level HIV transmission, population-level effects are unclear. We aimed to investigate whether treatment-as-prevention could achieve population-level reductions in HIV incidence among gay, bisexual, and other men who have sex with men (GBM) in Australia's most populous states, New South Wales and Victoria. METHODS TAIPAN was a longitudinal cohort study using routine health record data extracted from 69 health services that provide HIV diagnosis and care to GBM in New South Wales and Victoria, Australia. Data from Jan 1, 2010, to Dec 31, 2019, were linked within and between services and over time. TAIPAN collected data from all cisgender GBM who attended participating services, resided in New South Wales or Victoria, and were 16 years or older. Two cohorts were established: one included HIV-positive patients, and the other included HIV-negative patients. Population prevalence of viral suppression (plasma HIV viral load <200 RNA copies per μL) was calculated by combining direct measures of viral load among the HIV-positive cohort with estimates for undiagnosed GBM. The primary outcome of HIV incidence was measured directly via repeat testing in the HIV-negative cohort. Poisson regression analyses with generalised estimating equations assessed temporal associations between population prevalence of viral suppression and HIV incidence among the subsample of HIV-negative GBM with multiple instances of HIV testing. FINDINGS At baseline, the final sample (n=101 772) included 90 304 HIV-negative and 11 468 HIV-positive GBM. 59 234 patients in the HIV-negative cohort had two or more instances of HIV testing and were included in the primary analysis. Over the study period, population prevalence of viral suppression increased from 69·27% (95% CI 66·41-71·96) to 88·31% (86·37-90·35), while HIV incidence decreased from 0·64 per 100 person-years (95% CI 0·55-0·76) to 0·22 per 100 person-years (0·17-0·28). Adjusting for sociodemographic characteristics and HIV pre-exposure prophylaxis (PrEP) use, treatment-as-prevention achieved significant population-level reductions in HIV incidence among GBM: a 1% increase in population prevalence of viral suppression corresponded with a 6% decrease in HIV incidence (incidence rate ratio [IRR] 0·94, 95% CI 0·93-0·96; p<0·0001). PrEP was introduced in 2016 with 17·60% uptake among GBM that year, which increased to 36·38% in 2019. The relationship between population prevalence of viral suppression and HIV incidence was observed before the availability of PrEP (IRR 0·98, 95% CI 0·96-0·99; p<0·0001) and was even stronger after the introduction of PrEP (0·80, 0·70-0·93; p=0·0030). INTERPRETATION Our results suggest that further investment in HIV treatment, especially alongside PrEP, can improve public health by reducing HIV incidence among GBM. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Hamish McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Richard T Gray
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Carr
- HIV and Immunology Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Christopher K Fairley
- Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Positive Life New South Wales, Sydney, NSW, Australia
| | - Siaw-Teng Liaw
- School of Population Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James H McMahon
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | | | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Hellard
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; The Burnet Institute, Melbourne, VIC, Australia
| | | | - Julian Elliott
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Phillip Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jane Costello
- Positive Life New South Wales, Sydney, NSW, Australia
| | | | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark Stoové
- The Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Chimbindi N, Mthiyane N, Chidumwa G, Zuma T, Dreyer J, Birdthistle I, Floyd S, Kyegombe N, Grundy C, Cawood C, Danaviah S, Smit T, Pillay D, Baisley K, Harling G, Seeley J, Shahmanesh M. Evaluating use of mass-media communication intervention 'MTV-Shuga' on increased awareness and demand for HIV and sexual health services by adolescent girls and young women in South Africa: an observational study. BMJ Open 2023; 13:e062804. [PMID: 37208144 PMCID: PMC10201230 DOI: 10.1136/bmjopen-2022-062804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE To investigate the effect of exposure to MTV Shuga:Down South' (MTVShuga-DS) during the scale-up of combination HIV-prevention interventions on awareness and uptake of sexual reproductive health (SRH) and HIV-prevention services by adolescent girls and young women (AGYW). DESIGN One longitudinal and three cross-sectional surveys of representative samples of AGYW. SETTING AGYW in four South African districts with high HIV prevalence (>10%) (May 2017 and September 2019). PARTICIPANTS 6311 AGYW aged 12-24. MEASURES Using logistic regression, we measured the relationship between exposure to MTV Shuga-DS and awareness of pre-exposure prophylaxis (PrEP), condom use at last sex, uptake of HIV-testing or contraception, and incident pregnancy or herpes simplex virus 2 (HSV-2) infection. RESULTS Within the rural cohort 2184 (85.5%) of eligible sampled individuals were enrolled, of whom 92.6% had at least one follow-up visit; the urban cross-sectional surveys enrolled 4127 (22.6%) of eligible sampled individuals. Self-report of watching at least one MTV Shuga-DS episode was 14.1% (cohort) and 35.8% (cross-section), while storyline recall was 5.5% (cohort) and 6.7% (cross-section). In the cohort, after adjustment (for HIV-prevention intervention-exposure, age, education, socioeconomic status), MTVShuga-DS exposure was associated with increased PrEP awareness (adjusted OR (aOR) 2.06, 95% CI 1.57 to 2.70), contraception uptake (aOR 2.08, 95% CI 1.45 to 2.98) and consistent condom use (aOR 1.84, 95% CI 1.24 to 2.93), but not with HIV testing (aOR 1.02, 95% CI 0.77 to 1.21) or acquiring HSV-2 (aOR 0.92, 95% CI 0.61 to 1.38). In the cross-sections, MTVShuga-DS was associated with greater PrEP awareness (aOR 1.7, 95% CI 1.20 to 2.43), but no other outcome. CONCLUSIONS Among both urban and rural AGYW in South Africa, MTVShuga-DS exposure was associated with increased PrEP awareness and improved demand for some HIV prevention and SRH technologies but not sexual health outcomes. However, exposure to MTVShuga-DS was low. Given these positive indications, supportive programming may be required to raise exposure and allow future evaluation of edu-drama impact in this setting.
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Affiliation(s)
- Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | | | - Glory Chidumwa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Sian Floyd
- Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- MRC Uganda Virus Research Institute, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Grundy
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Siva Danaviah
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Infection and Immunity, University College London, London, UK
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
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Shri N, Bhattacharyya K, Dhamnetiya D, Singh M, Jha RP, Patel P. Long-term trends of HIV/AIDS incidence in India: an application of joinpoint and age-period-cohort analyses: a gendered perspective. Front Public Health 2023; 11:1093310. [PMID: 37261236 PMCID: PMC10227429 DOI: 10.3389/fpubh.2023.1093310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/06/2023] [Indexed: 06/02/2023] Open
Abstract
Background Monitoring the transmission patterns of human immunodeficiency virus (HIV) in a population is fundamental for identifying the key population and designing prevention interventions. In the present study, we aimed to estimate the gender disparities in HIV incidence and the age, period, and cohort effects on the incidence of HIV in India for identifying the predictors that might have led to changes in the last three decades. Data and methods This study utilizes data from the Global Burden of Disease Study for the period 1990-2019. The joinpoint regression analysis was employed to identify the magnitude of the changes in age-standardized incidence rates (ASIRs) of HIV. The average annual percentage changes in the incidence were computed, and the age-period-cohort analysis was performed. Results A decreasing trend in the overall estimates of age-standardized HIV incidence rates were observed in the period 1990-2019. The joinpoint regression analysis showed that the age-standardized incidence significantly declined from its peak in 1997 to 2019 (38.0 and 27.6 among males and females per 100,000 in 1997 to 5.4 and 4.6, respectively, in 2019). The APC was estimated to be 2.12 among males and 1.24 among females for the period 1990-2019. In recent years, although the gender gap in HIV incidence has reduced, females were observed to bear a proportionately higher burden of HIV incidence. Age effect showed a decline in HIV incidence by 91.1 and 70.1% among males and females aged between 15-19 years and 75-79 years. During the entire period from 1990-1994 to 2015-2019, the RR of HIV incidence decreased by 36.2 and 33.7% among males and females, respectively. Conclusion India is experiencing a decline in new HIV infections in recent years. However, the decline is steeper for males than for females. Findings highlight the necessity of providing older women and young women at risk with effective HIV prevention. This study emphasizes the need for large-scale HIV primary prevention efforts for teenage girls and young women.
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Affiliation(s)
- Neha Shri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | | | - Deepak Dhamnetiya
- Scientist II (Epidemiology), Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Singh
- Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India
| | - Ravi Prakash Jha
- Department of Community Medicine Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India
| | - Priyanka Patel
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
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24
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Luseno WK, Rennie S, Gilbertson A. A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa. Int J Impot Res 2023; 35:269-278. [PMID: 34702986 PMCID: PMC8545773 DOI: 10.1038/s41443-021-00484-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Ideally, the benefits of public health interventions should outweigh any associated harms, burdens, and adverse unintended consequences. The intended benefit of voluntary medical male circumcision (VMMC) programs in eastern and southern Africa (ESA) is the reduction of HIV infections. We review the literature for evidence of reductions in HIV incidence, evaluate the extent to which decreases in HIV incidence can be reasonably attributed to VMMC programs, and summarize social harms and ethical concerns associated with these programs. Review findings suggest that HIV incidence had been declining across ESA since before the large-scale rollout of VMMC as a public health intervention, and that this decline may be due to the combined effects of HIV prevention and treatment interventions, such as expanded antiretroviral therapy. The independent effect of VMMC programs in reducing HIV infections at the population level remains unknown. On the other hand, VMMC-associated evidence is increasing for the existence of negative social impacts such as stigmatization and/or discrimination, and ethically problematic practices, including lack of informed consent. We conclude that the relationship between the benefits and burdens of VMMC programs may be more unfavorable than what has been commonly suggested by proponents of global VMMC campaigns.
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Affiliation(s)
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Center for Bioethics, University of North Carolina, Chapel Hill, NC, USA
| | - Adam Gilbertson
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA
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25
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Monavarfeshani A, Yan W, Pappas C, Odenigbo KA, He Z, Segrè AV, van Zyl T, Hageman GS, Sanes JR. Transcriptomic Analysis of the Ocular Posterior Segment Completes a Cell Atlas of the Human Eye. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.26.538447. [PMID: 37162855 PMCID: PMC10168356 DOI: 10.1101/2023.04.26.538447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Although the visual system extends through the brain, most vision loss originates from defects in the eye. Its central element is the neural retina, which senses light, processes visual signals, and transmits them to the rest of the brain through the optic nerve (ON). Surrounding the retina are numerous other structures, conventionally divided into anterior and posterior segments. Here we used high-throughput single nucleus RNA sequencing (snRNA-seq) to classify and characterize cells in the extraretinal components of the posterior segment: ON, optic nerve head (ONH), peripheral sclera, peripapillary sclera (PPS), choroid, and retinal pigment epithelium (RPE). Defects in each of these tissues are associated with blinding diseases - for example, glaucoma (ONH and PPS), optic neuritis (ON), retinitis pigmentosa (RPE), and age-related macular degeneration (RPE and choroid). From ∼151,000 single nuclei, we identified 37 transcriptomically distinct cell types, including multiple types of astrocytes, oligodendrocytes, fibroblasts, and vascular endothelial cells. Our analyses revealed a differential distribution of many cell types among distinct structures. Together with our previous analyses of the anterior segment and retina, the new data complete a "Version 1" cell atlas of the human eye. We used this atlas to map the expression of >180 genes associated with the risk of developing glaucoma, which is known to involve ocular tissues in both anterior and posterior segments as well as neural retina. Similar methods can be used to investigate numerous additional ocular diseases, many of which are currently untreatable.
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Affiliation(s)
- Aboozar Monavarfeshani
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA, USA
- Equal contributions
| | - Wenjun Yan
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
- Equal contributions
| | - Christian Pappas
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Kenechukwu A. Odenigbo
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
| | - Zhigang He
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA, USA
| | - Ayellet V. Segrè
- Department of Ophthalmology, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA 02114
- Broad Institute of Harvard and MIT, Cambridge, MA
| | - Tavé van Zyl
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
- Department of Ophthalmology, Harvard Medical School and Massachusetts Eye and Ear, Boston, MA 02114
- Present address: Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT 06510
| | - Gregory S. Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Joshua R. Sanes
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138
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26
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Rosseto JHF, Tenório JR, Mamana AC, Tozetto-Mendoza TR, Andrade NS, Braz-Silva PH, Ortega KL. Epstein-Barr virus oral shedding and viremia and their association with oral hairy leukoplakia in HIV+ individuals. Oral Dis 2023; 29:796-802. [PMID: 34379873 DOI: 10.1111/odi.14001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the oral shedding and viremia of Epstein-Barr virus (EBV) in HIV-positive patients and their relationship with oral hairy leukoplakia (OHL). METHODOLOGY A total of 94 HIV-positive patients were included in the study, in which blood and saliva samples were collected for EBV quantification. Data on gender, age, time of HIV seropositivity, combined antiretroviral therapy (cART), CD4+ T-cell counts, and HIV viral load were collected. OHL diagnosis was based on histopathological examination and EBV in situ hybridization. RESULTS The EBV load in the 94 HIV-positive patients was higher in saliva than in blood (2.4 and 1.6, respectively), and there was a positive correlation between EBV oral shedding and viremia (p = 0.001). Twenty (21.27%) patients had OHL and also a higher EBV load in saliva (mean log10 = 3.11) compared to those who had no OHL (p = 0.045). Presence of OHL was only associated with age (p = 0.030). CONCLUSION In HIV-positive patients, the presence of OHL was associated with EBV oral shedding but not with viremia, regardless of the amount of circulating CD4+ T cells.
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Affiliation(s)
| | - Jefferson Rocha Tenório
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Department of Pathology and Oral Diagnosis, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Mamana
- Laboratory of Virology, School of Medicine, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Tânia Regina Tozetto-Mendoza
- Laboratory of Virology, School of Medicine, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Natália Silva Andrade
- Department of Dentistry, School of Dentistry, Federal University of Sergipe, Lagarto, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Virology, School of Medicine, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Karem L Ortega
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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27
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2023; 6:327. [PMID: 37416502 PMCID: PMC10320326 DOI: 10.12688/wellcomeopenres.17307.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 10/30/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan-Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003-2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15-54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1-4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003-2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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Affiliation(s)
- Mark Otiende
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Evasius Bauni
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amek Nyaguara
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Amadi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Christopher Nyundo
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Emmanuel Tsory
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Walumbe
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kinuthia
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Norbert Kihuha
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kahindi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Gideon Nyutu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Jennifer Moisi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amare Deribew
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Kevin Marsh
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Philip Bejon
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - J. Anthony G. Scott
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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28
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Manso-Ortega L, De Frutos-Sagastuy L, Gisbert- Muñoz S, Salamon N, Qiao J, Walshaw P, Quiñones I, Połczyńska MM. Grey matter reshaping of language-related regions depends on tumor lateralization. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.02.526219. [PMID: 36778417 PMCID: PMC9915653 DOI: 10.1101/2023.02.02.526219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A brain tumor in the left hemisphere can decrease language laterality as assessed with fMRI. However, it remains unclear whether or not this decreased language laterality is associated with a structural reshaping of the grey matter, particularly within the language network. Here, we examine if the disruption of language hubs exclusively affects macrostructural properties of contralateral homologues (as suggested by previous research), or whether it affects both hemispheres. This study uses voxel-based morphometry applied to high-resolution MR T1-weighted MPRAGE images from 31 adult patients left-dominant for language. Eighteen patients had brain tumors in the left hemisphere, and 13 had tumors in the right hemisphere. A cohort of 71 healthy individuals matched on age and sex was used as a baseline. We defined 10 ROIs per hemisphere known to subserve language function. Two separate repeated-measures ANOVAs were conducted with the volume per region as the dependent variables. For the patients, tumor lateralization (right versus left) served as a between-subject factor. The current study demonstrated that the presence of a brain tumor generates a global volumetric change affecting left language regions and their contralateral homologues. These changes are mediated by the lateralization of the lesion. Our findings suggest that compensatory functional mechanisms are supported by the rearrangement of the grey matter, although future longitudinal research should determine the temporal course of such changes.
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Affiliation(s)
- Lucia Manso-Ortega
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- University of the Basque Country, Bilbao, Spain
| | | | - Sandra Gisbert- Muñoz
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
- University of the Basque Country, Bilbao, Spain
| | - Noriko Salamon
- Dept. of Radiology, University of California, Los Angeles, USA
| | - Joe Qiao
- Dept. of Radiology, University of California, Los Angeles, USA
| | - Patricia Walshaw
- Dept. of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Ileana Quiñones
- Basque Center on Cognition, Brain and Language, BCBL, Donostia-San Sebastian, Spain
| | - Monika M. Połczyńska
- Dept. of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
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29
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Li Z, Li T, Yates ME, Wu Y, Ferber A, Chen L, Brown DD, Carroll JS, Sikora MJ, Tseng GC, Oesterreich S, Lee AV. EstroGene database reveals diverse temporal, context-dependent and directional estrogen receptor regulomes in breast cancer. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.30.526388. [PMID: 36778377 PMCID: PMC9915613 DOI: 10.1101/2023.01.30.526388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As one of the most successful cancer therapeutic targets, estrogen receptor-α (ER/ESR1) has been extensively studied in decade-long. Sequencing technological advances have enabled genome-wide analysis of ER action. However, reproducibility is limited by different experimental design. Here, we established the EstroGene database through centralizing 246 experiments from 136 transcriptomic, cistromic and epigenetic datasets focusing on estradiol-treated ER activation across 19 breast cancer cell lines. We generated a user-friendly browser ( https://estrogene.org/ ) for data visualization and gene inquiry under user-defined experimental conditions and statistical thresholds. Notably, documentation-based meta-analysis revealed a considerable lack of experimental details. Comparison of independent RNA-seq or ER ChIP-seq data with the same design showed large variability and only strong effects could be consistently detected. We defined temporal estrogen response metasignatures and showed the association with specific transcriptional factors, chromatin accessibility and ER heterogeneity. Unexpectedly, harmonizing 146 transcriptomic analyses uncovered a subset of E2-bidirectionally regulated genes, which linked to immune surveillance in the clinical setting. Furthermore, we defined context dependent E2 response programs in MCF7 and T47D cell lines, the two most frequently used models in the field. Collectively, the EstroGene database provides an informative resource to the cancer research community and reveals a diverse mode of ER signaling.
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Affiliation(s)
- Zheqi Li
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh PA, USA
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
| | - Tianqin Li
- School of Computer Science, Carnegie Mellon University, Pittsburgh PA, USA
| | - Megan E. Yates
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
- Integrative Systems Biology Program, University of Pittsburgh, Pittsburgh, PA, USA
- Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yang Wu
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
- School of Medicine, Tsinghua University, Beijing, China
| | - Amanda Ferber
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
| | - Lyuqin Chen
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh PA, USA
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
| | - Daniel D. Brown
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
- Institute for Precision Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason S. Carroll
- Cancer Research UK, Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Matthew J. Sikora
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - George C. Tseng
- Department of Biostatistics, University of Pittsburgh, Pittsburgh PA, USA
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh PA, USA
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
- Integrative Systems Biology Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adrian V. Lee
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh PA, USA
- Women’s Cancer Research Center, Magee Women’s Research Institute, UPMC Hillman Cancer Center, Pittsburgh PA, USA
- Integrative Systems Biology Program, University of Pittsburgh, Pittsburgh, PA, USA
- Institute for Precision Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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30
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Morar NS, Mansoor LE, Naidoo K, Katz AWK, Garcia M, Duma C, Tshbalala T, Naidoo S, Montgomery ET. Male Partner Opinions of the Dapivirine Vaginal Ring Used During an Open-Label Extension HIV Prevention Trial in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 2023; 92:127-133. [PMID: 36302179 PMCID: PMC9839591 DOI: 10.1097/qai.0000000000003119] [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: 12/23/2021] [Accepted: 10/04/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The dapivirine vaginal ring ("the ring") reduced HIV acquisition by about 35% in phase III trials, with modeling from open-label extension trials estimating 50% HIV protection with consistent use. The ring may be used without male partner knowledge. The Assessment of ASPIRE and HOPE Adherence (AHA) substudy aimed to understand the impact of sociocontextual issues on ring adherence. This subanalysis provides insight into disclosure and male partner influence on ring acceptability. METHODS Data were collected using 4 focus group discussions with 18 male partners of phase III trial participants at 2 sites in KwaZulu-Natal, South Africa. Qualitative data were coded, summarized by urban vs. rural location, and analyzed thematically. RESULTS Male partners aged 23-49 years wanted to be informed about the ring use to maintain the trust in their relationships. Their initial response to the ring was characterized by fear due to perceived impact of the ring on their female partner's reproductive system, their penile safety, and that the ring would encourage women to engage in unprotected sex and infidelity. Over time and with information and experience with having a partner who had used the vaginal ring, this fear transformed to support for women to have their own HIV prevention option. CONCLUSION Male partners supported the ring as an HIV prevention method for women but wanted to be informed about its use. Engaging male partners on female-initiated HIV prevention methods and increased education among rural men may contribute to improved partner support and facilitate women's consistent use.
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Affiliation(s)
- Neetha S Morar
- HIV Prevention Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Kalendri Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Ariana WK Katz
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
| | - Morgan Garcia
- Global Health Population and Nutrition, FHI 360, Durham, NC, USA
| | - Cebo Duma
- HIV Prevention Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | | | - Themba Tshbalala
- HIV Prevention Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
- The Aurum Institute, Johannesburg, South Africa
| | - Elizabeth T Montgomery
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
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31
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Lewis L, Kharsany ABM, Humphries H, Maughan-Brown B, Beckett S, Govender K, Cawood C, Khanyile D, George G. HIV incidence and associated risk factors in adolescent girls and young women in South Africa: A population-based cohort study. PLoS One 2022; 17:e0279289. [PMID: 36542645 PMCID: PMC9770356 DOI: 10.1371/journal.pone.0279289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, high HIV incidence rates in adolescent girls and young women (AGYW) persist despite extensive HIV prevention efforts. METHODS A prospective cohort of 2,710 HIV-negative AGYW (15-24 years) in KwaZulu-Natal, South Africa were interviewed at baseline and followed-up approximately 18 months later (2014-2017). Associations between HIV seroconversion and socio-demographic and behavioural variables measured at baseline and follow-up were examined using Cox regression and a proximate determinants framework. Inter-relationships between determinants were measured using logistic regression. Separate models were built for 15-19 and 20-24-year-olds. RESULTS Weighted HIV incidence was 3.92 per 100 person-years (95% confidence interval: 3.27-4.69; 163 seroconversions over 4,016 person-years). Among 15-19-year-olds, absence of family support (adjusted hazards ratio (aHR): 3.82 (1.89-7.72)), having a circumcised partner (aHR: 0.5 (0.27-0.94)) or one who was HIV-positive and not on antiretroviral therapy (ART) (aHR: 6.21 (2.56-15.06)) were associated with HIV incidence. Those reporting an absence of family support were also more likely to report >1 partner during follow-up (odds ratio (OR): 2.7(1.11-6.57)). Among 20-24-year-olds, failure to complete secondary school (aHR: 1.89 (1.11-3.21)), inconsistent condom use (aHR: 3.01 (1.14-7.96)) and reporting partner(s) who were HIV-positive and not on ART (aHR: 7.75 (3.06-19.66)) were associated with HIV incidence. Failure to complete secondary school among 20-24-year-olds was associated with inconsistent condom use (OR: 1.82 (1.20-2.77)) and reporting an HIV-positive partner not on ART (OR: 3.53(1.59-7.82)) or an uncircumcised partner (OR: 1.39 (1.08-1.82). CONCLUSION Absence of family support and incomplete schooling are associated with risky sexual behaviours and HIV acquisition in AGYW. In addition, partner-level prevention-condom use, medical circumcision, and viral suppression-continue to play an important role in reducing HIV risk in AGYW. These findings support the use of combination HIV prevention programs that consider structural as well as biological and behavioural HIV risk factors in their design.
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Affiliation(s)
- Lara Lewis
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,* E-mail:
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,School of Laboratory Medicine and Medical Science, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sean Beckett
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDs Risk Management, Cape Town, South Africa
| | | | - Gavin George
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa,Division of Social Medicine and Global Health, Lund University, Lund, Sweden
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Haeuser E, Serfes AL, Cork MA, Yang M, Abbastabar H, Abhilash ES, Adabi M, Adebayo OM, Adekanmbi V, Adeyinka DA, Afzal S, Ahinkorah BO, Ahmadi K, Ahmed MB, Akalu Y, Akinyemi RO, Akunna CJ, Alahdab F, Alanezi FM, Alanzi TM, Alene KA, Alhassan RK, Alipour V, Almasi-Hashiani A, Alvis-Guzman N, Ameyaw EK, Amini S, Amugsi DA, Ancuceanu R, Anvari D, Appiah SCY, Arabloo J, Aremu O, Asemahagn MA, Jafarabadi MA, Awedew AF, Quintanilla BPA, Ayanore MA, Aynalem YA, Azari S, Azene ZN, Darshan BB, Babalola TK, Baig AA, Banach M, Bärnighausen TW, Bell AW, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bijani A, Bitew ZW, Bohlouli S, Bolarinwa OA, Boloor A, Bozicevic I, Butt ZA, Cárdenas R, Carvalho F, Charan J, Chattu VK, Chowdhury MAK, Chu DT, Cowden RG, Dahlawi SMA, Damiani G, Darteh EKM, Darwesh AM, das Neves J, Weaver ND, De Leo D, De Neve JW, Deribe K, Deuba K, Dharmaratne S, Dianatinasab M, Diaz D, Didarloo A, Djalalinia S, Dorostkar F, Dubljanin E, Duko B, El Tantawi M, El-Jaafary SI, Eshrati B, Eskandarieh S, Eyawo O, Ezeonwumelu IJ, Ezzikouri S, Farzadfar F, Fattahi N, Fauk NK, Fernandes E, Filip I, Fischer F, Foigt NA, Foroutan M, Fukumoto T, Gad MM, Gaidhane AM, Gebregiorgis BG, Gebremedhin KB, Getacher L, Ghadiri K, Ghashghaee A, Golechha M, Gubari MIM, Gugnani HC, Guimarães RA, Haider MR, Haj-Mirzaian A, Hamidi S, Hashi A, Hassanipour S, Hassankhani H, Hayat K, Herteliu C, Ho HC, Holla R, Hosseini M, Hosseinzadeh M, Hwang BF, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Islam RM, Iwu CCD, Jakovljevic M, Jha RP, Ji JS, Johnson KB, Joseph N, Joshua V, Joukar F, Jozwiak JJ, Kalankesh LR, Kalhor R, Kamyari N, Kanchan T, Matin BK, Karimi SE, Kayode GA, Karyani AK, Keramati M, Khan EA, Khan G, Khan MN, Khatab K, Khubchandani J, Kim YJ, Kisa A, Kisa S, Kopec JA, Kosen S, Laxminarayana SLK, Koyanagi A, Krishan K, Defo BK, Kugbey N, Kulkarni V, Kumar M, Kumar N, Kusuma D, La Vecchia C, Lal DK, Landires I, Larson HJ, Lasrado S, Lee PH, Li S, Liu X, Maleki A, Malik P, Mansournia MA, Martins-Melo FR, Mendoza W, Menezes RG, Mengesha EW, Meretoja TJ, Mestrovic T, Mirica A, Moazen B, Mohamad O, Mohammad Y, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed S, Mohammed S, Mokdad AH, Moradi M, Moraga P, Mubarik S, Mulu GBB, Mwanri L, Nagarajan AJ, Naimzada MD, Naveed M, Nazari J, Ndejjo R, Negoi I, Ngalesoni FN, Nguefack-Tsague G, Ngunjiri JW, Nguyen CT, Nguyen HLT, Nnaji CA, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Odukoya OO, Olagunju AT, Olakunde BO, Olusanya BO, Olusanya JO, Bali AO, Onwujekwe OE, Orisakwe OE, Otstavnov N, Otstavnov SS, Owolabi MO, Mahesh PA, Padubidri JR, Pana A, Pandey A, Pandi-Perumal SR, Kan FP, Patton GC, Pawar S, Peprah EK, Postma MJ, Preotescu L, Syed ZQ, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahmani AM, Ramezanzadeh K, Rana J, Ranabhat CL, Rao SJ, Rawaf DL, Rawaf S, Rawassizadeh R, Regassa LD, Rezaei N, Rezapour A, Riaz MA, Ribeiro AI, Ross JM, Rubagotti E, Rumisha SF, Rwegerera GM, Moghaddam SS, Sagar R, Sahiledengle B, Sahu M, Salem MR, Kafil HS, Samy AM, Sartorius B, Sathian B, Seidu AA, Shaheen AA, Shaikh MA, Shamsizadeh M, Shiferaw WS, Shin JI, Shrestha R, Singh JA, Skryabin VY, Skryabina AA, Soltani S, Sufiyan MB, Tabuchi T, Tadesse EG, Taveira N, Tesfay FH, Thapar R, Tovani-Palone MR, Tsegaye GW, Umeokonkwo CD, Unnikrishnan B, Villafañe JH, Violante FS, Vo B, Vu GT, Wado YD, Waheed Y, Wamai RG, Wang Y, Ward P, Wickramasinghe ND, Wilson K, Yaya S, Yip P, Yonemoto N, Yu C, Zastrozhin MS, Zhang Y, Zhang ZJ, Hay SI, Dwyer-Lindgren L. Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018. BMC Med 2022; 20:488. [PMID: 36529768 PMCID: PMC9760541 DOI: 10.1186/s12916-022-02639-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.
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Affiliation(s)
- Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Audrey L Serfes
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael A Cork
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mingyou Yang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hedayat Abbastabar
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - E S Abhilash
- Department of Botany, Sree Narayana Guru College Chelannur, Kozhikode, India
| | - Maryam Adabi
- Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Victor Adekanmbi
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - Daniel Adedayo Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Saira Afzal
- Department of Community Medicine, King Edward Memorial Hospital, Lahore, Pakistan
- Department of Public Health, Public Health Institute, Lahore, Pakistan
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, NSW, Australia
| | - Keivan Ahmadi
- School of Public Health, Imperial College London, London, UK
| | - Muktar Beshir Ahmed
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
- Australian Center for Precision Health, University of South Australia, Adelaide, SA, Australia
| | - Yonas Akalu
- Department of Medical Physiology, University of Gondar, Gondar, Ethiopia
| | - Rufus Olusola Akinyemi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Chisom Joyqueenet Akunna
- Department of Public Health, The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria
- Department of Public Health, Federal Ministry of Health, Garki, Nigeria
| | - Fares Alahdab
- Mayo Evidence-based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | | | - Turki M Alanzi
- Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia
| | - Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nelson Alvis-Guzman
- Research Group in Hospital Management and Health Policies, Universidad de la Costa (University of the Coast), Barranquilla, Colombia
- Research Group in Health Economics, University of Cartagena, Cartagena, Colombia
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, NSW, Australia
| | - Saeed Amini
- Department of Health Services Management, Khomein University of Medical Sciences, Khomein, Iran
| | - Dickson A Amugsi
- Department of Maternal and Child Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | - Robert Ancuceanu
- Pharmacy Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Davood Anvari
- Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Parasitology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Olatunde Aremu
- Department of Public Health, Birmingham City University, Birmingham, UK
| | | | - Mohammad Asghari Jafarabadi
- Department of Biostatistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Biostatistics and Epidemiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | | | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
- Department of Health Economics, Centre for Health Policy Advocacy Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana
| | | | - Samad Azari
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - B B Darshan
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Tesleem Kayode Babalola
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria
| | - Atif Amin Baig
- Unit of Biochemistry, Universiti Sultan Zainal Abidin (Sultan Zainal Abidin University), Kuala Terengganu, Malaysia
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Arielle Wilder Bell
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
- Department of Social Services, Tufts Medical Center, Boston, MA, USA
| | - Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nikha Bhardwaj
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
- School of Public Health, All India Institute of Medical Sciences, Jodhpur, India
| | - Krittika Bhattacharyya
- Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
- Department of Statistics, University of Calcutta, Kolkata, India
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Zebenay Workneh Bitew
- Nutrition Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Somayeh Bohlouli
- Department of Veterinary Medicine, Islamic Azad University, Kermanshah, Iran
| | | | - Archith Boloor
- Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Ivana Bozicevic
- WHO Collaborating Centre for HIV Strategic Information, University of Zagreb, Zagreb, Croatia
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Rosario Cárdenas
- Department of Health Care, Metropolitan Autonomous University, Mexico City, Mexico
| | - Felix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijay Kumar Chattu
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi, India
- Saveetha Medical College, Saveetha University, Chennai, India
| | - Mohiuddin Ahsanul Kabir Chowdhury
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, VNU-International School, Hanoi, Vietnam
| | - Richard G Cowden
- Department of Psychology, University of the Free State, Park West, South Africa
| | - Saad M A Dahlawi
- Environmental Health Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Giovanni Damiani
- IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | - José das Neves
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
- Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Keshab Deuba
- National Centre for AIDS and STD Control, Save the Children, Kathmandu, Nepal
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Samath Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mostafa Dianatinasab
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Daniel Diaz
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico
- Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Rosales, Culiacán, Mexico
| | - Alireza Didarloo
- Department of Community Medicine and Public Health, Urmia University of Medical Science, Urmia, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Fariba Dorostkar
- Department of Medical Laboratory Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Eleonora Dubljanin
- Institute of Microbiology and Immunology, University of Belgrade, Belgrade, Serbia
| | - Bereket Duko
- School of Public Health, Hawassa University, Hawassa, Ethiopia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt
| | | | - Babak Eshrati
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ifeanyi Jude Ezeonwumelu
- Institute for Health Science Research Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
- IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Sayeh Ezzikouri
- Department of Virology, Pasteur Institute of Morocco, Casablanca, Morocco
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazir Fattahi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nelsensius Klau Fauk
- Torrens University Australia, Adelaide, SA, Australia
- Institute of Resource Governance and Social Change, Kupang, Indonesia
| | - Eduarda Fernandes
- Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
- School of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
| | - Nataliya A Foigt
- Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Masoud Foroutan
- Department of Medical Parasitology, Abadan University of Medical Sciences, Abadan, Iran
- Faculty of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | | | - Mohamed M Gad
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Lemma Getacher
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | - Keyghobad Ghadiri
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Pediatric Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahmad Ghashghaee
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahaveer Golechha
- Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
| | | | - Harish Chander Gugnani
- Department of Microbiology, Saint James School of Medicine, The Valley, Anguilla
- Department of Epidemiology, Saint James School of Medicine, The Valley, Anguilla
| | | | | | - Arvin Haj-Mirzaian
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Abdiwahab Hashi
- Department of Public Health, Jigjiga University, Jijiga, Ethiopia
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
| | - Claudiu Herteliu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- School of Business, London South Bank University, London, UK
| | - Hung Chak Ho
- Department of Urban Planning and Design, University of Hong Kong, Hong Kong, China
| | - Ramesh Holla
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq
| | - Bing-Fang Hwang
- Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan
| | | | - Olayinka Stephen Ilesanmi
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Irena M Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milena D Ilic
- Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
| | - Rakibul M Islam
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chidozie C D Iwu
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
| | - Ravi Prakash Jha
- Department of Community Medicine, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, India
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kimberly B Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nitin Joseph
- Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Vasna Joshua
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Leila R Kalankesh
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rohollah Kalhor
- Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Naser Kamyari
- Department of Biostatistics, Abadan University of Medical Sciences, Abadan, Iran
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
| | - Behzad Karami Matin
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Gbenga A Kayode
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, Netherlands
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ejaz Ahmad Khan
- Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan
| | - Gulfaraz Khan
- Department of Medical Microbiology & Immunology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
- College of Arts and Sciences, Ohio University, Zanesville, OH, USA
| | | | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Jacek A Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Richmond, Canada
| | | | | | - Ai Koyanagi
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Barthelemy Kuate Defo
- Department of Demography, University of Montreal, Montreal, QC, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Nuworza Kugbey
- University of Environment and Sustainable Development, Somanya, Ghana
| | - Vaman Kulkarni
- Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Nithin Kumar
- Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Dian Kusuma
- Imperial College Business School, Imperial College London, London, UK
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Iván Landires
- Unit of Genetics and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Ministry of Health, Herrera, Panama
| | - Heidi Jane Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
| | - Paul H Lee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Xuefeng Liu
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Science, Case Western Reserve University, Cleveland, OH, USA
| | - Afshin Maleki
- Department of Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Preeti Malik
- Department of Pediatrics, Montefiore Medical Center, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Andreea Mirica
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Salahuddin Mohammed
- Department of Biomolecular Sciences, University of Mississippi, Oxford, MS, USA
- Department of Pharmacy, Mizan-Tepi University, Mizan, Ethiopia
| | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Masoud Moradi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Paula Moraga
- Computer, Electrical, and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Getaneh Baye B Mulu
- Department of Pediatrics and Child Health, Debre Berhan University, Debre Berhan, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adeaide, SA, Australia
| | - Ahamarshan Jayaraman Nagarajan
- Research and Analytics Department, Initiative for Financing Health and Human Development, Chennai, India
- Department of Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Mukhammad David Naimzada
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Experimental Surgery and Oncology Laboratory, Kursk State Medical University, Kursk, Russia
| | - Muhammad Naveed
- Department of Biotechnology, University of Central Punjab, Lahore, Pakistan
| | - Javad Nazari
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Ionut Negoi
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Frida N Ngalesoni
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | | | - Chukwudi A Nnaji
- South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
| | - Virginia Nuñez-Samudio
- Unit of Microbiology and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Department of Public Health, Ministry of Health, Herrera, Panama
| | - Vincent Ebuka Nwatah
- Department of Pediatrics, National Hospital, Abuja, Nigeria
- Department of International Public Health, University of Liverpool, Liverpool, UK
| | - Bogdan Oancea
- Administrative and Economic Sciences Department, University of Bucharest, Bucharest, Romania
| | - Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, University of Lagos, Idi Araba, Nigeria
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | | | | | | | - Ahmed Omar Bali
- Diplomacy and Public Relations Department, University of Human Development, Sulaymaniyah, Iraq
| | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | | | - Nikita Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Stanislav S Otstavnov
- Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Project Management, National Research University Higher School of Economics, Moscow, Russia
| | - Mayowa O Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
| | - P A Mahesh
- Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
| | - Jagadish Rao Padubidri
- Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
| | - Adrian Pana
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- Department of Health Metrics, Center for Health Outcomes & Evaluation, Bucharest, Romania
| | - Ashok Pandey
- Research Department, Nepal Health Research Council, Kathmandu, Nepal
- Research Department, Public Health Research Society Nepal, Kathmandu, Nepal
| | | | | | - George C Patton
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Shrikant Pawar
- Department of Genetics, Yale University, New Haven, CT, USA
| | - Emmanuel K Peprah
- School of Global Public Health, New York University, New York, NY, USA
| | - Maarten J Postma
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- School of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Liliana Preotescu
- National Institute of Infectious Diseases, Bucuresti, Romania
- Department of Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Zahiruddin Quazi Syed
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Navid Rabiee
- School of Engineering, Macquarie University, Sydney, NSW, Australia
- Pohang University of Science and Technology, Pohang, South Korea
| | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Metabolomics and Genomics Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Masoud Rahmani
- Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Kiana Ramezanzadeh
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Juwel Rana
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Research and Innovation Division, South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
| | - Chhabi Lal Ranabhat
- Research Department, Policy Research Institute, Kathmandu, Nepal
- Health and Public Policy Department, Global Center for Research and Development, Kathmandu, Nepal
| | - Sowmya J Rao
- Department of Oral Pathology, Sharavathi Dental College and Hospital, Shimogga, India
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
- University College London Hospitals, London, UK
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Academic Public Health England, Public Health England, London, UK
| | | | | | - Nima Rezaei
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mavra A Riaz
- Faculty of Business and Management, Universiti Sultan Zainal Abidin (Sultan Zainal Abidin University), Kuala Terengganu, Malaysia
| | - Ana Isabel Ribeiro
- Epidemiology Research Unit (EPIUnit), University of Porto, Porto, Portugal
| | - Jennifer M Ross
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Enrico Rubagotti
- African Genome Center, Mohammed VI Polytechnic University (UM6P), Ben Guerir, Morocco
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (Center for Research in Congenital Anomalies and Rare Diseases), Universidad ICESI (ICESI University), Cali, Colombia
| | - Susan Fred Rumisha
- Malaria Atlas Project, Telethon Kids Institute, Perth, Australia
- Department of Health Statistics, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Sahar Saeedi Moghaddam
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Maitreyi Sahu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marwa Rashad Salem
- Public Health and Community Medicine Department, Cairo University, Giza, Egypt
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Benn Sartorius
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Brijesh Sathian
- Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD, Townsville, Australia
| | - Amira A Shaheen
- Public Health Division, An-Najah National University, Nablus, Palestine
| | | | - Morteza Shamsizadeh
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden
| | | | - Jae Il Shin
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Roman Shrestha
- Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Jasvinder A Singh
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Medicine Service, US Department of Veterans Affairs (VA), Birmingham, AL, USA
| | | | - Anna Aleksandrovna Skryabina
- Department of Infectious Diseases and Epidemiology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Nuno Taveira
- University Institute "Egas Moniz", Monte da Caparica, Portugal
- Research Institute for Medicines, University of Lisbon, Lisbon, Portugal
| | - Fisaha Haile Tesfay
- School of Public Health, Mekelle University, Mekelle, Ethiopia
- Southgate Institute for Health and Society, Flinders University, Adelaide, SA, Australia
| | - Rekha Thapar
- Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
- Modestum LTD, London, UK
| | | | - Chukwuma David Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | | | | | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Bay Vo
- Faculty of Information Technology, HUTECH University, Ho Chi Minh City, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Yohannes Dibaba Wado
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Yasir Waheed
- Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
| | - Richard G Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA, USA
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Paul Ward
- Centre for Health Policy Research, Torrens University Australia, Adelaide, SA, Australia
| | | | - Katherine Wilson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Public Health, Juntendo University, Tokyo, Japan
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Mikhail Sergeevich Zastrozhin
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, USA
- Addictology Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Yunquan Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Brown MS, Hanif H, Little KM, Clark MR, Thurman AR, Flomen L, Doncel GF. End-user research in support of long-acting systemic antiretroviral delivery systems: insights from qualitative research with providers and target users in South Africa. BMC Infect Dis 2022; 22:919. [PMID: 36482336 PMCID: PMC9733032 DOI: 10.1186/s12879-022-07907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While oral pre-exposure prophylaxis (PrEP) has been shown to reduce the risk of HIV, challenges such as adhering to a daily-dosing regimen and persistence have emerged as barriers for at-risks populations in South Africa. This qualitative research sought to investigate perceptions of and preferences for a long-acting, biodegradable implantable PrEP product designed to address these barriers. METHODS To identify and understand motivators, barriers, and preferences for the PrEP implant, we conducted qualitative in-depth interviews (IDIs) among health care providers (HCPs) and target end-users (young women, adolescent girls, and female sex workers) in urban and rural/peri-urban regions of Gauteng Province, South Africa. The IDIs focused on defining values, beliefs, habits, lifestyles, influencers, and information channels for potential PrEP implant end-users. RESULTS We conducted 36 IDIs across health care providers and target end-user respondent segments. Respondents had generally positive reactions to the PrEP implant. Most end-users felt that some undesirable aspects of the implant (e.g., side effects, pain during insertion, potential scarring, and inability to remove implant) would be offset by having a highly effective, and long-lasting HIV prevention product. Although some HCPs believed the implantable PrEP would lead to increases in promiscuity and risky sexual behavior, most HCPs saw value in the PrEP implant's long duration of protection, its biodegradability, and the likelihood of higher adherence relative to oral PrEP. CONCLUSIONS This study is a first step toward further research needed to demonstrate the demand for a biodegradable, long-acting implantable PrEP and suggests such a product would be accepted by end-users and HCPs in South Africa. This study indicates the need to develop more convenient, discreet, long-acting, and highly effective biomedical HIV prevention options for at-risk populations.
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Affiliation(s)
- Morgan S. Brown
- grid.423224.10000 0001 0020 3631Evidence Department, Population Services International (PSI), 1120 19th Street NW, Suite 600, Washington, DC 20020 USA
| | - Homaira Hanif
- grid.255414.30000 0001 2182 3733CONRAD, Eastern Virginia Medical School, Norfolk, VA USA
| | - Kristen M. Little
- grid.423224.10000 0001 0020 3631Evidence Department, Population Services International (PSI), 1120 19th Street NW, Suite 600, Washington, DC 20020 USA
| | - Meredith R. Clark
- grid.255414.30000 0001 2182 3733CONRAD, Eastern Virginia Medical School, Norfolk, VA USA
| | - Andrea R. Thurman
- grid.255414.30000 0001 2182 3733CONRAD, Eastern Virginia Medical School, Norfolk, VA USA
| | - Lola Flomen
- grid.423224.10000 0001 0020 3631Evidence Department, Population Services International (PSI), 1120 19th Street NW, Suite 600, Washington, DC 20020 USA
| | - Gustavo F. Doncel
- grid.255414.30000 0001 2182 3733CONRAD, Eastern Virginia Medical School, Norfolk, VA USA
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Clipman SJ, Mehta SH, Mohapatra S, Srikrishnan AK, Zook KJC, Duggal P, Saravanan S, Nandagopal P, Kumar MS, Lucas GM, Latkin CA, Solomon SS. Deep learning and social network analysis elucidate drivers of HIV transmission in a high-incidence cohort of people who inject drugs. SCIENCE ADVANCES 2022; 8:eabf0158. [PMID: 36260674 PMCID: PMC9581475 DOI: 10.1126/sciadv.abf0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Globally, people who inject drugs (PWID) experience some of the fastest-growing HIV epidemics. Network-based approaches represent a powerful tool for understanding and combating these epidemics; however, detailed social network studies are limited and pose analytical challenges. We collected longitudinal social (injection partners) and spatial (injection venues) network information from 2512 PWID in New Delhi, India. We leveraged network analysis and graph neural networks (GNNs) to uncover factors associated with HIV transmission and identify optimal intervention delivery points. Longitudinal HIV incidence was 21.3 per 100 person-years. Overlapping community detection using GNNs revealed seven communities, with HIV incidence concentrated within one community. The injection venue most strongly associated with incidence was found to overlap six of the seven communities, suggesting that an intervention deployed at this one location could reach the majority of the sample. These findings highlight the utility of network analysis and deep learning in HIV program design.
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Affiliation(s)
- Steven J. Clipman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shobha Mohapatra
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | - Katie J. C. Zook
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shanmugam Saravanan
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), Chennai, India
| | | | | | - Gregory M. Lucas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sunil S. Solomon
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Walker GR. Analysing behavioural outcome effectiveness in a musical theatre-based HIV/AIDS intervention among South African farm workers. Health Promot Int 2022; 37:6749050. [DOI: 10.1093/heapro/daac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
In 2005, an applied theatre community outreach programme was launched to address low levels of HIV/AIDS awareness among farm workers in the Cape Winelands of South Africa. In cooperation with HIV testing organizations, the Lucky, the Hero mini-musical promoted regular HIV testing, condom use and acceptance of people living with HIV until being retired in 2017. Applying principles of the health belief model to interview data collected in 2015 from former Lucky, the Hero participants, this paper examines the effectiveness of the theatre production to achieve the behavioural outcomes of (i) encouraging regular HIV testing and ongoing awareness of HIV serostatus, and (ii) reducing AIDS-related social stigma. The findings suggest that the interventions were successful in persuading participants to know their HIV status immediately following the shows, as well as potentially contributing to a reduction of community-based external social stigma. However, the interventions were unable to maintain engagement with these behavioural outcomes in the years following the performances, resulting in low adherence to regular HIV testing and inconsistent condom use. Additionally, ongoing social and structural barriers to regular HIV testing and the potential for self-imposed HIV-related stigma were highlighted during the discussions. While applied theatre can be an effective avenue for HIV awareness and prevention, the paper demonstrates the importance of creating and maintaining strong community networks to support continued engagement with health-related behavioural outcomes.
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Affiliation(s)
- Gavin Robert Walker
- Minjiang University , 200, Xiyuangong Road, Fuzhou, Fujian , People’s Republic of China
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Social normative origins of the taboo gap and implications for adolescent risk for HIV infection in Zambia. Soc Sci Med 2022; 312:115391. [PMID: 36183540 PMCID: PMC9582197 DOI: 10.1016/j.socscimed.2022.115391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
Abstract
Zambian Demographic and Health Survey data reveal that increased discordance between professed attitudes and measures of behaviour regarding premarital sex among adults is strongly associated with increased risk of HIV in adolescents, particularly girls. We hypothesised that this was due to the reluctance to talk about premarital sex, resulting in a situation we call the “taboo gap” where sexual behaviour is a forbidden topic and adolescents feel unable to seek advice or sexual and reproductive health services. Our analysis revealed that the taboo gap is rooted in harmful gender norms that are perpetuated by schools, churches, cultural influences, development programmes and health systems. Challenges like food insecurity and household poverty may place girls in positions where they are vulnerable to sexual exploitation, increasing their risk of exposure to HIV. Unmarried adolescents, particularly girls, report being ridiculed when they go to reproductive health clinics, which discourages them from seeking care in the future. Strengthening peer support and parent-child interactions are important programmatic elements. We conclude that discordance serves as a novel measure and harbinger for the presence of gender norms which generated a taboo gap that impeded carseeking and increased risk for HIV among adolescents, especially girls, in Zambia. We propose that successful interventions must involve a multifaceted, gender transformative approach which engages peers and stakeholders in schools, churches, clinics, and families, particularly parents, to reduce the gendered gap in HIV risk and transmission. Premarital sex attitude-behaviour discordance is associated with risk of adolescent HIV. Taboo gap occurs where sexual behaviour is a forbidden topic and impedes care-seeking. Taboo gap was generated in schools, churches, culture, and development programmes. Unmarried adolescents, especially girls, risk sanction in seeking reproductive care. Strengthening peer support and parent-child interactions are important programmatically.
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Nascimento FF, Ragonnet-Cronin M, Golubchik T, Danaviah S, Derache A, Fraser C, Volz E. Evaluating whole HIV-1 genome sequence for estimation of incidence and migration in a rural South African community. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17891.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: South Africa has the largest number of people living with HIV (PLWHIV) in the world, with HIV prevalence and transmission patterns varying greatly between provinces. Transmission between regions is still poorly understood, but phylodynamics of HIV-1 evolution can reveal how many infections are attributable to contacts outside a given community. We analysed whole genome HIV-1 genetic sequences to estimate incidence and the proportion of transmissions between communities in Hlabisa, a rural South African community. Methods: We separately analysed HIV-1 for gag, pol, and env genes sampled from 2,503 PLWHIV. We estimated time-scaled phylogenies by maximum likelihood under a molecular clock model. Phylodynamic models were fitted to time-scaled trees to estimate transmission rates, effective number of infections, incidence through time, and the proportion of infections imported to Hlabisa. We also partitioned time-scaled phylogenies with significantly different distributions of coalescent times. Results: Phylodynamic analyses showed similar trends in epidemic growth rates between 1980 and 1990. Model-based estimates of incidence and effective number of infections were consistent across genes. Parameter estimates with gag were generally smaller than those estimated with pol and env. When estimating the proportions of new infections in Hlabisa from immigration or transmission from external sources, our posterior median estimates were 85% (95% credible interval (CI) = 78%–92%) for gag, 62% (CI = 40%–78%) for pol, and 77% (CI = 58%–90%) for env in 2015. Analysis of phylogenetic partitions by gene showed that most close global reference sequences clustered within a single partition. This suggests local evolving epidemics or potential unmeasured heterogeneity in the population. Conclusions: We estimated consistent epidemic dynamic trends for gag, pol and env genes using phylodynamic models. There was a high probability that new infections were not attributable to endogenous transmission within Hlabisa, suggesting high inter-connectedness between communities in rural South Africa.
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Floyd S, Mulwa S, Magut F, Gourlay A, Mthiyane N, Kamire V, Osindo J, Otieno M, Chimbindi N, Ziraba A, Phillips-Howard P, Kwaro D, Shahmanesh M, Birdthistle I. DREAMS impact on HIV status knowledge and sexual risk among cohorts of young women in Kenya and South Africa. AIDS 2022; 36:S61-S73. [PMID: 35766576 DOI: 10.1097/qad.0000000000003157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought evidence of DREAMS' impact on uptake of services and sexual risk among adolescent-girls-and-young-women (AGYW). DESIGN Cohorts of AGYW aged 13-22 years were randomly selected in 2017-2018 and followed-up to 2019; 1081 in Nairobi, Kenya;1171 in Gem, western Kenya;and 2184 in uMkhanyakude, South Africa. METHODS Outcomes were knowledge of HIV status, condomless sex (past 12 months), lifetime partners, transactional sex (past 12 months), and awareness and use of condoms and pre-exposure-prophylaxis (PrEP). Using a causal inference framework, we estimated the proportions with each outcome if all vs. none were DREAMS invitees by 2018. RESULTS Among AGYW followed up in 2019, the percentage invited to DREAMS by 2018 was 74, 57, and 53% in Nairobi, Gem, and uMkhanyakude, respectively. By 2018, the estimated percentages of AGYW who would know their HIV status, comparing the scenarios that all vs. none were DREAMS invitees, were 86 vs. 56% in Nairobi, 80 vs. 68% in Gem, and 56 vs. 49% in uMkhanyakude. By 2019, awareness of condoms and PrEP was high among DREAMS invitees, but recent participation in condom promotion activities was less than 50% and recent PrEP use was around 0-10%. In Gem, there was evidence of a reduction attributable to DREAMS in condomless sex, and among younger AGYW in the number of lifetime partners;in Nairobi evidence of a reduction in condomless sex among sexually active older AGYW;and in uMkhanya-kude no evidence that DREAMS changed these outcomes. CONCLUSION Alongside sustaining high levels of knowledge of HIV status, more is needed to link AGYW into prevention methods such as PrEP and condoms.Comprehensive HIV prevention promotes safer sexual partnerships, but poverty, social norms, and inequalities limit AGYW's prevention choices.
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Affiliation(s)
- Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Africa Population and Health Research Center, Nairobi, Kenya
| | - Faith Magut
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Annabelle Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | | | - Vivienne Kamire
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jane Osindo
- Africa Population and Health Research Center, Nairobi, Kenya
| | - Moses Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Abdhalah Ziraba
- Africa Population and Health Research Center, Nairobi, Kenya
| | | | - Daniel Kwaro
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
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Mthiyane N, Baisley K, Chimbindi N, Zuma T, Okesola N, Dreyer J, Herbst C, Smit T, Danaviah S, McGrath N, Harling G, Sherr L, Seeley J, Floyd S, Birdthistle I, Shahmanesh M. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa. AIDS 2022; 36:S39-S49. [PMID: 35766574 PMCID: PMC10700028 DOI: 10.1097/qad.0000000000003156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We investigate how risk of sexually acquiring or transmitting HIV in adolescent girls and young women (AGYW) changed following the real-world implementation of DREAMS (Determined, Resilient, Empowered, AIDS free, Mentored and Safe) HIV prevention programme. DESIGN A representative population-based prospective cohort study of AGYW living in rural KwaZulu-Natal. METHODS Between 2017 and 2019, we interviewed a random sample of AGYW aged 13-22 years annually. We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or participation in DREAMS activities that were provided by DREAMS implementing organizations. HIV and herpes simplex virus type 2 (HSV-2) statuses were ascertained through blood tests on Dried Blood Spot (DBS). We used multivariable regression analysis to assess the association between exposure to DREAMS and risk of acquiring HIV: measured as incident HSV-2 (a proxy of sexual risk) and incident HIV;and the risk of sexually transmitting HIV: measured as being HIV positive with a detectable HIV viral load (≥50 copie/ml) on the last available DBS. We adjusted for sociodemographic, sexual relationship, and migration. RESULTS Two thousand one hundred and eighty-four (86.4%) of those eligible agreed to participate and 2016 (92.3%) provided data for at least one follow-up time-point. One thousand and thirty (54%) were exposed to DREAMS;HIV and HSV-2 incidence were 2.2/100 person-years [95% confidence interval (CI) 1.66-2.86] and 17.3/100 person-years (95% CI 15.5-19.4), respectively. There was no evidence that HSV-2 and HIV incidence were lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.96 (95% CI 0.76-1.23 and 0.83 (95% CI 0.46-1.52), respectively. HIV viral load was detectable for 169 (8.9%) respondents;there was no evidence this was lower in those exposed to DREAMS with an adjusted risk difference, compared with those not exposed to DREAMS, of 0.99% (95% CI-1.52 to 3.82]. Participants who lived in peri-urban/ urban setting were more likely to have incident HIV and transmissible HIV. Both HSV-2 incidence and the transmissible HIV were associated with older age and ever having sex. Findings did not differ substantively by respondent age group. CONCLUSION DREAMS exposure was not associated with measurable reductions in risk of sexually acquiring or transmitting HIV amongst a representative cohort of AGYW in rural South Africa.
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Affiliation(s)
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Carina Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Siva Danaviah
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- University of Southampton, Southampton, UK
| | - Guy Harling
- Africa Health Research Institute, 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, Gauteng, South Africa
- Department of Epidemiology & Harvard Centre for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, UK
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Dzomba A, Kim HY, Tomita A, Vandormael A, Govender K, Tanser F. Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005-2017). BMC Public Health 2022; 22:1141. [PMID: 35672845 PMCID: PMC9175358 DOI: 10.1186/s12889-022-13526-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of internal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention efforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa, using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged 15-49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 person-years over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy (ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men. Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20-24 years compared to those aged ≥ 40 years (adjusted Hazard Ratio [aHR] = 3.37, 95% Confidence Interval [CI]: 3:19-3.57), and 2.9-times higher among young men aged 20-24 years compared to those aged ≥ 40 years (aHR = 2.86, 95% CI:2.69-3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR = 0.91, 95% CI: 0.83 - 0.99) and men (aHR = 0.73, 95% CI 0.66 - 0.82) respectively per every 1% increase in community ART coverage. Young unmarried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and lowered as ART coverage increased over time, reflecting the role of improved HIV services across space in reducing out-migration. A deeper understanding of the characteristics of a migrating population provides critical information towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility.
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Affiliation(s)
- Armstrong Dzomba
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa.
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.
- Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Acornhoek, South Africa.
| | - Hae-Young Kim
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, USA
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
- Department of Medicine, Stanford University, Stanford, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Lincoln Institute for Health, University of Lincoln, Lincoln, LN6 7TS, UK
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Sheira LA, Kwena ZA, Charlebois ED, Agot K, Ayieko B, Gandhi M, Bukusi EA, Thirumurthy H, Camlin CS. Testing a social network approach to promote HIV self-testing and linkage to care among fishermen at Lake Victoria: study protocol for the Owete cluster randomized controlled trial. Trials 2022; 23:463. [PMID: 35668499 PMCID: PMC9169331 DOI: 10.1186/s13063-022-06409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nearly 50% of men living with HIV in many countries are unaware of their HIV status; men also have lower uptake of HIV treatment and pre-exposure prophylaxis (PrEP). In SSA, highly mobile men such as those working in fishing communities alongside Lake Victoria have low uptake of HIV testing and low rates of linkage to HIV treatment and PrEP, despite increasing availability of these services. HIV self-testing (HIVST) kits hold promise for overcoming barriers to HIV testing and linkage to services for HIV-positive and HIV-negative men. We describe here a protocol for an HIV status-neutral, social network-based approach to promote HIV testing, linkage to care and prevention, and better health outcomes, including adherence, in fishermen around Lake Victoria. METHODS Utilizing beach management unit (BMU) registries of fishermen operating in three Lake Victoria fishing communities in Siaya County, Kenya, we completed a census and social network mapping to identify close social networks of men. Network clusters identified by a socially-central lead ("promotor") and selected to ensure maximal separation between treatment and control will be randomized. Promotors in both arms will receive basic HIV training; intervention promotors are further trained in HIVST to distribute kits to their cluster, while control promotors will distribute to their cluster vouchers for free HIVST at nearby clinics. We will test whether these promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. We will also measure 6- and 12-month viral load in those living with HIV and PrEP adherence among those without HIV via urine tenofovir levels as objective markers of adherence. DISCUSSION This study has the potential to improve HIV health and promote HIV prevention among a hard to reach, at-risk, and highly mobile population of men in Western Kenya-a critical population in Kenya's HIV prevention and treatment program. Further, if successful, this innovative social networks-based model could be scaled at the regional level to address HIV prevention and care among similarly at-risk populations of men in eastern Africa and inland fisheries settings across the continent. TRIAL REGISTRATION Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men, registered on February 26, 2021, registration # NCT04772469 .
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Affiliation(s)
- Lila A. Sheira
- grid.266102.10000 0001 2297 6811Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, 1001 Potrero Ave. Building 100, Ward 84, San Francisco, USA
| | - Zachary A. Kwena
- grid.33058.3d0000 0001 0155 5938Centre for Microbiology Research, Kenya Medical Research institute, Nairobi, Kenya
| | - Edwin D. Charlebois
- grid.266102.10000 0001 2297 6811Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Kawango Agot
- grid.434865.80000 0004 0605 3832Impact Research and Development Organization, Kisumu, Kenya
| | - Benard Ayieko
- grid.434865.80000 0004 0605 3832Impact Research and Development Organization, Kisumu, Kenya
| | - Monica Gandhi
- grid.266102.10000 0001 2297 6811Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, 1001 Potrero Ave. Building 100, Ward 84, San Francisco, USA
| | - Elizabeth A. Bukusi
- grid.33058.3d0000 0001 0155 5938Centre for Microbiology Research, Kenya Medical Research institute, Nairobi, Kenya ,grid.266102.10000 0001 2297 6811Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
| | - Harsha Thirumurthy
- grid.25879.310000 0004 1936 8972Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Carol S. Camlin
- grid.266102.10000 0001 2297 6811Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
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Johnson LF, Meyer-Rath G, Dorrington RE, Puren A, Seathlodi T, Zuma K, Feizzadeh A. The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019. J Acquir Immune Defic Syndr 2022; 90:115-123. [PMID: 35125471 DOI: 10.1097/qai.0000000000002927] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs. METHODS We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented. RESULTS The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women. CONCLUSIONS HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline.
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Affiliation(s)
- Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Rob E Dorrington
- Centre for Actuarial Research, School of Management Studies, University of Cape Town, Cape Town, South Africa
| | - Adrian Puren
- Division of Virology, School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Thapelo Seathlodi
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Khangelani Zuma
- Human Sciences Research Council, Pretoria, South Africa ; and
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Nxumalo V, Nxumalo S, Smit T, Khoza T, Mdaba F, Khumalo T, Cislaghi B, McGrath N, Seeley J, Shahmanesh M, Harling G. Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study. Wellcome Open Res 2022; 7:164. [PMID: 36324699 PMCID: PMC9608251 DOI: 10.12688/wellcomeopenres.17896.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.
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Affiliation(s)
- Vuyiswa Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Fikile Mdaba
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thulile Khumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Faculty of Social Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, 4041, South Africa
- MRC/Wits-Agincourt Unit, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Harvard Univeristy, Cambridge, MA, 02138, USA
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Chidumwa G, Chimbindi N, Herbst C, Okeselo N, Dreyer J, Zuma T, Smith T, Molina JM, Khoza T, McGrath N, Seeley J, Pillay D, Tanser F, Harling G, Sherr L, Copas A, Baisley K, Shahmanesh M. Isisekelo Sempilo study protocol for the effectiveness of HIV prevention embedded in sexual health with or without peer navigator support (Thetha Nami) to reduce prevalence of transmissible HIV amongst adolescents and young adults in rural KwaZulu-Natal: a 2 × 2 factorial randomised controlled trial. BMC Public Health 2022; 22:454. [PMID: 35255859 PMCID: PMC8900304 DOI: 10.1186/s12889-022-12796-8] [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: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Antiretroviral therapy (ART) through universal test and treat (UTT) and HIV pre-exposure prophylaxis (PrEP) substantially reduces HIV-related mortality, morbidity and incidence. Effective individual-level prevention modalities have not translated into population-level impact in southern Africa due to sub-optimal coverage among adolescents and youth who are hard to engage. We aim to investigate the feasibility, acceptability, and preliminary population level effectiveness of HIV prevention services with or without peer support to reduce prevalence of transmissible HIV amongst adolescents and young adults in KwaZulu-Natal. Methods We are conducting a 2 × 2 factorial trial among young men and women aged 16–29 years, randomly selected from the Africa Health Research Institute demographic surveillance area. Participants are randomly allocated to one of four intervention combinations: 1) Standard of Care (SOC): nurse-led services for HIV testing plus ART if positive or PrEP for those eligible and negative; 2) Sexual and Reproductive Health (SRH): Baseline self-collected vaginal and urine samples with study-organized clinic appointments for results, treatment and delivery of HIV testing, ART and PrEP integrated with SRH services; 3) Peer-support: Study referral of participants to a peer navigator to assess their health, social and educational needs and provide risk-informed HIV prevention, including facilitating clinic attendance; or 4) SRH + peer-support. The primary outcomes for effectiveness are: (1) the proportion of individuals with infectious HIV at 12 months and (2) uptake of risk-informed comprehensive HIV prevention services within 60 days of enrolment. At 12 months, all participants will be contacted at home and the study team will collect a dried blood spot for HIV ELISA and HIV viral load testing. Discussion This trial will enable us to understand the relative importance of SRH and peer support in creating demand for effective and risk informed biomedical HIV prevention and preliminary data on their effectiveness on reducing the prevalence of transmissible HIV amongst all adolescents and youth. Trial registration Trial Registry: clincialtrials.gov. ClinicalTrials.gov Identifier NCT04532307. Registered: March 2020.
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Affiliation(s)
- Glory Chidumwa
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa
| | - Carina Herbst
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nonhlanhla Okeselo
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jaco Dreyer
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa
| | - Theresa Smith
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hospitals Saint-Louis and Lariboisière, Paris, France
| | - Thandeka Khoza
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Nuala McGrath
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,University of Southampton, Southampton, UK
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,London School of Hygiene & Tropical Medicine, London, UK
| | - Deenan Pillay
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Frank Tanser
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,Lincoln University, London,, UK
| | - Guy Harling
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK.,University of KwaZulu-Natal, Durban, South Africa.,University of the Witwatersrand, Johannesburg, South Africa.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Lorraine Sherr
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Andrew Copas
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK
| | - Kathy Baisley
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.,London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa. .,UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, Capper Street, London, WC1E 6JP, UK. .,University of KwaZulu-Natal, Durban, South Africa.
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45
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Nduva GM, Otieno F, Kimani J, Wahome E, McKinnon LR, Cholette F, Majiwa M, Masika M, Mutua G, Anzala O, Graham SM, Gelmon L, Price MA, Smith AD, Bailey RC, Baele G, Lemey P, Hassan AS, Sanders EJ, Esbjörnsson J. Quantifying rates of HIV-1 flow between risk groups and geographic locations in Kenya: A country-wide phylogenetic study. Virus Evol 2022; 8:veac016. [PMID: 35356640 PMCID: PMC8962731 DOI: 10.1093/ve/veac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022] Open
Abstract
In Kenya, HIV-1 key populations including men having sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW) are thought to significantly contribute to HIV-1 transmission in the wider, mostly heterosexual (HET) HIV-1 transmission network. However, clear data on HIV-1 transmission dynamics within and between these groups are limited. We aimed to empirically quantify rates of HIV-1 flow between key populations and the HET population, as well as between different geographic regions to determine HIV-1 'hotspots' and their contribution to HIV-1 transmission in Kenya. We used maximum-likelihood phylogenetic and Bayesian inference to analyse 4058 HIV-1 pol sequences (representing 0.3 per cent of the epidemic in Kenya) sampled 1986-2019 from individuals of different risk groups and regions in Kenya. We found 89 per cent within-risk group transmission and 11 per cent mixing between risk groups, cyclic HIV-1 exchange between adjoining geographic provinces and strong evidence of HIV-1 dissemination from (i) West-to-East (i.e. higher-to-lower HIV-1 prevalence regions), and (ii) heterosexual-to-key populations. Low HIV-1 prevalence regions and key populations are sinks rather than major sources of HIV-1 transmission in Kenya. Targeting key populations in Kenya needs to occur concurrently with strengthening interventions in the general epidemic.
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Affiliation(s)
- George M Nduva
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Frederick Otieno
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Elizabeth Wahome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Lyle R McKinnon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella 4013, South Africa
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Canada
| | - Maxwell Majiwa
- Kenya Medical Research Institute/Center for Global Health Research, KEMRI-CGHR, P.O. Box 20778-00202, Kisumu, Kenya
| | - Moses Masika
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Gaudensia Mutua
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Omu Anzala
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Department of Epidemiology, University of Washington, Office of the Chair, UW Box # 351619, Seattle, DC, USA
| | - Larry Gelmon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Matt A Price
- IAVI Global Headquarters, 125 Broad Street, 9th Floor, New York, NY 10004, USA
- Department of Epidemiology and Biostatistics, University of California, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd Floor, San Francisco, CA 94158-2549, USA
| | - Adrian D Smith
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Robert C Bailey
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA
| | - Guy Baele
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Philippe Lemey
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Amin S Hassan
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
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46
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Bell GJ, Ncayiyana J, Sholomon A, Goel V, Zuma K, Emch M. Race, place, and HIV: The legacies of apartheid and racist policy in South Africa. Soc Sci Med 2022; 296:114755. [PMID: 35123373 PMCID: PMC8887645 DOI: 10.1016/j.socscimed.2022.114755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/18/2021] [Accepted: 01/25/2022] [Indexed: 12/01/2022]
Abstract
Black South Africans accounted for 6.2 out of 6.4 million people living with HIV in South Africa in 2012, highlighting extreme racial disparities in HIV infection. These racial disparities are the result of structural and historical factors, specifically, the racist policies which were facilitated by segregation before, during, and after Apartheid. First, we describe the theoretical context of how racist policies and segregation are linked to HIV prevalence. Next, using data from a 2012 national survey of South Africans (SABSSM IV) and Statistics South Africa (StatsSA), we describe the race-specific geospatial distribution of HIV in South Africa, provide empirical evidence for the impact of Apartheid on important risk factors for HIV infection, and describe the relationship between these risk factors and HIV within racial groups. Using multilevel logistic regression, we find that segregation increases the odds of HIV infection among Black South Africans, even after adjusting for many covariates which are sometimes blamed, in place of structural factors, for a higher HIV prevalence in Black South Africans. We found that the estimated odds of infection in the most segregated municipality was 1.95 (95% CI: 1.15, 3.32) times the odds of infection in the least segregated municipality for Black South Africans. In addition to segregation, we also find other covariates to be differentially associated with HIV infection depending on race, such as gender, age, and sexual behavior. We also find that the HIV infection odds ratio comparing Black and Coloured (i.e., multiple ethnic groups with mixed ancestries from Africa, Asia, and Europe) South Africans varies over space. These results continue to build evidence for the influence of structural and historical factors on the modern geospatial and demographic distribution of HIV.
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Affiliation(s)
- Griffin J. Bell
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jabulani Ncayiyana
- Division of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ari Sholomon
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Varun Goel
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Khangelani Zuma
- Human Sciences Research Council, Research Methodology Centre, Pretoria, South Africa,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Michael Emch
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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47
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Nsanzimana S, Rwibasira GN, Malamba SS, Musengimana G, Kayirangwa E, Jonnalagadda S, Fazito Rezende E, Eaton JW, Mugisha V, Remera E, Muhamed S, Mulindabigwi A, Omolo J, Weisner L, Moore C, Patel H, Justman JE. HIV incidence and prevalence among adults aged 15-64 years in Rwanda: Results from the Rwanda Population-based HIV Impact Assessment (RPHIA) and District-level Modeling, 2019. Int J Infect Dis 2022; 116:245-254. [PMID: 35066161 PMCID: PMC9069967 DOI: 10.1016/j.ijid.2022.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The 2018-2019 Rwanda Population-based HIV Impact Assessment (RPHIA) was conducted to measure national HIV incidence and prevalence. District-level estimates were modeled to inform resources allocation. METHODS RPHIA was a nationally representative cross-sectional household survey. Consenting adults were interviewed and tested for HIV using the national diagnostic algorithm followed by laboratory-based confirmation of HIV status and testing for viral load (VL), limiting antigen (LAg) avidity, and presence of antiretrovirals. Incidence was calculated using normalized optical density ≤ 1·5, VL ≥ 1,000 copies/mL, and undetectable antiretrovirals. Survey and programmatic data were used to model district-level HIV incidence and prevalence. RESULTS Of 31,028 eligible adults, 98·7% participated in RPHIA and 934 tested HIV positive. HIV prevalence among adults in Rwanda was 3·0% (95% CI:2·7-3·3). National HIV incidence was 0·08% (95% CI:0·02-0·14) and 0·11% (95% CI:0·00-0·26) in the City of Kigali (CoK). Based on district-level modeling, HIV incidence was greatest in the 3 CoK districts (0·11% to 0·15%) and varied across other districts (0·03% to 0·10%). CONCLUSIONS HIV prevalence among adults in Rwanda is 3.0%; HIV incidence is low at 0.08%. District-level modeling has identified disproportionately affected urban hotspots: areas to focus resources.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Eric Remera
- Ministry of Health, Rwanda Biomedical Centre
| | | | | | - Jared Omolo
- US Centers for Disease Control and Prevention
| | - Lubbe Weisner
- UCT Pharmacology Research Laboratory, City of Cape Town, Western Cape, South Africa, Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Hetal Patel
- US Centers for Disease Control and Prevention
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48
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Chimbindi N, Mthiyane N, Zuma T, Baisley K, Pillay D, McGrath N, Harling G, Sherr L, Birdthistle I, Floyd S, Dreyer J, Nakasone S, Seeley J, Shahmanesh M. Antiretroviral therapy based HIV prevention targeting young women who sell sex: a mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa. AIDS Care 2022; 34:232-240. [PMID: 33769156 PMCID: PMC8464632 DOI: 10.1080/09540121.2021.1902933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a potential game-changer for HIV. We used PrEP introduction for Young Women Who Sell Sex (YWSS) in a rural South Africa district to understand community norms and PrEP coverage in YWSS. Between 2017 and 2018, we measured awareness and uptake of PrEP in a representative cohort of 2184 Adolescent Girls and Young Women (AGYW) aged 13-22. We conducted group discussions with young people and community members (19); key informant interviews (9), in-depth interviews with 15-24 year-olds (58) and providers (33). Interviews were analysed using thematic analysis. PrEP awareness increased from 2% to 9%. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4%-15.7%) reported transactional sex and 10.6% (95%CI: 8.85-12.7%) sex for money. Of the 194 YWSS, 21 were aware of PrEP, but none had used it. Youth were enthusiastic about PrEP as tool for HIV prevention; whilst older community members were cautious about a technology they had limited experience with but could benefit select groups. Teachers and healthcare providers were concerned that PrEP would lower personal responsibility for sexual health. In conclusion, the narrow and limited introduction of PrEP to YWSS reduced the accessibility and reach. Introducing PrEP as part of sexual healthcare may improve demand and access for YWSS.
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Affiliation(s)
- Natsayi Chimbindi
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,University College London, United Kingdom
| | | | - Thembelihle Zuma
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,London School of Hygiene & Tropical Medicine, United Kingdom
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,University College London, United Kingdom
| | - Nuala McGrath
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,University of Southampton, United Kingdom
| | - Guy Harling
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,University College London, United Kingdom,Harvard University, United States of America,University of the Witwatersrand, South Africa
| | | | | | - Sian Floyd
- London School of Hygiene & Tropical Medicine, United Kingdom
| | - Jaco Dreyer
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | | | - Janet Seeley
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,London School of Hygiene & Tropical Medicine, United Kingdom
| | - Maryam Shahmanesh
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa,,University College London, United Kingdom,Corresponding author: Maryam Shahmanesh, University College London (UCL) Institute for Global Health, Mortimer Market Centre off Capper Street, London, WC1E 6JB, United Kingdom. Phone number: +44 7776185572
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49
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Roberts DA, Cuadros D, Vandormael A, Gareta D, Barnabas RV, Herbst K, Tanser F, Akullian A. Predicting the Risk of Hiv-1 Acquisition in Rural South Africa Using Geospatial Data. Clin Infect Dis 2022; 75:1224-1231. [PMID: 35100612 PMCID: PMC9525068 DOI: 10.1093/cid/ciac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Accurate human immunodeficiency virus (HIV) risk assessment can guide optimal HIV prevention. We evaluated the performance of risk prediction models incorporating geospatial measures. Methods We developed and validated HIV risk prediction models in a population-based cohort in South Africa. Individual-level covariates included demographic and sexual behavior measures, and geospatial covariates included community HIV prevalence and viral load estimates. We trained models on 2012–2015 data using LASSO Cox models and validated predictions in 2016–2019 data. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. We compared the spatial distribution of predicted risk to that of high incidence areas (≥ 3/100 person-years). Results Our analysis included 19 556 individuals contributing 44 871 person-years and 1308 seroconversions. Incidence among the highest predicted risk quintile using the full model was 6.6/100 person-years (women) and 2.8/100 person-years (men). Models using only age group and geospatial covariates had similar performance (women: AUROC = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). Geospatial models more accurately identified high incidence regions than individual-level models; 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. Conclusions Geospatial models with no individual measures other than age group predicted HIV risk nearly as well as models that included detailed behavioral data. Geospatial models may help guide HIV prevention efforts to individuals and geographic areas at highest risk.
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Affiliation(s)
- D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Diego Cuadros
- Department of Geography, University of Cincinnati, Cincinnati, USA
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Ruanne V Barnabas
- Department of Epidemiology, University of Washington, Seattle, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa
| | - Adam Akullian
- Department of Global Health, University of Washington, Seattle, USA.,Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, USA
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50
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Mosha NR, Todd J, Mukerebe C, Marston M, Colombe S, Clark B, Beard J, Mtenga B, Slaymaker E, Boerma T, Zaba B, Urassa M. The prevalence and incidence of HIV in the ART era (2006-2016) in North West Tanzania. Int J STD AIDS 2022; 33:337-346. [PMID: 35040735 PMCID: PMC7612632 DOI: 10.1177/09564624211065232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Sub-Saharan countries bears a disproportionate percentage of HIV infections and HIV related deaths despite the efforts to strengthen HIV prevention and treatments services, including ART. It is important to demonstrate how these services have contributed to reducing the epidemic using available population data. Methods We estimated the prevalence and incidence rates from a cohort running over 23 years in Magu District, Mwanza Region-North West Tanzania. Adults 15 years and over who were residents of the Kisesa observational HIV cohort study between 2006 and 2016 were eligible for inclusion. Survival analysis was used to calculate person-time at risk, incidence rates and 95% confidence intervals (CI). Cox regression models were used for the risk factor analyses disaggregated by sex and age group. Results The HIV prevalence in the sero-surveys decreased from 7.2% in 2006/07 to 6.6% in 2016, with a notable decrease of over 50% for both men and women aged 15-24 years. The incidence rate for HIV was estimated to be 5.5 (95% CI 4.6 - 6.6) per 1000 person-years in women compared to 4.6 (95% CI 3.5 – 5.8) in men, with a decrease over time. Despite the availability of ART services, the uptake is still small. Conclusions New infections are still occurring, with high HIV incidence in individuals aged below 45 years. With new guidelines and the 95-95-95 UNAIDS target, prevalence and incidence must be adequately assessed. In addition, there is a need for additional efforts to assess the impact of HIV/AIDS prevention programmes and intervention services, especially in these areas where resources are limited.
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Affiliation(s)
- Neema R Mosha
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, 121470Stellenbosch University, Cape Town, South Africa.,Mwanza Intervention Trials Unit, Mwanza, Tanzania.,119151National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Jim Todd
- 119151National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania.,Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Crispin Mukerebe
- 119151National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Milly Marston
- Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | | | - Benjamin Clark
- Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - James Beard
- Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Baltazar Mtenga
- 119151National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Emma Slaymaker
- Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Ties Boerma
- University of Manitoba, Winnipeg, MB, Canada
| | - Basia Zaba
- Department of Population Health, 4906London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Urassa
- 119151National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
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