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Remera E, Tuyishime E, Kayitesi C, Malamba SS, Sangwayire B, Umutesi J, Ruisenor-Escudero H, Oluoch T. HIV and hepatitis B, C co-infection and correlates of HIV infection among men who have sex with men in Rwanda, 2021: a respondent-driven sampling, cross-sectional study. BMC Infect Dis 2024; 24:347. [PMID: 38521947 PMCID: PMC10960483 DOI: 10.1186/s12879-024-09206-2] [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: 11/03/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are a key population group disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. In Rwanda, the HIV epidemic remains a significant public health concern, and understanding the burden of HIV and hepatitis B and C coinfections among MSM is crucial for designing effective prevention and control strategies. This study aims to determine the prevalence of HIV, hepatitis B, and hepatitis C infections among MSM in Rwanda and identify correlates associated with HIV infection within this population. METHODS We used respondent-driven sampling (RDS) to recruit participants between November and December 2021. A face-to-face, structured questionnaire was administered. Testing for HIV infection followed the national algorithm using two rapid tests: Alere Combo and STAT PAK as the first and second screening tests, respectively. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were performed. All statistics were adjusted for RDS design, and a multivariable logistic regression model was constructed to identify factors associated with HIV infection. RESULTS The prevalence of HIV among MSM was 6·9% (95% CI: 5·5-8·6), and among HIV-positive MSM, 12·9% (95% CI: 5·5-27·3) were recently infected. The prevalence of hepatitis B and C was 4·2% (95% CI: 3·0-5·7) and 0·7% (95% CI: 0·4-1·2), respectively. HIV and hepatitis B virus coinfection was 0·5% (95% CI: 0·2-1·1), whereas HIV and hepatitis C coinfection was 0·1% (95% CI: 0·0-0·5), and no coinfection for all three viruses was observed. MSM groups with an increased risk of HIV infection included those who ever suffered violence or abuse because of having sex with other men (AOR: 3·42; 95% CI: 1·87-6·25), those who refused to answer the question asking about 'ever been paid money, goods, or services for sex' (AOR: 10·4; 95% CI: 3·30-32·84), and those not consistently using condoms (AOR: 3·15; 95% CI: 1·31-7·60). CONCLUSION The findings suggest more targeted prevention and treatment approaches and underscore the importance of addressing structural and behavioral factors contributing to HIV vulnerability, setting interventions to reduce violence and abuse against MSM, promoting safe and consensual sexual practices, and expanding access to HIV prevention tools such as condoms and preexposure prophylaxis (PrEP).
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Affiliation(s)
- Eric Remera
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre (RBC) ), Kigali, Rwanda
| | - Elysee Tuyishime
- Division of Global HIV and TB, Global Health Center (GHC), US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda.
| | - Catherine Kayitesi
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre (RBC) ), Kigali, Rwanda
| | - Samuel S Malamba
- Division of Global HIV and TB, Global Health Center (GHC), US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Beata Sangwayire
- Division of Global HIV and TB, Global Health Center (GHC), US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
| | - Justine Umutesi
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre (RBC) ), Kigali, Rwanda
| | - Horacio Ruisenor-Escudero
- Division of Global HIV and TB, Global Health Center (GHC), US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tom Oluoch
- Division of Global HIV and TB, Global Health Center (GHC), US Centers for Disease Control and Prevention (CDC), Kigali, Rwanda
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Mukuku O, Kiakuvue YN, Numbi GY, Ruhindiza BM, Kakisingi C, Mwamba CM, Katabwa JK. Assessing high-risk sexual practices associated with human immunodeficiency virus infection among young female sex workers in Lubumbashi, Democratic Republic of the Congo: a cross-sectional study. AIDS Res Ther 2024; 21:16. [PMID: 38504236 PMCID: PMC10949734 DOI: 10.1186/s12981-024-00602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Young female sex workers (YFSWs) face a higher risk of HIV infection compared to older workers, but there is a lack of comprehensive data on their sexual practices and HIV infection risks, which may present unique challenges and vulnerabilities. The study aimed to identify high-risk sexual practices associated with HIV infection among YFSWs in Lubumbashi. METHODS We conducted an analytical cross-sectional study and used a comprehensive sample of all YFSWs who presented to the HIV/Sexually Transmitted Infections Screening and Treatment Center in Lubumbashi between April 2016 and December 2017. We collected data on socio-demographic characteristics and behavioral risk factors of female sex workers were collected using a structured questionnaire. Using STATA version 16, multivariate logistic regression was fitted and the results were presented as adjusted odds ratios (aORs) with their 95% confidence intervals (95% CIs). RESULTS A total of 572 YFSWs were included in the study, 19 of whom were HIV-positive (3.3%; 95% CI: 2.1-5.1%). Participants who were forced to have sex (aOR = 12.2; 95% CI: 3.2-46.4; p < 0.0001), those who did not use condoms systematically (aOR = 4.1; 95% CI: 1.3-13.0; p = 0.018), and those who had anal sex (aOR = 23.8; 95% CI: 6.9-82.4; p < 0.0001) were more likely to be HIV-positive. CONCLUSION The study reveals a concerning trend of higher hospital HIV prevalence among YFSWs compared to the general Congolese population. It also highlights a significant link between high-risk sexual practices and HIV infection, highlighting the need for urgent interventions.
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Affiliation(s)
- Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
| | | | - Georges Yumba Numbi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | | | - Christian Kakisingi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Claude Mulumba Mwamba
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Joe Kabongo Katabwa
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Bolo A, Ochira P, Hakim AJ, Katoro J, Bunga S, Lako R, Anib V, Arkangelo GC, Lobojo BN, Okiria AG. Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan. BMC Public Health 2023; 23:692. [PMID: 37059971 PMCID: PMC10103365 DOI: 10.1186/s12889-023-15593-z] [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] [Received: 04/30/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan. METHODS Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13-18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13. RESULTS A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%. CONCLUSION Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
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Affiliation(s)
- Alex Bolo
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan.
| | | | - Avi J Hakim
- United States Centers for Disease Control and Prevention, DGHT, Atlanta, GA, USA
| | - Joel Katoro
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Sudhir Bunga
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
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Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
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Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Makuza JD, Soe P, Jeong D, Nisingizwe MP, Dushimiyimana D, Umutesi J, Nshimiyimana L, Maliza C, Serumondo J, Remera E, Rwibasira GN, Tuyishime A, Riedel DJ. Epidemiology of sexually transmitted infections: trends among patients screened for sexually transmitted infections in rwandan health facilities 2014–2020. BMC Infect Dis 2022; 22:701. [PMID: 35987614 PMCID: PMC9392439 DOI: 10.1186/s12879-022-07685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sexually Transmitted Infections (STIs) are of great global health concern. Currently, there are limited epidemiological data characterizing STIs in the general population in Rwanda. We assessed the national and regional epidemiology of STIs in Rwanda from 2014–2020 among patients syndromically screened for STIs in all health facilities in Rwanda. Methods This is a retrospective analysis of the trend of STIs epidemiology among screened patients at all health facilities in Rwanda using data from the Health Management Information System (HMIS) reporting. Adult patients (15 years and over) screened for STIs between July 2014 and June 2020 were included in the analysis. Outcomes of interest were the number of individuals screened for STIs and individuals diagnosed with at least one STI with a syndromic approach only or plus a test together. Results Overall, the number of individuals screened for STIs over the study period was 5.3 million (M) in 2014–2015, 6.6 M in 2015–2016, 6.3 M in 2016–2017, 6.7 M in 2017–2018, 6.2 M in 2018–2019, and 4.9 M in 2019–2020. There was a modest increase in the number of individuals diagnosed and treated for STIs from 139,357 in 2014–15 to 202,294 (45% increase) in 2019–2020. At the national level, the prevalence of STI syndromes amongst individuals screened at health facilities in Rwanda varied between 2.37% to 4.16% during the study period. Among the provinces, Kigali city had the highest prevalence for the whole 6 years ranging from 3.46% (95%CI: 3.41, 3.51) in 2014–2015 to 8.23% (95%CI: 8.15, 8.31) in 2019–2020. Conclusion From 2014 to 2020, the number of patients screened for STI syndromes in Rwanda varied between 4.9 M and 6.7 M. However, the prevalence of STIs among screened patients increased considerably over time, which could be associated with public awareness and improved data recording. The highest prevalence of all STIs was observed in urban areas and near borders, and private clinics reported more cases, suggesting the need to improve awareness in these settings and increase confidentiality and trust in public health clinics.
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Mizinduko MM, Moen K, Likindikoki S, Mwijage A, Leyna GH, Makyao N, Leshabari MT, Ramadhan A, Kambi MB, Meyrowitsch D, Tersbøl B, Mmbaga EJ. HIV prevalence and associated risk factors among female sex workers in Dar es Salaam, Tanzania: tracking the epidemic. Int J STD AIDS 2021; 31:950-957. [PMID: 32772690 DOI: 10.1177/0956462420917848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since 2014, HIV care and treatment services among key populations including female sex workers (FSWs) have intensified in Tanzania. We sought to track the epidemic among FSWs in Dar es Salaam, Tanzania. We conducted a cross-sectional integrated bio-behavioral survey using respondent-driven sampling and a structured questionnaire. Blood was drawn for HIV testing. Modified Poisson regression was used to determine factors associated with HIV infection. We recruited 958 FSWs (median age 26 years) of whom 952 consented to HIV testing. The HIV prevalence was 15.3% (95%CI: 12.5-18.6). Factors associated with higher HIV prevalence included old age (25-34 years: aPR 2.38; 95%CI: 1.23, 4.60 and over 35 years: aPR = 6.08; 95%CI: 3.19, 11.58) and having experienced sexual violence in the past year (aPR = 1.94; 95%CI: 1.34, 2.82). Attaining higher education level was associated with lower HIV prevalence (aPR = 0.51; 95%CI: 0.36, 0.73 for primary school level and aPR = 0.20; 95%CI: 0.08, 0.46 for secondary school level and/or above). The HIV prevalence among FSWs in Dar es Salaam has decreased by half since 2013. Prevention strategies should target older FSWs, aim to educate young girls, and institute approaches to mitigate violence among FSWs.
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Affiliation(s)
- M M Mizinduko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - K Moen
- University of Oslo, Oslo, Norway
| | - S Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - A Mwijage
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - G H Leyna
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - N Makyao
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - M T Leshabari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - A Ramadhan
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - M B Kambi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | - B Tersbøl
- University of Copenhagen, Copenhagen, Denmark
| | - E J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,University of Oslo, Oslo, Norway
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Use of propensity score matching to create counterfactual group to assess potential HIV prevention interventions. Sci Rep 2021; 11:7017. [PMID: 33782485 PMCID: PMC8007631 DOI: 10.1038/s41598-021-86539-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/17/2021] [Indexed: 11/08/2022] Open
Abstract
The design of HIV prevention trials in the context of effective HIV preventive methods is a challenge. Alternate designs, including using non-randomised 'observational control arms' have been proposed. We used HIV simulated vaccine efficacy trials (SiVETs) to show pitfalls that may arise from using such observational controls and suggest how to conduct the analysis in the face of the pitfalls. Two SiVETs were nested within previously established observational cohorts of fisherfolk (FF) and female sex workers (FSW) in Uganda. SiVET participants received a licensed Hepatitis B vaccine in a schedule (0, 1 and 6 months) similar to that for a possible HIV vaccine efficacy trial. All participants received HIV counselling and testing every quarter for one year to assess HIV incidence rate ratio (IRR) between SiVET and non-SiVET (observational data). Propensity scores, conditional on baseline characteristics were calculated for SiVET participation and matched between SiVET and non-SiVET in the period before and during the SiVET study. We compared IRR before and after propensity score matching (PSM). In total, 3989 participants were enrolled into observational cohorts prior to SiVET, (1575 FF prior to Jul 2012 and 2414 FSW prior to Aug 2014). SiVET enrolled 572 participants (Jul 2012 to Apr 2014 in FF and Aug 2014 to Apr 2017 in FSW), with 953 non-SiVET participants observed in the SiVET concurrent period and 2928 from the pre-SiVET period (before Jul 2012 in FF or before Apr 2014 in FSW). Imbalances in baseline characteristics were observed between SiVET and non-SiVET participants in both periods before PSM. Similarly, HIV incidence was lower in SiVET than non-SiVET; SiVET-concurrent period, IRR = 0.59, 95% CI 0.31-0.68, p = 0.033 and pre-SiVET period, IRR = 0.77, 95% CI 0.43-1.29, p = 0.161. After PSM, participants baseline characteristics were comparable and there were minimal differences in HIV incidence between SiVET and non-SiVET participants. The process of screening for eligibility for efficacy trial selects participants with baseline characteristics different from the source population, confounding any observed differences in HIV incidence. Propensity score matching can be a useful tool to adjust the imbalance in the measured participants' baseline characteristics creating a counterfactual group to estimate the effect of interventions on HIV incidence.
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Irungu EM, Baeten JM. PrEP rollout in Africa: status and opportunity. Nat Med 2020; 26:655-664. [PMID: 32405065 DOI: 10.1038/s41591-020-0872-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Following recommendations by the World Health Organization in 2015, and key clinical trials, countries in sub-Saharan Africa, the region with the highest burden of human immunodeficiency virus (HIV), developed policies that incorporate pre-exposure prophylaxis (PrEP) into national HIV-prevention strategies. By the end of 2019, more than one third of people receiving PrEP globally were in Africa. Crucial understandings gained from early rollout among at-risk populations, such as HIV-serodiscordant couples, adolescent girls and young women, female sex workers, and men who have sex with men, include the importance of strategies for maintaining persistent adherence to PrEP and novel approaches to making PrEP services accessible, simplified and efficient. This Perspective will discuss the current status of these programs and how to further widen their implementation.
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Affiliation(s)
- Elizabeth M Irungu
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA.
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9
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Abaasa A, Todd J, Nash S, Mayanja Y, Kaleebu P, Fast PE, Price M. Comparison of retention in observational cohorts and nested simulated HIV vaccine efficacy trials in the key populations in Uganda. BMC Med Res Methodol 2020; 20:32. [PMID: 32050900 PMCID: PMC7014936 DOI: 10.1186/s12874-020-00920-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background Outcomes in observational studies may not best estimate those expected in the HIV vaccine efficacy trials. We compared retention in Simulated HIV Vaccine Efficacy Trials (SiVETs) and observational cohorts drawn from two key populations in Uganda. Methods Two SiVETs were nested within two observational cohorts, one in Fisherfolk (FF) and another one in Female Sex Workers (FSW). Adult participants in each observational cohort were screened for enrolment into SiVETs. Those screened-out or not screened continued participation in the observational (non-SiVET) cohorts. SiVET participants were administered a licensed hepatitis B vaccine in a schedule that mimicked an actual HIV vaccine efficacy trial. Both cohorts were followed for 12 months and retention was assessed through dropout, defined as lost to follow up, being uncontactable, refusal to continue or missing the last study clinic visit. Dropout rates were compared using Poisson models giving rate ratios and 95% confidence intervals (95%CI). Results Out of 1525 participants (565 FF and 960 FSW), 572 (38%) were enrolled into SiVETs (282-FF and 290-FSW), and 953 (62%) remained in the non-SiVET cohorts. Overall, 326 (101 SiVET, 225 non-SiVET) dropped out in 1260 Person Years of Observation (PYO), a dropout rate of 25.9 /100 PYO (95%CI: 23.2–28.8); fewer dropped out in the SiVET cohorts (18.4, 95% CI: 15.1–22.4) than in the non-SiVET cohorts (31.6, 95% CI: 27.8–36.1), rate ratio (RR) =0.58, 95% CI: 0.46–0.73. In all cohorts, the dropout was more marked in FSW than in FF population. Duration lived in community was associated with dropout in both SiVETs and religion in both non-SiVET cohorts. Conclusion The rate of dropout was lower in SiVET compared to non-SiVET cohort. Though the difference in dropout between SiVET and non-SiVET was generally similar, the actual dropout rates were higher in the FSW population. Conduct of SiVETs in these key populations could mean that designing HIV Vaccine Efficacy Trials will benefit from lower dropout rate shown in SiVET than non-SiVET observational cohort.
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Affiliation(s)
- Andrew Abaasa
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Yunia Mayanja
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Patricia E Fast
- International AIDS Vaccine Initiative, New York, USA.,Pediatric Infectious Diseases, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Matt Price
- International AIDS Vaccine Initiative, New York, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, USA
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10
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van Dulm E, Marra E, Kroone MM, van Dijk AE, Hogewoning AA, Schim van der Loeff MF. Sexually transmissible infections among female sex workers in Amsterdam between 2011 and 2016: does risk vary by work location? Sex Health 2020; 17:368-376. [PMID: 32731918 DOI: 10.1071/sh19153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/11/2020] [Indexed: 11/23/2022]
Abstract
Background Female sex workers (FSW) are at risk for sexually transmissible infections (STI). This study aimed to investigate whether the risk for chlamydia and gonorrhoea differs by work location among FSW in Amsterdam. Additionally, trends in STI positivity rates between 2011 and 2016 were assessed. METHODS This was a retrospective analysis of routinely collected clinical data during STI consultations of FSW by the Prostitution and Healthcare Centre (P&G292). Work location was categorised as window prostitution, escorts/homeworkers, clubs/brothels/private houses/massage salons and other. RESULTS In total, 7558 STI consultations of 2529 FSW in the period 2011-16 were included. Positivity rates for chlamydia and gonorrhoea were 6.6% and 2.0%, respectively. Infectious hepatitis B virus, syphilis and HIV were diagnosed in <0.2% of consultations. Positivity rates of chlamydia and rectal gonorrhoea differed significantly by work location (P < 0.001). Genital and rectal chlamydia and rectal gonorrhoea were significantly less likely among women working in window prostitution, except for the other-group. Risk factors for STI did not vary by work location. Among women working in window prostitution, positivity rates for oropharyngeal and genital chlamydia and genital gonorrhoea were significantly decreasing between 2011 and 2016 (P trend <0.05). CONCLUSIONS The higher STI positivity among escorts/homeworkers and FSW in clubs/brothels/private houses/massage salons emphasises the need for extra attention to improve condom use and STI testing in this group. Factors associated with STI did not vary by work location, thus interventions, including those used by P&G292, to reduce STI risk, can be used for women at all work locations.
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Affiliation(s)
- Eline van Dulm
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands; and Corresponding author.
| | - Elske Marra
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Michelle M Kroone
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Anna E van Dijk
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Arjan A Hogewoning
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands; and Department of Dermatology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands; and Amsterdam Infection and Immunity Institute (AI&I), Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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11
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Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia. AIDS Behav 2019; 23:183-193. [PMID: 31134462 PMCID: PMC6773675 DOI: 10.1007/s10461-019-02537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February–June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.
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12
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Ingabire R, Parker R, Nyombayire J, Ko JE, Mukamuyango J, Bizimana J, Price MA, Laufer D, Tichacek A, Wall K, Allen S, Karita E. Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy. Int J STD AIDS 2019; 30:557-568. [PMID: 30727831 PMCID: PMC6512058 DOI: 10.1177/0956462418817050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
Female sex workers (FSWs) were recruited from known hotspots in Kigali, Rwanda, and offered free, anonymous human immunodeficiency virus (HIV) counseling and testing, diagnosis and treatment of sexually transmitted infections (STIs) and long-acting reversible contraception (LARC). From September 2012 to March 2015, 1168 FSWs sought services, including 587 (50%) who were HIV-positive. More than 90% had previously tested for HIV, and 26% who reported previously testing negative had seroconverted. Of the 349 who already knew their HIV-positive status, 74% were on antiretroviral treatment. The prevalence of serologic syphilis was 43% in HIV-positive and 19% in HIV-negative FSWs (p < 0.0001), and Trichomonas vaginalis was found in vaginal wet mounts in 21% of HIV-positive and 13% of HIV-negative FSWs (p < 0.0001). Signs and symptoms of STIs were found in 35% of HIV-positive compared with 21% of HIV-negative FSWs (p < 0.0001). Only one-third reported consistent condom use in the last month. Modern contraceptive use was reported by 43% of HIV-positive and 56% of HIV-negative FSWs (p < 0.0001). Current pregnancy was reported by 4% of HIV-positive and 6% of HIV-negative FSWs (p = 0.0409). Despite Rwanda's successes with preventing 70% of new infections in the general population through nationwide couples' testing in antenatal clinics, prevention and timely treatment in key populations including FSWs are lacking. The prevalence of HIV - including many new cases - and STIs among FSWs in Kigali is high and condom and contraceptive use are low. Tailored and integrated HIV/STIs and family planning programs are urgently needed for FSWs.
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Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Jasmine E Ko
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | | | - Jean Bizimana
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of
California at San Francisco, San Francisco, CA, USA
| | - Dagna Laufer
- International AIDS Vaccine Initiative, New York, NY, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Kristin Wall
- Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
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13
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Abaasa A, Nash S, Mayanja Y, Price M, Fast PE, Kamali A, Kaleebu P, Todd J. Simulated vaccine efficacy trials to estimate HIV incidence for actual vaccine clinical trials in key populations in Uganda. Vaccine 2019; 37:2065-2072. [PMID: 30857933 DOI: 10.1016/j.vaccine.2019.02.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fisherfolks (FF) and female sex workers (FSW) in Uganda could be suitable key populations for HIV vaccine efficacy trials because of the high HIV incidence and good retention in observational cohorts. However, the observed HIV incidence may differ in participants who enroll into a trial. We used simulated vaccine efficacy trials (SiVET) nested within observational cohorts in these populations to evaluate this difference. METHODS SiVETs were nested in two observational cohorts (Jul 2012-Apr 2014 in FF and Aug 2014-Apr 2017 in FSW). From Jan 2012 all observational cohort participants (aged 18-49 years) presenting for quarterly visits were screened for enrolment into SiVETs, until 572 were enrolled. Those not enrolled (screened-out or not screened) in SiVET continued participation in the observational cohorts. In addition to procedures in the observational cohorts (HIV testing & risk assessment), SiVET participants were given a licensed Hepatitis B vaccine mimicking a schedule of a possible HIV vaccine, and followed-up for 12 months. FINDINGS In total, 3989 participants were enrolled into observational cohorts (1575 FF prior to Jul 2012 and 2414 FSW prior to Aug 2014). Of these 3622 (90.8%) returned at least once, 672 (44.1%) were screened and 572 enrolled in the SiVETs. HIV incidence pre SIVETs was 4.5/100 person years-at-risk (pyar), 95%CI (3.8-5.5). HIV incidence in SiVET was 3.5/100 pyar, (2.2-5.6) and higher in those not enrolled in the SiVET, 5.9/100 pyar, (4.3-8.1). This difference was greatest among FF. In the 12 months post-SIVET period (FF, May 2014-Apr 2015 and FSW, May 2017-Apr 2018), the HIV incidence was 3.7/100 pyar, (2.5-5.8). INTERPRETATION HIV incidence was lower in SiVET participants compared to non-SiVET. This difference was different for the two populations. Researchers designing HIV efficacy trials using observational cohort data need to consider the potential for lower than expected HIV incidence following screening and enrolment.
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Affiliation(s)
- Andrew Abaasa
- MRC/UVRI & LSTHM Uganda Research Unit, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK.
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Yunia Mayanja
- MRC/UVRI & LSTHM Uganda Research Unit, Entebbe, Uganda
| | - Matt Price
- International AIDS Vaccine Initiative, New York, USA; University of California at San Francisco, Department of Epidemiology and Biostatistics, San Francisco, USA
| | - Patricia E Fast
- International AIDS Vaccine Initiative, New York, USA; Pediatric Infectious Diseases, School of Medicine, Stanford University, USA
| | | | | | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
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Rockliffe L, Chorley AJ, Marlow LAV, Forster AS. It's hard to reach the "hard-to-reach": the challenges of recruiting people who do not access preventative healthcare services into interview studies. Int J Qual Stud Health Well-being 2018; 13:1479582. [PMID: 29912650 PMCID: PMC6127841 DOI: 10.1080/17482631.2018.1479582] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 01/18/2023] Open
Abstract
In this article, we discuss the challenges faced in recruiting "hard-to-reach" groups for interview studies, specifically those who do not access preventative healthcare services. We do this by reflecting on the varying success of different recruitment methods we have used in two recent studies; one investigating ethnic disparities in human papillomavirus vaccination uptake and another exploring difference in cervical screening non-participation. Engaging new community groups to help with recruitment proved particularly difficult, as did recruiting online. Our most successful recruitment methods included recruiting through community groups with whom we had previously established relationships, recruiting through schools and re-contacting participants who previously completed a related survey. We conclude that successful recruitment is dependent on study awareness and engagement. We urge others to be transparent in reporting recruitment methods in order to benefit the qualitative research community and suggest that details are published as supplementary material alongside qualitative articles in future.
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Affiliation(s)
- Lauren Rockliffe
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Amanda J. Chorley
- Research Department of Behavioural Science and Health, UCL, London, UK
| | | | - Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, London, UK
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Ndori‐Mharadze T, Fearon E, Busza J, Dirawo J, Musemburi S, Davey C, Acharya X, Mtetwa S, Hargreaves JR, Cowan F. Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015. J Int AIDS Soc 2018; 21 Suppl 5:e25138. [PMID: 30033558 PMCID: PMC6055130 DOI: 10.1002/jia2.25138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION 'Sisters with a Voice', Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation. METHODS We used mixed methods to collect data at three sites: in-depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS-1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education. RESULTS 870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio-demographic differences, we found higher estimates of the proportion of HIV-positive FSWs and HIV-positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV-negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites. CONCLUSIONS Improvements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90-90-90 targets.
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Affiliation(s)
| | - Elizabeth Fearon
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Joanna Busza
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Jeffrey Dirawo
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | | | - Calum Davey
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Xeno Acharya
- Epidemiology and Public HealthHarvard TH Chan School of Public HealthBostonMA
| | - Sibongile Mtetwa
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | - James R Hargreaves
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Frances Cowan
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
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