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Tesfie TK, Yismaw GA, Yirsaw BG, Abuhay HW, Alemayehu MA, Derseh NM, Alemu GG, Agimas MC. Prevalence and associated factors of HIV among female sex workers in Eastern and Southern Africa: Systematic review and meta-analysis. PLoS One 2024; 19:e0313868. [PMID: 39621614 PMCID: PMC11611193 DOI: 10.1371/journal.pone.0313868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 10/31/2024] [Indexed: 12/11/2024] Open
Abstract
BACKGROUND Female sex workers (FSWs) are marginalized groups of the population who have limited access to healthcare and a higher risk of HIV infection due to biobehavioral and structural risk factors. Although it is known that the Eastern and Southern African region is affected by the highest HIV incidence and prevalence, understanding the burden among FSWs in the region remains limited. We aimed to assess the pooled prevalence and associated factors of HIV in this vulnerable population. METHODS Relevant studies were searched on PubMed, Embase, Scopus, ScienceDirect, Hinari, African Journals Online (AJOL), Google, and Google Scholar. The searching mechanism was constructed using keywords identified by CoCoPop (Condition, Context, and Population) framework and medical subject heading terms to recruit studies published between January 1, 2015 and March 30, 2024. Observational studies that estimate the prevalence or incidence or associated factors of HIV among FSWs, even if FSWs were not the main focus of the study, were included. The quality of included studies was assessed using Joana Brigg's Institute checklist. Data were extracted and analyzed using STATA 17 software. To estimate the pooled effect sizes with their 95% confidence intervals, a random effect model was fitted. The I2 statistic was used to evaluate heterogeneity. Funnel plot and Egger's regression test were utilized to assess the small study effect. Publication bias was managed using trim-and-fill analysis. Subgroup and sensitivity analysis were considered to handle heterogeneity among studies. RESULTS A total of 54 articles with 78,747 FSWs who had successful HIV biological test were included in the analysis. The pooled prevalence of HIV among FSWs in Eastern and Southern Africa was 36.0% (95% CI: 31.0%-41.0%). Regionally, the pooled prevalence was 59.0% (95% CI: 53.0%-64.0%) and 29.0% (95% CI: 25.0%-34.0%) in Southern and Eastern Africa, respectively. Age above 35 (POR = 7.35; 95% CI: 5.26, 10.28) and 25-34 years (POR = 2.91; 95% CI: 2.02, 4.21), being married (POR = 1.33; 95% CI: 1.07, 1.66), divorced (POR = 1.72; 95% CI: 1.39, 2.13), and widowed (POR = 2.70; 95% CI: 2.09, 3.49), primary education (POR = 1.29; 95% CI:1.08, 1.55), history of sexually transmitted infection (POR = 1.51; 95% CI: 1.20, 1.90), syphilis (POR = 2.57; 95% CI: 1.66, 3.98), Hepatitis B infection (POR = 2.60; 95% CI: 1.07,6.32), drinking alcohol (POR = 1.21; 95% CI: 1.01, 1.45) and injectable drug use before sex (POR = 1.75; 95% CI: 1.24, 2.47) were found significantly associated with the increased risk of HIV infection among FSWs. CONCLUSION These data suggest an urgent need to improve access to HIV prevention programs for FSWs. Providing behavioral interventions including reduction of alcohol and injectable drug use before sex, initiating tailored healthcare services, strengthening the psychosocial and legal support network, and fostering partnership might reduce the burden in the region. Clinicians could facilitate early detection and treatment of STIs, and Hepatitis B virus infection. TRIAL REGISTRATION Protocol registration: The protocol for this systematic review and meta-analysis was registered in the PROSPERO with registration number CRD42024509200.
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Affiliation(s)
- Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Awoke Yismaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bantie Getnet Yirsaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Wagnew Abuhay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mekonnen Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebrie Getu Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mokinu RA, Yonge SA, Lafort Y, Sandfort TGM, Mantell JE, Gichangi PB. Sexual practices, their influencers, and utilization of HIV services among female sex workers in Mombasa County, Kenya. Pan Afr Med J 2024; 47:209. [PMID: 39247770 PMCID: PMC11380618 DOI: 10.11604/pamj.2024.47.209.41775] [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: 09/20/2023] [Accepted: 01/13/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction female sex workers (FSWs) are vulnerable to acquiring HIV and other sexually transmitted infections due to unprotected sex. Understanding and addressing the gaps in safer sex among FSWs can help to reduce HIV acquisition and transmission. This study described sexual practices, their correlates and use of HIV services among FSWs in Mombasa County, Kenya. Methods participants were recruited for a baseline survey by a time-location cluster randomized design at predetermined intervals from five bars and five clubs in Mombasa County until a sample size of 160 was reached. Descriptive statistics and inferential analysis using R were conducted, and p<0.05 was regarded as statistically significant. Results nearly all (99%) of the participants were unmarried, and 11% had tertiary education. Ninety-eight percent (98%) reported vaginal intercourse, 51% reported using alcohol/drugs before sex, and 28% practiced unprotected intercourse. About 64% had tested for HIV within three months, 14% believed that it is safe to reuse condoms, and 10% that it is safe to engage in unprotected sex. In bi-variate analysis, FSWs were more likely to engage in unprotected intercourse if they reported more frequent sex, more frequent sex with regular clients, poor HIV knowledge, alcohol/drug use, and violence. In multivariate analysis, risky sexual practices were associated with frequency of sexual intercourse, alcohol/drug use, and poor HIV knowledge. Conclusion female sex workers engage in unprotected sex while under the influence of substances, belief in re-using condoms and have high frequency of sexual intercourse. Inadequate knowledge of HIV and substance use significantly correlated with unprotected sex. Interventions to address these modifiable factors are needed to mitigate the risk of HIV among FSWs.
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Affiliation(s)
- Robert Abuga Mokinu
- County Government of Mombasa, Mombasa, Kenya
- Department of Environment and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Shadrack Ayieko Yonge
- Department of Environment and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Yves Lafort
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium
| | - Theodorus Gustavus Maria Sandfort
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Joanne Ellen Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Peter Bundi Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Wariso FB, Ayalew J, Barba A, Bedassa BB, Ebo GG, Tura JB, Rameto M, Belihu WB, Asfaw D, Amogne MD, Negeri L, Lulseged S, Abrahim SA. Determinants of sexually transmitted infections among female sex workers in Ethiopia: a count regression model approach. Front Public Health 2023; 11:1190085. [PMID: 37601188 PMCID: PMC10437068 DOI: 10.3389/fpubh.2023.1190085] [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: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Background Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia. Methods A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p-value of ≤0.05 was used as a threshold for statistical significance. Results At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs. Conclusion STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis.
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Affiliation(s)
| | - Jemal Ayalew
- College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Ammar Barba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Lemessa Negeri
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Perrault Sullivan G, Guédou FA, Tounkara FK, Béhanzin L, Camara N, Aza-Gnandji M, Keita BD, Azonnadou O, Thera I, Avery L, Alary M. Longitudinal study of pregnancy intention and its association with pregnancy occurrence among female sex workers in Benin and Mali. Reprod Health 2023; 20:25. [PMID: 36717914 PMCID: PMC9887776 DOI: 10.1186/s12978-023-01565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The intention of becoming pregnant has an evident impact on the prenatal and postnatal period. For female sex workers (FSWs) in West Africa, among whom pregnancies are frequent as are HIV and sexually transmitted infections, a better understanding of their pregnancy intention and its influence on pregnancy occurrence could help prevent unwanted pregnancies and adverse effects on wanted pregnancies. METHODS We recruited 330 FSWs in Benin and 322 in Mali and followed them for 12 months. We evaluated their pregnancy intention at recruitment and 6-month follow-up, using a multidimensional prospective measure that we developed. We assessed pregnancy occurrence with a pregnancy test and a retrospective questionnaire at 6 and 12 months. A Cox proportional hazard model was used to estimate the association between intention and pregnancy. We carried out an analysis to take losses to follow-up into account using the inverse of probability of censoring weights and a cluster analysis to corroborate that the multidimensional measure of pregnancy intention fitted the data. RESULTS 407 FSWs were included in the first 6-month analysis and 284 at 12 months. Mean age was 30.9 years. The pregnancy intention distribution was similar between the two periods: 15.2% in the first period and 16.3% in the second had a positive intention. One out of four were ambivalent and almost 60% (57.7% and 56.3%) had a negative intention. For 38.2% of the FSWs, the intention changed between the two periods. The global incidence rate (to first event) was 19.1 pregnancies per 100 person-years. There was a borderline significant trend (p = 0.0529) of decreased pregnancy incidence with decreasing intention. Compared to positive intention, the adjusted hazard ratio (aHR) for ambivalent and negative intentions were 0.71 [95% confidence interval (95% CI) 0.32-1.60] and 0.46 (95% CI 0.21-1.01), respectively. CONCLUSION The level of pregnancy intention influences its occurrence among FSWs and nearly one out of six wants a baby despite working in the sex trade. Programmatically, early identification of these women could facilitate provision of quality antenatal and postnatal care. Given other health risks associated with sex work this care may decrease potential risks of adverse maternal, fetal and neonatal outcomes.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada.
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec - Université Laval, Québec, Canada.
- Institut National de Santé Publique, Québec, Canada.
| | - Fernand Aimé Guédou
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec - Université Laval, Québec, Canada
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | | | - Luc Béhanzin
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec - Université Laval, Québec, Canada
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | | | | | | | - Odette Azonnadou
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | | | - Lisa Avery
- Institute for Global Public Health, Dept. Obstetrics, Gynecology and Reproductive Sciences, Max Rady Medical College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michel Alary
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec - Université Laval, Québec, Canada
- Institut National de Santé Publique, Québec, Canada
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Barba A, Bati F, Tura JB, Addis B, Abrahim S. Magnitude and Determinants of Syphilis and HIV Co-Infection Among Female Sex Workers in Ethiopia: Evidence from Respondent Driven Samples, 2019-2020. HIV AIDS (Auckl) 2022; 14:473-485. [PMID: 36337317 PMCID: PMC9635310 DOI: 10.2147/hiv.s384213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/08/2022] [Indexed: 11/08/2022] Open
Abstract
Background Female sex workers (FSWs) play an important role in transmitting Human Immunodeficiency Virus (HIV) and syphilis from high-risk groups to the general population. Syphilis and HIV infections are generally more prevalent among FSWs. However, in Ethiopia, up-to-date evidence about Syphilis-HIV co-infections among FSWs was lacking. Objective To determine the magnitude and determinants of Syphilis-HIV co-infection among FSWs in Ethiopia, 2019-2020. Methods A cross-sectional HIV and other sexually transmitted infections Bio-Behavioral Survey (HSBS) was conducted using respondent-driven sampling (RDS) among 6,085 FSWs in Ethiopia from August 2019 to January 2020. Data was collected, merged with laboratory data, and analyzed in R software using the RDS package. The odds ratio was calculated at 95% CI to measure associations between the dependent and independent variables. Variables that yield p<0.25 in univariate analysis were included in multivariate analysis. In multivariate analysis, variables with p<0.05 were declared as statistically significant. Results were presented in frequency tables and charts. Results The prevalence of Syphilis-HIV co-infection among FSWs was 2.9% [95% CI=2.6-3.2]. Age of the FSWs (15-19 years old (AOR=0.03; 95% CI=0.01-0.12)), non-formal educational level (AOR=3.18; 95% CI=1.78-5.68), monthly income <2,500 ETB (AOR=3.05; 95% CI=1.45-6.42), major depression (AOR=1.85; 95% CI=1.18-2.89), forced first sex experience (AOR=1.71; 95% CI=1.2-2.44), condom breakage (AOR=1.62; 95% CI=1.14-2.30), Hepatitis B seropositivity (AOR=2.32; 95% CI=1.10-4.90), and Hepatitis C seropositivity (AOR=5.37; 95% CI=1.70-16.93) were strongly associated with Syphilis-HIV co-infection among FSWs in Ethiopia. Conclusion The prevalence of Syphilis-HIV co-infection among FSWs in Ethiopia was high. To ward off Syphilis-HIV co-infection among FSWs, a special FSWs-targeted HIV and Syphilis/STIs prevention program and treatment approach needs to be devised. An outreach approach to address the sexual and reproductive health needs of FSWs has to be part of the strategy.
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Affiliation(s)
- Ammar Barba
- Director General Office, Ethiopian Public Health Institute, Addis Ababa, Ethiopia,Correspondence: Ammar Barba, Director General Office, Ethiopian Public Health Institute, Addis Ababa, Ethiopia, Tel +251 925 229 205, Email
| | - Fayiso Bati
- Tuberculosis and HIV/AIDS Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jaleta Bulti Tura
- Tuberculosis and HIV/AIDS Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Beza Addis
- Director General Office, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Saro Abrahim
- Tuberculosis and HIV/AIDS Research Directorate, Ethiopian Public Health Institute, 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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Bitty-Anderson AM, Gbeasor-Komlanvi FA, Bakoubayi AW, Tchankoni MK, Sadio AJ, Salou M, Dagnra CA, Ekouevi DK, Coffie PA. High burden of self-reported sexually transmitted infections among female sex workers in Togo in 2021. Front Public Health 2022; 10:915029. [PMID: 35991055 PMCID: PMC9381961 DOI: 10.3389/fpubh.2022.915029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sexually Transmitted Infections (STI) remain a public health challenge, especially for Female Sex Workers (FSW) who are particularly vulnerable. In sub-Saharan Africa where the overlapping epidemics of STI and HIV are concentrated among key populations, epidemiological data are needed in order to better understand STI trends in this population. The aim of this study was to assess the prevalence of self-reported STI symptoms and their risk factors among FSW in Togo in 2021. Methods A cross-sectional study was completed in June and July 2021 among FSW in two cities of Togo: in Lomé (capital city, south of Togo) and in Kara (north of Togo). A snowball sampling method was used and after consent, a standardized questionnaire was administered by trained research staff to collect information on STI. A multivariate logistic regression model was used to identify factors associated with self-reported STI. Results A total of 447 FSW, 300 in Lomé and 147 in Kara participated in this study. Median age was 30 [IQR: 24-38] and STI symptoms in the previous 12 months were reported by 191 FSW [42.7%, 95% CI: (38.1-47.5)], among whom 116 (60.7%) sought medical care. The most common reported symptoms were abnormal vaginal discharge (n = 78; 67.2%) and vaginal itching (n = 68; 58.6%). Current STI symptoms (at the time of the survey) were reported by 88 FSW (19.7%). In multivariable logistic regression, self-reported STI symptoms in the previous 12 months was negatively associated with living in the Lomé and older age and positively associated with having more than 15 clients in the previous week and being victim of violence. Conclusions Findings from this study reveal that the self-reported STI burden is relatively high among FSW Togo. Additional strategies are needed at the structural, medical, political and social levels to curb this trend and effectively aim at the elimination of STI epidemics by the year 2030.
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Affiliation(s)
- Alexandra M. Bitty-Anderson
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- PAC-CI Research Center – ANRS Site Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Fifonsi A. Gbeasor-Komlanvi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Akila W. Bakoubayi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Martin K. Tchankoni
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
| | - Arnold J. Sadio
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Mounerou Salou
- Molecular Biology Laboratory, Fundamental Sciences Department, University of Lomé, Lomé, Togo
- National HIV/AIDS, Viral Hepatitis and Sexually Transmitted Infections Program (PNLS/HV/IST), Lomé, Togo
- Laboratory Services, University Hospital Campus (CHU Campus), Lomé, Togo
| | - Claver A. Dagnra
- Molecular Biology Laboratory, Fundamental Sciences Department, University of Lomé, Lomé, Togo
- National HIV/AIDS, Viral Hepatitis and Sexually Transmitted Infections Program (PNLS/HV/IST), Lomé, Togo
| | - Didier K. Ekouevi
- African Research Center in Epidemiology and Public Health (CARESP), Lomé, Togo
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- Public Health Department, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Patrick A. Coffie
- PAC-CI Research Center – ANRS Site Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire
- Medical Sciences Research and Formation Unit, Dermatology and Infectiology Department, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- University Hospital of Treichville, Infectious and Tropical Diseases Service, Abidjan, Côte d'Ivoire
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DiCarlo MC, Dallabetta GA, Akolo C, Bautista-Arredondo S, Digolo HV, Fonner VA, Kumwenda GJ, Mbulaje P, Mwangi PW, Persuad NE, Sikwese S, Wheeler TA, Wolf RC, Mahler HR. Adequate funding of comprehensive community-based programs for key populations needed now more than ever to reach and sustain HIV targets. J Int AIDS Soc 2022; 25:e25967. [PMID: 35880969 PMCID: PMC9318644 DOI: 10.1002/jia2.25967] [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: 02/17/2022] [Accepted: 07/06/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Globally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services. Discussion The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID‐19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered “extras,” not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements. Conclusions As nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community‐based and community‐driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95‐95‐95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered.
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Affiliation(s)
- Meghan C DiCarlo
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | | | - Chris Akolo
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | - Sergio Bautista-Arredondo
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | | | - Virginia A Fonner
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
| | - Grace Jill Kumwenda
- Pakachere Institute for Health and Development Communication, Blantyre, Malawi
| | | | - Peninah W Mwangi
- Bar Hostess Empowerment and Support Program (BHESP), Nairobi, Kenya
| | | | - Simon Sikwese
- Pakachere Institute for Health and Development Communication, Blantyre, Malawi
| | - Tisha A Wheeler
- Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USA
| | - R Cameron Wolf
- Office of HIV/AIDS, United States Agency for International Development (USAID), Washington, DC, USA
| | - Hally R Mahler
- Global Health Population and Nutrition, FHI 360, Washington, DC, USA
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9
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Macleod CI, Reynolds JH, Delate R. Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion. Public Health Rev 2022; 43:1604376. [PMID: 35646420 PMCID: PMC9131513 DOI: 10.3389/phrs.2022.1604376] [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: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.
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Affiliation(s)
- Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | | | - Richard Delate
- 2gether 4 SRHR, United Nations Population Fund, Johannesburg, South Africa
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10
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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: 16] [Impact Index Per Article: 8.0] [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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11
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Twahirwa Rwema JO, Nizeyimana V, Prata NM, Okonkwo NE, Mazzei AA, Muhirwa S, Rukundo A, Lucas L, Niyigena A, Makuza JD, Beyrer C, Baral SD, Kagaba A. Injection drug use practices and HIV infection among people who inject drugs in Kigali, Rwanda: a cross-sectional study. Harm Reduct J 2021; 18:130. [PMID: 34911554 PMCID: PMC8672501 DOI: 10.1186/s12954-021-00579-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Background In Rwanda, epidemiological data characterizing people who inject drugs (PWID) and their burden of HIV are limited. We examined injection drug use (IDU) history and practices, and HIV infection in a sample of PWID in Kigali. Methods From October 2019 to February 2020, 307 PWID aged ≥ 18 were enrolled in a cross-sectional study using convenience sampling in Kigali. Participants completed interviewer-administered questionnaires on IDU history and practices and HIV testing. We used Poisson regression with robust variance estimation to assess IDU practices associated with HIV infection and assessed factors associated with needle sharing in the six months preceding the study. Results The median age was 28 years (IQR 24–31); 81% (251) were males. Female PWID were more likely to report recent IDU initiation, selling sex for drugs, and to have been injected by a sex partner (p < 0.05). In the prior six months, heroin was the primary drug of choice for 99% (303) of participants, with cocaine and methamphetamine also reported by 10% (31/307) and 4% (12/307), respectively. In total, 91% (280/307) of participants reported ever sharing needles in their lifetime and 43% (133) knew someone who died from a drug-related overdose. HIV prevalence was 9.5% (95% CI 8.7–9.3). Sharing needles at least half of the time in the previous six months was positively associated with HIV infection (adjusted prevalence ratio (aPR) 2.67; 95% CI 1.23–5.78). Overall, 31% (94/307) shared needles and 33% (103/307) reused needles in the prior six months. Female PWID were more likely to share needles compared to males (aPR 1.68; 95% CI 1.09–2.59). Additionally, bisexual PWID (aPR 1.68; 95% CI 1.09–2.59), those who shared needles at the first injection (aPR 2.18; 95% CI 1.59–2.99), reused needles recently (aPR 2.27; 95% CI 1.51–3.43) and shared other drug paraphernalia (aPR 3.56; 95% CI 2.19–5.81) were more likely to report recent needle sharing. Conclusion HIV infection was common in this study. The high prevalence of needle reuse and sharing practices highlights significant risks for onward transmission and acquisition of HIV and viral hepatitis. These data highlight the urgent need for PWID-focused harm reduction services in Rwanda, including syringe services programs, safe injection education, naloxone distribution, and substance use disorder treatment programs and optimizing these services to the varied needs of people who use drugs in Rwanda.
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Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA.
| | | | - Neia M Prata
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Nneoma E Okonkwo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amelia A Mazzei
- Emory University School of Medicine, Atlanta, GA, USA.,Projet San Francisco, Kigali, Rwanda
| | | | | | - Lisa Lucas
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Audace Niyigena
- Département de Psychiatrie, Service d'addictologie, Hôpitaux Universitaire de Genève, Geneva, Switzerland
| | - Jean Damascene Makuza
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,BC Center for Disease Control, Vancouver, BC, Canada.,Rwanda Biomedical Center, Kigali, Rwanda
| | - Chris Beyrer
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
| | - Stefan D Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street E 7133, Baltimore, MD, 21205, USA
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12
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Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018-2020. PLoS One 2021; 16:e0259708. [PMID: 34788323 PMCID: PMC8598012 DOI: 10.1371/journal.pone.0259708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
Background Despite Rwanda’s progress toward HIV epidemic control, 16.2% of HIV-positive individuals are unaware of their HIV positive status. Tailoring the public health strategy could help reach these individuals with new HIV infection and achieve epidemic control. Recency testing is primarily for surveillance, monitoring, and evaluation but it’s not for diagnostic purposes. However, it’s important to know what proportion of the newly diagnosed are recent infections so that HIV prevention can be tailored to the profile of people who are recently infected. We therefore used available national data to characterize individuals with recent HIV infection in Rwanda to inform the epidemic response. Methods We included all national-level data for recency testing reported from October 2018 to June 2020. Eligible participants were adults (aged ≥15 years) who had a new HIV diagnosis, who self-reported being antiretroviral therapy (ART) naïve, and who had consented to recency testing. Numbers and proportions of recent HIV infections were estimated, and precision around these estimates was calculated with 95% confidence intervals (CI). Logistic regression was used to assess factors associated with being recently (within 12 months) infected with HIV. Results Of 7,785 eligible individuals with a new HIV-positive diagnosis, 475 (6.1%) met the criteria for RITA recent infection. The proportion of RITA recent infections among individuals with newly identified HIV was high among those aged 15–24 years (9.6%) and in men aged ≥65 years (10.3%) compared to other age groups; and were higher among women (6.7%) than men (5.1%). Of all recent cases, 68.8% were women, and 72.2% were aged 15–34 years. The Northern province had the fewest individuals with newly diagnosed HIV but had the highest proportion of recent infections (10.0%) compared to other provinces. Recent infections decreased by 19.6% per unit change in time (measured in months). Patients aged ≥25 years were less likely to have recent infection than those aged 15–24 years with those aged 35–49 years being the least likely to have recent infection compared to those aged 15–24 years (adjusted odds ratio [aOR], 0.415 [95% CI: 0.316–0.544]). Conclusion Public health surveillance targeting the areas and the identified groups with high risk of recent infection could help improve outcomes.
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13
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Tchankoni MK, Bitty-Anderson AM, Sadio AJ, Gbeasor-Komlanvi FA, Ferré VM, Zida-Compaore WIC, Dorkenoo AM, Saka B, Dagnra AC, Charpentier C, Ekouevi DK. Prevalence and factors associated with trichomonas vaginalis infection among female sex workers in Togo, 2017. BMC Infect Dis 2021; 21:775. [PMID: 34372785 PMCID: PMC8351109 DOI: 10.1186/s12879-021-06432-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence and factors associated with Trichomonas vaginalis (T. vaginalis) among female sex workers (FSW) in Togo in 2017. A cross-sectional bio-behavioral study was conducted from August to October 2017 using a respondent-driven sampling method in four cities in Togo. METHOD A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. T. vaginalis detection by molecular biology tests was performed using Allplex STI Essential Assay which detect also 6 others micro-organisms. A blood sample was drawn and serological test using SD Bioline Duo VIH/Syphilis rapid test was performed for Human immunodeficiency virus (HIV) and syphilis testing. RESULTS A total of 310 FSW with median age 25 years, interquartile range (IQR) [21-32 years] were included. The prevalence of T. vaginalis was 6.5% (95%CI = [4.1-9.9]) and, overall, prevalence of other STI ranged from 4.2% (95%CI = [2.3-7.2]) for N. gonorrhoeae to 10.6% (95% CI = [7.5-14.7]) for HIV. Binary logistic regression was conducted to assess factors associated with T. vaginalis infection. Living in Lomé (aOR = 3.19; 95%CI = [1.11-11.49]), having had sexual intercourse before the age of 18 (aOR = 5.72; 95%CI = [1.13-10.89]), and being infected with C. trachomatis (aOR = 3.74; 95%CI = [2.95-12.25]) were factors associated with T. vaginalis among FSW. CONCLUSION The prevalence of T. vaginalis infection using molecular test was low among FSW in Togo. Extensive studies are needed to confirm and to better understand the epidemiology of T. vaginalis among this population and in other populations in Togo.
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Affiliation(s)
| | | | - Arnold Junior Sadio
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
| | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
| | - Valentine Marie Ferré
- Université de Paris, INSERM UMR 1137 IAME, F-75018, Paris, France
- Laboratoire de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | | | - Ameyo Monique Dorkenoo
- Département des Sciences Fondamentales, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
| | - Bayaki Saka
- CHU Sylvanus Olympio, Service de Dermatologie et Vénérologie, Université de Lomé, Lomé, Togo
| | - Anoumou Claver Dagnra
- Programme national de lutte contre le sida, les hépatites virales, et les infections sexuellement transmissibles, Lomé, Togo
| | - Charlotte Charpentier
- Université de Paris, INSERM UMR 1137 IAME, F-75018, Paris, France
- Laboratoire de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | - Didier Koumavi Ekouevi
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France.
- Université de Lomé, Laboratoire de Biologie Moléculaire et d'Immunologie, Lomé, Togo.
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14
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Coelho EC, Souza SB, Costa CCS, Costa LM, Pinheiro LML, Machado LFA, Silva-Oliveira GC, Martins LC, Frade PCR, Oliveira-Filho AB. Treponema pallidum in female sex workers from the Brazilian Marajó Archipelago: prevalence, risk factors, drug-resistant mutations and coinfections. Trans R Soc Trop Med Hyg 2021; 115:792-800. [PMID: 33210137 DOI: 10.1093/trstmh/traa127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are an especially vulnerable group for syphilis and other sexually transmitted infection (STIs). This study determined the prevalence of syphilis in FSWs and factors associated with this disease in the Marajó Archipelago (northern Brazil), as well as the frequency of point mutations (A2058G and A2059G) in the 23S rRNA gene of Treponema pallidum and coinfections with hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV). METHODS FSWs were diagnosed using a rapid qualitative test and the isolates were evaluated for the presence of point mutations by real-time PCR. Blood samples with T. pallidum were tested for the presence of HBV, HCV and HDV by ELISA and confirmed by real-time PCR. The factors associated with syphilis were identified using Poisson regression models. RESULTS Overall, 41.1% FSWs tested positive for syphilis and 23.5% were infected with strains having A2058G/A2059G point mutations. HBV (23.0%) and HCV (8.1%) were detected among FSWs with syphilis. Six factors were associated with syphilis: low levels of education, reduced income, drug use, unprotected sex, a lengthy career in prostitution and a lack of regular medical check-ups. CONCLUSIONS These findings indicate an urgent need for implementation of effective strategies to diagnose, prevent and treat syphilis, as well as other STIs, in this Brazilian region.
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Affiliation(s)
- Evelen C Coelho
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antônio Maria Zaccaria, Bragança PA, Brazil
| | - Samara B Souza
- Programa de Pós-Graduação em Linguagens e Saberes na Amazônia, Universidade Federal do Pará, Bragança PA, Brazil
| | - Camila Carla S Costa
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém PA, Brazil
| | - Luana M Costa
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém PA, Brazil
| | - Luiz Marcelo L Pinheiro
- Faculdade de Ciências Biológicas, Campus do Marajó, Universidade Federal do Pará, Soure PA, Brazil
| | - Luiz Fernando A Machado
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém PA, Brazil
| | - Gláucia C Silva-Oliveira
- Laboratório de Células e Patógenos, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil
| | - Luísa Caricio Martins
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém PA, Brazil.,Laboratório de Patologia Clínica de Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém PA, Brazil
| | - Paula Cristina R Frade
- Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém PA, Brazil
| | - Aldemir B Oliveira-Filho
- Programa de Pós-Graduação em Linguagens e Saberes na Amazônia, Universidade Federal do Pará, Bragança PA, Brazil.,Programa de Pós-Graduação em Doenças Tropicais, Universidade Federal do Pará, Belém PA, Brazil.,Laboratório de Células e Patógenos, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança PA, Brazil
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15
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Wall KM, Nyombayire J, Parker R, Ingabire R, Bizimana J, Mukamuyango J, Mazzei A, Price MA, Unyuzimana MA, Tichacek A, Allen S, Karita E. Developing and validating a risk algorithm to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis in symptomatic Rwandan women. BMC Infect Dis 2021; 21:392. [PMID: 33910514 PMCID: PMC8080377 DOI: 10.1186/s12879-021-06073-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Algorithms that bridge the gap between syndromic sexually transmitted infection (STI) management and treatment based in realistic diagnostic options and local epidemiology are urgently needed across Africa. Our objective was to develop and validate a risk algorithm for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) diagnosis among symptomatic Rwandan women and to compare risk algorithm performance to the current Rwandan National Criteria for NG/CT diagnosis. METHODS The risk algorithm was derived in a cohort (n = 468) comprised of symptomatic women in Kigali who sought free screening and treatment for sexually transmitted infections and vaginal dysbioses at our research site. We used logistic regression to derive a risk algorithm for prediction of NG/CT infection. Ten-fold cross-validation internally validated the risk algorithm. We applied the risk algorithm to an external validation cohort also comprised of symptomatic Rwandan women (n = 305). Measures of calibration, discrimination, and screening performance of our risk algorithm compared to the current Rwandan National Criteria are presented. RESULTS The prevalence of NG/CT in the derivation cohort was 34.6%. The risk algorithm included: age < =25, having no/primary education, not having full-time employment, using condoms only sometimes, not reporting genital itching, testing negative for vaginal candida, and testing positive for bacterial vaginosis. The model was well calibrated (Hosmer-Lemeshow p = 0.831). Higher risk scores were significantly associated with increased prevalence of NG/CT infection (p < 0.001). Using a cut-point score of > = 5, the risk algorithm had a sensitivity of 81%, specificity of 54%, positive predictive value (PPV) of 48%, and negative predictive value (NPV) of 85%. Internal and external validation showed similar predictive ability of the risk algorithm, which outperformed the Rwandan National Criteria. Applying the Rwandan National Criteria cutoff of > = 2 (the current cutoff) to our derivation cohort had a sensitivity of 26%, specificity of 89%, PPV of 55%, and NPV of 69%. CONCLUSIONS These data support use of a locally relevant, evidence-based risk algorithm to significantly reduce the number of untreated NG/CT cases in symptomatic Rwandan women. The risk algorithm could be a cost-effective way to target treatment to those at highest NG/CT risk. The algorithm could also aid in sexually transmitted infection risk and prevention communication between providers and clients.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Julien Nyombayire
- 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 and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Jean Bizimana
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | | | - Amelia Mazzei
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Matt A Price
- IAVI, NY, NY, University of California San Francisco, San Francisco, CA, 94115, USA
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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16
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Wall KM, Nyombayire J, Parker R, Ingabire R, Bizimana J, Mukamuyango J, Mazzei A, Price MA, Unyuzimana MA, Tichacek A, Allen S, Karita E. Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services. PLoS One 2021; 16:e0250044. [PMID: 33878134 PMCID: PMC8057583 DOI: 10.1371/journal.pone.0250044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms. METHODS Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men. RESULTS Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. CONCLUSIONS Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.
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Affiliation(s)
- Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Julien Nyombayire
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Rosine Ingabire
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Jean Bizimana
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | | | - Amelia Mazzei
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Matt A. Price
- IAVI, NY, NY, University of California San Francisco, San Francisco, CA, United States of America
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Etienne Karita
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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Dzinamarira T, Mulindabigwi A, Mashamba-Thompson TP. Co-creation of a health education program for improving the uptake of HIV self-testing among men in Rwanda: nominal group technique. Heliyon 2020; 6:e05378. [PMID: 33163663 PMCID: PMC7610321 DOI: 10.1016/j.heliyon.2020.e05378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. Methods We employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. Results Eleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. Conclusion Key stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.
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Affiliation(s)
- Tafadzwa Dzinamarira
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | | | - Tivani Phosa Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.,Department of Public Health, University of Limpopo, Polokwane, Limpopo Province, South Africa
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Makofane K, van der Elst EM, Walimbwa J, Nemande S, Baral SD. From general to specific: moving past the general population in the HIV response across sub-Saharan Africa. J Int AIDS Soc 2020; 23 Suppl 6:e25605. [PMID: 33000913 PMCID: PMC7527769 DOI: 10.1002/jia2.25605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION As the HIV field evolves to better serve populations which are diverse in risk and access to services, it is crucial to understand and adapt the conceptual tools used to make sense of the HIV pandemic. In this commentary, we discuss the concept of general population. Using a synthetic and historical review, we reflect on the genesis and usage of the general population in HIV research and programme literature, pointing to its moral connotations and its impact on epidemiologic reasoning. DISCUSSION From the early days of the HIV pandemic, the category of general population has carried implicit normative meanings. General population represented those people considered to be undeserving of HIV acquisition, and therefore deserving of a response. Framing the HIV epidemic in sub-Saharan Africa as a generalized epidemic primarily affecting the general population has contributed to the exclusion of men who have sex with men from epidemic responses. The usage of this category has also masked heterogeneity among those it includes; the increasing focus on the use of interventions such as circumcision and HIV treatment as general population HIV prevention approaches has been marked by a lack of attention to heterogeneity among beneficiaries. CONCLUSIONS We recommend that the term general population be retired from the field's lexicon. HIV programmes should strengthen their capacity to describe the heterogeneity of those they serve and plan their interventions accordingly. To increase the efficiency and impact of the HIV response, it is urgent to stratify the category of general population by risk. Sexual networks are a promising basis for this stratification.
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Affiliation(s)
- Keletso Makofane
- FXB Center for Health and Human RightsHarvard UniversityBostonMAUSA
| | | | | | | | - Stefan D Baral
- Center for Public Health and Human RightsDepartment of EpidemiologyJohns Hopkins School of Public HealthBaltimoreUSA
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Characterizing the role of intersecting stigmas and sustained inequities in driving HIV syndemics across low-to-middle-income settings. Curr Opin HIV AIDS 2020; 15:243-249. [PMID: 32487815 DOI: 10.1097/coh.0000000000000630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In 2020, key populations around the world still have disproportionate risks for HIV acquisition and experiencing HIV-related syndemics. This review presents current data around HIV-related syndemics among key populations globally, and on the role of intersecting stigmas in producing these syndemics in low-to-middle-income settings. RECENT FINDINGS Sex workers, sexual and gender minorities, prisoners, and people who use drugs experience high burdens of tuberculosis, sexually transmitted infections, viral hepatitis, and violence linked to heightened HIV-related risks or acquisition. Adverse sexual, reproductive, and mental health outcomes are also common and similarly amplify HIV acquisition and transmission risks, highlighting the need for psychosocial and reproductive health services for key populations. SUMMARY Achieving the promise of biomedical interventions to support HIV care and prevention requires action towards addressing syndemics of HIV, and the stigmas that reproduce them, among those most marginalized globally.
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Edi Putra IGN, Januraga PP. Social Capital and HIV Testing Uptake among Indirect Female Sex Workers in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5020073. [PMID: 32392824 PMCID: PMC7345714 DOI: 10.3390/tropicalmed5020073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023] Open
Abstract
Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali 80361, Indonesia
- Correspondence: ; Tel.: +6281246180389
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