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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Kangethe JM, Gichuhi S, Odari E, Pintye J, Mutai K, Abdullahi L, Maiyo A, Mureithi MW. Confronting the human papillomavirus-HIV intersection: Cervical cytology implications for Kenyan women living with HIV. South Afr J HIV Med 2023; 24:1508. [PMID: 37928501 PMCID: PMC10623654 DOI: 10.4102/sajhivmed.v24i1.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 11/07/2023] Open
Abstract
Background High-risk human papillomavirus (HR-HPV) is the primary cause of cervical cancer, leading to over 311 000 global deaths, mainly in low- and middle-income countries. Kenyan women living with HIV (WLHIV) face a disproportionate burden of HR-HPV. Objectives We determined the prevalence of HR-HPV infections and their association with cervical cytology findings among Kenyan WLHIV. Method We conducted a cross-sectional study among WLHIV attending the HIV care and treatment clinic at the Kenyatta National Hospital (KNH), Kenya's national referral hospital. Study nurses collected a cervical sample with a cytobrush for HR-HPV genotyping using Gene Xpert® assays and HPV Genotypes 14 Real-TM Quant V67-100FRT. Bivariate analysis explored the associations. Results We enrolled 647 WLHIV (mean age of 42.8 years), with 97.2% on antiretroviral therapy (ART) and 79% with a suppressed viral load (< 50 copies/mL plasma). The prevalence of any and vaccine-preventable HR-HPV was 34.6% and 29.4%, respectively, with HPV 52 being the most common genotype (13.4%). Among WLHIV with HR-HPV infections, 21.4% had abnormal cervical cytology. Women with multiple HR-HPV infections were more likely to have abnormal cytology compared to those with single HR-HPV infections (34.9 vs 9.3%, adjusted odds ratio [aOR] = 6.2, 95% confidence interval [CI]: 2.7-14.1, P = 0.001). Women with HR-HPV infection (single or multiple) were more likely to be on the second-line ART regimen compared to those without HR-HPV infections (53.1% vs 46.7%, aOR = 2.3, 95% CI: 1.3-4.1, P = 0.005). Conclusion Among WLHIV at KNH, abnormal cytology was common and more frequent among women with multiple HR-HPV infections.
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Affiliation(s)
- James M Kangethe
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya
- Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen Gichuhi
- Department of Ophthalmology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Eddy Odari
- Department of Medical Microbiology, Faculty of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States of America
| | - Kenneth Mutai
- Comprehensive Care Center for HIV, Kenyatta National Hospital, Nairobi, Kenya
| | - Leila Abdullahi
- Research and Policy Development, African Institute for Development Policy, Nairobi, Kenya
| | - Alex Maiyo
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Kenya
- KAVI Institute of Clinical Research, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
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Paraná VC, Souza Santos D, Barreto de Souza Silva DI, Lima GC, Gois LL, Santos LA. Anal and cervical human papillomavirus genotypes in women co-infected with human immunodeficiency virus: A systematic review. Int J STD AIDS 2022; 33:530-543. [PMID: 35333098 DOI: 10.1177/09564624221076293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human papillomavirus (HPV) and human immunodeficiency virus (HIV) infections are sexually transmitted. There are several HPV genotypes and clinical manifestations. Determining which genotypes circulate worldwide and/or in specific geographic areas can help with prevention programs and vaccine distribution. This systematic review aimed to investigate the most frequent anal and cervical HPV genotypes in women co-infected with HPV/HIV. The PubMed, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases were used to search for articles published between January 2015 and August 2021, and the included articles followed the defined selection criteria. Based on the 51 articles included, HPV16 was the most prevalent (41%) genotype, followed by HPV52 (17%) and HPV58 (14%). Based on the comparative analyses of the HIV-negative women with HPV and the HPV/HIV co-infected groups, HPV16 was frequent in both groups; HPV58, HPV31, and HPV52 were more frequent in the co-infected group; and HPV18 was more common in HIV-negative women with HPV. HPV/HIV co-infected women most frequently presented the HPV genotypes 16, 58, and 52, whereas HIV-negative women with HPV had a higher frequency of HPV16, HPV18, and HPV52 genotypes. The results indicate the importance of genotype surveillance as a strategy to improve preventive measures against HPV infection and its complications. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42020220121.
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Affiliation(s)
- Victoria C Paraná
- 156427Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Davi Souza Santos
- 156427Bahiana School of Medicine and Public Health, Salvador, Brazil
| | | | - Gabriela C Lima
- 156427Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Luana L Gois
- 156427Bahiana School of Medicine and Public Health, Salvador, Brazil.,Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Catholic University of Salvador, Salvador, Brazil
| | - Luciane Amorim Santos
- 156427Bahiana School of Medicine and Public Health, Salvador, Brazil.,Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Catholic University of Salvador, Salvador, Brazil.,Bahia School of Medicine, Federal University of Bahia, Salvador, Brazil
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Kangethe JM, Monroe-Wise A, Muiruri PN, Komu JG, Mutai KK, Nzivo MM, Pintye J. Utilisation of cervical cancer screening among women living with HIV at Kenya’s national referral hospital. South Afr J HIV Med 2022; 23:1353. [PMID: 35706549 PMCID: PMC9082290 DOI: 10.4102/sajhivmed.v23i1.1353] [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: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology. Objectives We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH. Method From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers. Results Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28–43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times. Conclusion Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation.
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Affiliation(s)
- James M Kangethe
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Peter N Muiruri
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - James G Komu
- Department of Medical Laboratory Sciences, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Kenneth K Mutai
- Comprehensive Care Center, HIV Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Mirriam M Nzivo
- Department of Biological Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Biological Sciences, University of Embu, Embu, Kenya
| | - Jillian Pintye
- Department of Global Health, International AIDS Research and Training Program, University of Washington, Seattle, United States of America
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, United States of America
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Chinn JO, Runge AS, Dinicu AI, Chang J, Maher JA, Crawford EW, Naaseh A, Cooper EC, Zezoff DC, White KM, Lucas AN, Bera KR, Bernstein M, Hari A, Ziogas A, Tewari SE, Pearre DC, Tewari KS. Visual inspection with acetic acid screening for cervical cancer among women receiving anti-retroviral therapy for human immunodeficiency virus infection in northern Tanzania. J Obstet Gynaecol Res 2021; 47:4365-4370. [PMID: 34614540 DOI: 10.1111/jog.15011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/04/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate visual inspection with acetic acid (VIA) screening for cervical cancer among human immunodeficiency virus (HIV)-positive patients in an East African community. METHODS During a July 2018 cervical cancer screen-and-treat in Mwanza, Tanzania, participants were offered free cervical VIA screening, cryotherapy when indicated, and HIV testing. Acetowhite lesions and/or abnormal vascularity were designated VIA positive in accordance with current guidelines. The association between VIA results and HIV status was compared using Chi-square and Fisher exact tests. RESULTS Eight hundred and twenty-four of 921 consented participants underwent VIA screening and 25.0% (n = 206) were VIA positive. VIA-positive nonpregnant women (n = 147) received cryotherapy and 15 (1.8%) with cancerous-appearing lesions were referred to Bugando Hospital. Sixty-six women were HIV-positive and included 25 diagnosed with HIV at the cervical cancer VIA screening and 41 with a prior diagnosis of HIV who were receiving antiretroviral therapy (ART) at the time of cervical cancer VIA screening. Sixty-four of these 66 patients, were screened with VIA. HIV infection was not associated with VIA findings. Abnormal VIA positive screening was observed in 20.3% (n = 13) of HIV-positive patients and in 24.4% (n = 145) of HIV-negative patients (p = 0.508). A nonsignificant trend of higher VIA positive screens among newly diagnosed HIV patients of 26.1% (n = 6) versus patients with preexisting HIV on ART of 17.1% (n = 7) was observed (p = 0.580). CONCLUSION The unexpected lack of correlation between HIV infection and VIA positivity in a community with access to ART warrants additional research regarding the previously described role of ART in attenuating HPV-mediated neoplasia.
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Affiliation(s)
- Justine O Chinn
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Ava S Runge
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Andreea I Dinicu
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | - Justine A Maher
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Elizabeth W Crawford
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Ariana Naaseh
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Emma C Cooper
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Danielle C Zezoff
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Kayla M White
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Alexa N Lucas
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Kevin R Bera
- Department of Medical Education, University of California, Irvine College of Medicine, Irvine, California, USA
| | - Megan Bernstein
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Anjali Hari
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Argyrios Ziogas
- Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA
| | | | - Diana C Pearre
- Department of Gynecology Oncology, University of California Irvine, Orange, California, USA
| | - Krishnansu S Tewari
- Department of Gynecology Oncology, University of California Irvine, Orange, California, USA
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Orang’o EO, Emont JP, Ermel AC, Liu T, Omodi V, Tong Y, Itsura PM, Tonui PK, Maina T, Ong’echa JM, Muthoka K, Kiptoo S, Moormann A, Hogan J, Loehrer PJ, Brown D, Cu-Uvin S. Detection of types of HPV among HIV-infected and HIV-uninfected Kenyan women undergoing cryotherapy or loop electrosurgical excision procedure. Int J Gynaecol Obstet 2020; 151:279-286. [PMID: 32715467 PMCID: PMC7541596 DOI: 10.1002/ijgo.13330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/31/2020] [Accepted: 07/16/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia. METHODS A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array. RESULTS Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence of low-risk HPV types (odds ratio [OR] 5.28, P=0.005) compared with HIV-negative women. The most common high-risk (HR)-HPV types in HIV-positive women were HPV 16 (13.9%) and HPV 18 (11.1%). HIV-positive women requiring LEEP were more likely to have HR-HPV types (OR 6.67, P=0.012) and to be infected with multiple HR-HPV types (OR 7.79, P=0.024) compared to those undergoing cryotherapy. CONCLUSION HIV-positive women requiring LEEP versus cryotherapy had a higher prevalence of any HR-HPV type and multiple HR-HPV types. There were no such differences in HPV types identified among HIV-negative women.
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Affiliation(s)
| | | | - Aaron C. Ermel
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tao Liu
- Brown University, Providence, RI, USA
| | | | - Yan Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Titus Maina
- Maseno University, Maseno, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - Ann Moormann
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Darron Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
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Omire A, Budambula NLM, Kirumbi L, Langat H, Kerosi D, Ochieng W, Lwembe R. Cervical Dysplasia, Infection, and Phylogeny of Human Papillomavirus in HIV-Infected and HIV-Uninfected Women at a Reproductive Health Clinic in Nairobi, Kenya. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4945608. [PMID: 32685493 PMCID: PMC7317317 DOI: 10.1155/2020/4945608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/08/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
High risk human Papillomavirus (HPV) infections ultimately cause cervical cancer. Human Immunodeficiency Virus (HIV) infected women often present with multiple high-risk HPV infections and are thus at a higher risk of developing cervical cancer. However, information on the circulating high-risk HPV genotypes in Kenya in both HIV-infected and HIV-uninfected women is still scanty. This study is aimed at determining the phylogeny and the HPV genotypes in women with respect to their HIV status and at correlating this with cytology results. This study was carried out among women attending the Reproductive Health Clinic at Kenyatta National Hospital, a referral hospital in Nairobi, Kenya. A cross-sectional study recruited a total of 217 women aged 18 to 50 years. Paired blood and cervical samples were obtained from consenting participants. Blood was used for serological HIV screening while cervical smears were used for cytology followed by HPV DNA extraction, HPV DNA PCR amplification, and phylogenetic analysis. Out of 217 participants, 29 (13.4%) were HIV seropositive, while 68 (31.3%) were positive for HPV DNA. Eight (3.7%) of the participants had abnormal cervical cytology. High-risk HPV 16 was the most prevalent followed by HPV 81, 73, 35, and 52. One participant had cervical cancer, was HIV infected, and had multiple high-risk infections with HPV 26, 35, and 58. HPV 16, 6, and 81 had two variants each. HPV 16 in this study clustered with HPV from Iran and Africa. This study shows the circulation of other HPV 35, 52, 73, 81, 31, 51, 45, 58, and 26 in the Kenyan population that play important roles in cancer etiology but are not included in the HPV vaccine. Data from this study could inform vaccination strategies. Additionally, this data will be useful in future epidemiological studies of HPV in Nairobi as the introduction or development of new variants can be detected.
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Affiliation(s)
- Agnes Omire
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | | | - Leah Kirumbi
- Kenya Medical Research Institute, P.O. Box 54840-00100, Nairobi, Kenya
| | - Hillary Langat
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | - Danvas Kerosi
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya
| | - Washingtone Ochieng
- Center for Virus Research in Therapeutic Sciences, P.O. Box 59857-00200, Nairobi, Kenya
| | - Raphael Lwembe
- Kenya Medical Research Institute, P.O. Box 54840-00100, Nairobi, Kenya
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Vasnik GK, Jain G, Husainy FA, Bansal V. Correlation of Cervical Squamous Intraepithelial Lesions with Human Papillomavirus in Women Infected with the Human Immunodeficiency Virus. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-018-0251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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