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Awareness, Willingness and Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers Living in Dar-es-Salaam, Tanzania. AIDS Behav 2023; 27:335-343. [PMID: 35838859 PMCID: PMC9852168 DOI: 10.1007/s10461-022-03769-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
Tanzania is in the final stages to roll out pre-exposure prophylaxis (PrEP) to Female Sex Workers (FSWs) so as to reduce new infections. PrEP demonstration projects support programming through gaining first experiences.We analyzed data from a cohort of 700 HIV negative FSWs in Dar-es-Salaam to determine proportions of FSWs who were aware, willing and used PrEP. We compared proportions at cohort enrolment and after 12 months. Logistic regression was used to determine factors associated with PrEP use. PrEP awareness increased from 67% to 97% after 12 months. Willingness was high at both time points (98% versus 96%). Only 8% (57/700) had used PrEP. Being married/cohabiting or separated/divorced/widowed and having sex with a HIV infected partner were independently associated with PrEP use. The PrEP program should focus on scaling up access as willingness to use PrEP is high.
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The Prevalence, Incidence, and Risk Factors for HIV Among Female Sex Workers-A Cohort Being Prepared for a Phase IIb HIV Vaccine Trial in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2022; 91:439-448. [PMID: 36126184 PMCID: PMC9646411 DOI: 10.1097/qai.0000000000003097] [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: 07/21/2021] [Accepted: 06/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A cohort of female sex workers (FSWs) was established to determine HIV prevalence and incidence, and associated factors in preparation for a phase IIb HIV vaccine and pre-exposure prophylaxis trial (PrEPVacc). SETTING A cohort of FSWs in Dar es Salaam, Tanzania. METHODS FSWs aged 18-45 years were recruited using a respondent-driven sampling method. Social demographic data, HIV risk behavioral assessments, and blood samples for testing of HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) infections were collected at baseline and then at 3, 6, 9, and 12 months. Poisson regressions were used to estimate the prevalence ratios for factors associated with HIV prevalence and to estimate the 12-month HIV incidence rate. RESULTS Between October and December 2018, a total of 773 FSWs were screened for eligibility and 700 were enrolled. The baseline prevalence of HIV, syphilis, HBV, and HCV was 7.6%, 1.2%, 1.7%, and 1.0%, respectively. HIV prevalence was associated with older age, using illicit drugs, and being infected with syphilis, HBV, or HCV. Attendance at 12 months was 80% (562/700). Twenty-one FSWs seroconverted during follow-up, giving a 12-month HIV incidence rate of 3.45 per 100 person-years at risk (95% CI; 2.25-5.28/100 person-years at risk). The HIV incidence rate was higher among FSWs aged 18-24 years, FSWs who used drugs, and those diagnosed with syphilis, HBV, or HCV. CONCLUSION The high HIV incidence rate and retention rate among FSWs enrolled into the cohort demonstrate that this population is suitable for participation in HIV prevention trials.
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Sanchez T, Mavragani A, Materu J, Drake M, Majani E, Casalini C, Mjungu D, Mbita G, Kalage E, Komba A, Nyato D, Nnko S, Shao A, Changalucha J, Wambura M. Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e30372. [PMID: 36121686 PMCID: PMC9531008 DOI: 10.2196/30372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. OBJECTIVE This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. METHODS A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. RESULTS Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. CONCLUSIONS Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. TRIAL REGISTRATION ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243.
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Affiliation(s)
| | | | - Jacqueline Materu
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mary Drake
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Majani
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Caterina Casalini
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Deusdedit Mjungu
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Gaspar Mbita
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Kalage
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Albert Komba
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
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Mulholland GE, Markiewicz M, Arimi P, Ssengooba F, Weir S, Edwards JK. HIV Prevalence and the HIV Treatment Cascade Among Female Sex Workers in Cross-Border Areas in East Africa. AIDS Behav 2022; 26:556-568. [PMID: 34379274 DOI: 10.1007/s10461-021-03411-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90-90-90 targets. The 2016-2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing.
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Affiliation(s)
- Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA.
| | - Milissa Markiewicz
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peter Arimi
- Centre for Research, Innovation and Grants Advancement, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
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Seroprevalence of Human Herpesvirus Infections in Newly Diagnosed HIV-Infected Key Populations in Dar es Salaam, Tanzania. Int J Microbiol 2021; 2021:4608549. [PMID: 34484345 PMCID: PMC8410440 DOI: 10.1155/2021/4608549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Human herpesvirus (HHV) infections can significantly increase the risk of human immunodeficiency virus (HIV) transmission and accelerate disease progression. In the population at high risk of HIV infection, also termed as key populations (female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID)), and their sexual partners, HHV infections can potentially compromise the efforts to prevent and control HIV infection. Here, we investigated the seroprevalence of HHV infections among HIV-infected key populations in Dar es Salaam, Tanzania. Methodology. We analyzed 262 archived serum samples of HIV-infected key populations from the integrated biobehavioral surveillance (IBBS) study conducted in Dar es Salaam, Tanzania. The enzyme-linked immunosorbent assay was used to determine IgG and IgM titers for cytomegalovirus (CMV) and herpes simplex virus (HSV) types 1 and 2. Results The overall seropositivity of HHV IgG was 92% (95% CI: 87.7–95.3%). HHV IgM was not detected in any of the samples. The most seroprevalent coinfection was CMV at 69.1% (181/262), followed by HSV-2 33.2% (87/262) and HSV-1 32.1% (84/262). HSV-2 infection differed by key population groups; it accounted for FSW (46.3%) (p=0.0001) compared to PWID (21.6%) and MSM (22.7%). In contrast, seroprevalence for CMV and HSV-1 was comparable across the key population groups; whereby, CMV was 62%, 75.3%, and 75% and HSV-1 was 26.4%, 39.2%, and 31.8% for FSW, MSM, and PWID, respectively. We also observed that multiple coinfections with CMV-HSV-2 (p=0.042) and CMV-HSV-1-HSV-2 (p=0.006) were significantly associated with key population aged above 40 years. Conclusion The IgG seroprevalence of CMV, HSV-1, and HSV-2 was high among HIV-positive key populations. These findings indicate that these individuals are prone to recurrence of HHV infections and may harbor replicating viruses that subsequently may affect HIV disease progression. Therefore, this warrants concerted efforts for integrated HIV and sexually transmitted infection prevention programs targeting key populations.
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Faini D, Hanson C, Baisley K, Kapiga S, Hayes R. Sexual behaviour, changes in sexual behaviour and associated factors among women at high risk of HIV participating in feasibility studies for prevention trials in Tanzania. PLoS One 2020; 15:e0231766. [PMID: 32298383 PMCID: PMC7162511 DOI: 10.1371/journal.pone.0231766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/31/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Risk reduction towards safer behaviour is promoted after enrolment in HIV prevention trials. We evaluated sexual behaviour, changes in sexual behaviour and factors associated with risky behaviour after one-year of follow-up among women enrolled in HIV prevention trials in Northern Tanzania. METHODS Self-reported information from 1378 HIV-negative women aged 18-44 enrolled in microbicide and vaccine feasibility studies between 2008-2010,was used to assess changes in behaviour during a 12-month follow-up period. Logistic regression with random intercepts was used to estimate odds ratios for trends in each behaviour over time. A behavioural risk score was derived from coefficients of three behavioural variables in a Poisson regression model for HIV incidence and thereafter, dichotomized to risky vs less-risky behaviour. Logistic regression was then used to identify factors associated with risky behaviour at 12 months. RESULTS At baseline, 22% reported multiple partners, 28% were involved in transactional sex and only 22% consistently used condoms with non-regular partners. The proportion of women reporting multiple partners, transactional sex and high-risk sex practices reduced at each 3-monthly visit (33%, 43% and 47% reduction in odds per visit respectively, p for linear trend <0.001 for all), however, there was no evidence of a change in the proportion of women consistently using condoms with non-regular partners (p = 0.22). Having riskier behaviours at baseline, being younger than 16 years at sexual debut, having multiple partners, selling sex and excessive alcohol intake at baseline were strongly associated with increased odds of risky sexual behaviour after 12 months (p<0.005 for all). CONCLUSION An overall reduction in risky behaviours over time was observed in HIV prevention cohorts. Risk reduction counselling was associated with decreased risk behaviour but was insufficient to change behaviours of all those at highest risk. Biological HIV prevention interventions such as PrEP for individuals at highest risk, should complement risk reduction counselling so as to minimize HIV acquisition risk.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Department of Global Public Health, Global Health—Health Systems and Policy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Claudia Hanson
- Department of Global Public Health, Global Health—Health Systems and Policy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wambura M, Drake M, Kuringe E, Majani E, Nyato D, Casalini C, Materu J, Mjungu D, Nnko S, Mbita G, Kalage E, Shao A, Changalucha J, Komba A. Cash Transfer to Adolescent Girls and Young Women to Reduce Sexual Risk Behavior (CARE): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14696. [PMID: 31859686 PMCID: PMC6942193 DOI: 10.2196/14696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background The HIV epidemic in Eastern and Southern Africa is characterized by a high incidence and prevalence of HIV infection among adolescent girls and young women (AGYW) aged 15-24 years. For instance, in some countries, HIV prevalence in AGYW aged 20-24 years exceeds that in AGYW aged 15-19 years by 2:1. Sauti (meaning voices), a project supported by the United States Agency for International Development, is providing HIV combination prevention interventions to AGYW in the Shinyanga region, Tanzania. Objective The aim of this study is to determine the impact of cash transfer on risky sexual behavior among AGYW receiving cash transfer and HIV combination prevention interventions. This paper describes the research methods and general protocol of the study. Risky sexual behavior will be assessed by herpes simplex virus type 2 (HSV-2) incidence, compensated sex (defined as sexual encounters motivated by exchange for money, material support, or other benefits), and intergenerational sex (defined as a sexual partnership between AGYW and a man 10 or more years older). Through a qualitative study, the study seeks to understand how the intervention affects the structural and behavioral drivers of the HIV epidemic. Methods The trial employs audio computer-assisted self-interviewing, participatory group discussions (PGDs), and case studies to collect data. A total of 30 matched villages (15 intervention and 15 control clusters) were randomized to either receive cash transfer delivered over 18 months in addition to other HIV interventions (intervention arm) or to receive other HIV interventions without cash transfer (control arm). Study participants are interviewed at baseline and 6, 12, and 18 months to collect data on demographics, factors related to HIV vulnerabilities, family planning, sexual risk behavior, gender-based violence, and HSV-2 and HIV infections. A total of 6 PGDs (3 intervention, 3 control) were conducted at baseline to describe perceptions and preferences of different intervention packages, whereas 20 case studies are used to monitor and unearth the dynamics involved in delivery and uptake of cash transfer. Results The study was funded in June 2017; enrollment took place in December 2017. A total of two rounds of the follow-up survey are complete, and one round has yet to be conducted. The results are expected in December 2019 and will be disseminated through conferences and peer-reviewed publications. Conclusions This study will document the synergetic impact of cash transfer in the presence of HIV combination prevention interventions on risky sexual behavior among out-of-school AGYW. The results will strengthen the evidence of cash transfer in the reduction of risky sexual behavior and provide feasible HIV prevention strategies for AGYW. Trial Registration Clinicaltrials.gov NCT03597243; https://clinicaltrials.gov/ct2/show/NCT03597243. International Registered Report Identifier (IRRID) DERR1-10.2196/14696
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Affiliation(s)
- Mwita Wambura
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Mary Drake
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Evodius Kuringe
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Esther Majani
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Daniel Nyato
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Caterina Casalini
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Jacqueline Materu
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Deusdedit Mjungu
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Soori Nnko
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Gaspar Mbita
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Esther Kalage
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
| | - Amani Shao
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - John Changalucha
- National Institute for Medical Research, Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Albert Komba
- Jhpiego Tanzania - an Affiliate of Johns Hopkins University, Sauti project, Dar es Salaam, United Republic of Tanzania
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Huai P, Li F, Li Z, Sun L, Fu X, Pan Q, Yu G, Chai Z, Chu T, Mi Z, Bao F, Wang H, Zhou B, Wang C, Sun Y, Niu G, Zhang Y, Fu F, Lang X, Wang X, Zhao H, Liu D, Liu H, Liu D, Liu J, Xu A, Zhang F. Seroprevalence and associated factors of HSV-2 infection among general population in Shandong Province, China. BMC Infect Dis 2019; 19:382. [PMID: 31060582 PMCID: PMC6501424 DOI: 10.1186/s12879-019-3995-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Herpes simplex virus type-2 (HSV-2) infection is the main cause of genital ulcer disease and increases the risk of HIV acquisition. Little information is available regards the epidemiological characteristics of HSV-2 among general population in China. The aim of this study was to explore seroprevalence and associated factors of HSV-2 and provide information for design of HSV-2 control strategy in Shandong, China. Methods In this cross-sectional study, a total of 8074 persons, 18–49 years of age, were selected using multi-stage probability sampling to represent the general population of Shandong in 2016. Demographic data were collected through face-to-face interviews. Other variables were obtained by self-administered questionnaire surveys. Blood was collected for HSV-2 IgG detection with ELISA. Results A total of 7256 sexually-active participants were included in the analysis. The weighted seroprevalence of HSV-2 infection was 4.2% (95% confidence interval [CI], 3.2–5.3) in females, which was significant higher than that in males (2.7%; 95% CI, 1.1–4.2) (P = 0.04). The seroprevalence of HSV-2 was higher in individuals from eastern region (6.4%; 95% CI, 5.9–6.9) and urban areas (4.3%; 95% CI, 2.6–6.0) of Shandong than those from other regions (P < 0.01). Associated factors for HSV-2 infection among men were being urban residents (adjusted odds ratio [AOR], 2.36; 95% CI, 1.14–4.88), having two or more sex partners in the past year (AOR, 3.22; 95% CI, 1.90–5.43) and having commercial sex (AOR, 1.51; 95% CI, 1.00–2.26). Among females, being divorced or widowed (AOR, 1.79; 95% CI, 1.08–2.97), having a tattoo (AOR, 2.89; 95% CI, 1.07–7.84), and being dissatisfied with the sex activity quality (AOR, 2.12; 95% CI, 1.24–3.63) was associated with HSV-2 infection. Conclusions This study showed a relatively low burden of HSV-2 in Shandong province, China compared with the seroprevalence reported in many other provinces and countries. HSV-2 control programs in Shandong should focus on eastern, urban and female residents, and pay more attention to individuals with identified associated factors.
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Affiliation(s)
- Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Furong Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zhen Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Lele Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xi'an Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Qing Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Gongqi Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Zemin Chai
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Tongsheng Chu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zihao Mi
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fangfang Bao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Honglei Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Bingni Zhou
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Chuan Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Guiye Niu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yuan Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fanghui Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoqiao Lang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoling Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hui Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Daina Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Dianchang Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Jian Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.,Shandong Center for Disease Control and Prevention, Jinan, China
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China. .,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China.
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Price J, Pettifor A, Selin A, Wagner RG, MacPhail C, Agyei Y, Gómez-Olivé FX, Kahn K. The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study. PLoS One 2019; 14:e0210632. [PMID: 30653540 PMCID: PMC6336295 DOI: 10.1371/journal.pone.0210632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To characterise perceived household support for female education and the associations between educational support and HIV prevalence, HSV-2 prevalence and sexual risk behaviours. METHODS This cross-sectional study used baseline survey data from the Swa Koteka HPTN 068 trial undertaken in Mpumalanga, South Africa. The study included 2533 young women aged 13-20, in grades 8-11 at baseline. HIV and HSV-2 status were determined at baseline. Information about patterns of sexual behaviour and household support for education was collected during the baseline survey. Linear regression and binary logistic regression were used to determine associations between household support for education and both biological and behavioural outcomes. RESULTS High levels of educational support were reported across all measures. HIV prevalence was 3.2% and HSV-2 prevalence was 4.7%, both increasing significantly with age. Over a quarter (26.6%) of young women reported vaginal sex, with 60% reporting condom use at last sex. The median age of sexual debut was 16 years. Household educational support was not significantly associated with HIV or HSV-2; however, the odds of having had vaginal sex were significantly lower in those who reported greater homework supervision (OR 0.82, 95%CI: 0.72-0.94), those who engaged in regular discussion of school marks with a caregiver (OR 0.82, 95%CI: 0.71-0.95) and when caregivers had greater educational goals for the young woman (OR 0.82, 95%CI: 0.71-0.96). In contrast, greater caregiver disappointment at dropout was significantly associated with reported vaginal sex (OR 1.29, 95%CI: 1.14-1.46). CONCLUSION Young women in rural South Africa report experiencing high levels of household educational support. This study suggests that greater household educational support is associated with lower odds of having vaginal sex and engaging in risky sexual behaviour, though not with HIV or HSV-2 prevalence.
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Affiliation(s)
- Jessica Price
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Selin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yaw Agyei
- Johns Hopkins University, School of Medicine, Department of Pathology, HPTN Laboratory Center, Baltimore, Maryland, United States of America
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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10
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Abbai NS, Govender S, Nyirenda M. Herpes simplex virus-2 infections in pregnant women from Durban, South Africa: prevalence, risk factors and co-infection with HIV-1. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1531479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Nathlee S Abbai
- School of Clinical Medicine, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shanthie Govender
- School of Clinical Medicine, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
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11
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Torrone EA, Morrison CS, Chen PL, Kwok C, Francis SC, Hayes RJ, Looker KJ, McCormack S, McGrath N, van de Wijgert JHHM, Watson-Jones D, Low N, Gottlieb SL. Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med 2018; 15:e1002511. [PMID: 29485986 PMCID: PMC5828349 DOI: 10.1371/journal.pmed.1002511] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Estimates of sexually transmitted infection (STI) prevalence are essential for efforts to prevent and control STIs. Few large STI prevalence studies exist, especially for low- and middle-income countries (LMICs). Our primary objective was to estimate the prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, herpes simplex virus type 2 (HSV-2), and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population type. METHODS AND FINDINGS We analyzed individual-level data from 18 HIV prevention studies (cohort studies and randomized controlled trials; conducted during 1993-2011), representing >37,000 women, that tested participants for ≥1 selected STIs or BV at baseline. We used a 2-stage meta-analysis to combine data. After calculating the proportion of participants with each infection and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each infection and 95% confidence interval (CI) across ages, regions, and population types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across the three primary region/population groups (South Africa community-based, Southern/Eastern Africa community-based, and Eastern Africa higher-risk), prevalence was higher among 15-24-year-old than 25-49-year-old women for all STIs except HSV-2. In general, higher-risk populations had greater prevalence of gonorrhea and syphilis than clinic/community-based populations. For chlamydia, prevalence among 15-24-year-olds was 10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%) among women specifically recruited from higher-risk settings for HIV in Eastern Africa and was 15.1% (95% CI: 12.7%, 17.8%; I2 = 82.3%) in South African clinic/community-based populations. Among clinic/community-based populations, prevalence was generally greater in South Africa than in Southern/Eastern Africa for most STIs; for gonorrhea, prevalence among 15-24-year-olds was 4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%) in South Africa and was 1.7% (95% CI: 1.2%, 2.6%; I2 = 55.2%) in Southern/Eastern Africa. Across the three primary region/population groups, HSV-2 and BV prevalence was high among 25-49-year-olds (ranging from 70% to 83% and 33% to 44%, respectively). The main study limitation is that the data are not from random samples of the target populations. CONCLUSIONS Combining data from 18 HIV prevention studies, our findings highlight important features of STI/BV epidemiology among sub-Saharan African women. This methodology can be used where routine STI surveillance is limited and offers a new approach to obtaining critical information on STI and BV prevalence in LMICs.
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Affiliation(s)
- Elizabeth A. Torrone
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Charles S. Morrison
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Pai-Lien Chen
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Cynthia Kwok
- Global Health, Population and Nutrition, FHI 360, Durham, North Carolina, United States of America
| | - Suzanna C. Francis
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard J. Hayes
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katharine J. Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Nuala McGrath
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | | | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sami L. Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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12
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Looker KJ, Elmes JAR, Gottlieb SL, Schiffer JT, Vickerman P, Turner KME, Boily MC. Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:1303-1316. [PMID: 28843576 PMCID: PMC5700807 DOI: 10.1016/s1473-3099(17)30405-x] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
Background HIV and herpes simplex virus type 2 (HSV-2) infections cause a substantial global disease burden and are epidemiologically correlated. Two previous systematic reviews of the association between HSV-2 and HIV found evidence that HSV-2 infection increases the risk of HIV acquisition, but these reviews are now more than a decade old. Methods For this systematic review and meta-analysis, we searched PubMed, MEDLINE, and Embase (from Jan 1, 2003, to May 25, 2017) to identify studies investigating the risk of HIV acquisition after exposure to HSV-2 infection, either at baseline (prevalent HSV-2 infection) or during follow-up (incident HSV-2 infection). Studies were included if they were a cohort study, controlled trial, or case-control study (including case-control studies nested within a cohort study or clinical trial); if they assessed the effect of pre-existing HSV-2 infection on HIV acquisition; and if they determined the HSV-2 infection status of study participants with a type-specific assay. We calculated pooled random-effect estimates of the association between prevalent or incident HSV-2 infection and HIV seroconversion. We also extended previous investigations through detailed meta-regression and subgroup analyses. In particular, we investigated the effect of sex and risk group (general population vs higher-risk populations) on the relative risk (RR) of HIV acquisition after prevalent or incident HSV-2 infection. Higher-risk populations included female sex workers and their clients, men who have sex with men, serodiscordant couples, and attendees of sexually transmitted infection clinics. Findings We identified 57 longitudinal studies exploring the association between HSV-2 and HIV. HIV acquisition was almost tripled in the presence of prevalent HSV-2 infection among general populations (adjusted RR 2·7, 95% CI 2·2–3·4; number of estimates [Ne]=22) and was roughly doubled among higher-risk populations (1·7, 1·4–2·1; Ne=25). Incident HSV-2 infection in general populations was associated with the highest risk of acquisition of HIV (4·7, 2·2–10·1; Ne=6). Adjustment for confounders at the study level was often incomplete but did not significantly affect the results. We found moderate heterogeneity across study estimates, which was explained by risk group, world region, and HSV-2 exposure type (prevalent vs incident). Interpretation We found evidence that HSV-2 infection increases the risk of HIV acquisition. This finding has important implications for management of individuals diagnosed with HSV-2 infection, particularly for those who are newly infected. Interventions targeting HSV-2, such as new HSV vaccines, have the potential for additional benefit against HIV, which could be particularly powerful in regions with a high incidence of co-infection. Funding World Health Organization.
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Affiliation(s)
- Katharine J Looker
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Jocelyn A R Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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13
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Wagner J, Coupland P, Browne HP, Lawley TD, Francis SC, Parkhill J. Evaluation of PacBio sequencing for full-length bacterial 16S rRNA gene classification. BMC Microbiol 2016; 16:274. [PMID: 27842515 PMCID: PMC5109829 DOI: 10.1186/s12866-016-0891-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Currently, bacterial 16S rRNA gene analyses are based on sequencing of individual variable regions of the 16S rRNA gene (Kozich, et al Appl Environ Microbiol 79:5112–5120, 2013).This short read approach can introduce biases. Thus, full-length bacterial 16S rRNA gene sequencing is needed to reduced biases. A new alternative for full-length bacterial 16S rRNA gene sequencing is offered by PacBio single molecule, real-time (SMRT) technology. The aim of our study was to validate PacBio P6 sequencing chemistry using three approaches: 1) sequencing the full-length bacterial 16S rRNA gene from a single bacterial species Staphylococcus aureus to analyze error modes and to optimize the bioinformatics pipeline; 2) sequencing the full-length bacterial 16S rRNA gene from a pool of 50 different bacterial colonies from human stool samples to compare with full-length bacterial 16S rRNA capillary sequence; and 3) sequencing the full-length bacterial 16S rRNA genes from 11 vaginal microbiome samples and compare with in silico selected bacterial 16S rRNA V1V2 gene region and with bacterial 16S rRNA V1V2 gene regions sequenced using the Illumina MiSeq. Results Our optimized bioinformatics pipeline for PacBio sequence analysis was able to achieve an error rate of 0.007% on the Staphylococcus aureus full-length 16S rRNA gene. Capillary sequencing of the full-length bacterial 16S rRNA gene from the pool of 50 colonies from stool identified 40 bacterial species of which up to 80% could be identified by PacBio full-length bacterial 16S rRNA gene sequencing. Analysis of the human vaginal microbiome using the bacterial 16S rRNA V1V2 gene region on MiSeq generated 129 operational taxonomic units (OTUs) from which 70 species could be identified. For the PacBio, 36,000 sequences from over 58,000 raw reads could be assigned to a barcode, and the in silico selected bacterial 16S rRNA V1V2 gene region generated 154 OTUs grouped into 63 species, of which 62% were shared with the MiSeq dataset. The PacBio full-length bacterial 16S rRNA gene datasets generated 261 OTUs, which were grouped into 52 species, of which 54% were shared with the MiSeq dataset. Alpha diversity index reported a higher diversity in the MiSeq dataset. Conclusion The PacBio sequencing error rate is now in the same range of the previously widely used Roche 454 sequencing platform and current MiSeq platform. Species-level microbiome analysis revealed some inconsistencies between the full-length bacterial 16S rRNA gene capillary sequencing and PacBio sequencing. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0891-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josef Wagner
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, Cambridge, UK.
| | - Paul Coupland
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, Cambridge, UK
| | - Hilary P Browne
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, Cambridge, UK
| | - Trevor D Lawley
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, Cambridge, UK
| | - Suzanna C Francis
- Tropical Epidemiology Group, London Schools of Hygiene and Tropical Medicine, London, UK
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, Cambridge, UK
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14
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An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women. AIDS 2016; 30:2665-2683. [PMID: 27500670 PMCID: PMC5106090 DOI: 10.1097/qad.0000000000001228] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective and design: Some studies suggest that specific hormonal contraceptive methods [particularly depot medroxyprogesterone acetate (DMPA)] may increase women's HIV acquisition risk. We updated a systematic review to incorporate recent epidemiological data. Methods: We searched for articles published between 15 January 2014 and 15 January 2016 and hand-searched reference lists. We identified longitudinal studies comparing users of a specific hormonal contraceptive method against either nonusers of hormonal contraception or users of another specific hormonal contraceptive method. We added newly identified studies to those in the previous review, assessed study quality, created forest plots to display results, and conducted a meta-analysis for data on DMPA versus non-use of hormonal contraception. Results: We identified 10 new reports of which five were considered ‘unlikely to inform the primary question’. We focus on the other five reports, along with nine from the previous review, which were considered ‘informative but with important limitations’. The preponderance of data for oral contraceptive pills, injectable norethisterone enanthate, and levonorgestrel implants do not suggest an association with HIV acquisition, though data for implants are limited. The new, higher quality studies on DMPA (or nondisaggregated injectables), which had mixed results in terms of statistical significance, had hazard ratios between 1.2 and 1.7, consistent with our meta-analytic estimate for all higher quality studies of hazard ratio 1.4. Conclusion: Although confounding in these observational data cannot be excluded, new information increases concerns about DMPA and HIV acquisition risk in women. If the association is causal, the magnitude of effect is likely hazard ratio 1.5 or less. Data for other hormonal contraceptive methods, including norethisterone enanthate, are largely reassuring.
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15
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Gallagher KE, Baisley K, Grosskurth H, Vallely A, Kapiga S, Vandepitte J, Kamali A, De Sanjosé S, Changalucha J, Hayes R, Watson-Jones D. The Association Between Cervical Human Papillomavirus Infection and Subsequent HIV Acquisition in Tanzanian and Ugandan Women: A Nested Case-Control Study. J Infect Dis 2016; 214:87-95. [PMID: 26951818 PMCID: PMC4907415 DOI: 10.1093/infdis/jiw094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study was performed to analyze the associations between cervical human papillomavirus (HPV) infection and human immunodeficiency virus (HIV) acquisition, using cervical samples from previous studies in Tanzania and Uganda. METHODS A total of 161 adult women who acquired HIV infection during follow-up and 464 individually matched HIV-seronegative controls were selected from 5 cohorts of women working in bars and recreational facilities. Stored cervical samples were tested for 37 HPV genotypes, using a polymerase chain reaction assay (Roche Linear Array genotyping assay). Multivariate matched analysis using conditional logistic regression was performed to evaluate HPV infection, persistence, and clearance as predictors of HIV acquisition. RESULTS HIV seroconverters were significantly more likely than controls to frequently drink alcohol and to be infected with Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex virus type 2. There was no evidence of an association between HIV acquisition and any detectable HPV at the visit prior to HIV seroconversion (adjusted odds ratio, 1.02; 95% confidence interval, .66-1.57) or between HIV acquisition and persistent HPV infection (defined as 2 positive HPV genotype-specific test results at least 6 months apart), cleared HPV infection (defined as a positive HPV test result followed by negative HPV genotype-specific test result), or newly acquired HPV infection, compared with HPV-negative women. CONCLUSIONS There was no evidence of association between HPV infection status and subsequent HIV acquisition. These results stand in contrast to other observational studies.
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Affiliation(s)
- Katherine E Gallagher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases Mwanza Intervention Trials Unit
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Heiner Grosskurth
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom Mwanza Intervention Trials Unit
| | - Andrew Vallely
- Public Health Interventions Research Group, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Saidi Kapiga
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom Mwanza Intervention Trials Unit
| | | | | | - Silvia De Sanjosé
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, CIBERESP, Barcelona, Spain
| | - John Changalucha
- Mwanza Research Center, National Institute for Medical Research, Tanzania
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases Mwanza Intervention Trials Unit
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16
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Traore IT, Hema NM, Sanon A, Some F, Ouedraogo D, Some R, Niessougou J, Konate I, Mayaud P, Van De Perre P, Meda N, Nagot N. HIV risk and behaviour among part-time versus professional FSW: baseline report of an interventional cohort in Burkina Faso. Sex Transm Infect 2016; 92:550-553. [PMID: 26834073 DOI: 10.1136/sextrans-2015-052038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 12/16/2015] [Accepted: 01/09/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To readjust HIV control programmes in Africa, we assessed the factors associated with high-risk behaviours and HIV infection among young female sex workers (FSW) in Burkina Faso. METHODS We carried out a cross-sectional study from September 2009 to September 2010 in Ouagadougou, the capital city. FSW were categorised as professionals and part-time sex workers (PTSW). After a face-to-face questionnaire, blood and urine samples were collected for HIV, HSV-2, genital infections and pregnancy. High-risk behaviour was defined as a recent unprotected sex with either casual clients, regular clients or regular partners. RESULTS We recruited 609 FSW including 188 (30.9%) professionals. Their median age was 21 years (IQR 19-23), and the prevalence of HIV was 10.3% among professionals and 6.5% among PTSW. Only 3 of 46 HIV-infected women were aware of their status. Overall, 277 (45.6%) women reported high-risk behaviours (41.2% among professionals and 47.5% among PTSW), which were driven mainly by non-systematic condom use with regular partners. In multivariable analysis, PTSW (adjusted OR (AOR)=1.89; 95% CI 1.27 to 2.82) and having a primary (AOR=1.75; 95% CI 1.15 to 2.67) or higher education level (AOR=1.80; 95% CI 1.13 to 2.89) remained associated with high-risk behaviours. HIV infection was associated with older age (AOR=1.44; 95% CI 1.22 to 1.71), with being married/cohabiting (AOR=2.70; 95% CI 1.21 to 6.04) and with Trichomonas vaginalis infection (AOR=9.63; 95% CI 2.93 to 31.59), while history of HIV testing was associated with a decreased risk (AOR=0.18; 95% CI 0.08 to 0.40). CONCLUSIONS This study highlights the need for targeted interventions among young FSW focusing particularly on PTSW, sexual behaviours with regular partners and regular HIV testing.
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Affiliation(s)
- Isidore T Traore
- Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Noelie M Hema
- Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Anselme Sanon
- Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Felicien Some
- Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Djeneba Ouedraogo
- Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Roselyne Some
- Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Josiane Niessougou
- Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Issouf Konate
- Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Nicolas Meda
- Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso.,Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
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17
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Francis SC, Hou Y, Baisley K, van de Wijgert J, Watson-Jones D, Ao TT, Herrera C, Maganja K, Andreasen A, Kapiga S, Coulton GR, Hayes RJ, Shattock RJ. Immune Activation in the Female Genital Tract: Expression Profiles of Soluble Proteins in Women at High Risk for HIV Infection. PLoS One 2016; 11:e0143109. [PMID: 26814891 PMCID: PMC4729472 DOI: 10.1371/journal.pone.0143109] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/30/2015] [Indexed: 01/20/2023] Open
Abstract
Soluble cervicovaginal biomarkers of inflammation, immune activation and risk of HIV acquisition are needed to reliably assess the safety of new biomedical prevention strategies including vaccines and microbicides. However, a fuller understanding of expression profiles in women at high risk for HIV infection is crucial to the effective use of these potential biomarkers in Phase 3 trial settings. We have measured 45 soluble proteins and peptides in cervicovaginal lavage samples from 100 HIV negative women at high risk for HIV infection. Women were followed over one menstrual cycle to investigate modulation by hormonal contraception, menstrual cycle phase, recent sexual exposure and intravaginal practices. Women using injectable DMPA had increased concentration of several soluble proteins of the innate and adaptive immune system, including IL-1α, IL-1β, IL-2, MIP-1β, IP-10, IL-8, TGF-β, HBD4, IgA, IgG1, and IgG2. Women using combined oral contraceptives had a similar signature. There were differences in concentrations among samples from post-ovulation compared to pre-ovulation, notably increased immunoglobulins. Increased prostate-specific antigen, indicative of recent sexual exposure, was correlated with increased IL-6, MCP-1, and SLPI, and decreased GM-CSF and HBD3. The identified signature profiles may prove critical in evaluating the potential safety and impact on risk of HIV acquisition of different biomedical intervention strategies.
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Affiliation(s)
- Suzanna C. Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
- * E-mail:
| | - Yanwen Hou
- Division of Basic Medical Sciences, St. George's Medical School, University of London, London, United Kingdom
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janneke van de Wijgert
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Trong T. Ao
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
| | - Carolina Herrera
- Mucosal Infection and Immunity Group, Imperial College, Department of Medicine, London, United Kingdom
| | - Kaballa Maganja
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
| | - Aura Andreasen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania, United Republic of Tanzania
| | - Gary R. Coulton
- Division of Basic Medical Sciences, St. George's Medical School, University of London, London, United Kingdom
| | - Richard J. Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin J. Shattock
- Mucosal Infection and Immunity Group, Imperial College, Department of Medicine, London, United Kingdom
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Abbai NS, Wand H, Ramjee G. Socio-demographic and behavioural characteristics associated with HSV-2 sero-prevalence in high risk women in KwaZulu-Natal. BMC Res Notes 2015; 8:185. [PMID: 25940115 PMCID: PMC4423103 DOI: 10.1186/s13104-015-1093-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization estimates that 536 million people aged 15-49 are infected with Herpes simplex virus type 2 (HSV-2), the causative agent of genital herpes. The aim of this study was to investigate the role of behavioral and demographic factors that contribute to the high HSV-2 sero-prevalence among women participating in a HIV prevention trial. The Methods for Improving Reproductive Health in Africa (MIRA) study assessed the effectiveness the latex diaphragm and lubricant gel on HIV prevention among women in South Africa and Zimbabwe. At screening an interviewer administered questionnaire on demographics and sexual behaviour was obtained. HSV-2 serum antibodies were detected using HerpeSelect™ ELISA IgG. Statistical analysis was performed using STATA release 12.0. This study was registered with ClinicalTrials.gov,number NCT00121459 on the 28th February 2007. FINDINGS Of the 3 472 women screened at the Durban research sites 2 218 (73%) had a prevalent HSV-2 infection and 1431 (41%) of the women were also co-infected with HIV. In the multivariate analyses, older women (adjusted odds ratio) [aOR]: 3.49, 95% CI: (2.71,4.49) for >35 years and aOR: 1.82, 95% CI: 1.49, 2.22 for 25-34 years compared with <25 years, p < 0.001 for both comparisons were more likely to be HSV-2 sero-positive. Low level of education (OR: 1.26 95% CI: 1.03, 1.53), having >1 life-time sexual partners (OR: 2.48, 95% CI: 1.92, 3.20), parity >1 (OR: 1.95 95% CI: 1.92, 3.20) and being HIV positive (OR: 6.31, 95% CI: 5.06, 7.88) were significantly associated with HSV-2 infection. CONCLUSION The high sero-prevalence of HSV-2 in the studied population is of great public health importance since this high risk population could act as a reservoir for future infections particularly HIV transmission.
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Affiliation(s)
- Nathlee Samantha Abbai
- HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban, 3630, South Africa.
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, 123 Jan Hofmeyr Road, Westville, Durban, 3630, South Africa.
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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De Baetselier I, Menten J, Cuylaerts V, Ahmed K, Deese J, Van Damme L, Crucitti T. Prevalence and incidence estimation of HSV-2 by two IgG ELISA methods among South African women at high risk of HIV. PLoS One 2015; 10:e0120207. [PMID: 25799522 PMCID: PMC4370866 DOI: 10.1371/journal.pone.0120207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Previous comparison studies of the Kalon and HerpeSelect 2 ELISA IgG assays on sub-Saharan samples have found differences in the sensitivity and specificity of these assays. Using longitudinal samples from an HIV prevention study, we compared both assays and determined the HSV-2 prevalence and incidence in a South African young female population at elevated risk of acquiring HIV. Methods Samples at baseline were tested in both assays using the manufacturers’ guidelines (cut-off > 1.10). When non-reactive in one assay, the final visit samples were tested to determine the incidence rate. Using correlation and regression analyses, the intra- and inter-assay variabilities were assessed. Results The prevalence rate was 41.1% and 44.9% for Kalon and HerpeSelect using the manufacturer guidelines, respectively. Agreement between the two tests were high (kappa = 0.92). The original optical density values of both assays were highly correlated (R = 0.94), but the calibrator and correspondingly cut-off index values differed between the assays. Lowering the index value cut-off for the Kalon assay by 40% (to 0.66) resulted in a HSV-2 prevalence of 43.2%, and increased agreement between the assays (to kappa = 0.96). The incidence rate was 16.3/100 Person Years using the lower cut-off for the Kalon assay. Discussion In this longitudinal study, we showed that the performance of the two assays was very similar. After lowering the cut-off for the Kalon assay to 0.66 early infections were detected without impairing its specificity. The prevalence and incidence rates are in line with previously described rates for sub-Saharan African cohorts.
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Affiliation(s)
| | - Joris Menten
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Khatija Ahmed
- Setshaba Research Center, Soshanguve, Pretoria, South Africa
| | - Jennifer Deese
- FHI-360, Durham, North Carolina, United States of America
| | - Lut Van Damme
- FHI-360, Durham, North Carolina, United States of America
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
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Gautam R, Borgdorff H, Jespers V, Francis SC, Verhelst R, Mwaura M, Delany-Moretlwe S, Ndayisaba G, Kyongo JK, Hardy L, Menten J, Crucitti T, Tsivtsivadze E, Schuren F, van de Wijgert JHHM. Correlates of the molecular vaginal microbiota composition of African women. BMC Infect Dis 2015; 15:86. [PMID: 25887567 PMCID: PMC4343073 DOI: 10.1186/s12879-015-0831-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/11/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sociodemographic, behavioral and clinical correlates of the vaginal microbiome (VMB) as characterized by molecular methods have not been adequately studied. VMB dominated by bacteria other than lactobacilli may cause inflammation, which may facilitate HIV acquisition and other adverse reproductive health outcomes. METHODS We characterized the VMB of women in Kenya, Rwanda, South Africa and Tanzania (KRST) using a 16S rDNA phylogenetic microarray. Cytokines were quantified in cervicovaginal lavages. Potential sociodemographic, behavioral, and clinical correlates were also evaluated. RESULTS Three hundred thirteen samples from 230 women were available for analysis. Five VMB clusters were identified: one cluster each dominated by Lactobacillus crispatus (KRST-I) and L. iners (KRST-II), and three clusters not dominated by a single species but containing multiple (facultative) anaerobes (KRST-III/IV/V). Women in clusters KRST-I and II had lower mean concentrations of interleukin (IL)-1α (p < 0.001) and Granulocyte Colony Stimulating Factor (G-CSF) (p = 0.01), but higher concentrations of interferon-γ-induced protein (IP-10) (p < 0.01) than women in clusters KRST-III/IV/V. A lower proportion of women in cluster KRST-I tested positive for bacterial sexually transmitted infections (STIs; ptrend = 0.07) and urinary tract infection (UTI; p = 0.06), and a higher proportion of women in clusters KRST-I and II had vaginal candidiasis (ptrend = 0.09), but these associations did not reach statistical significance. Women who reported unusual vaginal discharge were more likely to belong to clusters KRST-III/IV/V (p = 0.05). CONCLUSION Vaginal dysbiosis in African women was significantly associated with vaginal inflammation; the associations with increased prevalence of STIs and UTI, and decreased prevalence of vaginal candidiasis, should be confirmed in larger studies.
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Affiliation(s)
- Raju Gautam
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
| | - Hanneke Borgdorff
- Amsterdam Institute for Global Health and Development and Academic Medical Center, Amsterdam, The Netherlands.
| | | | - Suzanna C Francis
- London School for Hygiene and Tropical Medicine, MRC Tropical Epidemiology Group, London, UK.
| | - Rita Verhelst
- Ghent University, International Centre for Reproductive Health, Ghent, Belgium.
| | - Mary Mwaura
- International Centre for Reproductive Health Kenya, Mombasa, Kenya.
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Research Institute, Witwatersrand University, Johannesburg, South Africa.
| | | | | | | | - Joris Menten
- Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | - Janneke H H M van de Wijgert
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. .,Rinda Ubuzima, Kigali, Rwanda. .,Department of Clinical Infection, Immunology and Microbiology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, West Derby Street, Liverpool, L69 7BE, UK.
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Hormonal contraception and the risk of HIV acquisition: an individual participant data meta-analysis. PLoS Med 2015; 12:e1001778. [PMID: 25612136 PMCID: PMC4303292 DOI: 10.1371/journal.pmed.1001778] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/04/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Observational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC. METHODS AND FINDINGS Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15-49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24-1.83) for DMPA use, 1.24 (95% CI 0.84-1.82) for NET-EN use, and 1.03 (95% CI 0.88-1.20) for COC use. Between-study heterogeneity was mild (I(2) < 50%). DMPA use was associated with increased HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23-1.67) and NET-EN use (aHR 1.32, 95% CI 1.08-1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99-1.50; for NET-EN use 0.67, 95% CI 0.47-0.96; and for COC use 0.91, 95% CI 0.73-1.41) compared to those at higher risk of bias (p(interaction) = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC-HIV relationship. CONCLUSIONS This IPD meta-analysis found no evidence that COC or NET-EN use increases women's risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of hormonal contraception, particularly DMPA, on HIV risk.
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Ramjee G, Abbai NS, Naidoo S. Women and Sexually Transmitted Infections in Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojog.2015.57056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Francis SC, Ao TT, Vanobberghen FM, Chilongani J, Hashim R, Andreasen A, Watson-Jones D, Changalucha J, Kapiga S, Hayes RJ. Epidemiology of curable sexually transmitted infections among women at increased risk for HIV in northwestern Tanzania: inadequacy of syndromic management. PLoS One 2014; 9:e101221. [PMID: 25025338 PMCID: PMC4099080 DOI: 10.1371/journal.pone.0101221] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Curable, non-viral pathogens account for a significant burden of sexually transmitted infections (STIs), and there is established evidence that STIs increase both HIV acquisition and transmission. We investigated the prevalence, trends, and factors associated with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Treponema pallidum, and the performance of syndromic management, among a cohort of women working in bars, hotels, and other food and recreational facilities near large-scale mines in northwestern Tanzania. METHODS HIV-negative women aged 18-44 years (N = 966) were enrolled and followed for 12 months in a microbicides feasibility study. We collected sociodemographic and behavioural data, performed clinical examinations, and tested for STIs, at enrolment and 3-monthly. Risk factors for STIs were investigated using logistic regression models with random effects. Sensitivity, specificity and predictive values of syndromic management were calculated. RESULTS At enrolment, the prevalences of C. trachomatis, N. gonorrhoeae, T. vaginalis, and high-titre active syphilis were 111/956 (12%), 42/955 (4%), 184/945 (19%) and 46/965 (5%), respectively. There were significant decreases over time for C. trachomatis and T. vaginalis (OR trend per month: 0.94 [95% CI 0.91, 0.97]; and 0.95 [0.93, 0.98], respectively; both p<0.001). The majority of these infections were not diagnosed by the corresponding syndrome; therefore, most participants were not treated at the diagnosis visit. Syndromic management was poorly predictive of laboratory-diagnosed infections. We identified a number of risk factors for STIs, including low educational level, some sexual behaviours, and ever having been pregnant. CONCLUSIONS This analysis demonstrates that the prevalences of curable STIs are high among women who work in food and recreational facilities in northwestern Tanzania. Most of these infections are missed by syndromic management. Accurate and affordable rapid-point-of-care tests and innovative interventions are needed to reduce the burden of STIs in this population which is at increased risk for HIV.
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Affiliation(s)
- Suzanna C. Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Trong T. Ao
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Fiona M. Vanobberghen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Joseph Chilongani
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Aura Andreasen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Saidi Kapiga
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Richard J. Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mongi AS, Baisley K, Ao TTH, Chilongani J, Aguirre-Andreasen A, Francis SC, Shao J, Hayes R, Kapiga S. Factors associated with problem drinking among women employed in food and recreational facilities in northern Tanzania. PLoS One 2013; 8:e84447. [PMID: 24391956 PMCID: PMC3877296 DOI: 10.1371/journal.pone.0084447] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 11/13/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is growing evidence that alcohol consumption is associated with increased risk of HIV infection. To determine factors associated with problem drinking, we analyzed data collected in two prospective cohorts of at-risk female food and recreational facility workers in northern Tanzania. METHODS We enrolled HIV seronegative women aged 18-44 years and employed in the towns of Geita, Kahama, Moshi, and Shinyanga. At enrolment, women were interviewed to obtain information about alcohol use, using CAGE and AUDIT screening scales, and risk factors for HIV infection. Blood and genital samples were collected for detection of HIV and sexually transmitted infections (STIs). We characterized alcohol use, concordance, and agreement of the scales, and examined the associations between characteristics of participants and problem drinking as defined by both scales using logistic regression. Lastly, we assessed problem drinking as a risk factor for recent sexual behavior and prevalent STIs. RESULTS Among enrollees, 68% women reported ever drinking alcohol; of these 76% reported drinking alcohol in the past 12 months. The prevalence of problem drinking was 20% using CAGE and 13% using AUDIT. Overall concordance between the scales was 75.0% with a Kappa statistic of 0.58. After adjusting for age, independent factors associated with problem drinking, on both scales, were marital status, occupation, facility type, increasing number of lifetime sexual partners, and transactional sex in the past 12 months. In addition, women who were problem drinkers on either scale were more likely to report having ≥ 1 sexual partner (CAGE: aOR = 1.56, 95% confidence interval, CI: 1.10-2.23; AUDIT aOR = 2.00, 95% CI: 1.34-3.00) and transactional sex (CAGE: aOR = 1.79, 95% CI: 1.26-2.56; AUDIT aOR = 1.51, 95% CI: 1.04-2.18), in the past 3 months. CONCLUSION These findings suggest that interventions to reduce problem drinking in this population may reduce high-risk sexual behaviors and contribute in lowering the risk of HIV infection.
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Affiliation(s)
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Trong Thanh-Hoang Ao
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Suzanna C. Francis
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Shao
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Richard Hayes
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lees S, Zalwango F, Andrew B, Vandepitte J, Seeley J, Hayes RJ, Francis SC. Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: the embodiment of social and cultural norms and well-being. Soc Sci Med 2013; 102:165-73. [PMID: 24565154 PMCID: PMC3979101 DOI: 10.1016/j.socscimed.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
Some types of intravaginal practices (IVP) may increase the risk for HIV acquisition. This is particularly worrisome for populations with dual high prevalence of HIV and IVP. Women involved in transactional sex are at increased risk for HIV infection in sub-Saharan Africa. Social, cultural and economic influences are strong drivers of IVP in this population. To explore this, we carried out a qualitative research study to investigate the drivers and motivations for using IVP within a large observational study of women at high risk of HIV in Tanzania and Uganda from September 2008 to September 2009. Of the 201 women selected, 176 women took part in a semi-structured in-depth interview. Additionally, in Tanzania, eight focus group discussions among study participants and community members were carried out to obtain information on community norms and expectations. IVP were motivated by overlapping concerns with hygiene, morality, sexual pleasure, fertility, relationship security, and economic security. These motives were driven by the need to meet cultural and social expectations of womanhood, and at the same time attend to personal well-being. Among women involved in transactional sex in East Africa, interventions aimed at modifying or eliminating IVP should attend to local cultural and social norms as well as the individual as an agent of change. Previous research has shown that some types of intravaginal practice (IVP) may increase HIV risk. The motives of women at high risk of HIV to carry out IVP fulfil sociocultural norms of womanhood and well-being. Economic factors for women involved in transactional sex are an important motive. Interventions aimed at reducing or eliminating IVP should address these issues.
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Affiliation(s)
- Shelley Lees
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania.
| | - Flavia Zalwango
- Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Bahati Andrew
- Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania
| | - Judith Vandepitte
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda; University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom
| | - Richard J Hayes
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Suzanna C Francis
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research Mwanza Centre, P.O. Box 11936, Mwanza, Tanzania
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Francis SC, Baisley K, Lees SS, Andrew B, Zalwango F, Seeley J, Vandepitte J, Ao TT, van de Wijgert J, Watson-Jones D, Kapiga S, Grosskurth H, Hayes RJ. Vaginal practices among women at high risk of HIV infection in Uganda and Tanzania: recorded behaviour from a daily pictorial diary. PLoS One 2013; 8:e59085. [PMID: 23555618 PMCID: PMC3608607 DOI: 10.1371/journal.pone.0059085] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intravaginal practices (IVP) are highly prevalent in sub-Saharan African and have been implicated as risk factors for HIV acquisition. However, types of IVP vary between populations, and detailed information on IVP among women at risk for HIV in different populations is needed. We investigated IVP among women who practice transactional sex in two populations: semi-urban, facility workers in Tanzania who engage in opportunistic sex work; and urban, self-identified sex workers and bar workers in Uganda. The aim of the study was to describe and compare IVP using a daily pictorial diary. METHODOLOGY/PRINCIPAL FINDINGS Two hundred women were recruited from a HIV prevention intervention feasibility study in Kampala, Uganda and in North-West Tanzania. Women were given diaries to record IVP daily for six weeks. Baseline data showed that Ugandan participants had more lifetime partners and transactional sex than Tanzanian participants. Results from the diary showed that 96% of Tanzanian participants and 100% of Ugandan participants reported intravaginal cleansing during the six week study period. The most common types of cleansing were with water only or water and soap. In both countries, intravaginal insertion (e.g. with herbs) was less common than cleansing, but insertion was practiced by more participants in Uganda (46%) than in Tanzania (10%). In Uganda, participants also reported more frequent sex, and more insertion related to sex. In both populations, cleansing was more often reported on days with reported sex and during menstruation, and in Uganda, when participants experienced vaginal discomfort. Participants were more likely to cleanse after sex if they reported no condom use. CONCLUSIONS While intravaginal cleansing was commonly practiced in both cohorts, there was higher frequency of cleansing and insertion in Uganda. Differences in IVP were likely to reflect differences in sexual behaviour between populations, and may warrant different approaches to interventions targeting IVP. Vaginal practices among women at high risk in Uganda and Tanzania: recorded behaviour from a daily pictorial diary.
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Affiliation(s)
- Suzanna C Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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