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Kansiime S, Hansen CH, Hayes R, Ruzagira E. Developing HIV risk prediction tools in four African settings. Trop Med Int Health 2023; 28:720-730. [PMID: 37496465 PMCID: PMC10947046 DOI: 10.1111/tmi.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE HIV risk prediction tools are a critical component of efforts to end the HIV pandemic. We aimed to create and validate tools for identifying individuals at highest risk of prevalent and incident HIV in an African setting. METHODS We used Logistic regression and Poisson regression to determine risk factors for HIV prevalence and incidence in a multi-country HIV vaccine trial preparedness cohort study among individuals at high risk of HIV, and used the identified factors to create and validate tools that predict HIV risk. We also assessed the performance of the VOICE risk score in predicting HIV incidence among women in the cohort. RESULTS The prevalent HIV prediction tool created had good predictive ability [area under the curve (AUC) = 0.70, 95% CI 0.66-0.74]. It included the following participant variables: age, sex, recreational drug use, unprotected male-to-male anal sex, a sexual partner who had other partners, transactional sex and having a partner who was a long-distance truck driver/miner. It was not possible to create a valid HIV incidence prediction tool. Participants with high VOICE risk scores (≥7) had slightly higher HIV incidence but this tool performed poorly within our study (AUC = 0.58, 95% CI 0.51-0.64: Harrell's concordance index = 0.59). CONCLUSION We created a prevalent HIV prediction tool that could be used to increase efficiency in diagnosis of HIV and linkage to care in sub-Saharan Africa. Existing incident HIV prediction tools may need modification to include context-specific predictors such as calendar period, participant occupation, study site, before adoption in settings different from those in which they were developed.
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Affiliation(s)
- Sheila Kansiime
- Medical Research Council/Uganda Virus Research Council and London School of Hygiene and Tropical Medicine, Uganda Research UnitEntebbeUganda
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical MedicineLondonUK
| | - Christian Holm Hansen
- Medical Research Council/Uganda Virus Research Council and London School of Hygiene and Tropical Medicine, Uganda Research UnitEntebbeUganda
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical MedicineLondonUK
| | - Richard Hayes
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical MedicineLondonUK
| | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Council and London School of Hygiene and Tropical Medicine, Uganda Research UnitEntebbeUganda
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Matavele Chissumba R, Magul C, Macamo R, Monteiro V, Enosse M, Macicame I, Cumbane V, Bhatt N, Viegas E, Imbach M, Eller LA, Polyak CS, Kestens L. Helios expressing regulatory T cells are correlated with decreased IL-2 producing CD8 T cells and antibody diversity in Mozambican individuals living chronically with HIV-1. BMC Immunol 2022; 23:12. [PMID: 35287587 PMCID: PMC8922818 DOI: 10.1186/s12865-022-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Human immunodeficiency virus type 1 (HIV-1) causes impairment of T and B cell responses, which begins during the acute phase of infection and is not completely restored by antiretroviral treatment. Regulatory T cell (Tregs) can improve overall disease outcome by controlling chronic inflammation but may also suppress beneficial HIV-1 specific immune responses. We aimed to analyze the profile of Tregs and their correlation with the status of T cells activation, the expression of IL-2 and IFNγ and the profile of HIV-1 specific antibodies response in Mozambican people living chronically with HIV-1 (PLWH-C). Results In PLWH-C, the proportion of total Tregs was positively correlated with the proportion of IL-2+CD4 T cells (r = 0.647; p = 0.032) and IL-2+IFNγ+CD8 T cells (r = 0.551; p = 0.014), while the proportions of Helios+Tregs correlated inversely with levels of IL-2+CD8 T cells (r = − 0.541; p = 0.017). Overall, PLWH-C, with (82%) or without virologic suppression (64%), were seronegative for at least HIV-1 p31, gp160 or p24, and the breadth of antibody responses was positively correlated with proportions of CD38+HLA-DR+CD8 T cells (r = 0.620; p = 0.012), viral load (r = 0.452; p = 0.040) and inversely with absolute CD4 T cells count (r = − 0.481; p = 0.027). Analysis of all individuals living HIV-1 showed that the breadth of HIV-1 antibody responses was inversely correlated with the proportion of Helios+Tregs (r = − 0.45; p = 0.02). Conclusion Among Mozambican people living with HIV-1, seronegativity to some HIV-1 proteins is common, particularly in virologically suppressed individuals. Furthermore, lower diversity of HIV-specific antibodies is correlated to lower immune activation, lower viral replication and higher CD4 counts, in PLWH-C. Elevation in the proportion of Helios+Tregs is related to a reduction of CD8 T expressing intracellular IL-2, in PLWH-C, but may contribute to impairment of B cell function. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-022-00487-3.
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Affiliation(s)
- Raquel Matavele Chissumba
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique. .,Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium. .,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
| | - Cacildo Magul
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Rosa Macamo
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Vânia Monteiro
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Maria Enosse
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Ivalda Macicame
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Victória Cumbane
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Edna Viegas
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Luc Kestens
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Capitine IPU, Macicame IB, Uanela AM, Bhatt NB, Yates A, Milazzo M, Nwoga C, Crowell TA, Michael NL, Robb ML, Jani IV, Kroidl A, Polyak CS, De Schacht C. Young at risk-people in Maputo City, Mozambique, present a high willingness to participate in HIV trials: Results from an HIV vaccine preparedness cohort study. PLoS One 2021; 16:e0260126. [PMID: 34855790 PMCID: PMC8638929 DOI: 10.1371/journal.pone.0260126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaccine efficacy testing requires engagement of willing volunteers with high disease incidence. We evaluated factors associated with willingness to participate in potential future HIV vaccine trials in Maputo, Mozambique. METHODS Adults aged 18-35 years without HIV and who reported at least two sexual partners in the 3 months prior to screening were enrolled into a 24-month observational study. They were asked at screening and exit if they would be willing to participate in a theoretical HIV vaccine study. Bivariate and multivariate logistic regression analyses were done between willingness to participate, demographic, sexual behavior, and motivational factors for screening visit data. Logistic regression with generalized estimating equations (GEE) was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors potentially associated with willingness to participate for data from both visits. RESULTS A total of 577 participants without HIV were eligible, including 275 (48%) women. The mean age was 22.2 (SD ± 3.9) years. At screening 529 (92%) expressed willingness to participate and the proportion remained stable at 378 (88%) of the 430 participants retained through the exit visit (p = 0.209). Helping the country (n = 556) and fear of needles (n = 26) were the top motive and barrier for willingness to participate, respectively. Results from the GEE binary logistic regression (screening visit and exit visit) showed that wanting to learn how to avoid risk behaviors (aOR 3.33, 95% CI: 1.61-6.86) and feeling protected against HIV infection (aOR 2.24, 95% CI: 1.07-4.7) were associated with willingness to participate in HIV vaccine studies. CONCLUSION The majority of our study population in Mozambique expressed willingness to participate in a theoretical HIV vaccine trial. Participation in a HIV vaccine trial was seen as a way to contribute to the fight against HIV but was associated with some unrealistic expectations such as protection against HIV. This reinforces the need for continuous mobilization and awareness of potential participants to HIV vaccine trial.
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Affiliation(s)
- Igor P. U. Capitine
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany
| | | | - Artur M. Uanela
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Nilesh B. Bhatt
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Mark Milazzo
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Nelson L. Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Ilesh V. Jani
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | - Arne Kroidl
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Seroprevalence and Determinants of Human Immunodeficiency Virus Infection Among Women of Reproductive Age in Mozambique: A Multilevel Analysis. Infect Dis Ther 2020; 9:881-900. [PMID: 32910429 PMCID: PMC7680491 DOI: 10.1007/s40121-020-00336-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) has continued to be one of the foremost public health problems globally. Even as more people living with the disease can now have access to antiretroviral therapy (ART), there are still some regions in the world with high transmission rates. The objective of this study was to examine the prevalence and individual-, household- and community-level factors associated with HIV infection among women of reproductive age in Mozambique. Methods We used nationally representative cross-sectional data from the 2015 Survey of Indicators on Immunization, Malaria and HIV or Acquired Immunodeficiency Syndrome (AIDS) in Mozambique. A sample of 4726 women of reproductive age was included in this study. Prevalence was measured in percentage and the factors for HIV infection were examined using a multivariable multilevel logistic regression model. The level of significance was set at P < 0.05. Results The seroprevalence of HIV among women in Mozambique was 10.3% (95% CI 9.2%, 11.6%). Furthermore, women who had two, three and four or more total lifetime number of sex partners were 2.73, 5.61 and 3.95 times as likely to have HIV infection when compared with women with only one lifetime sex partners, respectively. In addition, women of Islam religion had 60% reduction in HIV infection when compared with Christian women (adjusted odds ratio, AOR = 0.40; 95% CI 0.16, 0.99). The individual-level model (model B) had the best model fitness with the lowest Akaike information criterion (AIC) = 500.87 and Bayesian information criterion (BIC) = 648.88. The variations in the odds of HIV infection across communities (σ2 = 9.61 × 10–8; SE = 0.55) and households (σ2 = 1.02 × 10–4; SE = 1.02) were estimated. Results from the median odds ratio (MOR = 1.00) did not show any evidence of community and household contextual factors shaping HIV infection. MOR equal to unity (1) indicated that there were no community or household variances given the ICC of 0.0%. At both community and household levels, the explained variances were each 100%. This implied total variances in HIV infection has been explained by the individual-level factors. Conclusion In this study, we found that having multiple total lifetime number of sexual partners and religion were predisposing factors for HIV infection at individual woman level. Female headship and wealth quintiles were associated with HIV infection at household level. Community illiteracy, intimate partner violence, poverty and geographical region were associated with HIV infection at community level. Therefore, multifaceted health intervention by stakeholders in the healthcare system will be useful in addressing the multilevel predisposing factors of HIV infection among Mozambican women.
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Agbadi P, Nutor JJ, Darkwah E, Duah HO, Duodu PA, Alhassan RK, Baltzell K. Covariates and Spatial Interpolation of HIV Screening in Mozambique: Insight from the 2015 AIDS Indicator Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165630. [PMID: 32764221 PMCID: PMC7460053 DOI: 10.3390/ijerph17165630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023]
Abstract
We examined the factors associated with human immunodeficiency virus (HIV) screening and developed a HIV screening prevalence surface map using spatial interpolation techniques to identify the geographical areas with the highest and lowest rates of HIV screening in Mozambique. We analyzed the cross-sectional 2015 Mozambique AIDS Indicator Surveys with an analytic sample of 12,995 participants. Analyses were conducted on SPSS-21, STATA-14, and R freeware 3.5.3. We adjusted for the sample design and population weights. Results indicated that 52.5% of Mozambicans had undergone HIV screening. Mozambicans with these characteristics have a higher probability of undergoing HIV screening: females, those with a primary education or higher, urban dwellers, residents of wealthy households, having at least one lifetime sexual partner, and dwelling in these provinces—Niassa, Tete, Manica, Sofala, Inhambane, Gaza, Maputo Provincia, and Maputo Cidade. The spatial map revealed that the national and regional estimates mask sub-regional level estimates. Generally, zones with the highest HIV screening prevalence are found in southern provinces while the lowest prevalence was found in the northern provinces. The map further revealed intraregional differences in HIV screening estimates. We recommend that HIV screening be expanded, with equitable screening resource allocations that target more nuanced areas within provinces which have a low HIV screening prevalence.
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Affiliation(s)
- Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
- Correspondence:
| | - Ernest Darkwah
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Ghana;
| | | | | | - Robert Kaba Alhassan
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana;
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
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