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Ruf S, Harding D, Sorie S, Janneh FM, Theuring S. Post-Omicron SARS-CoV-2 serostatus in Sierra Leone: A cross-sectional study in a maternity hospital setting in Freetown, November/December 2022. J Infect Public Health 2024; 17:102518. [PMID: 39142080 DOI: 10.1016/j.jiph.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Spread of SARS-CoV-2 in Sub-Saharan African countries has been poorly investigated, especially in the later pandemic stages. We aimed to assess the post-Omicron situation in Sierra Leone in November/December 2022 considering SARS-CoV-2 serostatus, vaccinations, and behavioral factors. METHODS In a cross-sectional study conducted in a maternity hospital in Freetown, Sierra Leone, both patients and staff provided dried blood spot samples for analysis of anti-S and anti-N IgG prevalence using Anti-SARS-CoV-2-ELISA. Additionally, we collected sociodemographic and infection-related information through questionnaires. Outcome parameters included seropositivity, infection-related seroprevalence, and self-reported vaccination status. We used logistic regression to identify associations with prior infection and with vaccination status. RESULTS Out of 791 participants (389 patients, 402 staff), 670 (84.7 %) displayed a positive SARS-CoV-2 serostatus resulting from either infection or vaccination. Among a sub-sample of 514 participants within which determination of prior natural infection was possible, 441individuals (85.8 %) were affected. Prior infection was associated with female sex and tertiary education level. Overall, 60.3 % reported having been vaccinated. Staff as opposed to patients, and individuals with higher socioeconomic status were more likely to report vaccination. Individuals who assessed their risk of COVID-19 as either higher or lower compared to a medium-level risk were more likely to have contracted the virus and less likely to have received vaccination. CONCLUSION Our findings suggest that since the Omicron wave in 2022, the Sierra Leonean population has almost universally been exposed to SARS-CoV-2. While this is encouraging in the light of relatively low excess mortality in the country, future investigations on the long-term effect of high viral exposure on epidemic resilience and public health impact will be crucial.
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Affiliation(s)
- Sebastian Ruf
- Institute of International Health, Charité- Universitätsmedizin Berlin, Corporate Member of Humboldt University and Freie Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Doris Harding
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Samuel Sorie
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Musa Janneh
- Ministry of Health and Sanitation, Freetown, Sierra Leone; Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Stefanie Theuring
- Institute of International Health, Charité- Universitätsmedizin Berlin, Corporate Member of Humboldt University and Freie Universität Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Young R, Ssekasanvu J, Kagaayi J, Ssekubugu R, Kigozi G, Reynolds SJ, Wawer MJ, Nonyane BAS, Nantume B, Quinn TC, Tobian AAR, Santelli J, Chang LW, Kennedy CE, Paina L, Anglewicz PA, Serwadda D, Nalugoda F, Grabowski MK. HIV incidence among non-migrating persons following a household migration event in Uganda. Int J Epidemiol 2024; 53:dyae118. [PMID: 39242079 PMCID: PMC11379466 DOI: 10.1093/ije/dyae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 08/22/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda. METHODS We used four survey rounds of data collected from July 2011 to May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study. Non-migrants were individuals with no-migration between surveys or at the prior survey. Household migration was defined as ≥1 household member migrating into or out of the house from another community between surveys (∼18 months). Incident HIV was defined as testing HIV seropositive following a negative result. Incidence rate ratios (IRRs) were estimated using Poisson regression with generalized estimating equations. Analyses were stratified by gender, migration into or out of the household and the relationship between non-migrants and migrants (e.g. spouse, child). RESULTS About 11 318 non-migrants (5674 women) were followed for 37 320 person-years. Twenty-eight percent (6059/21 370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV than non-migrants in households without any migration. However, men were significantly more likely to acquire HIV if their spouse had recently migrated in [adjusted IRR: 2.12; 95% confidence interval (CI): 1.05-4.27] or out (adjusted IRR: 4.01; 95% CI, 2.16-7.44) compared with men with no spousal migration. CONCLUSIONS HIV incidence is higher among non-migrant men with migrant spouses. Targeted HIV testing and prevention interventions like pre-exposure prophylaxis could be considered for men with migrant spouses.
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Affiliation(s)
- Ruth Young
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Steven J Reynolds
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Betty Nantume
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Aaron A R Tobian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Santelli
- Population and Family Health and Pediatrics, Columbia Mailman School of Public Health, New York, NY, USA
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philip A Anglewicz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Mary Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Jahn LS, Kengonzi A, Kabwama SN, Rubaihayo J, Theuring S. Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:745-756. [PMID: 37943471 PMCID: PMC10844405 DOI: 10.1007/s10508-023-02726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.
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Affiliation(s)
- Lisa S Jahn
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Agnes Kengonzi
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | | | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Stefanie Theuring
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Govender V, Moodley D, Naidoo M, Connoly C, Ngcapu S, Abdool Karim Q. High incidence of asymptomatic genital tract infections in pregnancy in adolescent girls and young women: need for repeat aetiological screening. Sex Transm Infect 2023; 99:482-488. [PMID: 37208192 DOI: 10.1136/sextrans-2022-055658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/10/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Sexually transmitted infection (STI) prevalence and incidence estimates for pregnant adolescents are under-reported. We estimated prevalence and incidence of STIs in pregnant adolescents (15-19 years) in comparison with pregnant women 20-24 and >25 years. METHODS Pregnant women registering at primary care clinics in Umlazi, a periurban subdistrict in KwaZulu-Natal, South Africa, were enrolled in an HIV incidence cohort study during February 2017-March 2018. Women were examined for abnormal vaginal discharge, received empirical treatment, tested for HIV-1 and had vaginal swabs taken at their first and a subsequent visit in the third trimester. Vaginal swabs were stored for STI testing at completion of study and tested for Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium using PCR. RESULTS A total of 752 HIV-negative pregnant women were enrolled at a median gestational age of 17 weeks: 180 (23.9%), 291 (38.7%) and 281 (37.4%) in the 15-19, 20-24 and >25 years age groups. Pregnant adolescents had an STI prevalence of 26.7% at baseline, not significantly lower than the 20-24 (34.7%, OR 1.4; 95% CI 1.0 to 2.1, p=0.09) and >25 years (33.8%, OR 1.4; 95% CI 0.9 to 2.1, p=0.12) age groups. T. vaginalis (11.1%), C. trachomatis (7.8%) and N. gonorrhoeae (4.4%) were most prevalent in adolescents, a trend similar to the other age groups. Overall, 43.4% were symptomatic and treated at baseline. Overall, 40.7% (118 of 290) of women who tested negative for an STI at baseline tested positive at the repeat visit (incidence 19.5/100 person years). STI incidence in pregnant adolescents was 23.9/100 person years and comparable with older age groups (20.5/100 person years and 16.2/100 person years). At the repeat visit, 19.0% of all women with an STI were symptomatic and treated. Performance of syndromic management was poor at baseline (negative predictive value (NPV) 68.6%, positive predictive value (PPV) 34.0%) and at repeat visit (NPV 58.4%, PPV 34.3%). CONCLUSIONS Prevalence of asymptomatic curable STIs in pregnant adolescents is high and comparable with women >20 years old. Adolescents remain at substantial risk of asymptomatic incident STIs during pregnancy.
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Affiliation(s)
- Vani Govender
- Centre for the AIDS Program of Research in South Africa, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Obstetrics and Gynaecology, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Dhayendre Moodley
- Centre for the AIDS Program of Research in South Africa, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Obstetrics and Gynaecology, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Megeshinee Naidoo
- Centre for the AIDS Program of Research in South Africa, CAPRISA, Durban, KwaZulu-Natal, South Africa
| | - Cathy Connoly
- Department of Biostatistics, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Program of Research in South Africa, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Program of Research in South Africa, CAPRISA, Durban, KwaZulu-Natal, South Africa
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Young R, Ssekasanvu J, Kagaayi J, Ssekubugu R, Kigozi G, Reynolds SJ, Wawer MJ, Nonyane BAS, Nantume B, Quinn TC, Tobian AAR, Santelli J, Chang LW, Kennedy CE, Paina L, Anglewicz PA, Serwadda D, Nalugoda F, Grabowski MK. HIV incidence among non-migrating persons following a household migration event: a population-based, longitudinal study in Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.23.23295865. [PMID: 37808671 PMCID: PMC10557776 DOI: 10.1101/2023.09.23.23295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda. Methods We used four survey rounds of data collected from July 2011-May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study, an open, population-based cohort. Non-migrants were individuals with no evidence of migration between surveys or at the prior survey. The primary exposure, household migration, was assessed using census data and defined as ≥1 household member migrating in or out of the house from another community between surveys (∼18 months). Incident HIV cases tested positive following a negative result at the preceding visit. Incidence rate ratios (IRR) with 95% confidence intervals were estimated using Poisson regression with generalized estimating equations and robust standard errors. Analyses were stratified by gender, migration into or out of the household, and the relationship between non-migrants and migrants (i.e., any household migration, spouse, child). Findings Overall, 11,318 non-migrants (5,674 women) were followed for 37,320 person-years. 28% (6,059/21,370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified in non-migrating household members. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV. However, HIV incidence among men was significantly higher when the spouse had recently migrated in (adjIRR:2·12;95%CI:1·05-4·27) or out (adjIRR:4·01;95%CI:2·16-7·44) compared to men with no spousal migration. Women with in- and out-migrant spouses also had higher HIV incidence, but results were not statistically significant. Interpretation HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses. Funding National Institutes of Health, US Centers for Disease Control and Prevention. Research in context We searched PubMed for studies focused on HIV acquisition, prevalence or sexual behaviors among non-migrants who lived with migrants in sub-Saharan Africa (SSA) using search terms such as "HIV", "Emigration and Immigration", "family", "spouses", "household", "parents", and "children". Despite high levels of migration and an established association with HIV risk in SSA, there is limited data on the broader societal impacts of migration on HIV acquisition risk among non-migrant populations directly impacted by it.There has been only one published study that has previously evaluated impact of migration on HIV incidence among non-migrating persons in sub-Saharan Africa. This study, which exclusively assessed spousal migration, was conducted in Tanzania more than two decades earlier prior to HIV treatment availability and found that non-migrant men with long-term mobile partners were more than four times as likely to acquire HIV compared to men who had partners that were residents. To the best of our knowledge, this is the first study to examine the effect of non-spousal migration, including any household migration and child migration, on HIV incidence among non-migrants. Added value of this study In this study, we used data from the Rakai Community Cohort Study (RCCS), a population-based HIV surveillance cohort to measure the impact of migration on HIV incidence for non-migrant household members. The RCCS captures HIV incident events through regular, repeat HIV testing of participants and migration events through household censuses. Our study adds to the current literature by examining the general effect of migration in the household on HIV incidence in addition to child, and spousal migration. Using data from over 11,000 non-migrant individuals, we found that spousal, but not other types of household migration, substantially increased HIV risk among non-migrants, especially among men. Taken together, our results suggest that spousal migration may be associated with an increased risk of HIV acquisition in the period surrounding and immediately after spousal migration. Implications of all the available evidence Our findings suggest that spousal migration in or out of the household is associated with greater HIV incidence. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for men with migrant spouses.
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Worku WZ, Azale T, Ayele TA, Mekonnen DK. HIV is still a major public health problem among pregnant women attending ANC in Referral Hospitals of the Amhara Regional State, Ethiopia: a cross sectional study. BMC Womens Health 2022; 22:468. [PMID: 36434557 PMCID: PMC9701049 DOI: 10.1186/s12905-022-02059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The burden of HIV is disproportionately higher among women of reproductive age contributing more than half of the global share. The situation in Ethiopia is not exceptional. The present study was done to determine the proportion of HIV among pregnant women in Amhara Regional State, Ethiopia. METHOD Institutions-based cross-sectional study was conducted from October 2020 to December 2020. Systematic random sampling technique was used to select 538 study participants from pregnant women who had ANC follow-up in Referral Hospitals of the Amhara Regional State. Data on socio-demographic, clinical, obstetric, behavioral as well as psychosocial characteristics were gathered using an interviewer administered structured and standardized instruments. The data was entered into Epi-Data Manager V4.6.0.0 and exported to STATA version 14 for data analyses. Descriptive statics were computed to summarize the participant's characteristics. Bi-variable and multivariable logistic regression analyses were conducted to identify the association between dependent and independent variables. Independent variables with a p-value of less than 0.05 were considered to be statistically significant at 95% confidence level (CI). RESULTS The proportion of HIV infection among pregnant women was 8.68% (95% CI: 6.5, 11.4). Completing secondary school education (Adjusted Odds Ratio (AOR = 0.15; 95% CI: 0.04-0.53), graduated from college (AOR = 0.03; 95% CI: 0.01-0.22), and family monthly income greater than 8001 ETB (1 USD = 56 ETB) (AOR = 0.19; 95% CI: 0.04-0.87) were protective factors associated with maternal HIV. On the other hand, history of previous abortion (AOR = 7.73; 95% CI: 3.33-17.95) and positive syphilis status (AOR = 10.28; 95% CI: 2.80-37.62) were risk factors associated with maternal HIV status. CONCLUSION The proportion of HIV infection among pregnant women was found to be high. Advanced level of education, relatively higher monthly income, history of abortion and previous syphilis status were associated factors with HIV status. Strengthening women's formal education; empowering women in all spheres of life (especially improving their economic standing that prevents women from engaging in risky sexual practices); educating women about HIV transmission methods and HIV prevention and control strategies using behavior change intervention strategy prepared for women to reduce their vulnerability; advocating for the use of family planning to reduce unsafe abortions and syphilis; as well as regular screening and testing for syphilis are recommended.
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Affiliation(s)
- Workie Zemene Worku
- grid.59547.3a0000 0000 8539 4635Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kassahun Mekonnen
- grid.59547.3a0000 0000 8539 4635Department of Gynaecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Olagunju A, Mathad J, Eke A, Delaney-Moretlwe S, Lockman S. Considerations for the Use of Long-Acting and Extended-Release Agents During Pregnancy and Lactation. Clin Infect Dis 2022; 75:S571-S578. [PMID: 36410383 PMCID: PMC10200321 DOI: 10.1093/cid/ciac659] [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: 11/22/2022] Open
Abstract
Long-acting agents hold significant promise for treating and preventing common illnesses, including infections. Pharmacokinetic and safety data during pregnancy and lactation are often unavailable for new drugs; these data are vital to facilitate optimal drug use by pregnant and lactating women and women who may conceive. In this commentary, we summarize the circumstances in which pregnant and lactating women are likely to use and benefit from long-acting agents. We focus on long-acting formulations of small molecules (rather than biologics such as monoclonal antibodies) and on several infections of global importance (human immunodeficiency virus, tuberculosis, malaria, and hepatitis C). We discuss pregnancy pharmacokinetic/pharmacodynamic and potential safety and efficacy considerations pertaining to the use of long-acting agents in pregnancy and lactation. Finally, we summarize existing preclinical and pregnancy pharmacokinetic data that are available (or expected in the near future) for several agents that are under development or approved, and how key research gaps may be addressed.
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Affiliation(s)
- Adeniyi Olagunju
- Centre of Excellence for Long-acting Therapeutics, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Jyoti Mathad
- Department of Medicine and Obstetrics and Gynecology, Center for Global Health, Weill Cornell Medicine, New York, New York, USA
| | - Ahizechukwu Eke
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sinead Delaney-Moretlwe
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Shahin Lockman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
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Astawesegn FH, Conroy E, Mannan H, Stulz V. Measuring socioeconomic inequalities in prenatal HIV test service uptake for prevention of mother to child transmission of HIV in East Africa: A decomposition analysis. PLoS One 2022; 17:e0273475. [PMID: 35998196 PMCID: PMC9398021 DOI: 10.1371/journal.pone.0273475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite efforts made towards the elimination of mother-to-child HIV transmission, socioeconomic inequality in prenatal HIV test uptake in East Africa is not well understood. Therefore, this study aimed at measuring socioeconomic inequalities in prenatal HIV test uptake and explaining its main determinants in East Africa Method We analysed a total weighted sample of 45,476 women aged 15–49 years who birthed in the two years preceding the survey. The study used the most recent DHS data from ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Zambia, and Zimbabwe). The socioeconomic inequality in prenatal HIV test uptake was measured by the concentration index and illustrated by the concentration curve. Then, regression based Erreygers decomposition method was applied to quantify the contribution of socioeconomic factors to inequalities of prenatal HIV test uptake in East Africa. Results The concentration index for prenatal HIV test uptake indicates that utilization of this service was concentrated in higher socio-economic groups with it being 15.94% higher among these groups in entire East Africa (p <0.001), 40.33% higher in Ethiopia (p <0.001) which was the highest and only 1.87% higher in Rwanda (p <0.01) which was the lowest. The decomposition analysis revealed that household wealth index (38.99%) followed by maternal education (13.69%), place of residence (11.78%), partner education (8.24%), watching television (7.32%), listening to the radio (7.11%) and reading newsletters (2.90%) made the largest contribution to socioeconomic inequality in prenatal HIV test in East Africa. Conclusion In this study, pro-rich inequality in the utilization of prenatal HIV tests was evident. The decomposition analysis findings suggest that policymakers should focus on improving household wealth, educational attainment, and awareness of mother-to-child transmission of HIV (MTCT) through various media outlets targeting disadvantaged sub-groups.
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Affiliation(s)
- Feleke Hailemichael Astawesegn
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, Australia
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Elizabeth Conroy
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Virginia Stulz
- School of Nursing and Midwifery Centre for Nursing and Midwifery Research, Western Sydney University, Nepean, Hospital 1 level Court Building, Kingswood, NSW, Australia
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HIV risk factors among adolescent and young adults: A geospatial–temporal analysis of Mozambique AIDS indicator survey data. Spat Spatiotemporal Epidemiol 2022; 41:100499. [DOI: 10.1016/j.sste.2022.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 11/22/2022]
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Genetu K, Abere K, Tachbele E. Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia. Infect Dis Obstet Gynecol 2022; 2022:6156613. [PMID: 35221648 PMCID: PMC8865988 DOI: 10.1155/2022/6156613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia. METHOD A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25. RESULT A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs. CONCLUSION There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.
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Affiliation(s)
- Kassa Genetu
- College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Kerebih Abere
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Erdaw Tachbele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Theuring S, Rubagumya K, Schumann H, Harms G, Rubaihayo J, Wanyenze R. Sexual Risk Behavior in HIV-Uninfected Pregnant Women in Western Uganda. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3277-3286. [PMID: 34647234 PMCID: PMC8563618 DOI: 10.1007/s10508-021-02062-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 05/30/2023]
Abstract
Our aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern.
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Affiliation(s)
- Stefanie Theuring
- Institute of Tropical Medicine and International Health, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Kenyonyozi Rubagumya
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Hannah Schumann
- Institute of Tropical Medicine and International Health, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Rhoda Wanyenze
- School of Public Health, Makerere University, Kampala, Uganda
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Theuring S, Kengonzi A, Hafermann L, Herrmann C, Kabwama SN, Rubaihayo J. Repercussions of the COVID-19 Response in Pregnant Women in Western Uganda: Knowledge, Behavior, and Emotional State after the First Lockdown in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7817. [PMID: 34360111 PMCID: PMC8345751 DOI: 10.3390/ijerph18157817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022]
Abstract
Limited research exists on pregnant women's knowledge, attitudes, and behavior concerning COVID-19 in sub-Saharan Africa. We performed a cross-sectional study among 648 pregnant women in Fort Portal, Uganda, after the first lockdown starting in June 2020. Structured interviews were conducted at three different facilities during routine antenatal care, assessing sociodemographic background, knowledge of COVID-19, prevention behavior adherence, and psycho-emotional stress levels. We performed descriptive analyses and examined associated factors using multivariable logistic regression. In Fort Portal Region, 32.8% of pregnant women had a higher knowledge regarding the COVID-19 pandemic, while all women at least heard of COVID-19. 88.6% of the women showed low self-reported prevention behavior adherence. More than one third of the pregnant women experienced high psycho-emotional stress related to the pandemic (39.8%). The odds for psycho-emotional stress were increased among the age group 21-30 years (AOR 1.97; 95% CI 1.18-3.35) compared to women under the age of 21, and decreased in single or divorced women compared to women in partnerships (AOR 0.42; 0.22-0.77) and in women having less COVID-19-related knowledge (AOR 0.40; 0.27-0.58). In conclusion, prevention behavior adherence seemed challenging, and psycho-emotional stress was ubiquitous among our cohort. To avoid adverse consequences in maternal and neonatal health, campaigns for hygiene but also women's emotional state should be a major focus of community healthcare in exceptional times such as the SARS-CoV-2 pandemic.
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Affiliation(s)
- Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany
| | - Agnes Kengonzi
- School of Health Sciences, Mountains of the Moon University, Fort Portal P.O. Box 837, Uganda; (A.K.); (J.R.)
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (L.H.); (C.H.)
| | - Carolin Herrmann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (L.H.); (C.H.)
| | | | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal P.O. Box 837, Uganda; (A.K.); (J.R.)
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