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Kusemererwa S, Ruzagira E, Onyango M, Kabarambi A, Abaasa A. Associations between intravaginal practices and incidence of sexually transmitted infections and bacterial vaginosis among women enrolled in the dapivirine vaginal ring trial (The Ring Study) in southwestern Uganda: a retrospective secondary analysis. BMJ Open 2024; 14:e079497. [PMID: 38589266 PMCID: PMC11015298 DOI: 10.1136/bmjopen-2023-079497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES We assessed associations between intravaginal practices (IVPs) and the incidence of sexually transmitted infections (STIs) and bacterial vaginosis (BV) among women using the dapivirine vaginal ring (DVR) or placebo vaginal ring in southwestern Uganda. METHODS This was a retrospective secondary analysis of data collected from women at risk of HIV infection recruited into the Ring Study. The latter evaluated the safety and efficacy of the DVR between 2013 and 2016. At baseline, a behavioural questionnaire was administered to obtain information on sexual activity and IVP (exposure) defined as; insertion inside the vagina of any items aimed at cleaning the vagina for any reason before, during or after sex other than practices to manage menses. Each participant self-inserted the DVR/placebo and replaced it every 4 weeks for 2 years. Outcomes were diagnosis of STIs, that is, Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis (TV), HIV and BV. The incidence rate of STI/BV was estimated, overall, by IVP and trial arm in single-event-per-participant and multiple-event-per-participant analyses. RESULTS Of the 197 women enrolled, 66 (33.5%) were <25 years of age. Overall, 93 (47.2%) practised at least one form of IVP. During the follow-up, 172 (87.3%) women were diagnosed with an STI/BV at least once. The majority had TV (73.6%, n=145). Overall rate of STI/BV was 51.9/100 person-years, 95% CI 44.7 to 60.3 (IVP: yes, 51.0 (40.8-63.8) vs no, 52.6 (43.0-64.4)). IVPs were not statistically significantly associated with rate of individual STIs/BV. Similar results were observed when the analyses were conducted separately for each trial arm. CONCLUSIONS IVP was not associated with risk of STIs/BV in the Ring Study. TRIAL REGISTRATION NUMBER NCT01539226.
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Affiliation(s)
- Sylvia Kusemererwa
- Viral Pathogens Epidemiology and Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Viral Pathogens Epidemiology and Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Onyango
- Viral Pathogens Epidemiology and Interventions, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Anita Kabarambi
- International Centre for Child Health and Development, Masaka, Uganda
| | - Andrew Abaasa
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Statistics & Data Science, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Rodriguez VJ, Pan Y, Salazar AS, Nogueira NF, Raccamarich P, Klatt NR, Jones DL, Alcaide ML. Using unsupervised machine learning to classify behavioral risk markers of bacterial vaginosis. Arch Gynecol Obstet 2024; 309:1053-1063. [PMID: 38310145 DOI: 10.1007/s00404-023-07360-7] [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] [Received: 07/06/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition. METHODS: Participants were 391 cisgender women in Miami, Florida, with a mean of 30.8 (SD = 7.81) years of age; 41.7% identified as Hispanic; 41.7% as Black and 44.8% as White. Participants completed measures of demographics, risk behaviors [sexual, medical, and reproductive history, substance use, and intravaginal practices (IVP)], and underwent collection of vaginal samples; 135 behavioral variables were analyzed. BV was diagnosed using Nugent criteria. RESULTS We identified four clusters, and variables were ranked by importance in distinguishing clusters: Cluster 1: nulliparous women who engaged in IVPs to clean themselves and please sexual partners, and used substances frequently [n = 118 (30.2%)]; Cluster 2: primiparous women who engaged in IVPs using vaginal douches to clean themselves (n = 112 (28.6%)]; Cluster 3: primiparous women who did not use IVPs or substances [n = 87 (22.3%)]; and Cluster 4: nulliparous women who did not use IVPs but used substances [n = 74 (18.9%)]. Clusters were related to BV (p < 0.001). Cluster 2, the cluster of women who used vaginal douches as IVPs, had the highest prevalence of BV (52.7%). CONCLUSIONS Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, in developing interventions intended to reduce BV and IVP, and ultimately in reducing the risk of HIV infection among women.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
- Department of Psychology, University of Georgia, Athens, USA
| | - Yue Pan
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Patricia Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Nichole R Klatt
- Surgical Outcomes and Precision Medicine Research Division, Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA.
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Rodriguez VJ, Salazar AS, Cherenack EM, Klatt NR, Jones DL, Alcaide ML. Assessing Intravaginal Practices in HIV Prevention Research: Development and Validation of an Intravaginal Practices Questionnaire. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:803-808. [PMID: 36459351 PMCID: PMC11046221 DOI: 10.1007/s10508-022-02484-4] [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: 03/30/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/01/2023]
Abstract
Intravaginal practices (IVPs) refer to placing items (e.g., water, soap, commercial douches, fingers, rags) inside the vagina. IVPs have been shown to contribute to the development of bacterial vaginosis (BV) and may increase sexually transmitted infections and HIV risk. We developed the Intravaginal Practices Questionnaire (IVQ). The purpose of this study was to validate the IVQ, with the goal of establishing a consistent method of assessing IVP across studies. Women enrolled in this study (n = 180) were on average 30 years of age (SD = 8.32). Half (54%) identified as non-Hispanic, and 45% identified as Black; 41% reported lifetime IVP. Past month IVP use included commercial douches (9%), water (35%), fingers (41%), soap (21%), cloths/rags/wipes (10%), and vinegar (3%), which were placed in the vagina. No women used yogurt or herbs. An exploratory factor analysis indicated that a single-factor structure best explained the underlying constructs in participant responses in six endorsed items assessing commercial douches, water, fingers, soap, clothes/rags/ wipes, and vinegar use, suggesting that a common factor underlies these behaviors. All factor loadings were > 0.496. Cronbach's α was 0.99, suggesting that the reliability of the scale was excellent. Lastly, a total IVQ score was related to BV diagnosis (p = .007) as well as self-reported symptoms of BV (p = .034). Results illustrate that the IVQ has adequate psychometric properties. This tool may be used by public health experts and clinicians to identify IVPs that may potentially increase HIV risk.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Ave, Suite 2300, Miami, FL, 33136, USA
| | - Emily M Cherenack
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nichole R Klatt
- Department of Surgery, Surgical Outcomes and Precision Medicine Research Division, University of Minnesota, Minneapolis, MN, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 7th Ave, Suite 2300, Miami, FL, 33136, USA.
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Salazar AS, Nogueira NF, Rodriguez VJ, Mantero A, Cherenack EM, Raccamarich P, Maddalon M, Brophy T, Montgomerie E, Klatt NR, Jones DL, Alcaide ML. A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis. AIDS Behav 2022; 26:3110-3118. [PMID: 35362906 PMCID: PMC9378611 DOI: 10.1007/s10461-022-03634-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.
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Affiliation(s)
- Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nicholas F Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Violeta J Rodriguez
- Department of Psychology, University of Georgia, Athens, Georgia
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Emily M Cherenack
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Patricia Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Marissa Maddalon
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Theodora Brophy
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Emily Montgomerie
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nichole R Klatt
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, United States.
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States.
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Lewis FM, Diesel J. Intravaginal Practices Among Women Attending a Sexually Transmitted Disease Clinic-Philadelphia, 2017. Sex Transm Dis 2021; 48:e64-e67. [PMID: 32842046 PMCID: PMC10189515 DOI: 10.1097/olq.0000000000001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We conducted a survey among women attending an urban public sexually transmitted disease clinic to determine the type and frequency of intravaginal cleansing practices. Both intravaginal washing and douching were frequent, performed mostly for routine hygiene, and associated with self-report of sexually transmitted infection and bacterial vaginosis (douching and intravaginal washing).
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Affiliation(s)
- Felicia M.T. Lewis
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Jill Diesel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Michigan Department of Health and Human Services, Lansing, MI
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Blondin-Ladrie L, Aranguren M, Doyon-Laliberté K, Poudrier J, Roger M. The Importance of Regulation in Natural Immunity to HIV. Vaccines (Basel) 2021; 9:vaccines9030271. [PMID: 33803543 PMCID: PMC8003059 DOI: 10.3390/vaccines9030271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023] Open
Abstract
Worldwide, most Human Immunodeficiency Virus (HIV) infections are acquired through heterosexual intercourse, and in sub-Saharan Africa, 59% of new HIV infections affect women. Vaccines and microbicides hold promise for preventing the acquisition of HIV. To this end, the study of HIV highly exposed seronegative (HESN) female commercial sex workers (CSWs), who constitute a model of natural immunity to HIV, provides an exceptional opportunity to determine important clues for the development of preventive strategies. Studies using both female genital tract (FGT) and peripheral blood samples of HESN CSWs, have allowed identifying distinct features, notably low-inflammatory patterns associated with resistance to infection. How this seemingly regulated response is achieved at the initial site of HIV infection remains unknown. One hypothesis is that populations presenting regulatory profiles contribute to the orchestration of potent anti-viral and low-inflammatory responses at the initial site of HIV transmission. Here, we view to update our knowledge regarding this issue.
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Affiliation(s)
- Laurence Blondin-Ladrie
- Axe Immunopathologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0A9, Canada; (L.B.-L.); (M.A.); (K.D.-L.)
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, QC H3C3J7, Canada
| | - Matheus Aranguren
- Axe Immunopathologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0A9, Canada; (L.B.-L.); (M.A.); (K.D.-L.)
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, QC H3C3J7, Canada
| | - Kim Doyon-Laliberté
- Axe Immunopathologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0A9, Canada; (L.B.-L.); (M.A.); (K.D.-L.)
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, QC H3C3J7, Canada
| | - Johanne Poudrier
- Axe Immunopathologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0A9, Canada; (L.B.-L.); (M.A.); (K.D.-L.)
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, QC H3C3J7, Canada
- Correspondence: (J.P.); (M.R.)
| | - Michel Roger
- Axe Immunopathologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X0A9, Canada; (L.B.-L.); (M.A.); (K.D.-L.)
- Département de Microbiologie, Infectiologie et Immunologie de l‘Université de Montréal, Montréal, QC H3C3J7, Canada
- Institut National de Santé Publique du Québec, Montréal, QC H2P1E2, Canada
- Correspondence: (J.P.); (M.R.)
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Bruxelle JF, Trattnig N, Mureithi MW, Landais E, Pantophlet R. HIV-1 Entry and Prospects for Protecting against Infection. Microorganisms 2021; 9:microorganisms9020228. [PMID: 33499233 PMCID: PMC7911371 DOI: 10.3390/microorganisms9020228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/19/2022] Open
Abstract
Human Immunodeficiency Virus type-1 (HIV-1) establishes a latent viral reservoir soon after infection, which poses a major challenge for drug treatment and curative strategies. Many efforts are therefore focused on blocking infection. To this end, both viral and host factors relevant to the onset of infection need to be considered. Given that HIV-1 is most often transmitted mucosally, strategies designed to protect against infection need to be effective at mucosal portals of entry. These strategies need to contend also with cell-free and cell-associated transmitted/founder (T/F) virus forms; both can initiate and establish infection. This review will discuss how insight from the current model of HIV-1 mucosal transmission and cell entry has highlighted challenges in developing effective strategies to prevent infection. First, we examine key viral and host factors that play a role in transmission and infection. We then discuss preventive strategies based on antibody-mediated protection, with emphasis on targeting T/F viruses and mucosal immunity. Lastly, we review treatment strategies targeting viral entry, with focus on the most clinically advanced entry inhibitors.
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Affiliation(s)
- Jean-François Bruxelle
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (J.-F.B.); (R.P.)
| | - Nino Trattnig
- Chemical Biology and Drug Discovery, Utrecht University, 3584 CG Utrecht, The Netherlands;
| | - Marianne W. Mureithi
- KAVI—Institute of Clinical Research, College of Health Sciences, University of Nairobi, P.O. Box, Nairobi 19676–00202, Kenya;
| | - Elise Landais
- IAVI Neutralizing Antibody Center, La Jolla, CA 92037, USA;
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA 92037, USA
| | - Ralph Pantophlet
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- Correspondence: (J.-F.B.); (R.P.)
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Kabapy AF, Shatat HZ, Abd El-Wahab EW. Attributes of HIV infection over decades (1982-2018): A systematic review and meta-analysis. Transbound Emerg Dis 2020; 67:2372-2388. [PMID: 32396689 DOI: 10.1111/tbed.13621] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
Abstract
Understanding the risk factors for HIV infection is the foundation of successful preventive strategies, which must bundle sociocultural, behavioural and biomedical interventions to halt disease transmission. We aimed in this study to provide a pooled estimation of HIV risk factors and trace changes across decades in order to drive consensus and accurate assessment of disease transmission risk. We comprehensively searched PubMed, ISI Web of Knowledge, Medline, EMBASE, ScienceDirect, Ovid, EBSCO, Google Scholar and the Egyptian Universities Library Consortium from October to December 2018. Two independent reviewers extracted data from eligible studies. Funnel plots were inspected to identify publication bias. Heterogeneity across studies was checked using the Q and I2 statistics. The results were reported based on the pooled odds ratio (pOR) with 95% CI using a random-effects model. Meta-analysis of HIV risk factors revealed a superior role for risky sexual practices (unprotected vaginal/anal sex), injecting drug use (IDU), sharing needles, sexually transmitted infections (STIs), child sexual abuse and vertical transmissions. Trends across decades (1982-1999 and 2000-2018, respectively) showed rising evidence for prostitution [pOR (95% CI)= 2.3 (1.12-4.68) versus 2.69 (1.67-4.32)] and men who have sex with men (MSM) [pOR (95% CI)= 2.28 (1.64-3.17) versus 3.67 (1.88-7.17)], while transmission through IDU [pOR (95% CI)= 3.42 (2.28-5.12) versus 2.16 (1.74-2.70)], alcoholism [pOR (95% CI)= 2.35 (0.73-7.59) versus 1.71(1.08-2.72)], and sharing syringes [pOR (95% CI)= 6.10 (2.57-14.5) versus 2.70 (2.01-6.35)] showed notable decline. Harm reduction programs and condom use have been recognized as chief HIV prevention strategies, while male circumcision contributed a partial role. Collectively, sexual risk factors continue to be a key driver of the global HIV epidemic. Persistent and emerging risk factors identified in our analysis should constitute the forefront targets of HIV prevention programmes to accelerate efforts towards HIV elimination.
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Affiliation(s)
- Ahmed F Kabapy
- Fellow of Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.,Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, Alexandria, Egypt
| | - Hanan Z Shatat
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Chitukuta M, Duby Z, Katz A, Nakyanzi T, Reddy K, Palanee-Phillips T, Tembo T, Etima J, Musara P, Mgodi NM, van der Straten A. Negative rumours about a vaginal ring for HIV-1 prevention in sub-Saharan Africa. CULTURE, HEALTH & SEXUALITY 2019; 21:1209-1224. [PMID: 30657023 PMCID: PMC6639142 DOI: 10.1080/13691058.2018.1552989] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 11/24/2018] [Indexed: 05/31/2023]
Abstract
Rumours may influence health-related behaviours, including the uptake of and adherence to HIV prevention products. This study assessed the safety and effectiveness of a vaginal ring delivering the antiretroviral dapivirine for HIV prevention in Africa. We explored negative rumours about study participation and the vaginal ring amongst study participants and their communities in Malawi, Uganda, South Africa and Zimbabwe. In total 214 women participated in either single or serial in-depth interviews, or a focus group discussion. Three key findings emerged in the data. Firstly, rumours reflected fears concerning the ring and trial participation. Given the historical-political context of the countries in which the trial was conducted, the ring's investigational nature and its foreign origin, ring use was rumoured to cause negative health outcomes such as cancer and infertility and to be associated with practices such as witchcraft or Satanism. The salience of these rumours varied by country. Secondly, rumours reportedly affected participants' adherence to the ring, and other women's willingness to participate in the study. Finally, participants reported that participant engagement activities helped address rumours, resulting in enhanced trust and rapport between staff and participants.
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Affiliation(s)
- Miria Chitukuta
- University of Zimbabwe College of Health Sciences-Clinical Trials Unit (UZCHS-CTRC), Harare, Zimbabwe
| | - Zoe Duby
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Ariana Katz
- Women’s Global Health Imperative (WGHI) RTI International, San Francisco, CA, USA
| | - Teopista Nakyanzi
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | | | - Juliane Etima
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Petina Musara
- University of Zimbabwe College of Health Sciences-Clinical Trials Unit (UZCHS-CTRC), Harare, Zimbabwe
| | - Nyaradzo M. Mgodi
- University of Zimbabwe College of Health Sciences-Clinical Trials Unit (UZCHS-CTRC), Harare, Zimbabwe
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Moise IK, de Joya E, Caplan B, Rodriguez VJ, Butts S, Chisembele M, Weiss SM, Jones DL, Alcaide ML. Adolescent and young adult couples' views of intravaginal practices: a qualitative analysis of a pilot study. Int J Womens Health 2019; 11:49-56. [PMID: 30697085 PMCID: PMC6342147 DOI: 10.2147/ijwh.s180233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, we evaluated the risk behaviors that are drivers of the HIV epidemic among adolescent girls and young women in Zambia using a focus group research technique. Subjects and methods Eighteen adolescent couples (n=18 females and 18 males) aged 16–24 participated in six focus groups discussions (3 per gender) convened at three health facilities in Lusaka, Zambia. Focus group moderators utilized a set of open-ended questions to guide the 60-minute sessions. The focus group audio recordings were transcribed, coded, and analyzed using qualitative content analysis in Nvivo 11. Results Three themes and four subthemes were identified relating to adolescent and young adult couples’ knowledge, views, and male partner attitudes toward intravaginal practices (IVPs). The first theme, knowledge and rationale for IVPs, consisted of the subthemes relating to why adolescents and young adult couples engage in IVPs and assessed their knowledge of health risks associated with IVPs. The second theme, attitudes toward IVPs, consisted of the subtheme willingness to stop or support partner to discontinue IVP and practices toward IVP and strategies for changing. The third theme, strategies for changing IVPs, consisted of the subtheme raise awareness. Conclusion IVPs used for cleaning purposes were perceived as essential to enhancing hygiene, health, and sexual satisfaction for both girls and boys. However, couples expressed concern about the health effects of IVPs used for tightening and a desire for learning more about this practice as well as stopping it.
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Affiliation(s)
- Imelda K Moise
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Evan de Joya
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL, USA
| | - Benjamin Caplan
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL33136, USA,
| | - Stefani Butts
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL33136, USA,
| | - Maureen Chisembele
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL33136, USA,
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL33136, USA,
| | - Maria L Alcaide
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL33136, USA,
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