1
|
Hofmeyr GJ, Singata-Madliki M, Batting J, Steyn P, Thomas KK, Issema R, Beesham I, Mbatsane E, Morrison C, Deese J, Smit J, Philip N, Palanee-Phillips T, Reddy K, Onono M, Mastro TD, Baeten JM. Sexual behaviour among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Data from the ECHO randomized trial. PLoS One 2024; 19:e0299802. [PMID: 38722832 PMCID: PMC11081305 DOI: 10.1371/journal.pone.0299802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/31/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments. METHODS This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression. RESULTS We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the '>' and '<' symbols indicate statistically significant differences): multiple sex partners 3.6% < 4.8% < 6.2% respectively; new sex partner 3.0% < 4.0% <5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM < Cu-IUD); unprotected sex 65% < 68%, 70%; unprotected sex past 7 days 33% <36%, 37%; sex during vaginal bleeding 7.1%, 7.1% < 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM > Cu-IUD); partner has sex with others 10% < 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% < 97.4% (DMPA-IM < Cu-IUD). Decrease in sexual desire was reported by 1.6% > 1.1% >0.5%; amenorrhoea by 49% > 41% >12% and regular menstrual pattern by 26% <35% < 87% respectively. CONCLUSIONS These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.
Collapse
Affiliation(s)
- G. Justus Hofmeyr
- University of Botswana, Gaborone, Botswana
- Effective Care Research Unit, University of the Witwatersrand/Walter Sisulu University, East London, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, University of Witwatersrand, University of Fort Hare, East London, South Africa
| | - Joanne Batting
- Effective Care Research Unit, University of Witwatersrand, University of Fort Hare, East London, South Africa
| | - Petrus Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Katherine K. Thomas
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Rodal Issema
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ivana Beesham
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, MatCH Research Unit (MRU), University of the Witwatersrand, Durban, South Africa
| | | | | | - Jen Deese
- Pfizer Inc., Collegeville, Pennsylvania, United States of America
| | - Jenni Smit
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, MatCH Research Unit (MRU), University of the Witwatersrand, Durban, South Africa
| | - Neena Philip
- Mailman School of Public Health, ICAP at Columbia University, New York, New York, United States of America
| | - Thesla Palanee-Phillips
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Wits Reproductive Health and HIV Institute, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Maricianah Onono
- Kenya Medical Research Institute, Centre for Microbiology Research, Kisumu, Kenya
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Gilead Sciences, Foster City, California, United States of America
| | | |
Collapse
|
2
|
Singata-Madliki M, Smit J, Beksinska M, Balakrishna Y, Avenant C, Beesham I, Seocharan I, Batting J, Hapgood JP, Hofmeyr GJ. Effects of injectable contraception with depot medroxyprogesterone acetate or norethisterone enanthate on estradiol levels and menstrual, psychological and behavioral measures relevant to HIV risk: The WHICH randomized trial. PLoS One 2024; 19:e0295764. [PMID: 38530848 DOI: 10.1371/journal.pone.0295764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/14/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Observational data suggest lower HIV risk with norethisterone enanthate (NET-EN) than with depo-medroxyprogesterone acetate intramuscular (DMPA-IM) injectable contraceptives. If confirmed, a switch between these similar injectable methods would be programmatically feasible and could impact the trajectory of the HIV epidemic. We aimed in this paper to investigate the effects of DMPA-IM and NET-EN on estradiol levels, measures of depression and sexual activity and menstrual effects, relevant to HIV risk; and to ascertain whether these measures are associated with estradiol levels. METHODS This open-label trial conducted at two sites in South Africa from 5 November 2018 to 30 November 2019, randomized HIV-negative women aged 18-40 to DMPA-IM 150 mg intramuscular 12-weekly (n = 262) or NET-EN 200 mg intramuscular 8-weekly (n = 259). Data were collected on hormonal, behavioral and menstrual effects at baseline and at 25 weeks (25W). RESULTS At 25W, median 17β estradiol levels were substantially lower than at baseline (p<0.001) for both methods: 76.5 pmol/L (interquartile range (IQR) 54.1 to 104.2) in the DMPA-IM group (n = 222), and 69.8 pmol/L (IQR: 55.1 to 89.3) in the NET-EN group (n = 225), with no statistical difference between the two methods (p = 0.450). Compared with DMPA-IM, NET-EN users reported significantly less amenorrhoea, fewer sexual acts, fewer users reporting at least one act of unprotected sex, more condom use with steady partner, more days with urge for sexual intercourse, more days feeling partner does not love her, and more days feeling sad for no reason. We did not find a clear association between estradiol levels and sexual behavior, depression and menstrual effects. Behavioral outcomes suggest less sexual exposure with NET-EN than DMPA-IM. The strength of this evidence is high due to the randomized study design and the consistency of results across the outcomes measured. CONCLUSIONS Estradiol levels were reduced to postmenopausal levels by both methods. Secondary outcomes suggesting less sexual exposure with NET-EN are consistent with reported observational evidence of less HIV risk with NET-EN. A randomized trial powered for HIV acquisition is feasible and needed to answer this important question. TRIAL REGISTRATION PACTR 202009758229976.
Collapse
Affiliation(s)
- Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | - Jenni Smit
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Chanel Avenant
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Ivana Beesham
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Joanne Batting
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | - Janet P Hapgood
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - G Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health/Universities of the Witwatersrand and Fort Hare, East London, South Africa
- Walter Sisulu University, East London, South Africa
- Department of Obstetrics and Gynecology, University of Botswana, Gabarone, Botswana
| |
Collapse
|
3
|
Hofmeyr GJ, Singata-Madliki M, Batting J, Balakrishna Y, Morroni C. Effects of depot medroxyprogesterone acetate, the copper IUD and the levonorgestrel implant on testosterone, sex hormone binding globulin and free testosterone levels: ancillary study of the ECHO randomized clinical trial. BMC Womens Health 2024; 24:167. [PMID: 38459552 PMCID: PMC10921651 DOI: 10.1186/s12905-024-02990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Robust information on relative effects of hormonal contraceptives on endogenous androgens is important for understanding beneficial and adverse effects, method choice and development of new methods. METHODS In this ancillary study at the East London, South Africa site of the ECHO multicentre randomized trial, we compared effects of three contraceptive methods on serum androgen levels among contraceptive users aged 18 to 35 years. Participants were allocated by centrally-managed randomization to open label depot medroxyprogesterone acetate (DMPA-IM), copper intrauterine device (IUD) or levonorgestrel implant. The primary outcome was free testosterone at 6 months. RESULTS We analysed stored baseline and 6-month serum samples in 398/615 participants (DMPA-IM 131/205, IUD 135/205 and implant 132/205). Median testosterone levels at baseline were DMPA-IM 0.82, IUD 0.9 and implant 0.87 nmol/L; at 6 months, DMPA 0.68 (lower than IUD, mean percentage difference 28.35, (p < 0.001), IUD 0.86 (unchanged) and implant 0.66, lower than IUD, mean percentage difference - 22.98, p < 0.001). Median SHBG levels at baseline were DMPA 52.4, IUD 50.5 and implant 55.75 nmol/L; at 6 months, DMPA 40.65, lower than IUD (mean percentage difference 21.19, p = 0.005), IUD 49.1 (unchanged), and implant 23.35 nmol/L, lower than IUD (mean percentage difference - 50.04, p < 0.001 and than DMPA (mean percentage difference - 39.45, p < 0.001). Free testosterone levels at baseline were DMPA 10, IUD 12 and implant 11 pmol/L; at 6 months, DMPA 11, less than IUD (mean percentage difference 13.53, p = 0.047), IUD 12 and implant 14, higher than IUD (mean percentage difference 14.15, p = 0.038) and than DMPA, (mean percentage difference 29.60, p < 0.001). CONCLUSIONS This is the first randomized trial to show lower SHBG and higher free testosterone with the levonorgestrel implant than with DMPA, and contrasts with reports of increased SHBG with combined oral ethinyl estradiol/levonorgestrel use, and reduced androgens (and impaired sexual function) reported with the etonorgestrel implant. The higher free testosterone with the LNG implant might improve sexual function, mood and bone health as well as increasing side-effects such as acne and hirsutism, and is consistent with the greater sexual activity (with respect to multiple sex partners, new sex partner and unprotected sex) with the implant compared with DMPA documented in the ECHO study. ECHO TRIAL REGISTRATION ClinicalTrials.gov , number NCT02550067 15/09/2015. Contraception, or family planning, is central to the role of women in societies. It is most important to have accurate information on the relative side-effects of various contraceptive options in order to empower women to make informed choices regarding their preferred method. Hormonal contraceptives contain various forms of the female sex hormones, estrogens and/or progestogens. These hormones have direct effects on the users, as well as modifying the levels of the users' own circulating sex hormones, both the 'female' and the 'male' sex hormones (androgens). In this study, consenting participants requesting contraception, were allocated randomly to receive either depot medroxyprogesterone acetate (DMPA-IM) a 3-monthly progestogen injection, the copper intrauterine device (IUD), a non-hormonal contraceptive inserted within the womb, or the levonorgestrel implant, a device placed under the skin which releases a progestogen for 5 years. We measured the participants' androgen levels after 6 months, and found for the first time that the active form of testosterone (free testosterone) was 29% higher with the implant than with DMPA-IM. The level with the IUD was intermediate, and significantly different from the other two methods. This finding is relevant to the effects experienced by users of these methods, because free testosterone has effects on sexual function, bone health and mood, as well as on conditions such as acne and hair distribution patterns.
Collapse
Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Notwane Rd, Gaborone, Botswana.
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
- Effective Care Research Unit, Walter Sisulu University, East London, South Africa.
- Effective Care Research Unit, Eastern Cape Department of Health, Bisho, South Africa.
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, University of Fort Hare, Church St, East London, South Africa
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Joanne Batting
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, University of Fort Hare, Church St, East London, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
4
|
Avenant C, Bick AJ, Skosana SB, Dlamini S, Balakrishna Y, Moliki JM, Singata-Madliki M, Hofmeyr GJ, Smit J, Beksinska M, Beesham I, Seocharan I, Batting J, Chen PL, Storbeck KH, Africander D, Hapgood JP. Misreporting contraceptive use and the association of peak study progestin levels with weight and BMI among women randomized to the progestin-only injectable contraceptives DMPA-IM and NET-EN. PLoS One 2023; 18:e0295959. [PMID: 38134043 PMCID: PMC10745193 DOI: 10.1371/journal.pone.0295959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Progestin-only injectable contraceptives, mainly depo-medroxyprogesterone acetate intramuscular (DMPA-IM), are the most widely used contraceptive methods in sub-Saharan Africa. Insufficient robust data on their relative side-effects and serum concentrations limit understanding of reported outcomes in contraception trials. The WHICH clinical trial randomized HIV-negative women to DMPA-IM (n = 262) or norethisterone enanthate (NET-EN) (n = 259) at two South African sites between 2018-2019. We measured serum concentrations of study and non-study progestins at initiation (D0) and peak serum levels, one week after the 24-week injection [25 weeks (25W)], (n = 435) and investigated associations between study progestin levels, and BMI and weight of participants. Peak median serum concentrations were 6.59 (IQR 4.80; 8.70) nM for medroxyprogesterone (MPA) (n = 161) and 13.6 (IQR 9.01; 19.0) nM for norethisterone (NET) (n = 155). MPA was the most commonly quantifiable non-study progestin at D0 in both arms (54%) and at 25W in the NET-EN arm (27%), followed by NET at D0 in both arms (29%) and at 25W in the DMPA-IM arm (19%). Levonorgestrel was quantifiable in both arms [D0 (6.9%); 25W (3.4%)], while other progestins were quantifiable in ≤ 14 participants. Significant negative time-varying associations were detected between MPA and NET concentrations and weight and BMI in both contraceptive arms and a significant increase was detected for peak serum progestin concentrations for normal weight versus obese women. Contraceptive-related reported outcomes are likely confounded by MPA, more so than NET, with reported DMPA-IM effects likely underestimated, at sites where DMPA-IM is widely used, due to misreporting of contraceptive use before and during trials, and 'tail' effects of DMPA-IM use more than six months before trial enrolment. Peak serum levels of MPA and NET are negatively associated with BMI and weight, suggesting another source of variability between trial outcomes and a potential increase in side-effects for normal weight versus overweight and obese women. Trail registration: The clinical trial was registered with the Pan African Clinical Trials Registry (PACTR 202009758229976).
Collapse
Affiliation(s)
- Chanel Avenant
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Alexis J. Bick
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Salndave B. Skosana
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Sigcinile Dlamini
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Johnson Mosoko Moliki
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | - G. Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand and Fort Hare, East London, South Africa
- Walter Sisulu University, East London, South Africa
- Department of Obstetrics and Gynecology, University of Botswana, Gabarone, Botswana
| | - Jenni Smit
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ivana Beesham
- Wits MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ishen Seocharan
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Joanne Batting
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | - Pai-Lien Chen
- Family Health International (FHI) 360, Durham, North Carolina, United States of America
| | - Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Donita Africander
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Janet P. Hapgood
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Palanee-Phillips T, Rees HV, Heller KB, Ahmed K, Batting J, Beesham I, Heffron R, Justman J, Makkan H, Mastro TD, Morrison SA, Mugo N, Nair G, Kiarie J, Philip NM, Pleaner M, Reddy K, Selepe P, Steyn PS, Scoville CW, Smit J, Thomas KK, Donnell D, Baeten JM. High HIV incidence among young women in South Africa: Data from a large prospective study. PLoS One 2022; 17:e0269317. [PMID: 35657948 PMCID: PMC9165791 DOI: 10.1371/journal.pone.0269317] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction South Africa has the highest national burden of HIV globally. Understanding drivers of HIV acquisition in recently completed, prospective studies in which HIV was an endpoint may help inform the strategy and investments in national HIV prevention efforts and guide the design of future HIV prevention trials. We assessed HIV incidence and correlates of incidence among women enrolled in ECHO (Evidence for Contraceptive Options and HIV Outcomes), a large, open-label randomized clinical trial that compared three highly effective. reversible methods of contraception and rates of HIV acquisition. Methods During December 2015 to October 2018, ECHO followed sexually active, HIV-seronegative women, aged 16–35 years, seeking contraceptive services and willing to be randomized to one of three contraceptive methods (intramuscular depot medroxyprogesterone acetate, copper intrauterine device, or levonorgestrel implant) for 12–18 months at nine sites in South Africa. HIV incidence based on prospectively observed HIV seroconversion events. Cox proportional hazards regression models were used to define baseline cofactors related to incident HIV infection. Results 5768 women were enrolled and contributed 7647 woman-years of follow-up. The median age was 23 years and 62.5% were ≤24 years. A total of 345 incident HIV infections occurred, an incidence of 4.51 per 100 woman-years (95%CI 4.05–5.01). Incidence was >3 per 100 woman-years at all sites. Age ≤24 years, baseline infection with sexually transmitted infections, BMI≤30, and having new or multiple partners in the three months prior to enrollment were associated with incident HIV. Conclusions HIV incidence was high among South African women seeking contraceptive services. Integration of diagnostic management of sexually transmitted infections alongside delivery of HIV prevention options in health facilities providing contraception services are needed to mitigate ongoing risks of HIV acquisition for this vulnerable population. Clinical trial registration ClinicalTrials.gov, number NCT02550067 was the main Clinical Trial from which this secondary, non-randomized / observational analysis was derived with data limited to just South African sites.
Collapse
Affiliation(s)
- Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Helen V. Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Kate B. Heller
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | | | - Joanne Batting
- Effective Care Research Unit (ECRU), University of the Witwatersrand/Fort Hare, East London, South Africa
| | - Ivana Beesham
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Renee Heffron
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Jessica Justman
- Mailman School of Public Health, ICAP at Columbia University, New York, New York, United States of America
| | - Heeran Makkan
- Klerksdorp Clinical Research Centre, The Aurum Institute, Johannesburg, South Africa
| | | | - Susan A. Morrison
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Nelly Mugo
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Gonasagrie Nair
- Emavundleni Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics and Law, Stellenbosch University, Stellenbosch, South Africa
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Neena M. Philip
- Mailman School of Public Health, ICAP at Columbia University, New York, New York, United States of America
| | - Melanie Pleaner
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Pearl Selepe
- Klerksdorp Clinical Research Centre, The Aurum Institute, Johannesburg, South Africa
| | - Petrus S. Steyn
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | | | - Jenni Smit
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Katherine K. Thomas
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Deborah Donnell
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Jared M. Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
- Gilead Sciences, Foster City, California, United States of America
| | | |
Collapse
|
6
|
Ryan R, Mussa A, Singtaa-Madliki M, Batting J, Balakrishna Y, Morroni C, Hofmeyr GJ. Effects of Depot Medroxyprogesterone Acetate Intramuscular Injection, Copper Intrauterine Device and Levonorgestrel Implant Contraception on Estradiol Levels: An Ancillary Study of the ECHO Randomized Trial. Front Glob Womens Health 2022; 3:887541. [PMID: 35669313 PMCID: PMC9163398 DOI: 10.3389/fgwh.2022.887541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Hormonal contraception affects endogenous sex steroid levels. Robust evidence from randomized trials of the relative effects of different contraceptive methods is scarce. We compared the effects of three contraceptive methods on serum estradiol levels using data from women (18–35 years) requesting contraception in the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Methods Women were randomly allocated to the depot medroxyprogesterone acetate intramuscular (DMPA-IM) injection, copper intrauterine device (IUD) or levonorgestrel (LNG) implant. In this sub-study, stored baseline and 6-month serum samples were analyzed in 401 participants from East London, South Africa (DMPA-IM: 131, IUD: 135 and LNG: 135). Results Baseline median (interquartile range, IQR) estradiol levels were similar between the three groups [DMPA-IM 229 (152–455), IUD 235 (168–426) and LNG 216 (153–419 pmol/L)]. At 6-months, median estradiol in the IUD group was unchanged (298 (163–467) pmol/L), whilst levels in the DMPA-IM and implant groups were significantly reduced from baseline. The median estradiol level in the DMPA-IM group [139 (97–193) pmol/L] was significantly lower than in both IUD (p < 0.0001) and implant (p = 0.005) groups; and level in the implant group [156 (112–250) pmol/L] was significantly lower than in the IUD group (p = 0.004). Conclusions At 6-months (DMPA-IM nadir), median estradiol with DMPA-IM was 53% lower and with the LNG implant, 48% lower than with the IUD. The greater reduction in estradiol levels with the DMPA-IM injection compared to the LNG implant and IUD has implications for the relative psychological, sexual as well as physiological side-effects of these contraceptive methods. ECHO Study Registration ClinicalTrials.gov, identifier: NCT02550067.
Collapse
Affiliation(s)
- Rebecca Ryan
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- *Correspondence: Rebecca Ryan
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Mandisa Singtaa-Madliki
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, University of Fort Hare, Alice, South Africa
| | - Joanne Batting
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Effective Care Research Unit, University of Fort Hare, Alice, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - G. Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- Eastern Cape Department of Health and Walter Sisulu University, Mthatha, South Africa
| |
Collapse
|
7
|
Stead D, Adeniyi OV, Singata-Madliki M, Abrahams S, Batting J, Jelliman E, Parrish A. Cumulative incidence of SARS-CoV-2 and associated risk factors among healthcare workers: a cross-sectional study in the Eastern Cape, South Africa. BMJ Open 2022; 12:e058761. [PMID: 35304402 PMCID: PMC8935006 DOI: 10.1136/bmjopen-2021-058761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study assesses the cumulative incidence of SARS-CoV-2 infection among healthcare workers (HCWs) during South Africa's first wave and examines the associated demographic, health-related and occupational risk factors for infection. METHODS Multistage cluster sampling was used in a cross-sectional study to recruit 1309 HCWs from two academic hospitals in the Eastern Cape, South Africa over 6 weeks in November and December 2020. Prior test results for SARS-CoV-2 PCR and participants' characteristics were recorded while a blood sample was drawn for detection of IgG antibodies against SARS-CoV-2 nucleocapsid protein. The primary outcome measure was the SARS-CoV-2 cumulative incidence rate, defined as the combined total of positive results for either PCR or IgG antibodies, divided by the total sample. The secondary outcome was significant risk factors associated with infection. RESULTS Of the total participants included in the analysis (n=1295), the majority were women (81.5%), of black race (78.7%) and nurses (44.8%). A total of 390 (30.1%) HCWs had a positive SARS-CoV-2 PCR result and SARS-CoV-2 antibodies were detected in 488 (37.7%), yielding a cumulative incidence of 47.2% (n=611). In the adjusted logistic regression model, being overweight (adjusted OR (aOR)=2.15, 95% CI 1.44 to 3.20), obese (aOR=1.37, 95% CI 1.02 to 1.85) and living with HIV (aOR=1.78, 95% CI 1.38 to 2.08) were independently associated with SARS-CoV-2 infection. There was no significant difference in infection rates between high, medium and low COVID-19 exposure working environments. CONCLUSIONS The high SARS-CoV-2 cumulative incidence in the cohort was surprising this early in the epidemic and probably related to exposure both in and outside the hospitals. To mitigate the impact of SARS-CoV-2 among HCWs, infection prevention and control strategies should target community transmission in addition to screening for HIV and metabolic conditions.
Collapse
Affiliation(s)
- David Stead
- Department of Internal Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Internal Medicine, Frere Hospital, East London, Eastern Cape, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Department of Family Medicine, Cecilia Makiwane Hospital, Mdantsane, Eastern Cape, South Africa
| | - Mandisa Singata-Madliki
- Department of Public health, University of Fort Hare East London Campus, East London, South Africa
- Obstetrics and Gynaecology, Wits University, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Shareef Abrahams
- Division of Microbiology, Department of Pathology, National Health Laboratory Service, Port Elizabeth, South Africa
| | - Joanne Batting
- Department of Public health, University of Fort Hare East London Campus, East London, South Africa
| | - Eloise Jelliman
- Radiology, Frere Hospital, East London, Eastern Cape, South Africa
| | - Andrew Parrish
- Department of Internal Medicine, Walter Sisulu University Faculty of Health Sciences, Mthatha, Eastern Cape, South Africa
- Internal Medicine, Frere Hospital, East London, Eastern Cape, South Africa
| |
Collapse
|
8
|
Cebekhulu SN, Abdul H, Batting J, Chauke L, Dlakavu F, Fawcus S, Govender L, Majeke B, Mbongozi X, Singata-Madliki M, Middleton K, Mlandu P, Naidoo P, Ndaba S, Soma-Pillay P, Spence T, Ntambua SC, Hofmeyr J. "Suction Tube Uterine Tamponade" for treatment of refractory postpartum hemorrhage: Internal feasibility and acceptability pilot of a randomized clinical trial. Int J Gynaecol Obstet 2021; 158:79-85. [PMID: 34605016 DOI: 10.1002/ijgo.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). METHODS We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe. RESULTS For this internal pilot study, 12 participants were allocated to STUT and 12 to UBT. Insertion failed in one of each group and was recorded as difficult in 3/10 STUT and 4/9 UBT insertions respectively (five missing data). There were two laparotomies and one intensive care unit admission in the UBT group. Pain during STUT insertion was graded as none/mild in 9/10 and severe in 1/10. The experience of the STUT procedure was graded as fine in 4/11 and "uncomfortable but acceptable" in 7/11. CONCLUSION STUT is feasible and acceptable, justifying continuation of our trial. These data will also inform a large World Health Organization trial to test effectiveness of uterine tamponade methods. The numbers are too small to support any clinical recommendation.
Collapse
Affiliation(s)
- Sylvia N Cebekhulu
- Department of Obstetrics and Gynaecology, Department of Health, Bloemfontein, Bongani Regional Hospital, University of the Free State, Hartbeespoort, South Africa
| | - Hazmath Abdul
- Department of Obstetrics & Gynaecology, Queen Nandi Regional Hospital, Empangeni, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Joanne Batting
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa
| | - Lawrence Chauke
- Department Obstetrics and Gynaecology Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Witwatersrand, South Africa
| | - Fuziwe Dlakavu
- Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Sue Fawcus
- Department Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Logie Govender
- Department of Obstetrics & Gynaecology, Queen Nandi Regional Hospital, Empangeni, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Busiwe Majeke
- Department of Obstetrics and Gynaecology at Cecilia Makiwane Hospital, Walter Sisulu University, East London, South Africa
| | - Xolani Mbongozi
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa
| | - Katrin Middleton
- Department of Obstetrics and Gynaecology, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Philiswa Mlandu
- Department of Obstetrics and Gynaecology, Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Poovangela Naidoo
- Department of Obstetrics and Gynaecology, Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanele Ndaba
- Department of Obstetrics and Gynaecology Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Soma-Pillay
- UP/SAMRC Research Centre for Maternal, Fetal, Newborn and Child Healthcare Strategies, Department of Obstetrics and Gynaecology Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Trevi Spence
- Department of Obstetrics and Gynaecology, New Somerset Hospital, Cape Town, South Africa
| | - Symphorien C Ntambua
- Department of Health, Department of Obstetrics and Gynaecology, Bongani Regional Hospital, Free State, Hartbeespoort, South Africa
| | - Justus Hofmeyr
- Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand, Walter Sisulu, and Fort Hare, East London, South Africa.,University of Botswana, Botswana, South Africa
| |
Collapse
|
9
|
Beesham I, Issema R, Palanee-Phillips T, Onono M, Evans S, Beksinska M, Ahmed K, Kasaro MP, Batting J, Deese J, Dlamini L, Yankurije B, Thomas KK, Heffron R. ART initiation among women newly diagnosed with HIV in a contraceptive trial in sub-Saharan Africa. AIDS Care 2021; 34:478-485. [PMID: 34180277 DOI: 10.1080/09540121.2021.1944601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current guidelines recommend starting antiretroviral therapy (ART) as soon as possible after HIV diagnosis to reduce morbidity, mortality and onward HIV transmission. We examined factors influencing ART initiation by women who seroconverted during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. ECHO, conducted between 2015 and 2018, enrolled HIV-negative, sexually active women, aged 16-35 years, from four African countries. Follow-up was 12-18 months, with quarterly HIV testing. Women with incident HIV infection received extensive counselling by trial staff and referral to local facilities for HIV care. Of 304 women with ≥90 days follow-up time since HIV diagnosis, 186(61.2%) initiated ART within 90 days, 69(22.7%) initiated after 90 days, and 49(16.1%) had not initiated by the end of the study. There were no statistically significant differences in characteristics among women who initiated ART ≤90 days versus those who did not. Frequent reasons for delayed or non-initiation of ART included not feeling ready to start ART and being newly diagnosed. In a large clinical trial, ART initiation was modest within 90 days of HIV diagnosis and grew to 84% with longer observation. Despite extensive counselling on the importance of early ART initiation, personal barriers delayed some women from starting ART.
Collapse
Affiliation(s)
- Ivana Beesham
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Rodal Issema
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Maricianah Onono
- Kenya Medical Research Institute Center for Microbiology Research, Nairobi, Kenya
| | - Shannon Evans
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa & Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | | | - Joanne Batting
- Effective Care Research Unit (ECRU), Universities of the Witwatersrand/Fort Hare/Walter Sisulu and Eastern Cape Department of Health, East London, South Africa
| | | | - Lunga Dlamini
- Family Life Association of Eswatini, Manzini, Eswatini
| | | | | | - Renee Heffron
- Department of Global Health and Department of Epidemiology, University of Washington, Seattle, USA
| | -
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| |
Collapse
|
10
|
Adeniyi OV, Stead D, Singata-Madliki M, Batting J, Wright M, Jelliman E, Abrahams S, Parrish A. Acceptance of COVID-19 Vaccine among the Healthcare Workers in the Eastern Cape, South Africa: A Cross Sectional Study. Vaccines (Basel) 2021; 9:666. [PMID: 34207018 PMCID: PMC8233726 DOI: 10.3390/vaccines9060666] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study assesses the perceptions and acceptance of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination. It also examines its influencing factors among the healthcare workers (HCWs) in the Eastern Cape, South Africa. METHODS In this cross-sectional study performed in November and December 2020, a total of 1308 HCWs from two large academic hospitals participated in the Eastern Cape Healthcare Workers Acquisition of SARS-CoV-2 (ECHAS) study. Validated measures of vaccine hesitancy were explored using a questionnaire. Logistic regression was used to identify the determinants of vaccine hesitancy. RESULTS The majority were nurses (45.2%), and at risk for unfavourable Covid-19 outcome, due to obesity (62.9%) and having direct contact with individuals confirmed to have Covid-19 (77.1%). The overall acceptance of SARS-CoV-2 vaccine was 90.1%, which differed significantly by level of education. Individuals with lower educational attainment (primary and secondary education) and those with prior vaccine refusal were less likely to accept the SARS-CoV-2 vaccine. However, positive perceptions about the SARS-CoV-2 vaccine were independently associated with vaccine acceptance. CONCLUSIONS The high level of acceptance of SARS-CoV-2 vaccine is reassuring; however, HCWs with a lower level of education and those with prior vaccine refusal should be targeted for further engagements to address their concerns and fears.
Collapse
Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London 5219, South Africa
| | - David Stead
- Department of Internal Medicine, Cecilia Makiwane and Frere Hospitals, Walter Sisulu University, East London 5219, South Africa; (D.S.); (M.W.); (A.P.)
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Department of Obstetrics & Gynaecology, Frere Hospital, University of Fort Hare, University of Witwatersrand, East London 5200, South Africa; (M.S.-M.); (J.B.)
| | - Joanne Batting
- Effective Care Research Unit, Department of Obstetrics & Gynaecology, Frere Hospital, University of Fort Hare, University of Witwatersrand, East London 5200, South Africa; (M.S.-M.); (J.B.)
| | - Matthew Wright
- Department of Internal Medicine, Cecilia Makiwane and Frere Hospitals, Walter Sisulu University, East London 5219, South Africa; (D.S.); (M.W.); (A.P.)
| | - Eloise Jelliman
- Department of Radiology, Frere Hospital, Walter Sisulu University, East London 5200, South Africa;
| | - Shareef Abrahams
- Department of Pathology, Division of Medical Microbiology, National Health Laboratory Service, Port Elizabeth 6001, South Africa;
| | - Andrew Parrish
- Department of Internal Medicine, Cecilia Makiwane and Frere Hospitals, Walter Sisulu University, East London 5219, South Africa; (D.S.); (M.W.); (A.P.)
| |
Collapse
|
11
|
Nagot N, Singata-Madliki M, Cournil A, Nalugya J, Tassembedo S, Quillet C, Tonga MW, Tumwine J, Meda N, Kankasa C, Mwiya M, Bangirana P, Peries M, Batting J, Engebretsen IMS, Tylleskär T, Perre PV, Ndeezi G, Molès JP. Growth, clinical and neurodevelopmental outcomes at school age are similar for children who received 1-year lamivudine or lopinavir/ritonavir HIV prophylaxis in early life. Sci Rep 2021; 11:3173. [PMID: 33542437 PMCID: PMC7862474 DOI: 10.1038/s41598-021-82762-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
In the ANRS 12174 trial, HIV-exposed uninfected African neonates who received lopinavir-ritonavir (LPV/r) prophylaxis for 1 year exhibited slower growth from birth to week 50 compared with those receiving lamivudine (3TC). We assessed whether this difference in growth persisted over time, and was accompanied by differences in neuropsychological and clinical outcomes. Between February 2017 and February 2018, we conducted a cross-sectional clinical evaluation among former trial participants who completed the 50-week follow-up and who were not HIV-infected. In addition to clinical examination, neuropsychological outcomes were assessed using the tests Kaufman-ABCII, Test of Variables of Attention, Movement Assessment Battery for Children and the Strengths and Difficulties questionnaire, parent version. Of 1101 eligible children, aged 5–7 years, 553 could be traced and analysed (274 in the LPV/r and 279 in the 3TC groups). Growth, clinical and neuropsychological outcomes did not differ between treatment groups. At school age, children exposed to LPV/r and 3TC at birth for 1 year had comparable growth and neuropsychological outcomes without evidence of long-term side-effects of LPV/r. It provides reassuring data on clinical outcomes for all HIV-infected children treated with this antiretroviral drug in early life.
Collapse
Affiliation(s)
- Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France.
| | | | - Amandine Cournil
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France
| | - Joyce Nalugya
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Catherine Quillet
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France
| | - Melany W Tonga
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - James Tumwine
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Mwiya Mwiya
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Paul Bangirana
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Marianne Peries
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France
| | | | | | | | - Philippe Vande Perre
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France
| | - Grace Ndeezi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic and Emerging Infections, INSERM U1058, Université de Montpellier, Etablissement Français du Sang, Université des Antilles, 60, rue de Navacelles, 34394, Montpellier Cedex, France
| |
Collapse
|
12
|
Deese J, Philip N, Lind M, Ahmed K, Batting J, Beksinska M, Edward VA, Louw CE, Onono M, Palanee-Phillips T, Smit JA, Baeten JM, Donnell D, Mastro TD, Mugo NR, Nanda K, Rees H, Morrison C. Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant. Sex Transm Infect 2020; 97:249-255. [PMID: 33208512 PMCID: PMC8165154 DOI: 10.1136/sextrans-2020-054590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives Reproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods. Methods We conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16–35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression. Results At baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87). Conclusions The findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.
Collapse
Affiliation(s)
- Jennifer Deese
- Global Public Health Impact Center, RTI International, Research Triangle Park, North Carolina, USA (formerly with FHI 360)
| | - Neena Philip
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Margaret Lind
- Department of Global Health, International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | | | - Joanne Batting
- Effective Care Research Unit, University of the Witwatersrand, East London, South Africa
| | - Mags Beksinska
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Vinodh A Edward
- The Aurum Institute, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl E Louw
- Madibeng Centre for Research, Brits, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jared M Baeten
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kavita Nanda
- Product Development and Introduction, FHI 360, Durham, North Carolina, USA
| | - Helen Rees
- Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Morrison
- Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| |
Collapse
|
13
|
Molès JP, Méda N, Kankasa C, Tumwine J, Singata-Madliki M, Tassemdebo S, Mwiya M, Ndeezi G, Batting J, Tylleskar T, Quillet C, Peries M, Van de Perre P, Nagot N. A new plan for extended paediatric HIV testing is needed in Africa. Lancet Glob Health 2020; 7:e1603-e1604. [PMID: 31708135 DOI: 10.1016/s2214-109x(19)30408-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jean-Pierre Molès
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, Montpellier 34394, France
| | | | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - James Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Mwiya Mwiya
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, Montpellier 34394, France
| | - Marianne Peries
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, Montpellier 34394, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, Montpellier 34394, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, INSERM, Etablissement Français du Sang, University of Montpellier, Montpellier 34394, France.
| |
Collapse
|