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Sing’oei V, Nwoga C, Yates A, Owuoth J, Otieno J, Broach E, Li Q, Hassen Z, Imbach M, Milazzo M, Mebrahtu T, Robb ML, Ake JA, Polyak CS, Crowell TA. HIV prevalence and awareness among adults presenting for enrolment into a study of people at risk for HIV in Kisumu County, Western Kenya. PLoS One 2024; 19:e0294860. [PMID: 38166089 PMCID: PMC10760834 DOI: 10.1371/journal.pone.0294860] [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: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Despite declines in new HIV diagnoses both globally and in Kenya, parts of Western Kenya still report high HIV prevalence and incidence. We evaluated HIV prevalence to inform the development of policies for strategic and targeted HIV prevention interventions. METHODS Adult participants aged 18-35 years were recruited in Kisumu County and screened for HIV for a prospective HIV incidence cohort. Questionnaires assessed HIV-associated risk behaviors. Participants who tested positive for HIV were disaggregated into groups based on prior knowledge of their HIV status: previously-diagnosed and newly-diagnosed. In separate analyses by prior knowledge, robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with a positive HIV test in each group, as compared to participants without HIV. RESULTS Of 1059 participants tested for HIV, 196 (18.5%) had a positive HIV test. Among PLWH, 78 (39.8%) were newly diagnosed with HIV at screening. After adjusting for other variables, previously-diagnosed HIV was more common among females than males (PR 2.70, 95%CI 1.69-4.28), but there was no observed sex difference in newly-diagnosed HIV prevalence (PR 1.05, 95%CI 0.65-1.69). Previously-diagnosed HIV was also more common among people reporting consistent use of condoms with primary sexual partners as compared to inconsistent condom use (PR 3.19, 95%CI 2.09-4.86), but newly-diagnosed HIV was not associated with such a difference between consistent and inconsistent condom use (PR 0.73, 95%CI 0.25-2.10). CONCLUSION Prevalence of newly-diagnosed HIV was high, at approximately 8% of participants, and not statistically different between genders, highlighting the need for improved HIV case finding regardless of sex. The higher prevalence of previously-diagnosed HIV in female participants may reflect higher rates of HIV testing through more encounters with the healthcare system. Higher prevalence of consistent condom use amongst those previously-diagnosed suggests behavioral change to reduce HIV transmission, a potential benefit of policies to facilitate earlier HIV diagnosis.
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Affiliation(s)
- Valentine Sing’oei
- HJF Medical Research International, Kisumu, Kenya
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - June Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Erica Broach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Qun Li
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Zebiba Hassen
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Mark Milazzo
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Tsedal Mebrahtu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Merlin L. Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
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Chachage M, Parikh AP, Mahenge A, Bahemana E, Mnkai J, Mbuya W, Mcharo R, Maganga L, Mwamwaja J, Gervas R, Kibuuka H, Maswai J, Singoei V, Iroezindu M, Fasina A, Esber A, Dear N, Imbach M, Crowell TA, Hern J, Song X, Hoelscher M, Polyak CS, Ake JA, Geldmacher C. High-risk human papillomavirus genotype distribution among women living with and at risk for HIV in Africa. AIDS 2023; 37:625-635. [PMID: 36398743 PMCID: PMC9994804 DOI: 10.1097/qad.0000000000003437] [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: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cervical cancer is a common preventable cancer among African women living with HIV (WLWH). Molecular diagnostics for high-risk human papillomavirus (HR-HPV) genotypes are standard components of cervical cancer screening in resource-rich countries but not in resource-limited settings. We evaluated HR-HPV genotypes among women with and without HIV in four African countries to inform cervical cancer preventive strategies. METHODS The African Cohort Study (AFRICOS) enrolled participants with and without HIV at 12 clinics in Tanzania, Kenya, Uganda, and Nigeria. Cervical cytobrush specimens from women were genotyped for 14 HR-HPV types using the multiplex Seegene Anyplex real-time PCR assay. Robust Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with HR-HPV in WLWH. RESULTS From January 2015 to March 2020, 868 WLWH and 134 women living without HIV (WLWoH) were tested for HR-HPV with prevalence of 50.9 and 38.1%, respectively ( P = 0.007). Among WLWH, 844 (97.4%) were antiretroviral therapy (ART)-experienced and 772 (89.7%) virally suppressed 1000 copies/ml or less. The most frequent HR-HPV types among WLWH were HPV-16 (13.5%), HPV-52 (9.5%), and HPV-35 (9.3%). HR-HPV infection was more common among Tanzanian WLWH (adjusted RR: 1.23, 95% CI 1.05-1.44, P = 0.012). Also, WLWH with CD4 + T cells of less than 200 cell/μl had 1.51-fold increased risk of having HR-HPV (95% CI 1.23-1.86, P < 0.001). CONCLUSION HR-HPV was common in WLWH in four African countries, particularly among women with low CD4 + cell count. Scale up of HPV vaccines and development of vaccines with broader activity against less common HR-HPV types may improve cervical cancer prevention in Africa.
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Affiliation(s)
- Mkunde Chachage
- National Institute for Medical Research-Mbeya Medical Research Centre
- University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Ajay P. Parikh
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Anifrid Mahenge
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Wilbert Mbuya
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Ruby Mcharo
- National Institute for Medical Research-Mbeya Medical Research Centre
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Centre
| | | | - Reginald Gervas
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- U.S. Army Medical Research Directorate – Africa, Kericho
| | - Valentine Singoei
- U.S. Army Medical Research Directorate – Africa, Kisumu
- HJF Medical Research International, Kisumu, Kenya
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Abiola Fasina
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Jaclyn Hern
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Xiaofang Song
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Matavele Chissumba R, Magul C, Macamo R, Monteiro V, Enosse M, Macicame I, Cumbane V, Bhatt N, Viegas E, Imbach M, Eller LA, Polyak CS, Kestens L. Helios expressing regulatory T cells are correlated with decreased IL-2 producing CD8 T cells and antibody diversity in Mozambican individuals living chronically with HIV-1. BMC Immunol 2022; 23:12. [PMID: 35287587 PMCID: PMC8922818 DOI: 10.1186/s12865-022-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 08/03/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Human immunodeficiency virus type 1 (HIV-1) causes impairment of T and B cell responses, which begins during the acute phase of infection and is not completely restored by antiretroviral treatment. Regulatory T cell (Tregs) can improve overall disease outcome by controlling chronic inflammation but may also suppress beneficial HIV-1 specific immune responses. We aimed to analyze the profile of Tregs and their correlation with the status of T cells activation, the expression of IL-2 and IFNγ and the profile of HIV-1 specific antibodies response in Mozambican people living chronically with HIV-1 (PLWH-C). Results In PLWH-C, the proportion of total Tregs was positively correlated with the proportion of IL-2+CD4 T cells (r = 0.647; p = 0.032) and IL-2+IFNγ+CD8 T cells (r = 0.551; p = 0.014), while the proportions of Helios+Tregs correlated inversely with levels of IL-2+CD8 T cells (r = − 0.541; p = 0.017). Overall, PLWH-C, with (82%) or without virologic suppression (64%), were seronegative for at least HIV-1 p31, gp160 or p24, and the breadth of antibody responses was positively correlated with proportions of CD38+HLA-DR+CD8 T cells (r = 0.620; p = 0.012), viral load (r = 0.452; p = 0.040) and inversely with absolute CD4 T cells count (r = − 0.481; p = 0.027). Analysis of all individuals living HIV-1 showed that the breadth of HIV-1 antibody responses was inversely correlated with the proportion of Helios+Tregs (r = − 0.45; p = 0.02). Conclusion Among Mozambican people living with HIV-1, seronegativity to some HIV-1 proteins is common, particularly in virologically suppressed individuals. Furthermore, lower diversity of HIV-specific antibodies is correlated to lower immune activation, lower viral replication and higher CD4 counts, in PLWH-C. Elevation in the proportion of Helios+Tregs is related to a reduction of CD8 T expressing intracellular IL-2, in PLWH-C, but may contribute to impairment of B cell function. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-022-00487-3.
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Affiliation(s)
- Raquel Matavele Chissumba
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique. .,Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium. .,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
| | - Cacildo Magul
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Rosa Macamo
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Vânia Monteiro
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Maria Enosse
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Ivalda Macicame
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Victória Cumbane
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Nilesh Bhatt
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Edna Viegas
- Instituto Nacional de Saúde, Distrito de Marracuene, Estrada Nacional N°1, Marracuene, Província de Maputo, Mozambique
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Luc Kestens
- Institute of Tropical Medicine, Department of Biomedical Sciences, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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Dear N, Esber A, Iroezindu M, Bahemana E, Kibuuka H, Maswai J, Owuoth J, Polyak CS, Ake JA, Crowell TA, Bartolanzo D, Reynolds A, Song K, Milazzo M, Francisco L, Mankiewicz S, Schech S, Golway A, Omar B, Mebrahtu T, Lee E, Bohince K, Parikh A, Hern J, Duff E, Lombardi K, Imbach M, Eller LA, Kibuuka H, Semwogerere M, Naluyima P, Zziwa G, Tindikahwa A, Mutebe H, Kafeero C, Baghendaghe E, Lwebuge W, Ssentogo F, Birungi H, Tegamanyi J, Wangiri P, Nabanoba C, Namulondo P, Tumusiime R, Musingye E, Nanteza C, Wandege J, Waiswa M, Najjuma E, Maggaga O, Kenoly IK, Mukanza B, Maswai J, Langat R, Ngeno A, Korir L, Langat R, Opiyo F, Kasembeli A, Ochieng C, Towett J, Kimetto J, Omondi B, Leelgo M, Obonyo M, Rotich L, Tonui E, Chelangat E, Kapkiai J, Wangare S, Kesi ZB, Ngeno J, Langat E, Labosso K, Rotich J, Cheruiyot L, Changwony E, Bii M, Chumba E, Ontango S, Gitonga D, Kiprotich S, Ngtech B, Engoke G, Metet I, Airo A, Kiptoo I, Owuoth J, Sing’oei V, Rehema W, Otieno S, Ogari C, Modi E, Adimo O, Okwaro C, Lando C, Onyango M, Aoko I, Obambo K, Meyo J, Suja G, Iroezindu M, Adamu Y, Azuakola N, Asuquo M, Tiamiyu AB, Kokogho A, Mohammed SS, Okoye I, Odeyemi S, Suleiman A, Umejo L, Enas O, Mbachu M, Chigbu-Ukaegbu I, Adai W, Odo FA, Abdu R, Akiga R, Nwandu H, Okolo CH, Okeke N, Parker Z, Linus AU, Agbaim CA, Adegbite T, Harrison N, Adelakun A, Chioma E, Idi V, Eluwa R, Nwalozie J, Faith I, Okanigbuan B, Emmanuel A, Nnadi N, Rosemary N, Natalie UA, Owanza OT, Francis FI, Elemere J, Lauretta OI, Akinwale E, Ochai I, Maganga L, Bahemana E, Khamadi S, Njegite J, Lueer C, Kisinda A, Mwamwaja J, Mbwayu F, David G, Mwaipopo M, Gervas R, Mkondoo D, Somi N, Kiliba P, Mwaisanga G, Msigwa J, Mfumbulwa H, Edwin P, Olomi W. Routine HIV clinic visit adherence in the African Cohort Study. AIDS Res Ther 2022; 19:1. [PMID: 34996470 PMCID: PMC8742415 DOI: 10.1186/s12981-021-00425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00425-0.
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Crowell TA, Daud II, Maswai J, Owuoth J, Sing’oei V, Imbach M, Dear N, Sawe F, Eller LA, Polyak CS, Ake JA. Severe acute respiratory syndrome coronavirus-2 antibody prevalence in people with and without HIV in rural Western Kenya, January to March 2020. AIDS 2021; 35:2401-2404. [PMID: 34482354 PMCID: PMC8631158 DOI: 10.1097/qad.0000000000003054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Among 582 participants in Western Kenya who were retrospectively tested from January through March 2020, 19 (3.3%) had detectable SARS-CoV-2 antibodies. The prevalence of detectable SARS-CoV-2 antibodies was similar between participants with and without HIV (3.1% vs. 4%, P = 0.68). One participant reported a cough in the preceding week but others denied symptoms. These may represent cross-reactivity or asymptomatic infections that predated the first reported COVID-19 cases in Kenya.
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Affiliation(s)
- Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Kericho
| | - John Owuoth
- US Army Medical Research Directorate – Africa, Kisumu, and
- HJF Medical Research International, Kisumu, Kenya
| | - Valentine Sing’oei
- US Army Medical Research Directorate – Africa, Kisumu, and
- HJF Medical Research International, Kisumu, Kenya
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Fred Sawe
- HJF Medical Research International, Kericho
- US Army Medical Research Directorate – Africa, Kisumu, and
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
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Kamau E, Yates A, Maisiba R, Singoei V, Opot B, Adeny R, Arima CO, Otieno V, Sumbi CS, Okoth RO, Abdi F, Mwalo M, Ochola J, Otieno J, Ake J, Imbach M, Turley HA, Juma D, Akala HM, Owuoth J, Andagalu B, Crowell TA, Nwoga C, Cowden J, Polyak CS. Epidemiological and clinical implications of asymptomatic malaria and schistosomiasis co-infections in a rural community in western Kenya. BMC Infect Dis 2021; 21:937. [PMID: 34503469 PMCID: PMC8431856 DOI: 10.1186/s12879-021-06626-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria and schistosomiasis present considerable disease burden in tropical and sub-tropical areas and severity is worsened by co-infections in areas where both diseases are endemic. Although pathogenesis of these infections separately is well studied, there is limited information on the pathogenic disease mechanisms and clinical disease outcomes in co-infections. In this study, we investigated the prevalence of malaria and schistosomiasis co-infections, and the hematologic and blood chemistry abnormalities in asymptomatic adults in a rural fishing community in western Kenya. METHODS This sub-study used samples and data collected at enrollment from a prospective observational cohort study (RV393) conducted in Kisumu County, Kenya. The presence of malaria parasites was determined using microscopy and real-time-PCR, and schistosomiasis infection by urine antigen analysis (CCA). Hematological analysis and blood chemistries were performed using standard methods. Statistical analyses were performed to compare demographic and infection data distribution, and hematologic and blood chemistry parameters based on different groups of infection categories. Clinically relevant hematologic conditions were analyzed using general linear and multivariable Poisson regression models. RESULTS From February 2017 to May 2018, we enrolled 671 participants. The prevalence of asymptomatic Plasmodium falciparum was 28.2% (157/556) and schistosomiasis 41.2% (229/562), with 18.0% (100/556) of participants co-infected. When we analyzed hematological parameters using Wilcoxon rank sum test to evaluate median (IQR) distribution based on malarial parasites and/or schistosomiasis infection status, there were significant differences in platelet counts (p = 0.0002), percent neutrophils, monocytes, eosinophils, and basophils (p < 0.0001 each). Amongst clinically relevant hematological abnormalities, eosinophilia was the most prevalent at 20.6% (116/562), whereas thrombocytopenia was the least prevalent at 4.3% (24/562). In univariate model, Chi-Square test performed for independence between participant distribution in different malaria parasitemia/schistosomiasis infection categories within each clinical hematological condition revealed significant differences for thrombocytopenia and eosinophilia (p = 0.006 and p < 0.0001, respectively), which was confirmed in multivariable models. Analysis of the pairwise mean differences of liver enzyme (ALT) and kidney function (Creatinine Clearance) indicated the presence of significant differences in ALT across the infection groups (parasite + /CCA + vs all other groups p < .003), but no differences in mean Creatinine Clearance across the infection groups. CONCLUSIONS Our study demonstrates the high burden of asymptomatic malaria parasitemia and schistosomiasis infection in this rural population in Western Kenya. Asymptomatic infection with malaria or schistosomiasis was associated with laboratory abnormalities including neutropenia, leukopenia and thrombocytopenia. These abnormalities could be erroneously attributed to other diseases processes during evaluation of diseases processes. Therefore, evaluating for co-infections is key when assessing individuals with laboratory abnormalities. Additionally, asymptomatic infection needs to be considered in control and elimination programs given high prevalence documented here.
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Affiliation(s)
- Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Risper Maisiba
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Valentine Singoei
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Benjamin Opot
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Rose Adeny
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Cornel O Arima
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Victor Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Catherine S Sumbi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Raphael O Okoth
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Farid Abdi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurine Mwalo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Jew Ochola
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - June Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Hannah A Turley
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Dennis Juma
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Hoseah M Akala
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - John Owuoth
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Ben Andagalu
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Jessica Cowden
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA.
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Sing’oei V, Ochola J, Owuoth J, Otieno J, Rono E, Andagalu B, Otieno L, Nwoga C, Copeland NK, Lawlor J, Yates A, Imbach M, Crowell TA, Eller LA, Kamau E, Modjarrad K, Cowden J, Ake J, Robb ML, Polyak CS. Clinical laboratory reference values in adults in Kisumu County, Western Kenya; hematology, chemistry and CD4. PLoS One 2021; 16:e0249259. [PMID: 33784358 PMCID: PMC8009432 DOI: 10.1371/journal.pone.0249259] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/15/2021] [Indexed: 12/25/2022] Open
Abstract
Background Clinical laboratory reference intervals (RIs) are essential for diagnosing and managing patients in routine clinical care as well as establishing eligibility criteria and defining adverse events in clinical trials, but may vary by age, gender, genetics, nutrition and geographic location. It is, therefore, critical to establish region-specific reference values in order to inform clinical decision-making. Methods We analyzed data from a prospective observational HIV incidence cohort study in Kombewa, Kenya. Study participants were healthy males and females, aged 18–35 years, without HIV. Median and 95% reference values (2.5th percentile to 97.5th percentile) were calculated for laboratory parameters including hematology, chemistry studies, and CD4 T cell count. Standard Deviation Ratios (SDR) and Bias Ratios (BR) are presented as measures of effect magnitude. Findings were compared with those from the United States and other Kenyan studies. Results A total of 299 participants were analyzed with a median age of 24 years (interquartile range: 21–28). Ratio of males to females was 0.9:1. Hemoglobin range (2.5th—97.5th percentiles) was 12.0–17.9 g/dL and 9.5–15.3 g/dL in men and women respectively. In the cohort, MCV range was 59-95fL, WBC 3.7–9.2×103/μL, and platelet 154–401×103/μL. Chemistry values were higher in males; the creatinine RI was 59–103 μmol/L in males vs. 46–76 μmol/L in females (BRUL>.3); and the alanine transferase range was 8.8–45.3 U/L in males vs. 7.5–36.8 U/L in females (SDR>.3). The overall CD4 T cell count RI was 491–1381 cells/μL. Some parameters including hemoglobin, neutrophil, creatinine and ALT varied with that from prior studies in Kenya and the US. Conclusion This study not only provides clinical reference intervals for a population in Kisumu County but also highlights the variations in comparable settings, accentuating the requirement for region-specific reference values to improve patient care, scientific validity, and quality of clinical trials in Africa.
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Affiliation(s)
- Valentine Sing’oei
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - Jew Ochola
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - June Otieno
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric Rono
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ben Andagalu
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Lucas Otieno
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | | | - John Lawlor
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Jessica Cowden
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Merlin L. Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
- * E-mail:
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8
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Ochola J, Imbach M, Eller LA, de Souza M, Nwoga C, Otieno JD, Otieno L, Rono E, Kamau E, Crowell TA, Owuoth JK, Polyak CS, Sing'oei V. False reactive HIV-1 diagnostic test results in an individual from Kenya on multiple testing platforms-A case report. IDCases 2021; 23:e01035. [PMID: 33489756 PMCID: PMC7808907 DOI: 10.1016/j.idcr.2020.e01035] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Rapid diagnostic tests (RDT) are routinely used in screening for HIV infection. More complex diagnostic algorithms incorporating fourth-generation screening and confirmatory HIV-1/HIV-2 differentiation immunoassays (IA) may be used to confirm HIV infection. Co-infections and autoimmune diseases may lead to falsely reactive HIV diagnostic test results. Case presentation A Kenyan man with asymptomatic schistosomiasis and low risk factors for HIV infection demonstrated an inconsistent and discordant pattern of reactivity on HIV RDT, repeated reactivity on fourth-generation IA and positive at a single time-point for HIV-1 on the Geenius HIV1/HIV2 confirmatory assay during the course of a prospective cohort study with HIV repeat testing. The individual initiated antiretroviral therapy following HIV diagnosis. However, his bi-annual behavioral questionnaire suggested low-risk factors for infection. Supplementary confirmatory serologic and nucleic acid tests were performed and gave discordant results. The participant was determined to be HIV uninfected using cell-associated HIV-1 DNA/RNA testing and antiretroviral therapy was discontinued. Discussion and conclusions Sole reliance on diagnostic test results may result in misdiagnosis of HIV infection, social harm and potential antiretroviral induced drug toxicity. Interpretation of HIV test results should incorporate multiple parameters.
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Affiliation(s)
- Jew Ochola
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Mark de Souza
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - June Doryne Otieno
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Lucas Otieno
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric Rono
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - John Kevin Owuoth
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Valentine Sing'oei
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
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9
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Analogbei T, Dear N, Reed D, Esber A, Akintunde A, Bahemana E, Adamu Y, Iroezindu M, Maganga L, Kiweewa F, Maswai J, Owuoth J, Ake JA, Polyak CS, Crowell TA, Falodun O, Song K, Milazzo M, Mankiewicz S, Schech S, Golway A, Mebrahtu T, Lee E, Bohince K, Hamm T, Parikh A, Hern J, Lombardi K, Imbach M, Eller L, Peel S, Malia J, Kroidl A, Kroidl I, Geldmacher C, Kafeero C, Nambuya A, Tegamanyi J, Birungi H, Mugagga O, Nassali G, Wangiri P, Nantabo M, Nambulondo P, Atwijuka B, Asiimwe A, Nabanoba C, Semwogerere M, Mwesigwa R, Jjuuko S, Namagembe R, Bagyendagye E, Tindikahwa A, Rwomushana I, Ssentongo F, Kibuuka H, Millard M, Kapkiai J, Wangare S, Mangesoi R, Chepkwony P, Bor L, Maera E, Kasembeli A, Rotich J, Kipkoech C, Chepkemoi W, Rono A, Kesi Z, Ngeno J, Langat E, Labosso K, Langat K, Kirui R, Rotich L, Mabwai M, Chelangat E, Agutu J, Tonui C, Changwony E, Bii M, Chumba E, Korir J, Sugut J, Gitonga D, Ngetich R, Kiprotich S, Rehema W, Ogari C, Ouma I, Adimo O, Ogai S, Okwaro C, Maranga E, Ochola J, Obambo K, Sing'oei V, Otieno L, Nyapiedho O, Sande N, Odemba E, Wanjiru F, Khamadi S, Chiweka E, Lwilla A, Mkondoo D, Somi N, Kiliba P, Mwaipopo M, Mwaisanga G, Muhumuza J, Mkingule N, Mwasulama O, Sanagare A, Kishimbo P, David G, Mbwayu F, Mwamwaja J, Likiliwike J, Muhumuza J, Mcharo R, Mkingule N, Mwasulama O, Mtafya B, Lueer C, Kisinda A, Mbena T, Mfumbulwa H, Mwandumbya L, Edwin P, Olomi W, Adamu Y, Akintunde A, Tiamiyu A, Afoke K, Mohammed S, Harrison N, Agbaim U, Adegbite O, Parker Z, Adelakun G, Oni F, Ndbuisi R, Elemere J, Azuakola N, Williams T, Ayogu M, Enas O, Enameguono O, Odo A, Ukaegbu I, Ugwuezumba O, Odeyemi S, Okeke N, Umeji L, Rose A, Daniel H, Nwando H, Nicholas E, Iyanda T, Okolo C, Mene V, Dogonyaro B, Olabulo O, Akinseli O, Onukun F, Knopp G. Predictors and Barriers to Condom Use in the African Cohort Study. AIDS Patient Care STDS 2020; 34:228-236. [PMID: 32396478 DOI: 10.1089/apc.2019.0302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/13/2022] Open
Abstract
Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.
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Affiliation(s)
- Tope Analogbei
- Health Implementation Program, Nigerian Ministry of Defense, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
| | - Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Domonique Reed
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Allahna Esber
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Akindiran Akintunde
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
| | - Emmanuel Bahemana
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Mbeya, Tanzania
| | - Yakubu Adamu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Michael Iroezindu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Lucas Maganga
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- National Institute of Medical Research—Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Jonah Maswai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kericho, Kenya
| | - John Owuoth
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kisumu, Kenya
| | - Julie A. Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina S. Polyak
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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O'Connell RJ, Gates RG, Bautista CT, Imbach M, Eggleston JC, Beardsley SG, Manak MM, Gonzales R, Rentas FJ, Macdonald VW, Cardo LJ, Reiber DT, Stramer SL, Michael NL, Peel SA. Laboratory evaluation of rapid test kits to detect hepatitis C antibody for use in predonation screening in emergency settings. Transfusion 2012; 53:505-17. [DOI: 10.1111/j.1537-2995.2012.03770.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Imbach M, Hess C, Froesch T. [Uncertain neurological status in a depressed patient]. Praxis (Bern 1994) 2002; 91:1130-1134. [PMID: 12109278 DOI: 10.1024/0369-8394.91.25.1130] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Vorstellung eines 70-jährigen Patienten, der vom Hausarzt wegen eines akut aufgetretenen, unklaren neurologischen Zustandsbildes zugewiesen wird. Aufgrund der klinischen Symptomatik, der Anamnese und nach Ausschluss einer anderen Ursache, wird die Diagnose eines malignen Neuroleptika-Syndroms (MNS) gestellt. Trotz Standard-Therapie kam es zu einer Verschlechterung des Allgmeinzustandes mit Intubationsbedürftigkeit und schliesslich Exitus, wahrscheinlich infolge einer unkontrollierbaren Sepsis mit sekundärer Hirnblutung. Epidemiologie, Ätiologie, Kinik, diagnostische Kriterien, Differentialdiagnose und Therapie des MNS werden vorgestellt und diskutiert. Das maligne neuroleptische Syndrom ist eine seltene aber höchst gefährliche Komplikation einer Neuroleptika-Therapie und sollte deshalb erkannt werden.
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