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Dadabhai S, Chou VB, Pinilla M, Chinula L, Owor M, Violari A, Moodley D, Stranix-Chibanda L, Matubu TA, Chareka GT, Theron G, Kinikar AA, Mubiana-Mbewe M, Fairlie L, Bobat R, Mmbaga BT, Flynn PM, Taha TE, McCarthy KS, Browning R, Mofenson LM, Brummel SS, Fowler MG. Effects of preterm birth, maternal ART and breastfeeding on 24-month infant HIV-free survival in a randomized trial. AIDS 2024:00002030-990000000-00457. [PMID: 38427596 DOI: 10.1097/qad.0000000000003878] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND IMPAACT 1077BF/FF compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared to ZDV alone. We assessed the impact of preterm birth, breastfeeding and antepartum ART regimen on 24-month infant survival. METHODS We compared HIV-free and overall survival at 24-months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios (HR) were estimated. RESULTS 3,482 live-born infants (568 [16 3%] preterm and 2,914 [83 7%] term) were included. Preterm birth was significantly associated with lower HIV-free survival (0·85; 95% CI: 0·82-0·88) and lower overall survival (0·89; 95% CI: 0·86-0·91) versus term birth (0·96; 95% CI: 0·95-0·96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0·65; 95% CI: 0·54-0·73) and low overall survival (0·66; 95% CI: 0·56-0·74). Risk of HIV infection or death at 24-months was higher with TDF-ART than ZDV-ART (adjusted HR 2·37; 95% CI: 1·21-4·64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted HR 0·05; 95% CI: 0·03-0·08) compared to not breastfeeding. CONCLUSION Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared to term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/ARV-exposed infants remain global health priorities.
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Affiliation(s)
- Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe Street, Baltimore, MD 21205, USA
- Kamuzu University of Health Sciences-Johns Hopkins Research Project; P.O. Box 1131, Blantyre, Malawi
| | - Victoria B Chou
- Department of Pathology, Johns Hopkins University School of Medicine; 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Mauricio Pinilla
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health; 677 Huntington Avenue, Boston, MA 02115, USA
| | - Lameck Chinula
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA and University of North Carolina Project Malawi, Tidziwe Centre, 100 Mzimba Road, Lilongwe, Malawi
| | - Maxensia Owor
- MU-JHU Research Collaboration; Upper Mulago Hill Road, P.O. Box 23491, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Dhayendre Moodley
- Centre for the AIDS Programme of Research in South Africa and School of Clinical Medicine, University of KwaZulu Natal; Private Bag X7, Congella, 4013, South Africa
| | - Lynda Stranix-Chibanda
- Child, Adolescent and Women's Health Department, Faculty of Medicine and Health Sciences, University of Zimbabwe; P.O. Box A178, Avondale, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Taguma Allen Matubu
- University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Gift Tafadzwa Chareka
- University of Zimbabwe Clinical Trials Research Centre; 15 Phillips Avenue, Belgravia, Harare, Zimbabwe
| | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Mwangelwa Mubiana-Mbewe
- Centre for Infectious Disease Research in Zambia, George CRS, P.O. BOX 34681, Lusaka, Zambia
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raziya Bobat
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College/Kilimanjaro CRS, Box 3010, Moshi, Tanzania
| | - Patricia M Flynn
- St. Jude Children's Research Hospital; 262 Danny Thomas Place, Memphis, TN, USA 38105, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | - Renee Browning
- National Institute of Allergy and Infectious Diseases/NIH, Fishers Lane, Rockville, MD 20852, USA
| | - Lynne M Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, 1350 Eye Street, Suite 400, Washington DC 20005, USA
| | - Sean S Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health; 677 Huntington Avenue, Boston, MA 02115, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine; 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Shivakoti R, Giganti MJ, Lederman MM, Ketchum R, Brummel S, Moisi D, Dadabhai S, Moodley D, Violari A, Chinula L, Owor M, Gupta A, Currier JS, Taha TE, Fowler MG. Systemic inflammation in pregnant women with HIV: relationship with HIV treatment regimen and preterm delivery. AIDS 2024:00002030-990000000-00456. [PMID: 38411599 DOI: 10.1097/qad.0000000000003877] [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] [Indexed: 02/28/2024]
Abstract
OBJECTIVE : HIV treatment regimen during pregnancy was associated with preterm delivery (PTD) in the PROMISE 1077 BF trial. Systemic inflammation among pregnant women with HIV could help explain differences in PTD by treatment regimen. We assessed associations between inflammation, treatment regimen, and PTD. DESIGN/METHODS : A nested 1:1 case-control study (N = 362) was conducted within a multi-country randomized trial comparing three HIV regimens in pregnant women: zidovudine alone, or combination antiretroviral therapy (ART) with lopinavir/ritonavir and either zidovudine or tenofovir. Cases were women with PTD (<37 weeks of gestational age). The following inflammatory biomarkers were measured in plasma samples using immunoassays: soluble CD14 (sCD14) and sCD163, intestinal fatty acid-binding protein, interleukin (IL)-6, interferon γ, and tumor necrosis factor α. We fit regression models to assess associations between second trimester biomarkers (measured before ART initiation at 13-23 weeks of gestational age and 4 weeks later), treatment regimen, and PTD. We also assessed whether inflammation was a mediator in the relationship between ART regimen and PTD. RESULTS : Persistently high interleukin-6 was associated with increased PTD. Compared to zidovudine alone, the difference in biomarker concentration between week 0 and week 4 was significantly higher (p < 0.05) for both PI-based regimens. However, the estimated proportion of the ART effect on increased PTD mediated by persistently high biomarker levels was ≤5% for all biomarkers. CONCLUSIONS : Persistently high IL-6 during pregnancy was associated with PTD. While PI-based ART was associated with increases in inflammation, factors other than inflammation likely explain the increased PTD in ART-based regimens compared to zidovudine alone.
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Affiliation(s)
- Rupak Shivakoti
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mark J Giganti
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael M Lederman
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rachel Ketchum
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sean Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniela Moisi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa; Centre for the Program of AIDS Research in South Africa (CAPRISA), Durban, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lameck Chinula
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maxensia Owor
- Makerere University-John Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judith S Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Glenn Fowler
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dadabhai S, Quaynor L, Bandala-Jacques A, Seyama L, Rahman MH, Phiri R, Decker MR, Taha TE. Intimate partner violence and excess fertility among women of reproductive age in Malawi. PLoS One 2024; 19:e0297959. [PMID: 38277363 PMCID: PMC10817113 DOI: 10.1371/journal.pone.0297959] [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: 03/15/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
PURPOSE Gender inequity and adverse health outcomes continue to be of concern among women in sub-Saharan Africa. We determined prevalence of intimate partner violence and excess fertility (having more children than desired) in reproductive age women in Malawi. We also explored factors associated with these outcomes and with spousal fertility intentions. PATIENTS AND METHODS In a cross-sectional study, a total of 360 women and 410 men were recruited using multi-stage sampling from communities in a peri-urban setting in Blantyre District, Southern Malawi in 2021. Women and men were separately interviewed by trained study workers using a structured questionnaire. In addition to descriptive analyses, we used univariate and multivariate logistic regression models to assess associations of risk factors with the outcomes of intimate partner violence and excess fertility. RESULTS Among women, lifetime prevalence of intimate partner violence was 23.1%, and excess fertility was experienced by 25.6%. Intimate partner violence was associated with male partners alcohol consumption (adjusted odds ratio 2.13; P = 0.019). Women were more likely to report excess fertility if they were older (adjusted odds ratio 2.0, P<0.001, for a 5-year increase). Alcohol consumption by the male partner (adjusted odds ratio 2.14; P = 0.025) and women being able to refuse sex with their male partner (adjusted odds ratio 0.50; P = 0.036) were associated with discordant fertility preferences. CONCLUSIONS Intimate partner violence, excess fertility, and social and health inequities continue to be prevalent in Malawi. These data suggest the underlying proximal and distal factors associated with these adverse outcomes such as alcohol consumption may be addressed through education, couple interactive communication, and community dialogue. To ensure sustainability and effectiveness, strong leadership involvement, both governmental and non-governmental, is needed.
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Affiliation(s)
- Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Laura Quaynor
- Department of Advanced Studies in Education, Johns Hopkins School of Education, Baltimore, Maryland, United States of America
| | - Antonio Bandala-Jacques
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Linly Seyama
- Kamuzu University of Health Sciences-Johns Hopkins Research Project, Blantyre, Malawi
| | - Md Hafizur Rahman
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Taha TE, Bandala-Jacques A, Yende-Zuma N, Violari A, Stranix-Chibanda L, Atuhaire P, Hanley S, Gadama L, Chinula L, Dadabhai S, Aizire J, Brummel SS, Fowler MG. Breastfeeding Among Women Living With HIV in the Era of Lifelong ART: An Observational Multicountry Study in Eastern and Southern Africa. J Acquir Immune Defic Syndr 2024; 95:10-17. [PMID: 37732877 PMCID: PMC10840656 DOI: 10.1097/qai.0000000000003306] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lifelong antiretroviral treatment (ART) use is recommended for pregnant and breastfeeding (BF) women living with HIV (WLWH) to prevent perinatal HIV transmission and improve maternal health. We address 2 objectives in this analysis: (1) determine timing and factors associated with BF cessation and (2) assess the impact of BF on health of WLWH on ART. SETTING This multicountry study included 8 sites in Uganda, Malawi, Zimbabwe, and South Africa. METHODS This was a prospective study of WLWH on lifelong ART. These women initially participated from 2011 to 2016 in a randomized clinical trial (PROMISE) to prevent perinatal HIV transmission and subsequently reenrolled in an observational study (PROMOTE, 2016-2021) to assess ART adherence, safety, and impact. RESULTS The PROMOTE cohort included 1987 women on ART. Of them, 752 breastfed and were included in analyses of objective 1; all women were included in analyses of objective 2. The median time to BF cessation varied by country (11.2-19.7 months). Country of residence, age, and health status of women were significantly associated with time to BF cessation (compared with Zimbabwe: Malawi, adjusted hazard ratio [aHR] 0.50, 95% confidence interval [95% CI]: 0.40 to 0.62, P < 0.001; South Africa, aHR 1.49, 95% CI: 1.11 to 2.00, P = 0.008; and Uganda, aHR 1.77, 95% CI: 1.37 to 2.29, P < 0.001). Women who breastfed had lower risk of being "unwell" compared with women who never breastfed (adjusted rate ratio 0.87, 95% CI: 0.81 to 0.95 P = 0.030). CONCLUSION Women on lifelong ART should be encouraged to continue BF with no concern for their health. Time to BF cessation should be monitored for proper counseling in each country.
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Affiliation(s)
- Taha E. Taha
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Antonio Bandala-Jacques
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Avy Violari
- University of the Witwatersrand, Perinatal HIV Research Unit, Johannesburg, South Africa
| | | | - Patience Atuhaire
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Sherika Hanley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, University of Kwazulu-Natal, Durban, South Africa and University of Kwazulu-Natal, Department of Family Medicine, Durban, South Africa
| | - Luis Gadama
- Kamuzu University of Health Sciences - Johns Hopkins Research Project, Blantyre, Malawi
| | - Lameck Chinula
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Department of Obstetrics and Gynecology, Chapel-Hill, NC, USA
| | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Jim Aizire
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Sean S. Brummel
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston MA, USA
| | - Mary Glenn Fowler
- Johns Hopkins School of Medicine, Department of Pathology, Baltimore, MD, USA
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Abdellatef E, Emara HM, Shoaib MR, Ibrahim FE, Elwekeil M, El-Shafai W, Taha TE, El-Fishawy AS, El-Rabaie ESM, Eldokany IM, Abd El-Samie FE. Automated diagnosis of EEG abnormalities with different classification techniques. Med Biol Eng Comput 2023; 61:3363-3385. [PMID: 37672143 DOI: 10.1007/s11517-023-02843-w] [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: 09/15/2022] [Accepted: 04/23/2023] [Indexed: 09/07/2023]
Abstract
Automatic seizure detection and prediction using clinical Electroencephalograms (EEGs) are challenging tasks due to factors such as low Signal-to-Noise Ratios (SNRs), high variance in epileptic seizures among patients, and limited clinical data constraints. To overcome these challenges, this paper presents two approaches for EEG signal classification. One of these approaches depends on Machine Learning (ML) tools. The used features are different types of entropy, higher-order statistics, and sub-band energies in the Hilbert Marginal Spectrum (HMS) domain. The classification is performed using Support Vector Machine (SVM), Logistic Regression (LR), and K-Nearest Neighbor (KNN) classifiers. Both seizure detection and prediction scenarios are considered. The second approach depends on spectrograms of EEG signal segments and a Convolutional Neural Network (CNN)-based residual learning model. We use 10000 spectrogram images for each class. In this approach, it is possible to perform both seizure detection and prediction in addition to a 3-state classification scenario. Both approaches are evaluated on the Children's Hospital Boston and the Massachusetts Institute of Technology (CHB-MIT) dataset, which contains 24 EEG recordings for 6 males and 18 females. The results obtained for the HMS-based model showed an accuracy of 100%. The CNN-based model achieved accuracies of 97.66%, 95.59%, and 94.51% for Seizure (S) versus Pre-Seizure (PS), Non-Seizure (NS) versus S, and NS versus S versus PS classes, respectively. These results demonstrate that the proposed approaches can be effectively used for seizure detection and prediction. They outperform the state-of-the-art techniques for automatic seizure detection and prediction. Block diagram of proposed epileptic seizure detection method using HMS with different classifiers.
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Affiliation(s)
- Essam Abdellatef
- Department of Electronics and Communications, Delta Higher Institute for Engineering and Technology (DHIET), 35511, Mansoura, Egypt
| | - Heba M Emara
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | - Mohamed R Shoaib
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Fatma E Ibrahim
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | - Mohamed Elwekeil
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | - Walid El-Shafai
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt.
- Security Engineering Laboratory, Department of Computer Science College of Engineering, Prince Sultan University, Riyadh, 11586, Saudi Arabia.
| | - Taha E Taha
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | - Adel S El-Fishawy
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | | | - Ibrahim M Eldokany
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
| | - Fathi E Abd El-Samie
- Faculty of Electronic Engineering, Menoufia University, 32952, Menouf, Egypt
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
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Selim A, Abdellatif H, Taha TE, El-Shanawany R, Zahran O, Abd El-Samie FE, El-Fishawy AS. Efficient image transmission in high-degradation scenarios. J Opt 2023. [DOI: 10.1007/s12596-023-01204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/12/2022] [Indexed: 09/02/2023]
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7
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El-Shafai W, Aly R, Taha TE, Abd El-Samie FE. CNN framework for optical image super-resolution and fusion. J Opt 2023. [DOI: 10.1007/s12596-023-01122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/28/2023] [Indexed: 09/01/2023]
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8
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Alsolami A, ALGhasab NS, Alharbi MSM, Bashir AI, Saleem M, Syed Khaja AS, Aldakheel DF, Rakha E, Alshammari JA, Taha TE, Melibari Z, Alharbi YH, Almutlag AA, Said KB. Community-Acquired Methicillin-Resistant Staphylococcus aureus in Hospitals: Age-Specificity and Potential Zoonotic-Zooanthroponotic Transmission Dynamics. Diagnostics (Basel) 2023; 13:2089. [PMID: 37370983 DOI: 10.3390/diagnostics13122089] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children's Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; n = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58-60 years in both genders. However, while CA-MRSA dominated early in life (0-20, 70% MCH), it increased with age in KKH adults; 21-50 (28%), >50 (59%) until the overall 80% (n = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin-clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic-zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative.
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Affiliation(s)
- Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Naif Saad ALGhasab
- Department of Cardiology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Mohammed S M Alharbi
- Department of Internal Medicine, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Abdelhafiz I Bashir
- Department of Physiology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Mohd Saleem
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | | | - Dakheel F Aldakheel
- Medical Coordination Unit, Ha'il General Hospital, Ha'il 55428, Saudi Arabia
| | - Ehab Rakha
- Departments of Microbiology, King Khalid Hospital, Ha'il 55421, Saudi Arabia
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Jabar Aziz Alshammari
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Taha E Taha
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ziyad Melibari
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Yaseer H Alharbi
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Ali A Almutlag
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
| | - Kamaleldin B Said
- Department of Pathology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia
- Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Drive, Ottawa, ON K1S 5B6, Canada
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Abd El-Fattah I, Ali AM, El-Shafai W, Taha TE, Abd El-Samie FE. Deep-learning-based super-resolution and classification framework for skin disease detection applications. Opt Quant Electron 2023; 55:427. [DOI: 10.1007/s11082-022-04432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/25/2022] [Indexed: 09/01/2023]
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10
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Emara HM, Shoaib MR, El-Shafai W, Elwekeil M, Hemdan EED, Fouda MM, Taha TE, El-Fishawy AS, El-Rabaie ESM, El-Samie FEA. Simultaneous Super-Resolution and Classification of Lung Disease Scans. Diagnostics (Basel) 2023; 13:diagnostics13071319. [PMID: 37046537 PMCID: PMC10093568 DOI: 10.3390/diagnostics13071319] [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: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Acute lower respiratory infection is a leading cause of death in developing countries. Hence, progress has been made for early detection and treatment. There is still a need for improved diagnostic and therapeutic strategies, particularly in resource-limited settings. Chest X-ray and computed tomography (CT) have the potential to serve as effective screening tools for lower respiratory infections, but the use of artificial intelligence (AI) in these areas is limited. To address this gap, we present a computer-aided diagnostic system for chest X-ray and CT images of several common pulmonary diseases, including COVID-19, viral pneumonia, bacterial pneumonia, tuberculosis, lung opacity, and various types of carcinoma. The proposed system depends on super-resolution (SR) techniques to enhance image details. Deep learning (DL) techniques are used for both SR reconstruction and classification, with the InceptionResNetv2 model used as a feature extractor in conjunction with a multi-class support vector machine (MCSVM) classifier. In this paper, we compare the proposed model performance to those of other classification models, such as Resnet101 and Inceptionv3, and evaluate the effectiveness of using both softmax and MCSVM classifiers. The proposed system was tested on three publicly available datasets of CT and X-ray images and it achieved a classification accuracy of 98.028% using a combination of SR and InceptionResNetv2. Overall, our system has the potential to serve as a valuable screening tool for lower respiratory disorders and assist clinicians in interpreting chest X-ray and CT images. In resource-limited settings, it can also provide a valuable diagnostic support.
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Affiliation(s)
- Heba M. Emara
- Department of Electronics and Communications Engineering, High Institute of Electronic Engineering, Ministry of Higher Education, Bilbis-Sharqiya 44621, Egypt
| | - Mohamed R. Shoaib
- School of Computer Science and Engineering (SCSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
| | - Walid El-Shafai
- Security Engineering Lab, Computer Science Department, Prince Sultan University, Riyadh 11586, Saudi Arabia
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - Mohamed Elwekeil
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - Ezz El-Din Hemdan
- Department of Computer Science and Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Taha E. Taha
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - Adel S. El-Fishawy
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - El-Sayed M. El-Rabaie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
| | - Fathi E. Abd El-Samie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf 32952, Egypt
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
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Nevrekar N, Butler K, Shapiro DE, Atuhaire P, Taha TE, Makanani B, Chinula L, Owor M, Moodley D, Chipato T, McCarthy K, Flynn PM, Currier J, Fowler MG, Gupta A, Suryavanshi N. Self-reported Antiretroviral Adherence: Association With Maternal Viral Load Suppression in Postpartum Women Living With HIV-1 From Promoting Maternal and Infant Survival Everywhere, a Randomized Controlled Trial in Sub-Saharan Africa and India. J Acquir Immune Defic Syndr 2023; 92:76-83. [PMID: 36170749 PMCID: PMC9722360 DOI: 10.1097/qai.0000000000003102] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Optimal adherence to antiretroviral therapy (ART) is crucial to promoting maternal-infant health. SETTING Fourteen sites in 7 countries within sub-Saharan Africa and India. METHODS The multicomponent, open-label strategy PROMISE trial enrolled breastfeeding mother-infant pairs not meeting in-country criteria for maternal ART (mART) initiation in the postpartum component within 5 days of delivery. Randomization was to mART versus infant NVP (iNVP) prophylaxis. Infants in the mART arm also received 6 weeks of iNVP. Self-reported adherence was assessed in a secondary analysis. Time-to-event analyses were performed to explore the association between adherence and maternal viral load (mVL) in the mART arm. RESULTS Two thousand four hundred thirty-one mother-infant pairs were enrolled between 2011 and 2014; the baseline maternal median CD4 was 686 (IQR 553-869), and the median mVL was 322 copies/mL (IQR 40-1422). Self-reported adherence was lower in the mART arm compared with the iNVP arm (no missed doses within 4 weeks of all study visits: 66% vs 83%; within 2 weeks: 71% vs 85%; P < 0.0001). The iNVP adherence at week 6 was high in both arms: 97% in mART arm; 95% in iNVP arm. Time-to-event analyses showed that adherence to mART was associated with time to first mVL ≥400 copies/mL ( P < 0.0001). Missing 1 full day of doses over 3 days was associated with a 66% risk of mVL ≥1000 copies/mL (HR: 1.66; 95% CI: 1.37, 1.99). CONCLUSIONS Postpartum women were less adherent to their own ART than mothers providing their infant's nevirapine prophylaxis. The self-reported missed mART doses were associated with high mVL. Strategies to optimize postpartum mART adherence are urgently needed. CLINICAL TRIAL NUMBER ClinicalTrials.gov: NCT01061151; closed to follow-up.
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Affiliation(s)
- Neetal Nevrekar
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
| | - Kevin Butler
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - David E. Shapiro
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Patience Atuhaire
- Makerere University–John Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Bonus Makanani
- College of Medicine-Johns Hopkins Project, Blantyre, Malawi
| | | | - Maxensia Owor
- Makerere University–John Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Dhayendre Moodley
- Centre for the AIDS Programme of Research in South Africa and Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
- Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Patricia M. Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN
| | - Judith Currier
- UCLA Centre for Clinical AIDS Research and Education, Los Angeles, CA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD; and
| | - Amita Gupta
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College- Johns Hopkins University Clinical Research Site, Pune, India
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Mutambanengwe-Jacob MT, Maponga CC, Amico KR, Ngara B, Yende-Zuma N, Chawana TD, Nematadzira T, Gumbo JF, Goverayi T, Matibe P, Malunda BV, Aizire J, Taha TE, Fowler MG, Stranix-Chibanda L. Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study. AIDS Res Treat 2022; 2022:4887202. [PMID: 36105074 PMCID: PMC9467808 DOI: 10.1155/2022/4887202] [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: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
We piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consenting women with last viral load ≥200 copies/ml and/or pill count outside 90-110% range were randomized 1 : 1 to receive the intervention or continue routine care, comprising laboratory-based VL monitoring and standard EAC, from trained nurses and counsellors. Viral load was measured 0, 3, 6, and 12 months after enrolment. We compared viral suppression <200 copies/ml at 6 and 12 months between the arms through Fisher's exact test and sought associated factors by logistic regression with a 95% confidence interval (CI). Between December 2018 and July 2019, 50 women were enrolled (25 intervention and 25 controls) and followed until November 2020. At entry, 60% of the women were virally suppressed, 52% intervention vs. 68% control arm. Viral suppression was balanced between the two arms (p value = 0.248). At month 6 post study entry (primary endpont), 64% of the women retained in care were virally suppressed, 54% intervention vs. 76% control arm (p value = 0.124). At month12 post study entry (secondary endpoint), 69% of the women retained in care were virally suppressed, 67% intervention vs. 71% control arm women (p value = 0.739). More intervention women completed all scheduled sessions by month 6. Control group women were more likely to be virally suppressed at both timepoints. Only 25% had treatment switch by 12 months. Despite intense adherence support and viral load monitoring, sustained viral suppression remained elusive in women identified at risk of viral failure. These findings highlight the continued need for effective adherence intervention for women with unsuppressed HIV viral loads, efficient treatment switch strategies, as well as drug level monitoring.
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Affiliation(s)
- Mercy T. Mutambanengwe-Jacob
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Charles C. Maponga
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Bernard Ngara
- Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa
| | - Tariro D. Chawana
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Justice F. Gumbo
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Tendayi Goverayi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Petronella Matibe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Jim Aizire
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taha E. Taha
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary G. Fowler
- Department of Pathology, The Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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13
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Abdellatif H, Taha TE, El-Shanawany R, Zahran O, Abd El-Samie FE. Efficient ROI-based compression of mammography images. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Baltrusaitis K, Makanani B, Tierney C, Fowler MG, Moodley D, Theron G, Nyakudya LH, Tomu M, Fairlie L, George K, Heckman B, Knowles K, Browning R, Siberry GK, Taha TE, Stranix-Chibanda L. Maternal and infant renal safety following tenofovir disoproxil fumarate exposure during pregnancy in a randomized control trial. BMC Infect Dis 2022; 22:634. [PMID: 35858874 PMCID: PMC9297643 DOI: 10.1186/s12879-022-07608-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) in combination with other antiretroviral (ARV) drugs has been in clinical use for HIV treatment since its approval in 2001. Although the effectiveness of TDF in preventing perinatal HIV infection is well established, information about renal safety during pregnancy is still limited. TRIAL DESIGN The IMPAACT PROMISE study was an open-label, strategy trial that randomized pregnant women to one of three arms: TDF based antiretroviral therapy (ART), zidovudine (ZDV) based ART, and ZDV alone (standard of care at start of enrollment). The P1084s substudy was a nested, comparative study of renal outcomes in women and their infants. METHODS PROMISE participants (n = 3543) were assessed for renal dysfunction using calculated creatinine clearance (CrCl) at study entry (> 14 weeks gestation), delivery, and postpartum weeks 6, 26, and 74. Of these women, 479 were enrolled in the P1084s substudy that also assessed maternal calcium and phosphate as well as infant calculated CrCl, calcium, and phosphate at birth. RESULTS Among the 1338 women who could be randomized to TDF, less than 1% had a baseline calculated CrCl below 80 mL/min. The mean (standard deviation) maternal calculated CrCl at delivery in the TDF-ART arm [147.0 mL/min (51.4)] was lower than the ZDV-ART [155.0 mL/min (43.3); primary comparison] and the ZDV Alone [158.5 mL/min (45.0)] arms; the mean differences (95% confidence interval) were - 8.0 mL/min (- 14.5, - 1.5) and - 11.5 mL/min (- 18.0, - 4.9), respectively. The TDF-ART arm had lower mean maternal phosphate at delivery compared with the ZDV-ART [- 0.14 mg/dL (- 0.28, - 0.01)] and the ZDV Alone [- 0.17 mg/dL (- 0.31, - 0.02)] arms, and a greater percentage of maternal hypophosphatemia at delivery (4.23%) compared with the ZDV-ART (1.38%) and the ZDV Alone (1.46%) arms. Maternal calcium was similar between arms. In infants, mean calculated CrCl, calcium, and phosphate at birth were similar between arms (all CIs included 0). CONCLUSIONS Although mean maternal calculated CrCl at Delivery was lower in the TDF-ART arm, the difference between arms is unlikely to be clinically significant. During pregnancy, the TDF-ART regimen had no observed safety concerns for maternal or infant renal function. TRIAL REGISTRATION NCT01061151 on 10/02/2010 for PROMISE (1077BF). NCT01066858 on 10/02/2010 for P1084s.
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Affiliation(s)
- Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA.
| | - Bonus Makanani
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Camlin Tierney
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Dhayendre Moodley
- Centre for AIDS Prevention Research in South Africa and Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lynette H Nyakudya
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Musunga Tomu
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Renee Browning
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - George K Siberry
- United States Agency for International Development, Washington, DC, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.,Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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15
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El-Gindy SAE, Ibrahim FE, Alabasy M, Abdelzaher HM, El-Refy M, Khalaf AAM, El-Dolil SM, El-Fishawy AS, Taha TE, El-Rabaie ESM, Dessouky MI, El-Dokany I, Oraby OA, N. Alotaiby T, Alshebeili SA, Abd El-Samie FE. Detection of Abnormal Activities from Various Signals Based on Statistical Analysis. Wireless Pers Commun 2022; 125:1013-1046. [DOI: 10.1007/s11277-022-09565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 09/02/2023]
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16
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selim A, Taha TE, El-fishawy A, Zahran O, Hadhoud MM, Dessouky MI, El-samie FEA, El-hag NA. A simplified Algorithm and Spiral Fractal in Transform Domain.. [DOI: 10.21203/rs.3.rs-1633883/v1] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
This paper proposes a simplified fractal image compression algorithm which is implemented on a block by block basis. This algorithm achieves a compression ratio of up to 1:10 with a peak signal to noise ratio (PSNR) as high as 35dB. The idea of the proposed algorithm is based on the segmentation of the image, first, into blocks to setup reference blocks. The image is then decomposed again into block ranges and a search process is carried out to find the reference blocks with best match. The transmitted or stored values, after compression, are the reference block values and the indices of the reference block that achieves the best match. If there is no match, the average value of the block range is transmitted or stored instead. It proposes also the effect of using the spiral architecture instead of square block decomposition and searching in fractal compression. Comparisons with other systems; conventional square, the proposed simplified fractal compression and the standard JPEG are introduced. We applied these types of fractal compression systems on a video sequence. Also the effect of using the fractal image compression algorithms in transform domain is proposed. The image is transferred firstly to the transform domain. The Discrete Cosine Transform (DCT) and Wavelet Transform (DWT) are used. After transformation takes place the fractal algorithms is applied. Comparisons between three fractal algorithms; conventional square, spiral, and a simplified fractal compression are proposed. The comparisons are repeated in the two cases of transformation. The discrete wavelet is used also in this paper to increase the compression ratio in case of using the conventional method. We used the two dimension discrete wavelet to increase the compression ratio of the block domain pool transmission. We decompose the block domain by wavelet decomposition to two levels which gives a compression ratio of block domain transmission as high as 1:16. The advantages of the proposed algorithm are the simplicity of computation. We found that the using of spiral architecture in fractal compression, the produced or decoded image and so the video sequence visual quality are better than that produced with conventional square method and the proposed simplified system at the same compression ratio but with longer time consumed. We found also that all types of fractal compression system give better quality than the standard JPEG. We found also that the decoded images in case of using the wavelet transform are the best. And the in case of using DCT the decoded images has bad qualities.
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17
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Correspondence: J. B. Nachega, University of Pittsburgh School of Public Health, Department of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health 130 DeSoto Street, A532 Crabtree Hall, Pittsburgh, PA 15261 ()
| | | | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya,Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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Ibrahim FE, Emara HM, El-Shafai W, Elwekeil M, Rihan M, Eldokany IM, Taha TE, El-Fishawy AS, El-Rabaie ESM, Abdellatef E, Abd El-Samie FE. Deep-learning-based seizure detection and prediction from electroencephalography signals. Int J Numer Method Biomed Eng 2022; 38:e3573. [PMID: 35077027 DOI: 10.1002/cnm.3573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Electroencephalography (EEG) is among the main tools used for analyzing and diagnosing epilepsy. The manual analysis of EEG must be conducted by highly trained clinicians or neuro-physiologists; a process that is considered to have a comparatively low inter-rater agreement. Furthermore, the new data interpretation consumes an excessive amount of time and resources. Hence, an automatic seizure detection and prediction system can improve the quality of patient care in terms of shortening the diagnosis period, reducing manual errors, and automatically detecting debilitating events. Moreover, for patient treatment, it is important to alert the patients of epilepsy seizures prior to seizure occurrence. Various distinguished studies presented good solutions for two-class seizure detection problems with binary classification scenarios. To deal with these challenges, this paper puts forward effective approaches for EEG signal classification for normal, pre-ictal, and ictal activities. Three models are presented for the classification task. Two of them are patient-specific, while the third one is patient non-specific, which makes it better for the general classification tasks. The two-class classification is implemented between normal and pre-ictal activities for seizure prediction and between normal and ictal activities for seizure detection. A more generalized three-class classification framework is considered to identify all EEG signal activities. The first model depends on a Convolutional Neural Network (CNN) with residual blocks. It contains thirteen layers with four residual learning blocks. It works on spectrograms of EEG signal segments. The second model depends on a CNN with three layers. It also works on spectrograms. On the other hand, the third model depends on Phase Space Reconstruction (PSR) to eliminate the limitations of the spectrograms used in the first models. A five-layer CNN is used with this strategy. The advantage of the PSR is the direct projection from the time domain, which keeps the main trend of different signal activities. The third model deals with all signal activities, and it was tested for all patients of the CHB-MIT dataset. It has a superior performance compared to the first models and the state-of-the-art models.
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Affiliation(s)
- Fatma E Ibrahim
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - Heba M Emara
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - Walid El-Shafai
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
- Security Engineering Lab, Computer Science Department, Prince Sultan University, Riyadh, Saudi Arabia
| | - Mohamed Elwekeil
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
- Department of Electrical and Information Engineering (DIEI), University of Cassino and Southern Lazio, Cassino, 03043, Italy
| | - Mohamed Rihan
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
- Department of Electrical and Information Engineering (DIEI), University of Cassino and Southern Lazio, Cassino, 03043, Italy
| | - Ibrahim M Eldokany
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - Taha E Taha
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - Adel S El-Fishawy
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - El-Sayed M El-Rabaie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
| | - Essam Abdellatef
- Delta Higher Institute for Engineering and Technology (DHIET), Mansoura, Egypt
| | - Fathi E Abd El-Samie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, Egypt
- Department of Information Technology, College of Computer and Information sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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19
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Taha TE, Yende-Zuma N, Brummel SS, Stranix-Chibanda L, Wambuzi Ogwang L, Dadabhai S, Chinula L, Nyati MM, Hanley S, Makanani B, Chipato T, Atuhaire P, Aizire J, Fowler MG. Effects of long-term antiretroviral therapy in reproductive-age women in sub-Saharan Africa (the PEPFAR PROMOTE study): a multi-country observational cohort study. Lancet HIV 2022; 9:e394-e403. [PMID: 35489365 PMCID: PMC9639003 DOI: 10.1016/s2352-3018(22)00037-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/08/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND We report the long-term impact of ART in women of reproductive age (15-49 years) in Africa who have been using ART for up to 10 years. We assess outcomes of retention, adherence, maternal health, fertility intentions, and safety. METHODS This longitudinal, multicountry study (PROMOTE) enrolled women who initiated ART in an earlier perinatal clinical trial, PROMISE. PROMISE occurred from 2011 to 2016 and PROMOTE follow-up started in 2016 and is ongoing. The PROMOTE study was done at eight sites in four countries: Malawi (Blantyre and Lilongwe), South Africa (Durban and Soweto), Uganda (Kampala), and Zimbabwe (Harare, Seke North, and St Mary's). After baseline enrolment, women and their children are followed up every 6 months to collect information on medical history, antiretroviral therapy (ART) use, adherence, and health information, and to do physical examinations and laboratory tests. Obesity was defined as a body-mass index of 30 kg/m2 or more. Data analyses were restricted to summaries of the main long-term outcomes (retention, adherence, maternal health, fertility intentions, and safety). We used descriptive and stratified analyses, and estimated rates using person-years of follow-up and computed probabilities based on Kaplan-Meier methods. FINDINGS PROMOTE enrolled 1987 mothers and 2522 children. The median follow-up time for mothers was 41·8 (IQR 35·8-42·0) months and for children was 35·7 (23·8-42·0) months. Overall retention rates were 96·5% for mothers and 94·3% for children at 12 months, and, at 42 months, were 88·9% for mothers and 85·4% for children. 1115 (89·1%) of 1252 women had an undetectable viral load at 42 months, which varied by site (81·7-93·8%). Reported maternal health improved over time, with the proportion of women with excellent to very good health increasing from 67·5% at baseline to 87·5% at 42 months, the proportion of unwell participants who visited a health centre declining from 14·7% to 2·8%, and the proportion of those admitted to hospital declining from 1·5% to 1·0%. The desire to have more children was consistently high at some sites. The proportion of women with obesity was high in South Africa and increased over time from 40·2% at baseline to 52·8% at 42 months. The overall pregnancy rate was 17·6 (95% CI 16·5-18·7) per 100 women-years, and mortality rates were 2·4 (1·4-3·9) per 1000 person-years for mothers and 3·4 (2·2-5·10) per 1000 person-years for children (0-9 years). INTERPRETATION The findings from this multicountry study are reassuring. These findings show that African women can consistently use ART for a long period after initiation, and long-term benefits can be maintained. Services to support maternal HIV care, treatment, and reproductive health should be strengthened. FUNDING US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
- Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; SAMRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Sean S Brummel
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lynda Stranix-Chibanda
- Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lameck Chinula
- University of North Carolina Project, Lilongwe, Malawi; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Mandisa M Nyati
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherika Hanley
- Centre for the AIDS Programme of Research in South Africa, Umlazi Clinical Research Site, University of KwaZulu-Natal, Durban, South Africa
| | - Bonus Makanani
- Department of Obstetrics and Gynecology, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tsungai Chipato
- Clinical Trials Research Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Patience Atuhaire
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jim Aizire
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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20
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Said KB, Alsolami A, Moussa S, Alfouzan F, Bashir AI, Rashidi M, Aborans R, Taha TE, Almansour H, Alazmi M, Al-Otaibi A, Aljaloud L, Al-Anazi B, Mohialdin A, Aljadani A. COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria. Int J Environ Res Public Health 2022; 19:ijerph19095270. [PMID: 35564665 PMCID: PMC9101447 DOI: 10.3390/ijerph19095270] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 01/08/2023]
Abstract
Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% (n = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant Klebsiella pneumoniae (37%, n = 48), extremely drug-resistant Acinetobacter baumannii (26%, n = 34), multidrug-resistant Eschericia. coli (18.6%, n = 24), and extremely drug-resistant Pseudomonas aeruginosa (8.5%, n = 11), in addition to other bacterial species (9.3%, n = 12). Increased co-infection of K. pneumoniae and A. baumannii was associated with increased death rates of 29% (n = 14) and 32% (n = 11), respectively. Klebsiella pneumoniae was equally frequent in respiratory and urinary tract infections (UTI), while E. coli mostly caused UTI (67%), and A. baumannii and P. aeruginosa dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors ≥ 50 years (71%), young adults 21–49 years (25.6%), and children 0–20 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.
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Affiliation(s)
- Kamaleldin B. Said
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.-O.); (L.A.); (B.A.-A.)
- Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Dr, Ottawa, ON K1S 5B6, Canada
- ASC, McGill University, 21111 Lakeshore Rd, Montreal, QC H9X 3L9, Canada
- Correspondence: Correspondence: ; Tel.: +966-500771459
| | - Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (A.A.)
| | - Safia Moussa
- Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia; (S.M.); (F.A.)
| | - Fayez Alfouzan
- Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia; (S.M.); (F.A.)
| | - Abdelhafiz I. Bashir
- Department of Physiology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Musleh Rashidi
- Ministry of Health, Hail Region, Ha’il 55476, Saudi Arabia;
| | - Rana Aborans
- Department of Community Medicine, Faculty of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Taha E. Taha
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Husam Almansour
- Health Management Department, College of Public Health and Health Informatics, University of Ha’il, Ha’il 81481, Saudi Arabia;
| | - Mashari Alazmi
- College of Computer Science and Engineering, University of Ha’il, Ha’il 81481, Saudi Arabia;
| | - Amal Al-Otaibi
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.-O.); (L.A.); (B.A.-A.)
| | - Luluh Aljaloud
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.-O.); (L.A.); (B.A.-A.)
| | - Basmah Al-Anazi
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.-O.); (L.A.); (B.A.-A.)
| | - Ahmed Mohialdin
- Department of Surgery, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Ahmed Aljadani
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (A.A.)
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21
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Emara HM, Elwekeil M, Taha TE, El-Fishawy AS, El-Rabaie ESM, El-Shafai W, El Banby GM, Alotaiby T, Alshebeili SA, Abd El-Samie FE. Efficient Frameworks for EEG Epileptic Seizure Detection and Prediction. Ann Data Sci 2022; 9:393-428. [DOI: 10.1007/s40745-020-00308-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 06/19/2020] [Accepted: 07/19/2020] [Indexed: 09/02/2023]
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22
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Shoaib MR, Emara HM, Elwekeil M, El-Shafai W, Taha TE, El-Fishawy AS, El-Rabaie ESM, El-Samie FEA. Hybrid classification structures for automatic COVID-19 detection. J Ambient Intell Humaniz Comput 2022; 13:4477-4492. [PMID: 35280854 PMCID: PMC8898749 DOI: 10.1007/s12652-021-03686-9] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
This paper explores the issue of COVID-19 detection from X-ray images. X-ray images, in general, suffer from low quality and low resolution. That is why the detection of different diseases from X-ray images requires sophisticated algorithms. First of all, machine learning (ML) is adopted on the features extracted manually from the X-ray images. Twelve classifiers are compared for this task. Simulation results reveal the superiority of Gaussian process (GP) and random forest (RF) classifiers. To extend the feasibility of this study, we have modified the feature extraction strategy to give deep features. Four pre-trained models, namely ResNet50, ResNet101, Inception-v3 and InceptionResnet-v2 are adopted in this study. Simulation results prove that InceptionResnet-v2 and ResNet101 with GP classifier achieve the best performance. Moreover, transfer learning (TL) is also introduced in this paper to enhance the COVID-19 detection process. The selected classification hierarchy is also compared with a convolutional neural network (CNN) model built from scratch to prove its quality of classification. Simulation results prove that deep features and TL methods provide the best performance that reached 100% for accuracy.
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Affiliation(s)
- Mohamed R. Shoaib
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
| | - Heba M. Emara
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
| | - Mohamed Elwekeil
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
- Department of Electrical and Information Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Walid El-Shafai
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
- Security Engineering Lab, Computer Science Department, Prince Sultan University, Riyadh, 11586 Saudi Arabia
| | - Taha E. Taha
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
| | - Adel S. El-Fishawy
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
| | - El-Sayed M. El-Rabaie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
| | - Fathi E. Abd El-Samie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic Engineering, Menoufia University, Menouf, 32952 Egypt
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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23
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El-Shafai W, A. Mahmoud A, M. El-Rabaie ES, E. Taha T, F. Zahran O, S. El-Fishawy A, Abd-Elnaby M, E. Abd El-Samie F. Traditional Chinese Medicine Automated Diagnosis Based on Knowledge Graph Reasoning. Computers, Materials & Continua 2022; 71:159-170. [DOI: 10.32604/cmc.2022.017295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 09/01/2023]
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24
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El-Shafai W, A. Mahmoud A, M. El-Rabaie ES, E. Taha T, F. Zahran O, S. El-Fishawy A, Abd-Elnaby M, E. Abd El-Samie F. Efficient Deep CNN Model for COVID-19 Classification. Computers, Materials & Continua 2022; 70:4373-4391. [DOI: 10.32604/cmc.2022.019354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/18/2021] [Indexed: 09/01/2023]
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25
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Shoaib MR, Elshamy MR, Taha TE, El-Fishawy AS, Abd El-Samie FE. Efficient Brain Tumor Detection Based on Deep Learning Models. J Phys : Conf Ser 2021; 2128:012012. [DOI: 10.1088/1742-6596/2128/1/012012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
Brain tumor is an acute cancerous disease that results from abnormal and uncontrollable cell division. Brain tumors are classified via biopsy, which is not normally done before the brain ultimate surgery. Recent advances and improvements in deep learning technology helped the health industry in getting accurate disease diagnosis. In this paper, a Convolutional Neural Network (CNN) is adopted with image pre-processing to classify brain Magnetic Resonance (MR) images into four classes: glioma tumor, meningioma tumor, pituitary tumor and normal patients, is provided. We use a transfer learning model, a CNN-based model that is designed from scratch, a pre-trained inceptionresnetv2 model and a pre-trained inceptionv3 model. The performance of the four proposed models is tested using evaluation metrics including accuracy, sensitivity, specificity, precision, F1_score, Matthew’s correlation coefficient, error, kappa and false positive rate. The obtained results show that the two proposed models are very effective in achieving accuracies of 93.15% and 91.24% for the transfer learning model and BRAIN-TUMOR-net based on CNN, respectively. The inceptionresnetv2 model achieves an accuracy of 86.80% and the inceptionv3 model achieves an accuracy of 85.34%. Practical implementation of the proposed models is presented.
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26
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Flynn PM, Taha TE, Cababasay M, Butler K, Fowler MG, Mofenson LM, Owor M, Fiscus S, Stranix-Chibanda L, Coutsoudis A, Gnanashanmugam D, Chakhtoura N, McCarthy K, Frenkel L, Beck I, Mukuzunga C, Makanani B, Moodley D, Nematadzira T, Kusakara B, Patil S, Vhembo T, Bobat R, Mmbaga BT, Masenya M, Nyati M, Theron G, Mulenga H, Shapiro DE. Association of Maternal Viral Load and CD4 Count With Perinatal HIV-1 Transmission Risk During Breastfeeding in the PROMISE Postpartum Component. J Acquir Immune Defic Syndr 2021; 88:206-213. [PMID: 34108383 PMCID: PMC8434954 DOI: 10.1097/qai.0000000000002744] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 11/27/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breastfeeding mothers with HIV infection not qualifying for antiretroviral therapy (ART) based on country-specific guidelines at the time of the Promoting Maternal-Infant Survival Everywhere trial and their uninfected neonates were randomized to maternal ART (mART) or infant nevirapine prophylaxis (iNVP) postpartum. HIV transmission proportions were similar (<1%) in the 2 arms. We assessed whether maternal viral load (MVL) and CD4 cell counts were associated with breastfeeding HIV transmission. METHODS MVL was collected at entry (7-14 days postpartum) and at weeks 6, 14, 26, and 50 postpartum. CD4 cell counts were collected at entry and weeks 14, 26, 38, and 50 postpartum. Infant HIV-1 nucleic acid test was performed at weeks 1 and 6, every 4 weeks until week 26, and then every 12 weeks. The associations of baseline and time-varying MVL and CD4 cell counts with transmission risk were assessed using time-to-event analyses by randomized treatment arm. RESULTS Two thousand four hundred thirty-one mother-infant pairs were enrolled in the study. Baseline MVL (P = 0.11) and CD4 cell counts (P = 0.51) were not significantly associated with infant HIV-1 infection. Time-varying MVL was significantly associated with infant HIV-1 infection {hazard ratio [95% confidence interval (CI)]: 13.96 (3.12 to 62.45)} in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 1.04 (0.20 to 5.39)]. Time-varying CD4 cell counts were also significantly associated with infant HIV-1 infection [hazard ratio (95% CI): 0.18 (0.03 to 0.93)] in the mART arm but not in the iNVP arm [hazard ratio (95% CI): 0.38 (0.08 to 1.77)]. CONCLUSIONS In women receiving mART, increased MVL and decreased CD4 cell counts during breastfeeding were associated with increased risk of infant HIV-1 infection.
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Affiliation(s)
- Patricia M. Flynn
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mae Cababasay
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Kevin Butler
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maxensia Owor
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Susan Fiscus
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lynda Stranix-Chibanda
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, , University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Anna Coutsoudis
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Devasena Gnanashanmugam
- Division of AIDS, National Institute of Allergy and Immunology, National Institutes of Health, Bethesda, MD
| | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | | | - Lisa Frenkel
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Ingrid Beck
- Seattle Children’s Research Institute, Seattle, WA
| | - Cornelius Mukuzunga
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Bonus Makanani
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dhayendre Moodley
- Centre for the AIDS Programme of Research in South Africa and School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Bangani Kusakara
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sandesh Patil
- Department of Obstetrics and Gynecology, Byramjee Jeejeebhoy Government Medical College and Johns Hopkins Clinical Trials Unit, Pune, India
| | - Tichaona Vhembo
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Raziya Bobat
- Department of Pediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Blandina T Mmbaga
- Department of Pediatrics, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maysseb Masenya
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Mandisa Nyati
- Perinatal HIV Research Unit, Chris Baragwanath Hospital, Johannesburg, South Africa
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helen Mulenga
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - David E. Shapiro
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
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El-Gindy SAE, Hamad A, El-Shafai W, Khalaf AAM, El-Dolil SM, Taha TE, El-Fishawy AS, Alotaiby TN, Alshebeili SA, El-Samie FEA. Efficient communication and EEG signal classification in wavelet domain for epilepsy patients. J Ambient Intell Human Comput 2021; 12:9193-9208. [DOI: 10.1007/s12652-020-02624-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/20/2020] [Indexed: 09/01/2023]
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Said KB, Alsolami A, Khalifa AM, Khalil NA, Moursi S, Osman A, Fahad D, Rakha E, Rashidi M, Moussa S, Bashir AI, Alfouzan F, Hammam S, Taha TE, Al-hazimi A, Al Jadani A. A Multi-Point Surveillance for Antimicrobial Resistance Profiles among Clinical Isolates of Gram-Negative Bacteria Recovered from Major Ha'il Hospitals, Saudi Arabia. Microorganisms 2021; 9:microorganisms9102024. [PMID: 34683344 PMCID: PMC8537776 DOI: 10.3390/microorganisms9102024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/23/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022] Open
Abstract
The devastating nosocomial resistance is an on-going global concern. Surveillance of resistance is crucial for efficient patient care. This study was aimed to conduct a surveillance in four major Ha'il Hospitals from September to December 2020. Using a multipoint program, records of 621 non-duplicate Gram-negative cultures were tested across 21 drugs belonging to different categories. Major species were Klebsiella pneumoniae (n = 187, 30%), E. coli (n = 151, 24.5%), Pseudomonas aeruginosa, (n = 84, 13.6%), Acinetobacter baumannii (n = 82, 13.3%), and Proteus mirabilis (n = 46, 7%). Based on recent resistance classifications, A. baumanni, P. aeruginosa, and enteric bacteria were defined as pan-resistant, extremely resistant, and multi-drug resistant, respectively. A. baumannii (35%) and K. pneumoniae (23%) dominated among coinfections in SARS-CoV2 patients. The "other Gram-negative bacteria" (n = 77, 12.5%) from diverse sources showed unique species-specific resistance patterns, while sharing a common Gram-negative resistance profile. Among these, Providencia stuartii was reported for the first time in Ha'il. In addition, specimen source, age, and gender differences played significant roles in susceptibility. Overall infection rates were 30% in ICU, 17.5% in medical wards, and 13.5% in COVID-19 zones, mostly in male (59%) senior (54%) patients. In ICU, infections were caused by P. mirabilis (52%), A. baumannii (49%), P. aeruginosa (41%), K. pneumoniae (24%), and E. coli (21%), and most of the respiratory infections were caused by carbapenem-resistant A. baumannii and K. pneumoniae and UTI by K. pneumoniae and E. coli. While impressive IC, hospital performances, and alternative treatment options still exist, the spread of resistant Gram-negative bacteria is concerning especially in geriatric patients. The high selective SARS-CoV2 coinfection by A. baumannii and K. pneumoniae, unlike the low global rates, warrants further vertical studies. Attributes of resistances are multifactorial in Saudi Arabia because of its global partnership as the largest economic and pilgrimage hub with close social and cultural ties in the region, especially during conflicts and political unrests. However, introduction of advanced inter-laboratory networks for genome-based surveillances is expected to reduce nosocomial resistances.
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Affiliation(s)
- Kamaleldin B. Said
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.M.K.); (N.A.K.); (S.M.)
- Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Drive, Ottawa, ON K1S 5B6, Canada
- ASC Molecular Bacteriology, McGill University, 21111 Lakeshore Rd, Montreal, QC H9X 3L9, Canada
- Correspondence: ; Tel.: +966-500771459
| | - Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (A.A.J.)
| | - Amany M. Khalifa
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.M.K.); (N.A.K.); (S.M.)
| | - Nuha A. Khalil
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.M.K.); (N.A.K.); (S.M.)
| | - Soha Moursi
- Department of Pathology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.M.K.); (N.A.K.); (S.M.)
| | - Abuzar Osman
- Department of Pharmacology, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia;
| | - Dakheel Fahad
- Departments of Microbiology, Education, Research and Training, King Khalid Hospital, Ha’il 55476, Saudi Arabia; (D.F.); (E.R.)
| | - Ehab Rakha
- Departments of Microbiology, Education, Research and Training, King Khalid Hospital, Ha’il 55476, Saudi Arabia; (D.F.); (E.R.)
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Musleh Rashidi
- Ministry of Health, Hail Region, Ha’il 55476, Saudi Arabia;
| | - Safia Moussa
- Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia; (S.M.); (F.A.)
| | - Abdelhafiz I. Bashir
- Department of Physiology, College of Medicine, University of Hail, Ha’il 55476, Saudi Arabia; (A.I.B.); (A.A.-h.)
| | - Fayez Alfouzan
- Department of Microbiology, King Salman Specialist Hospital, Ha’il 55476, Saudi Arabia; (S.M.); (F.A.)
| | - Sahar Hammam
- Department of Microbiology, Maternity and Children Hospital, Ha’il 55476, Saudi Arabia;
| | - Taha E. Taha
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Awdah Al-hazimi
- Department of Physiology, College of Medicine, University of Hail, Ha’il 55476, Saudi Arabia; (A.I.B.); (A.A.-h.)
| | - Ahmed Al Jadani
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il 55476, Saudi Arabia; (A.A.); (A.A.J.)
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Hirudayakanth K, Gadama L, Dadabhai S, Katumbi C, Mvula H, Makanani B, Taulo F, Taha TE. Mid-thigh circumference as an indicator of nutritional status to predict adverse pregnancy outcomes among HIV-infected and HIV-uninfected women in Malawi. BMC Pregnancy Childbirth 2021; 21:646. [PMID: 34556074 PMCID: PMC8461852 DOI: 10.1186/s12884-021-04118-4] [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: 02/22/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women. METHODS Sociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight < 2.5 kg; PTB as gestational age < 37 weeks using Ballard score; and SGA as birth weight < 10th percentile for gestational age. Descriptive, stratified, and multivariable logistic regression were conducted using R. RESULTS Data from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p < 0.001), after controlling for HIV status, age, socioeconomic status and hemoglobin. The association between MTC and SGA was (aOR 0.99, p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p < 0.001), LBW (aOR 0.93, p = 0.05), and SGA (aOR 0.95, p = 0.04). CONCLUSIONS We observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.
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Affiliation(s)
- Keerthana Hirudayakanth
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Luis Gadama
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Chaplain Katumbi
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | - Hazzie Mvula
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | - Bonus Makanani
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Frank Taulo
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Taha E Taha
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
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Boyce CL, Sils T, Ko D, Wong-On-Wing A, Beck IA, Styrchak SM, DeMarrais P, Tierney C, Stranix-Chibanda L, Flynn PM, Taha TE, Owor M, Fowler MG, Frenkel LM. Maternal HIV drug resistance is associated with vertical transmission and is prevalent in infected infants. Clin Infect Dis 2021; 74:2001-2009. [PMID: 34467974 DOI: 10.1093/cid/ciab744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to assess if maternal HIV drug resistance is associated with an increased risk of HIV vertical transmission and to describe the dynamics of drug resistance in HIV-infected infants. METHODS A case-control study of PROMISE study participants. "Cases" were mother-infant pairs with HIV vertical transmission during pregnancy or breastfeeding and "controls" were mother-infant pairs without transmission matched 1:3 by delivery date and clinical site. Genotypic HIV drug resistance analyses were performed on mothers' and their infants' plasma at or near the time of infant HIV diagnosis. Longitudinal analysis of genotypic resistance was assessed in available specimens from infants, from diagnosis and beyond, including ART initiation and last study visits. RESULTS Our analyses included 85 cases and 255 matched controls. Maternal HIV drug resistance, adjusted for plasma HIV RNA load at infant HIV diagnosis, enrollment CD4 count, and antepartum regimens, was not associated with in utero/peripartum HIV transmission. In contrast, both maternal plasma HIV RNA load and HIV drug resistance were independent risk factors associated with vertical transmission during breastfeeding. Furthermore, HIV drug resistance was selected across infected infants during infancy. CONCLUSIONS Maternal HIV drug resistance and maternal viral load were independent risk factors for vertical transmission during breastfeeding, suggesting that nevirapine alone may be insufficient infant prophylaxis against drug-resistant variants in maternal breast milk. These findings support efforts to achieve suppression of HIV replication during pregnancy and suggest that breastfeeding infants may benefit from prophylaxis with a greater barrier to drug resistance than nevirapine alone.
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Affiliation(s)
- Ceejay L Boyce
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tatiana Sils
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daisy Ko
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Annie Wong-On-Wing
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ingrid A Beck
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Sheila M Styrchak
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Patricia DeMarrais
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Camlin Tierney
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Patricia M Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Maxensia Owor
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa M Frenkel
- Department of Global Health, University of Washington, Seattle, WA, USA.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics and Laboratory Medicine, University of Washington, Seattle, WA, USA
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Abedellatif H, Taha TE, El-Shanawany R, El-Samie FEA, Zahran OF. Non-Exhaustive Search Method for Fractal Image Compression. 2021 International Conference on Electronic Engineering (ICEEM) 2021. [DOI: 10.1109/iceem52022.2021.9480381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Tobin NH, Murphy A, Li F, Brummel SS, Taha TE, Saidi F, Owor M, Violari A, Moodley D, Chi B, Goodman KD, Koos B, Aldrovandi GM. Comparison of dried blood spot and plasma sampling for untargeted metabolomics. Metabolomics 2021; 17:62. [PMID: 34164733 PMCID: PMC8340475 DOI: 10.1007/s11306-021-01813-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Untargeted metabolomics holds significant promise for biomarker detection and development. In resource-limited settings, a dried blood spot (DBS)-based platform would offer significant advantages over plasma-based approaches that require a cold supply chain. OBJECTIVES The primary goal of this study was to compare the ability of DBS- and plasma-based assays to characterize maternal metabolites. Utility of the two assays was also assessed in the context of a case-control predictive model in pregnant women living with HIV. METHODS Untargeted metabolomics was performed on archived paired maternal plasma and DBS from n = 79 women enrolled in a large clinical trial. RESULTS A total of 984 named biochemicals were detected across both plasma and DBS samples, of which 627 (63.7%), 260 (26.4%), and 97 (9.9%) were detected in both plasma and DBS, plasma alone, and DBS alone, respectively. Variation attributable to study individual (R2 = 0.54, p < 0.001) exceeded that of the sample type (R2 = 0.21, p < 0.001), suggesting that both plasma and DBS were capable of differentiating individual metabolomic profiles. Log-transformed metabolite abundances were strongly correlated (mean Spearman rho = 0.51) but showed low agreement (mean intraclass correlation of 0.15). However, following standardization, DBS and plasma metabolite profiles were strongly concordant (mean intraclass correlation of 0.52). Random forests classification models for cases versus controls identified distinct feature sets with comparable performance in plasma and DBS (86.5% versus 91.2% mean accuracy, respectively). CONCLUSION Maternal plasma and DBS samples yield distinct metabolite profiles highly predictive of the individual subject. In our case study, classification models showed similar performance albeit with distinct feature sets. Appropriate normalization and standardization methods are critical to leverage data from both sample types. Ultimately, the choice of sample type will likely depend on the compounds of interest as well as logistical demands.
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Affiliation(s)
- Nicole H Tobin
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Aisling Murphy
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Fan Li
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Sean S Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Friday Saidi
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Maxie Owor
- MU-JHU Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Dhayendre Moodley
- Centre for AIDS Research in South Africa, Durban, South Africa
- Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Benjamin Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Brian Koos
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Grace M Aldrovandi
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
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Emara HM, Shoaib MR, Elwekeil M, El‐Shafai W, Taha TE, El‐Fishawy AS, El‐Rabaie EM, Alshebeili SA, Dessouky MI, Abd El‐Samie FE. Deep convolutional neural networks for COVID-19 automatic diagnosis. Microsc Res Tech 2021; 84:2504-2516. [PMID: 34121273 PMCID: PMC8420362 DOI: 10.1002/jemt.23713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
This article is mainly concerned with COVID‐19 diagnosis from X‐ray images. The number of cases infected with COVID‐19 is increasing daily, and there is a limitation in the number of test kits needed in hospitals. Therefore, there is an imperative need to implement an efficient automatic diagnosis system to alleviate COVID‐19 spreading among people. This article presents a discussion of the utilization of convolutional neural network (CNN) models with different learning strategies for automatic COVID‐19 diagnosis. First, we consider the CNN‐based transfer learning approach for automatic diagnosis of COVID‐19 from X‐ray images with different training and testing ratios. Different pre‐trained deep learning models in addition to a transfer learning model are considered and compared for the task of COVID‐19 detection from X‐ray images. Confusion matrices of these studied models are presented and analyzed. Considering the performance results obtained, ResNet models (ResNet18, ResNet50, and ResNet101) provide the highest classification accuracy on the two considered datasets with different training and testing ratios, namely 80/20, 70/30, 60/40, and 50/50. The accuracies obtained using the first dataset with 70/30 training and testing ratio are 97.67%, 98.81%, and 100% for ResNet18, ResNet50, and ResNet101, respectively. For the second dataset, the reported accuracies are 99%, 99.12%, and 99.29% for ResNet18, ResNet50, and ResNet101, respectively. The second approach is the training of a proposed CNN model from scratch. The results confirm that training of the CNN from scratch can lead to the identification of the signs of COVID‐19 disease.
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Affiliation(s)
- Heba M. Emara
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Mohamed R. Shoaib
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Mohamed Elwekeil
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Walid El‐Shafai
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
- Security Engineering LabComputer Science Department, Prince Sultan UniversityRiyadhSaudi Arabia
| | - Taha E. Taha
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Adel S. El‐Fishawy
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - El‐Sayed M. El‐Rabaie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Saleh A. Alshebeili
- Electrical Engineering DepartmentKACST‐TIC in Radio Frequency and Photonics for the e‐Society (RFTONICS), King Saud UniversityRiyadhSaudi Arabia
- Department of Electrical EngineeringKing Saud UniversityRiyadhSaudi Arabia
| | - Moawad I. Dessouky
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
| | - Fathi E. Abd El‐Samie
- Department of Electronics and Electrical Communications Engineering, Faculty of Electronic EngineeringMenoufia UniversityMenoufEgypt
- Department of Information TechnologyCollege of Computer and Information Sciences, Princess Nourah Bint Abdulrahman UniversityRiyadhSaudi Arabia
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Chamanga R, Katumbi C, Gadama L, Kawalazira R, Dula D, Makanani B, Dadabhai S, Taha TE. Comparison of adverse birth outcomes among HIV-infected and HIV-uninfected women delivering in high and low risk settings in the era of universal ART in Malawi: a registry study. Paediatr Int Child Health 2021; 41:112-122. [PMID: 33881967 DOI: 10.1080/20469047.2021.1874200] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Recent studies show that ART is associated with an adverse birth outcome in HIV-infected women.Aim: To compare rates of low birthweight (LBW) and preterm birth (PTB) between HIV-infected women receiving lifelong ART and HIV-uninfected women giving birth in low- and high-risk settings in Malawi.Methods: This observational, registry study was conducted from January 2016 to August 2017 in one large, tertiary referral hospital and four primary healthcare (PHC) facilities in Blantyre, Malawi. Women who delivered singleton live births or stillbirths of ≥20 weeks gestation were included in the analysis. Descriptive and stratified analyses were conducted using χ2 tests and multivariable logistic models to control for maternal age, gravidity and health facility.Results: A total of 14,233 births were included in the analysis (7715 from the tertiary hospital and 6518 from PHC facilities). In the univariable analysis, there were no differences in rates of LBW (6.7% vs 6.4%) and PTB (42.5% vs 42.0%) between HIV-infected and -uninfected women delivering in PHC facilities. However, differences in LBW were significantly higher in HIV-infected women in multivariable analysis (LBW aOR 1.40, 95% CI 1.01-1.95). Rates of LBW and PTB were significantly higher in HIV-infected women than in uninfected women delivering at the tertiary hospital (LBW 17.6% vs 13.2%, aOR 1.53, 95% CI 1.27-1.85; PTB 28.2% vs 24.9%, aOR 1.37, 95% CI 1.17-1.60)Conclusion: Rates of adverse birth outcomes are significantly higher in HIV-infected women than in HIV-uninfected women, and this is more apparent in high-risk hospital settings than in low-risk PHC settings.
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Affiliation(s)
- Rachel Chamanga
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Chaplain Katumbi
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Luis Gadama
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rachel Kawalazira
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Dingase Dula
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi
| | - Bonus Makanani
- College of Medicine, Johns Hopkins Research Project, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Brummel SS, Taha TE, Angelidou K(N, Saidi F, Atuhaire P, Dula D, Moodley D, Matubu A, Chareka G, Nevrekar N, Vhembo T, Fairlie L, Theron G, Mlay P, George K, Basar M, Chakhtoura N, Browning R, Fowler MG, Currier JS. Brief Report: Impact of ART on Maternal Health After Cessation of Breastfeeding. J Acquir Immune Defic Syndr 2021; 86:450-454. [PMID: 33273210 PMCID: PMC8143379 DOI: 10.1097/qai.0000000000002586] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT IMPAACT PROMISE 1077BF/FF was a sequentially randomized study of pregnant and postpartum women living with HIV to investigate the efficacy and safety of antiretroviral therapy (ART). This Maternal Health Component investigated efficacy for the risk of developing AIDS or death; and safety among women randomized to continue ART (CTART: N = 289) or discontinue ART (N = 268) after cessation of breastfeeding or after confirmation of infant infection. No AIDS-defining illnesses were reported during follow-up in either arm. Adverse events of grade 3 or higher were more frequent in the CTART arm [hazard ratio = 1.78, 95% confidence interval: (1.05 to 3.02), P-value = 0.03]. The difference in adverse events in the 2 groups was mostly driven by moderate weight loss for women on the CTART arm.
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Affiliation(s)
- Sean S. Brummel
- The Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Taha E. Taha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Friday Saidi
- University of North Carolina (UNC) Project—Malawi, Kamuzu Central Hospital, Malawi
| | - Patience Atuhaire
- Makerere University –John Hopkins University Research Collaboration (MUJHU CARE LTD) CRS, Kampala, Uganda
| | - Dingase Dula
- Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi
| | - Dhayendre Moodley
- Centre for AIDS Research in South Africa and Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Allen Matubu
- Department of Obstetrics and Gynecology, UZ-UCSF Collaborative Project, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Gift Chareka
- Department of Obstetrics and Gynecology, UZ-UCSF Collaborative Project, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Neetal Nevrekar
- Byramjee Jeejeebhoy Government Medical College and Clinical Research Site, Pune, India
| | - Tichaona Vhembo
- University of Zimbabwe College of Health Sciences—Clinical Trials Research Centre, Harare, Zimbabwe
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gerhard Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pendo Mlay
- Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Michael Basar
- Frontier Science and Technology Research Foundation, Amherst, NY
| | - Nahida Chakhtoura
- National Institute for Child Health and Human Development, Washington, D.C
| | - Renee Browning
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | | | - Judith S. Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Baeten JM, Palanee-Phillips T, Mgodi NM, Mayo AJ, Szydlo DW, Ramjee G, Gati Mirembe B, Mhlanga F, Hunidzarira P, Mansoor LE, Siva S, Govender V, Makanani B, Naidoo L, Singh N, Nair G, Chinula L, Parikh UM, Mellors JW, Balán IC, Ngure K, van der Straten A, Scheckter R, Garcia M, Peda M, Patterson K, Livant E, Bunge K, Singh D, Jacobson C, Jiao Y, Hendrix CW, Chirenje ZM, Nakabiito C, Taha TE, Jones J, Torjesen K, Nel A, Rosenberg Z, Soto-Torres LE, Hillier SL, Brown ER. Safety, uptake, and use of a dapivirine vaginal ring for HIV-1 prevention in African women (HOPE): an open-label, extension study. Lancet HIV 2021; 8:e87-e95. [PMID: 33539762 PMCID: PMC8038210 DOI: 10.1016/s2352-3018(20)30304-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation. METHODS We did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037. FINDINGS Between July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (>0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p<0·0001). HIV-1 incidence was 2·7 per 100 person-years (95% CI 1·9-3·8, 35 infections), compared with an expected incidence of 4·4 per 100 person-years (3·2-5·8) among a population matched on age, site, and presence of a sexually transmitted infection from the placebo group of ASPIRE. No serious adverse events or grade 3 or higher adverse events observed were assessed as related to the DVR. INTERPRETATION High uptake and persistent use in this open-label extension study support the DVR as an HIV-1 prevention option for women. With an increasing number of HIV-1 prophylaxis choices on the horizon, these results suggest that the DVR will be an acceptable and practical option for women in Africa. FUNDING The Microbicide Trials Network and the National Institute of Allergy and Infectious Diseases, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health, all components of the US National Institutes of Health.
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Affiliation(s)
- Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyaradzo M Mgodi
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Daniel W Szydlo
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa; Aurum Institute, Johannesburg, South Africa
| | - Brenda Gati Mirembe
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Felix Mhlanga
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Portia Hunidzarira
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Leila E Mansoor
- Centre for AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Vaneshree Govender
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa; Aurum Institute, Johannesburg, South Africa
| | - Bonus Makanani
- College of Medicine-Johns Hopkins Research Project, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Logashvari Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nishanta Singh
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Gonasagrie Nair
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lameck Chinula
- University of North Carolina Project, Lilongwe, Malawi; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Urvi M Parikh
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John W Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Iván C Balán
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA; Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Melissa Peda
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karen Patterson
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Edward Livant
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Katherine Bunge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Devika Singh
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Yuqing Jiao
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Zvavahera M Chirenje
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Taha E Taha
- College of Medicine-Johns Hopkins Research Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Judith Jones
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Annalene Nel
- International Partnership for Microbicides, Silver Spring, MD, USA
| | - Zeda Rosenberg
- International Partnership for Microbicides, Silver Spring, MD, USA
| | - Lydia E Soto-Torres
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Brown
- Department of Biostatistics, University of Washington, Seattle, WA, USA; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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37
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Nachega JB, Sam-Agudu NA, Budhram S, Taha TE, Vannevel V, Somapillay P, Ishoso DK, Tshiasuma Pipo M, Bongo-Pasi Nswe C, Ditekemena J, Ayele BT, Machekano RN, Gachuno OW, Kinuthia J, Mwongeli N, Sekikubo M, Musoke P, Agbeno EK, Umar LW, Ntakwinja M, Mukwege DM, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Kayembe JMN, Mavungu Landu DJ, Muyembe Tamfum JJ, Zumla A, Langenegger EJ, Mofenson LM. Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration. Am J Trop Med Hyg 2020; 104:461-465. [PMID: 33372651 PMCID: PMC7866362 DOI: 10.4269/ajtmh.20-1553] [Citation(s) in RCA: 10] [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: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.
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Affiliation(s)
- Jean B. Nachega
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Valerie Vannevel
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Daniel Katuashi Ishoso
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Tshiasuma Pipo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
| | - Christian Bongo-Pasi Nswe
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - John Ditekemena
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Birhanu T. Ayele
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick N. Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W. Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
| | - Lawal W. Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Eduard J. Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean-Marie N. Kayembe
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Don Jethro Mavungu Landu
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Eduard J. Langenegger
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - for the AFREhealth COVID-19 Research Collaboration Working Group
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- International Research Center of Excellence, Department of Pediatrics and Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
- UP/SAMRC Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
- Maternal Foetal Medicine, Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
- Department of Community Health, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of Congo
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynecology, Cape Coast Teaching Hospital, University of Cape Coast, Cape Coast, Ghana
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
- Department of Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Medical Microbiology and Virology, Faculty of Medicine, National Institute of Biomedical Research (INRB), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
- Department of Obstetrics and Gynecology, Tyberberg Teaching Hospital, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
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Dadabhai S, Makanani B, Hua N, Kawalazira R, Taulo F, Gadama L, Taha TE. Resumption of postpartum sexual activity and menses among HIV-infected women on lifelong antiretroviral treatment compared to HIV-uninfected women in Africa. Int J Gynaecol Obstet 2020; 149:211-218. [PMID: 32037538 DOI: 10.1002/ijgo.13113] [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: 05/22/2019] [Revised: 11/11/2019] [Accepted: 02/06/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine time from delivery to resumption of sexual activity and menses among HIV-infected women on antiretroviral treatment (ART) and HIV-uninfected women. METHODS HIV-infected women on ART and HIV-uninfected women were recruited from five health facilities at delivery and followed prospectively for a maximum of 1 year in Blantyre, Malawi from January 2016 to September 2017. Sociodemographic, clinical, and laboratory data were collected at delivery and 1.5, 3, 6, 9, and 12 months. Descriptive, time to event Kaplan-Meier, and multivariable Cox proportional hazards analyses were conducted. RESULTS Data on 878 women (460 [52.4%] HIV-uninfected and 418 [47.6%] HIV-infected, P=0.156) who attended at least one follow-up visit were analyzed. Among HIV-uninfected compared to HIV-infected women, respectively, the median number of days to resumption of sexual activity was 180 vs 181; to irregular menses was 82 vs 71; and to regular menses was 245 vs 366. In multivariable models, being married was associated with early resumption of sexual activity (hazard ratio [HR] 1.91, P<0.001), and being HIV-infected and use of an effective method of family planning were associated with later start of regular menses (HR<1.0, P<0.050). CONCLUSION Counseling of women on reproductive intentions should start early irrespective of HIV infection or use of ART.
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Affiliation(s)
- Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bonus Makanani
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nan Hua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Kawalazira
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | - Frank Taulo
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Abd El-Samie FE, Ashiba HI, Shendy H, Mansour HM, Ahmed HM, Taha TE, Dessouky MI, Elkordy MF, Abd‑Elnaby M, El-Fishawy AS. Enhancement of Infrared Images Using Super Resolution Techniques Based on Big Data Processing. Multimed Tools Appl 2020; 79:5671-5692. [DOI: 10.1007/s11042-019-7634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 09/01/2023]
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Sebikari D, Farhad M, Fenton T, Owor M, Stringer JSA, Qin M, Chakhtoura N, Chi BH, Saidi F, Nevrekar N, Violari A, Chipato T, McIntyre JA, Moodley D, Taha TE, Theron G, Fowler MG. Risk Factors for Adverse Birth Outcomes in the PROMISE 1077BF/1077FF Trial. J Acquir Immune Defic Syndr 2019; 81:521-532. [PMID: 31295174 PMCID: PMC6702964 DOI: 10.1097/qai.0000000000002072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the multicountry PROMISE 1077BF/1077FF trial, the risk of low birth weight (LBW; <2500 g) and preterm delivery (PTD; <37 weeks) was significantly higher among women initiating a protease inhibitor-based antiretroviral treatment (ART) regimen than those receiving ZDV alone. Among those assigned to a protease inhibitor regimen, tenofovir/emtricitabine was associated with the more severe outcomes of very LBW (<1500 g) and very PTD (<34 weeks) compared with zidovudine/lamivudine. METHODS We used multivariate logistic regression to further explore these treatment findings, taking into account demographic baseline clinical and postentry obstetrical factors. We evaluated individual adverse outcomes and composites that included stillbirth and early loss/spontaneous abortion. RESULTS Among 3333 women delivering at least 1 live infant, median maternal age at enrollment was 26 years; 661 (20%) were primiparous, and 110 (3.3%) reported at least 1 previous PTD. Seventeen percent of newborns were LBW, 1% were very LBW, 17% had PTD, and 3% had very PTD. Treatment allocation remained strongly associated with multiple adverse outcomes after controlling for other risk factors with both ART regimens exhibiting increased risk relative to ZDV alone. Other risk factors remaining significant in at least one of the multivariate models included the following: country, gestational age at entry, maternal age, maternal body mass index, previous PTD, history of alcohol use, baseline HIV viral titer, multiple gestation, and several obstetric risk factors. CONCLUSIONS ART effects on adverse pregnancy outcomes reported in the randomized PROMISE trial remained strongly significant even after controlling for demographic, baseline clinical, and obstetrical risk factors, which were also associated with these outcomes.
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Affiliation(s)
- Dorothy Sebikari
- Clinical Department, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mona Farhad
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | - Terry Fenton
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | - Maxensia Owor
- Clinical Department, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Min Qin
- Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | - Nahida Chakhtoura
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Paediatric Infectious Diseases Branch, Bethesda, MD
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Friday Saidi
- Department of Obstetrics and Gynaecology, University of North Carolina (UNC) Project Lilongwe, Lilongwe, Malawi
| | - Neetal Nevrekar
- Clinical Research Department, Byramiee Jeeieebhoy Government Medical College, Pune, India
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Dhayendre Moodley
- Department of Obstetrics and Gynecology, School of Clinical Medicine, Centre for AIDS Research in South Africa, University of KwaZulu Natal, Durban, South Africa
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Dessouky AM, Taha TE, Dessouky MM, Eltholth AA, Hassan E, Abd El-Samie FE. Visual representation of DNA sequences for exon detection using non-parametric spectral estimation techniques. Nucleosides Nucleotides Nucleic Acids 2019; 38:321-337. [PMID: 30861361 DOI: 10.1080/15257770.2018.1536270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper presents a new approach for modeling of DNA sequences for the purpose of exon detection. The proposed model adopts the sum-of-sinusoids concept for the representation of DNA sequences. The objective of the modeling process is to represent the DNA sequence with few coefficients. The modeling process can be performed on the DNA signal as a whole or on a segment-by-segment basis. The created models can be used instead of the original sequences in a further spectral estimation process for exon detection. The accuracy of modeling is evaluated evaluated by using the Root Mean Square Error (RMSE) and the R-square metrics. In addition, non-parametric spectral estimation methods are used for estimating the spectral of both original and modeled DNA sequences. The results of exon detection based on original and modeled DNA sequences coincide to a great extent, which ensures the success of the proposed sum-of-sinusoids method for modeling of DNA sequences.
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Affiliation(s)
| | - Taha E Taha
- b Department of Electronics and Electrical Communication Engineering, Faculty of Electronic Engineering , Menoufia University , Menouf , Egypt
| | - Mohamed M Dessouky
- c Department of Computer Science and Engineering , Faculty of Electronic Engineering, Menoufia University , Menouf , Egypt
| | | | - Emadeldeen Hassan
- b Department of Electronics and Electrical Communication Engineering, Faculty of Electronic Engineering , Menoufia University , Menouf , Egypt.,e Department of computing science , Umeå University , Sweden
| | - Fathi E Abd El-Samie
- b Department of Electronics and Electrical Communication Engineering, Faculty of Electronic Engineering , Menoufia University , Menouf , Egypt
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Dadabhai S, Gadama L, Chamanga R, Kawalazira R, Katumbi C, Makanani B, Dula D, Hua N, Lau B, Mallewa M, Taha TE. Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study). J Acquir Immune Defic Syndr 2019; 80:7-14. [PMID: 30272628 PMCID: PMC6289692 DOI: 10.1097/qai.0000000000001875] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse pregnancy outcomes such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) remain major global problems. We compared pregnancy outcomes among HIV-infected women receiving antiretroviral treatment (ART) and with CD4 ≥350 cells, and HIV-uninfected women to assess whether disparities associated with HIV infection have been eliminated through use of ART. SETTING Observational study conducted at 5 health facilities in Blantyre, Malawi, during 2016-2017. METHODS HIV-infected women receiving the national ART regimen (efavirenz + lamivudine + tenofovir) and HIV-uninfected women were consented and enrolled at delivery. Data collected included sociodemographic and clinical; gestational age; BW; infant/maternal anthropometry; and laboratory results. We defined PTB as GA <37 weeks; LBW as BW <2·5 kg; and SGA as BW <10th percentile of GA. SGA infants were classified into proportionate and disproportionate based on ponderal index. Descriptive, stratified, and multivariate logistic and linear regression analyses were used. RESULTS Of 5423 women approached, 614 HIV-infected and 685 HIV-uninfected women were enrolled. Rates of PTB, LBW, and SGA were 10.6%, 7.2%, and 17.1% among HIV-infected women on ART and 9.5%, 5.0%, and 18.4% among HIV-uninfected women, respectively. None of these differences were statistically significant in univariate- or multivariate-adjusted analyses (P > 0.05). Of 231 SGA infants, 78.8% were proportionate and 21% were disproportionate. Of the 614 HIV-infected women on ART, 75% had undetectable virus at delivery. CONCLUSIONS ART use has reduced the high rates of adverse pregnancy outcomes among HIV-infected women. However, the rates remain high irrespective of HIV infection and require appropriate interventions.
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Affiliation(s)
- Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Luis Gadama
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Rachel Chamanga
- Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi
| | - Rachel Kawalazira
- Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi
| | - Chaplain Katumbi
- Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi
| | - Bonus Makanani
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dingase Dula
- Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi
| | - Nan Hua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Macpherson Mallewa
- Department of Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Taha E. Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Taha TE, Yende-Zuma N, Aizire J, Chipato T, Wambuzi Ogwang L, Makanani B, Chinula L, Nyati MM, Hanley S, Brummel SS, Fowler MG. The multi-country PROMOTE HIV antiretroviral treatment observational cohort in Sub-Saharan Africa: Objectives, design, and baseline findings. PLoS One 2018; 13:e0208805. [PMID: 30543692 PMCID: PMC6292608 DOI: 10.1371/journal.pone.0208805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/12/2018] [Accepted: 11/25/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The PROMOTE study aims to measure long-term antiretroviral treatment (ART) safety and adherence; compare HIV disease progression; assess subsequent adverse pregnancy outcomes; evaluate effect of ART exposure on growth and development in HIV-exposed uninfected children; and assess long-term survival of mothers and children. This report primarily describes cohort characteristics at baseline to better understand long-term outcomes. METHODS AND FINDINGS This is a prospective study. HIV-infected mothers and their children originally recruited in a multisite randomized clinical trial for prevention of perinatal HIV transmission were re-enrolled in PROMOTE. A total of 1987 mothers and 1784 children were enrolled from eight sites in Uganda, Malawi, Zimbabwe and South Africa. Most women (≥75%) reported being married in Malawi and Zimbabwe compared to low proportions in South Africa (4.4% in Durban and 15% in Soweto), and 43.5% in Uganda (p<0.001). There were variabilities in contraceptive practices: injectable contraceptive was the commonest reported method (40.9% overall); implant was the second commonest (15.7% overall); oral contraceptives were common in Zimbabwe; and tubal ligation was common in Malawi and South Africa. At baseline, 97.8% of women reported currently using ART; 96.4% were in WHO clinical class 1 or 2; median CD4 cell count was 825 cells per uL; and viral load was undetectable in 1637 (~85%) of the women. Approximately, 14% of women did not inform their primary partners of their own HIV status, 18% reported that they knew their partners were not HIV tested, and 9% did not know if partner was tested. Overall mean age of children at enrollment was 3.5 years; and 5.7% and 25.0% had weight-for-age and height-for-age z-scores <2 standard deviations, respectively. CONCLUSIONS These baseline data show high adherence to ART use. However, issues of HIV disclosure and reproductive intentions remain important. In addition to ART and ensuring high adherence, other preventive measures should be included.
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Affiliation(s)
- Taha E. Taha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jim Aizire
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Tsungai Chipato
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Lillian Wambuzi Ogwang
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Bonus Makanani
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Lameck Chinula
- UNC Project-Malawi, Lilongwe, Malawi; UNC-CH Department of Obstetrics and Gynecology, Chapel Hill, NC, United States of America
| | - Mandisa M. Nyati
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherika Hanley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, Durban, South Africa
| | - Sean S. Brummel
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Mary Glenn Fowler
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
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Aizire J, Dadabhai S, Taulo F, Makanani B, Gadama L, Sun J, Tsui A, Taha TE. Use of effective family planning methods and frequency of sex among HIV-infected and HIV-uninfected African women. Contracept Reprod Med 2018; 3:10. [PMID: 30002871 PMCID: PMC6036664 DOI: 10.1186/s40834-018-0063-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/01/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background Frequency of sex, contraceptive use and HIV infection are key determinants of fertility. Use of an effective family planning (EFP) method (injectable, oral, intra-uterine contraceptive device (IUCD), or Norplant) potentially eliminates women’s concerns of unintended pregnancy. We report the association between EFP and frequency of sex among HIV-infected and HIV-uninfected non-pregnant African women. Methods Prospective fertility intentions study nested within a phase 3 randomized double-masked placebo-controlled trial (2003-2005) to treat genital tract infections in HIV-infected and HIV-uninfected non-pregnant women. Enrollment of study participants was stratified by HIV infection status. Data on demographics, family planning and sexual history were obtained at baseline and at 3, 6, 9 and 12 months. Chi square and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables, respectively. Generalized Estimating Equations method was used to estimate relative risk (RR) of frequent sex (≥ 2 acts/week) among users of different EFP methods (injectable, oral, implant or intra-uterine contraceptive device). Results After adjusting for age, current health status, and fertility intentions, EFP use was significantly associated with frequent sex among HIV-infected women (RR 1.32; 95% Confidence Interval [CI] 1.14-1.52); this association was not statistically significant among HIV-uninfected women (RR 1.10; 95% CI 0.96-1.24). Fertility intentions among HIV-infected, and education among HIV-uninfected womenwere independent predictors of sex frequency. Conclusion These data suggest that the association between EFP use and frequency of sex among women varies by HIV infection status. Service-delivery of diverse EFP methods should be integrated within HIV counseling, testing and treatment facilities. Trial registration Registration number NCT00140764 under the clinicaltrials.gov, first Posted: September 1, 2005, last Update Posted: August 10, 2011.
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Affiliation(s)
- Jim Aizire
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Sufia Dadabhai
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Frank Taulo
- 2Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Bonus Makanani
- 2Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Luis Gadama
- 2Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jin Sun
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Amy Tsui
- 3Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Taha E Taha
- 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA.,3Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Mahmoud AA, El-Rabaie ESM, Taha TE, Elfishawy A, Zahran O, Abd El-Samie FE. Medical Image Segmentation Techniques, a Literature Review, and Some Novel Trends. Menoufia Journal of Electronic Engineering Research 2018; 27:23-58. [DOI: 10.21608/mjeer.2018.63179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Affiliation(s)
- Mary G Fowler
- Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | - Taha E Taha
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Taha TE, Soliman AM, Eldosoky MA. Analysis improvement of standing surface acoustic wave microfluidic devices for bio-particles separation. IJCAT 2017. [DOI: 10.1504/ijcat.2017.10005863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, Mgodi NM, Matovu Kiweewa F, Nair G, Mhlanga F, Siva S, Bekker LG, Jeenarain N, Gaffoor Z, Martinson F, Makanani B, Pather A, Naidoo L, Husnik M, Richardson BA, Parikh UM, Mellors JW, Marzinke MA, Hendrix CW, van der Straten A, Ramjee G, Chirenje ZM, Nakabiito C, Taha TE, Jones J, Mayo A, Scheckter R, Berthiaume J, Livant E, Jacobson C, Ndase P, White R, Patterson K, Germuga D, Galaska B, Bunge K, Singh D, Szydlo DW, Montgomery ET, Mensch BS, Torjesen K, Grossman CI, Chakhtoura N, Nel A, Rosenberg Z, McGowan I, Hillier S. Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. N Engl J Med 2016; 375:2121-2132. [PMID: 26900902 PMCID: PMC4993693 DOI: 10.1056/nejmoa1506110] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antiretroviral medications that are used as prophylaxis can prevent acquisition of human immunodeficiency virus type 1 (HIV-1) infection. However, in clinical trials among African women, the incidence of HIV-1 infection was not reduced, probably because of low adherence. Longer-acting methods of drug delivery, such as vaginal rings, may simplify use of antiretroviral medications and provide HIV-1 protection. METHODS We conducted a phase 3, randomized, double-blind, placebo-controlled trial of a monthly vaginal ring containing dapivirine, a non-nucleoside HIV-1 reverse-transcriptase inhibitor, involving women between the ages of 18 and 45 years in Malawi, South Africa, Uganda, and Zimbabwe. RESULTS Among the 2629 women who were enrolled, 168 HIV-1 infections occurred: 71 in the dapivirine group and 97 in the placebo group (incidence, 3.3 and 4.5 per 100 person-years, respectively). The incidence of HIV-1 infection in the dapivirine group was lower by 27% (95% confidence interval [CI], 1 to 46; P=0.046) than that in the placebo group. In an analysis that excluded data from two sites that had reduced rates of retention and adherence, the incidence of HIV-1 infection in the dapivirine group was lower by 37% (95% CI, 12 to 56; P=0.007) than that in the placebo group. In a post hoc analysis, higher rates of HIV-1 protection were observed among women over the age of 21 years (56%; 95% CI, 31 to 71; P<0.001) but not among those 21 years of age or younger (-27%; 95% CI, -133 to 31; P=0.45), a difference that was correlated with reduced adherence. The rates of adverse medical events and antiretroviral resistance among women who acquired HIV-1 infection were similar in the two groups. CONCLUSIONS A monthly vaginal ring containing dapivirine reduced the risk of HIV-1 infection among African women, with increased efficacy in subgroups with evidence of increased adherence. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01617096 .).
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Affiliation(s)
- Jared M Baeten
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Thesla Palanee-Phillips
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Elizabeth R Brown
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Katie Schwartz
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Lydia E Soto-Torres
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Vaneshree Govender
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Nyaradzo M Mgodi
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Flavia Matovu Kiweewa
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Gonasagrie Nair
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Felix Mhlanga
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Samantha Siva
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Linda-Gail Bekker
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Nitesha Jeenarain
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Zakir Gaffoor
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Francis Martinson
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Bonus Makanani
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Arendevi Pather
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Logashvari Naidoo
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Marla Husnik
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Barbra A Richardson
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Urvi M Parikh
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - John W Mellors
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Mark A Marzinke
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Craig W Hendrix
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Ariane van der Straten
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Gita Ramjee
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Zvavahera M Chirenje
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Clemensia Nakabiito
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Taha E Taha
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Judith Jones
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Ashley Mayo
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Rachel Scheckter
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Jennifer Berthiaume
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Edward Livant
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Cindy Jacobson
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Patrick Ndase
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Rhonda White
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Karen Patterson
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Donna Germuga
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Beth Galaska
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Katherine Bunge
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Devika Singh
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Daniel W Szydlo
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Elizabeth T Montgomery
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Barbara S Mensch
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Kristine Torjesen
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Cynthia I Grossman
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Nahida Chakhtoura
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Annalene Nel
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Zeda Rosenberg
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Ian McGowan
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
| | - Sharon Hillier
- From the Departments of Global Health (J.M.B., B.A.R., P.N.), Medicine (J.M.B.), Epidemiology (J.M.B., M.H.), and Biostatistics (E.R.B., B.A.R.), University of Washington, and the Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center (E.R.B., M.H., B.A.R., J.B., K.P., D.W.S.) - both in Seattle; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg (T.P.-P.), HIV Prevention Research Unit, South African Medical Research Council (V.G., S.S., N.J., Z.G., A.P., L.N., G.R.), and Center for AIDS Programme of Research in South Africa (G.N.), Durban, and the Desmond Tutu HIV Center, University of Cape Town, Cape Town (L.-G.B.) - all in South Africa; FHI 360, Durham, NC (K.S., A.M., R.S., R.W., K.T.); National Institute of Allergy and Infectious Diseases (L.E.S.-T., D.G.), National Institute of Mental Health (C.I.G.), and Eunice Kennedy Shiver National Institute of Child Health and Human Development (N.C.), National Institutes of Health, Bethesda, the Departments of Medicine (M.A.M., C.W.H.) and Epidemiology (T.E.T.), Johns Hopkins University, Baltimore, and the International Partnership for Microbicides, Silver Spring (A.N., Z.R.) - all in Maryland; University of Zimbabwe-University of California San Francisco Collaborative Research Program, Harare, Zimbabwe (N.M.M., F. Mhlanga, Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (F.M.K., C.N.); University of North Carolina Project, Lilongwe (F. Martinson), and Malawi College of Medicine-Johns Hopkins University Research Project, Queen Elizabeth Central Hospital, Blantyre (B.M., T.E.T.) - both in Malawi; the Departments of Medicine (U.M.P., J.W.M., I.M.) and Obstetrics, Gynecology, and Reproductive Sciences (K.B., S.H.), University of Pittsburgh, and Magee-Women's Research Institute (J.J., E.L., C.J., B.G., D.S.) - both in Pittsburgh; the Women's Global Health Imperative, RTI International (A.S., E.T.M.), and the Department of Medicine, University of California (A.S.) - both in San Francisco; and the Population Council, New York (B.S.M.)
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Fowler MG, Qin M, Fiscus SA, Currier JS, Flynn PM, Chipato T, McIntyre J, Gnanashanmugam D, Siberry GK, Coletti AS, Taha TE, Klingman KL, Martinson FE, Owor M, Violari A, Moodley D, Theron GB, Bhosale R, Bobat R, Chi BH, Strehlau R, Mlay P, Loftis AJ, Browning R, Fenton T, Purdue L, Basar M, Shapiro DE, Mofenson LM. Benefits and Risks of Antiretroviral Therapy for Perinatal HIV Prevention. N Engl J Med 2016; 375:1726-1737. [PMID: 27806243 PMCID: PMC5214343 DOI: 10.1056/nejmoa1511691] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Randomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking. METHODS We randomly assigned HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells per cubic millimeter to zidovudine and single-dose nevirapine plus a 1-to-2-week postpartum "tail" of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine, and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine, and lopinavir-ritonavir (tenofovir-based ART). The primary outcomes were HIV transmission at 1 week of age in the infant and maternal and infant safety. RESULTS The median CD4 count was 530 cells per cubic millimeter among 3490 primarily black African HIV-infected women enrolled at a median of 26 weeks of gestation (interquartile range, 21 to 30). The rate of transmission was significantly lower with ART than with zidovudine alone (0.5% in the combined ART groups vs. 1.8%; difference, -1.3 percentage points; repeated confidence interval, -2.1 to -0.4). However, the rate of maternal grade 2 to 4 adverse events was significantly higher with zidovudine-based ART than with zidovudine alone (21.1% vs. 17.3%, P=0.008), and the rate of grade 2 to 4 abnormal blood chemical values was higher with tenofovir-based ART than with zidovudine alone (2.9% vs. 0.8%, P=0.03). Adverse events did not differ significantly between the ART groups (P>0.99). A birth weight of less than 2500 g was more frequent with zidovudine-based ART than with zidovudine alone (23.0% vs. 12.0%, P<0.001) and was more frequent with tenofovir-based ART than with zidovudine alone (16.9% vs. 8.9%, P=0.004); preterm delivery before 37 weeks was more frequent with zidovudine-based ART than with zidovudine alone (20.5% vs. 13.1%, P<0.001). Tenofovir-based ART was associated with higher rates than zidovudine-based ART of very preterm delivery before 34 weeks (6.0% vs. 2.6%, P=0.04) and early infant death (4.4% vs. 0.6%, P=0.001), but there were no significant differences between tenofovir-based ART and zidovudine alone (P=0.10 and P=0.43). The rate of HIV-free survival was highest among infants whose mothers received zidovudine-based ART. CONCLUSIONS Antenatal ART resulted in significantly lower rates of early HIV transmission than zidovudine alone but a higher risk of adverse maternal and neonatal outcomes. (Funded by the National Institutes of Health; PROMISE ClinicalTrials.gov numbers, NCT01061151 and NCT01253538 .).
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Affiliation(s)
- Mary G Fowler
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Min Qin
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Susan A Fiscus
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Judith S Currier
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Patricia M Flynn
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Tsungai Chipato
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - James McIntyre
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Devasena Gnanashanmugam
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - George K Siberry
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Anne S Coletti
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Taha E Taha
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Karin L Klingman
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Francis E Martinson
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Maxensia Owor
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Avy Violari
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Dhayendre Moodley
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Gerhard B Theron
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Ramesh Bhosale
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Raziya Bobat
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Benjamin H Chi
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Renate Strehlau
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Pendo Mlay
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Amy J Loftis
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Renee Browning
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Terence Fenton
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Lynette Purdue
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Michael Basar
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - David E Shapiro
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
| | - Lynne M Mofenson
- From the Department of Pathology, Johns Hopkins University School of Medicine (M.G.F.), and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (T.E.T.), Baltimore, and the Division of AIDS, National Institute of Allergy and Infectious Diseases (D.G., K.L.K., R. Browning, L.P.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (G.K.S.), National Institutes of Health, Bethesda - all in Maryland; the Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston (M.Q., T.F., D.E.S.); the Retrovirology Core Laboratory, University of North Carolina School of Medicine, Chapel Hill (S.A.F., A.J.L.), and FHI 360, Durham (A.S.C.) - both in North Carolina; the UCLA Center for Clinical AIDS Research and Education, Los Angeles (J.S.C.); St. Jude Children's Research Hospital, Memphis, TN (P.M.F.); the Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare (T.C.); Anova Health Institute (J.M.), Perinatal HIV Research Unit, University of the Witwatersrand, Faculty of Health Sciences (A.V.), and Empilweni Services and Research Unit (R.S.), Johannesburg, School of Public Health and Family Medicine, University of Cape Town (J.M.), and the Department of Obstetrics and Gynaecology, Stellenbosch University (G.B.T.), Cape Town, and the Centre for the AIDS Programme of Research in South Africa-Umlazi Clinical Research Site (D.M.) and Durban Paediatric HIV (R. Bobat), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban - all in South Africa; the University of North Carolina Project, Kamuzu Central Hospital-Tidziwe Center, Lilongwe, Malawi (F.E.M.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (M.O.); the Department of Obstetrics and Gynecology, B.J. Medical College, Pune, India (R. Bhosale); the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia (B.H.C.); Kilimanjaro Christian Medical Center-Duke University Collaboration, Moshi, Tanzania (P.M.); Frontier Science and Technology Research Foundation, Amherst, NY (M.B.); and the Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC (L.M.M.)
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Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JHS, Godbole SV, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Cottle L, Zhang XC, Makhema J, Mills LA, Panchia R, Faesen S, Eron J, Gallant J, Havlir D, Swindells S, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano DD, Essex M, Hudelson SE, Redd AD, Fleming TR. Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med 2016; 375:830-9. [PMID: 27424812 PMCID: PMC5049503 DOI: 10.1056/nejmoa1600693] [Citation(s) in RCA: 1101] [Impact Index Per Article: 137.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission. METHODS We randomly assigned 1763 index participants to receive either early or delayed ART. In the early-ART group, 886 participants started therapy at enrollment (CD4+ count, 350 to 550 cells per cubic millimeter). In the delayed-ART group, 877 participants started therapy after two consecutive CD4+ counts fell below 250 cells per cubic millimeter or if an illness indicative of the acquired immunodeficiency syndrome (i.e., an AIDS-defining illness) developed. The primary study end point was the diagnosis of genetically linked HIV-1 infection in the previously HIV-1-negative partner in an intention-to-treat analysis. RESULTS Index participants were followed for 10,031 person-years; partners were followed for 8509 person-years. Among partners, 78 HIV-1 infections were observed during the trial (annual incidence, 0.9%; 95% confidence interval [CI], 0.7 to 1.1). Viral-linkage status was determined for 72 (92%) of the partner infections. Of these infections, 46 were linked (3 in the early-ART group and 43 in the delayed-ART group; incidence, 0.5%; 95% CI, 0.4 to 0.7) and 26 were unlinked (14 in the early-ART group and 12 in the delayed-ART group; incidence, 0.3%; 95% CI, 0.2 to 0.4). Early ART was associated with a 93% lower risk of linked partner infection than was delayed ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22). No linked infections were observed when HIV-1 infection was stably suppressed by ART in the index participant. CONCLUSIONS The early initiation of ART led to a sustained decrease in genetically linked HIV-1 infections in sexual partners. (Funded by the National Institute of Allergy and Infectious Diseases; HPTN 052 ClinicalTrials.gov number, NCT00074581 .).
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Affiliation(s)
- Myron S Cohen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Ying Q Chen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Marybeth McCauley
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Theresa Gamble
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Mina C Hosseinipour
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Nagalingeswaran Kumarasamy
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - James G Hakim
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Johnstone Kumwenda
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Beatriz Grinsztejn
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Jose H S Pilotto
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sheela V Godbole
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Suwat Chariyalertsak
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Breno R Santos
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Kenneth H Mayer
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Irving F Hoffman
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Susan H Eshleman
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Estelle Piwowar-Manning
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Leslie Cottle
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Xinyi C Zhang
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joseph Makhema
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Lisa A Mills
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Ravindre Panchia
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sharlaa Faesen
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joseph Eron
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Joel Gallant
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Diane Havlir
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Susan Swindells
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Vanessa Elharrar
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - David Burns
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Taha E Taha
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Karin Nielsen-Saines
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - David D Celentano
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Max Essex
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Sarah E Hudelson
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Andrew D Redd
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
| | - Thomas R Fleming
- From the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.S.C., M.C.H., I.F.H., J.E.); the Divisions of Vaccine and Infectious Disease (Y.Q.C., X.C.Z.) and Public Health Science (Y.Q.C.) and the Statistical Center for HIV/AIDS Research and Prevention (L.C.), Fred Hutchinson Cancer Research Center, and the Department of Biostatistics, University of Washington (T.R.F.) - both in Seattle; FHI 360, Washington, DC (M.M.), and Durham, NC (T.G.); Y.R. Gaitonde Center for AIDS Research and Education, Chennai (N.K.), and National AIDS Research Institute, Pune (S.V.G.) - both in India; University of Zimbabwe, Harare (J.G.H.); College of Medicine-Johns Hopkins Project, Blantyre, Malawi (J.K.); Instituto de Pesquisa Clinica Evandro Chagas (B.G.) and Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz (J.H.S.P.), Rio de Janeiro, and Servico de Infectologia, Hospital Nossa Senhora da Conceicao/GHC, Porto Alegre (B.R.S.) - both in Brazil; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand (S.C.); Fenway Institute (K.H.M.) and Harvard School of Public Health (M.E.) - both in Boston; the Departments of Pathology (S.H.E., E.P.-M., S.E.H.) and Medicine (A.D.R.), Johns Hopkins University School of Medicine, the Department of Epidemiology, Bloomberg School of Public Health (T.E.T.), and Johns Hopkins Bloomberg School of Public Health (D.D.C.), Baltimore, and the Division of AIDS (V.E., D.B.) and Laboratory of Immunoregulation (A.D.R.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda - both in Maryland; Botswana Harvard AIDS Institute, Gaborone (J.M.); Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention/KEMRI-CDC Research and Public Health Collaboration HIV Research Branch, Kisumu, Kenya (L.A.M.); Perinatal HIV Research Unit (R.P.) and Clinical HIV Research Unit, Department of Medicine, Faculty of Health Scien
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