1
|
Randremanana RV, Andriamandimby S, Rakotondramanga JM, Razanajatovo NH, Mangahasimbola RT, Randriambolamanantsoa TH, Ranaivoson HC, Rabemananjara HA, Razanajatovo I, Razafindratsimandresy R, Rabarison JH, Brook CE, Rakotomanana F, Rabetombosoa RM, Razafimanjato H, Ahyong V, Raharinosy V, Raharimanga V, Raharinantoanina SJ, Randrianarisoa MM, Bernardson B, Randrianasolo L, Randriamampionona LBN, Tato CM, DeRisi JL, Dussart P, Vololoniaina MC, Randriatsarafara FM, Randriamanantany ZA, Heraud J. The COVID-19 epidemic in Madagascar: clinical description and laboratory results of the first wave, march-september 2020. Influenza Other Respir Viruses 2021; 15:457-468. [PMID: 33586912 PMCID: PMC8013501 DOI: 10.1111/irv.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Following the first detection of SARS-CoV-2 in passengers arriving from Europe on 19 March 2020, Madagascar took several mitigation measures to limit the spread of the virus in the country. METHODS Nasopharyngeal and/or oropharyngeal swabs were collected from travellers to Madagascar, suspected SARS-CoV-2 cases and contact of confirmed cases. Swabs were tested at the national reference laboratory using real-time RT-PCR. Data collected from patients were entered in an electronic database for subsequent statistical analysis. All distribution of laboratory-confirmed cases were mapped, and six genomes of viruses were fully sequenced. RESULTS Overall, 26,415 individuals were tested for SARS-CoV-2 between 18 March and 18 September 2020, of whom 21.0% (5,553/26,145) returned positive. Among laboratory-confirmed SARS-CoV-2-positive patients, the median age was 39 years (IQR: 28-52), and 56.6% (3,311/5,553) were asymptomatic at the time of sampling. The probability of testing positive increased with age with the highest adjusted odds ratio of 2.2 [95% CI: 1.9-2.5] for individuals aged 49 years and more. Viral strains sequenced belong to clades 19A, 20A and 20B indicative of several independent introduction of viruses. CONCLUSIONS Our study describes the first wave of the COVID-19 in Madagascar. Despite early strategies in place Madagascar could not avoid the introduction and spread of the virus. More studies are needed to estimate the true burden of disease and make public health recommendations for a better preparation to another wave.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fanjasoa Rakotomanana
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | | | - Vaomalala Raharimanga
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | - Barivola Bernardson
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | - Laurence Randrianasolo
- Epidemiology and Clinical Research UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | - Philippe Dussart
- Virology UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
| | | | | | | | - Jean‐Michel Heraud
- Virology UnitInstitut Pasteur de MadagascarAntananarivoMadagascar
- Present address:
Virology DepartmentInstitut Pasteur de DakarDakarSenegal
| |
Collapse
|
2
|
Chamberlin J, Jayne TS, Snapp S. The role of active soil carbon in influencing the profitability of fertilizer use: Empirical evidence from smallholder maize plots in Tanzania. Land Degrad Dev 2021; 32:2681-2694. [PMID: 34239284 PMCID: PMC8251585 DOI: 10.1002/ldr.3940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
We use recent plot-level panel data from Tanzanian smallholder farmers to investigate maize yield responses to inorganic fertilizer under variable soil carbon conditions. Unlike many prior studies which consider total carbon measurements, we focus on active soil carbon, which is a component strongly related to key soil functions, such as nutrient cycling and availability. Active soil carbon is found to be a strong predictor of maize yield response to nitrogen fertilizer. These results highlight important sources of variation in the returns to fertilizer investments across plots and smallholder farmers in the region. When farmgate prices for maize and fertilizer are incorporated into calculations of economic returns, we find that the profitability of fertilizer use is strongly dependent upon farmgate price ratio assumptions: under our most optimistic agronomic response estimates, 39% of farmer plots have an average value-cost ratio greater than 1.5 at a maize-nitrogen price ratio of 0.15. That share drops to 4% at a price ratio of 0.12 and 0% at a price ratio of 0.09. Our findings provide insights into the intertwined biophysical and economic underpinnings of low levels of fertilizer use in Tanzania and elsewhere in the region. Raising active carbon stocks in smallholder systems may be a strategic priority in many areas for incentivizing greater use of inorganic fertilizer, reversing land degradation, and achieving sustainable agricultural intensification.
Collapse
Affiliation(s)
| | - T. S. Jayne
- Department of Agricultural, Food, and Resource EconomicsMichigan State UniversityEast LansingMichiganUSA
| | - Sieglinde Snapp
- Department of Plant, Soil, and Microbial SciencesMichigan State UniversityEast LansingMichiganUSA
| |
Collapse
|
3
|
Meisner J, Roberts DA, Rodriguez P, Sharma M, Newman Owiredu M, Gomez B, de Mello MB, Bobrik A, Vodianyk A, Storey A, Githuka G, Chidarikire T, Barnabas R, Farid S, Essajee S, Jamil MS, Baggaley R, Johnson C, Drake AL. Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost-effectiveness analysis. J Int AIDS Soc 2021; 24:e25686. [PMID: 33787064 PMCID: PMC8010369 DOI: 10.1002/jia2.25686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION HIV retesting during late pregnancy and breastfeeding can help detect new maternal infections and prevent mother-to-child HIV transmission (MTCT), but the optimal timing and cost-effectiveness of maternal retesting remain uncertain. METHODS We constructed deterministic models to assess the health and economic impact of maternal HIV retesting on a hypothetical population of pregnant women, following initial testing in pregnancy, on MTCT in four countries: South Africa and Kenya (high/intermediate HIV prevalence), and Colombia and Ukraine (low HIV prevalence). We evaluated six scenarios with varying retesting frequencies from late in antenatal care (ANC) through nine months postpartum. We compared strategies using incremental cost-effectiveness ratios (ICERs) over a 20-year time horizon using country-specific thresholds. RESULTS We found maternal retesting once in late ANC with catch-up testing through six weeks postpartum was cost-effective in Kenya (ICER = $166 per DALY averted) and South Africa (ICER=$289 per DALY averted). This strategy prevented 19% (Kenya) and 12% (South Africa) of infant HIV infections. Adding one or two additional retests postpartum provided smaller benefits (1 to 2 percentage point increase in infections averted versus one retest). Adding three retests during the postpartum period averted additional infections (1 to 3 percentage point increase in infections averted versus one retest) but ICERs ($7639 and in Kenya and $11 985 in South Africa) greatly exceeded the cost-effectiveness thresholds. In Colombia and Ukraine, all retesting strategies exceeded the cost-effectiveness threshold and prevented few infant infections (up to 31 and 5 infections, respectively). CONCLUSIONS In high HIV burden settings with MTCT rates similar to those seen in Kenya and South Africa, HIV retesting once in late ANC, with subsequent intervention, is the most cost-effective strategy for preventing infant HIV infections. In these settings, two HIV retests postpartum marginally reduced MTCT and were less costly than adding three retests. Retesting in low-burden settings with MTCT rates similar to Colombia and Ukraine was not cost-effective at any time point due to very low HIV prevalence and limited breastfeeding.
Collapse
Affiliation(s)
| | - D Allen Roberts
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Patricia Rodriguez
- The Comparative Health Outcomes Policy & Economics InstituteUniversity of WashingtonSeattleWAUSA
| | - Monisha Sharma
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | - Bertha Gomez
- Pan American Health Organization/World Health OrganizationColombia OfficeBogotáColombia
| | - Maeve B de Mello
- Department of Communicable Diseases and Environmental Determinants of HealthPan American Health Organization/World Health OrganizationWashingtonDCUSA
| | - Alexey Bobrik
- Global Fund to Fight AIDS, Tuberculosis and MalariaGenevaSwitzerland
| | | | | | | | - Thato Chidarikire
- HIV Prevention ProgrammesNational Department of HealthPretoriaSouth Africa
| | - Ruanne Barnabas
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Shiza Farid
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | | | - Muhammad S Jamil
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Cheryl Johnson
- Global HIV, Hepatitis and STI programmeWorld Health OrganizationGenevaSwitzerland
| | - Alison L Drake
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| |
Collapse
|
4
|
Narayanan N, Beyene G, Chauhan RD, Grusak MA, Taylor NJ. Stacking disease resistance and mineral biofortification in cassava varieties to enhance yields and consumer health. Plant Biotechnol J 2021; 19:844-854. [PMID: 33190345 PMCID: PMC8051606 DOI: 10.1111/pbi.13511] [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] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/01/2020] [Accepted: 10/27/2020] [Indexed: 05/20/2023]
Abstract
Delivering the benefits of agricultural biotechnology to smallholder farmers requires that resources be directed towards staple food crops. To achieve effect at scale, beneficial traits must be integrated into multiple, elite farmer-preferred varieties with relevance across geographical regions. The staple root crop cassava (Manihot esculenta) is consumed for dietary calories by more than 800 million people, but its tuberous roots provide insufficient iron and zinc to meet nutritional needs. In Africa, cassava yields are furthermore limited by the virus diseases, cassava mosaic disease (CMD) and cassava brown streak disease (CBSD). In this study, we strove to develop cassava displaying high-level resistance to CBSD and CMD to attain food and economic security for cassava farmers, along with biofortified levels of iron and zinc to enhance consumer health. RNAi-mediated technology was used to achieve resistance to CBSD in two East African and one Nigerian farmer-preferred cultivars that harboured resistance to CMD. The Nigerian cvs. TMS 95/0505 and TMS 91/02324 were modified with T-DNA imparting resistance to CBSD, along with AtIRT1 (major iron transporter) and AtFER1 (ferritin) transgenes to achieve nutritionally significant levels of iron and zinc in cassava storage roots (145 and 40 µg/g dry weight, respectively). The inherent resistance to CMD was maintained in all four disease resistant and mineral enhanced cassava cultivars described here, demonstrating that this technique could be deployed across multiple farmer-preferred varieties to benefit the food and nutritional security of consumers in Africa.
Collapse
Affiliation(s)
| | - Getu Beyene
- Donald Danforth Plant Science CenterSt. LouisMOUSA
| | - Raj Deepika Chauhan
- Donald Danforth Plant Science CenterSt. LouisMOUSA
- Present address:
PairwiseDurhamNCUSA
| | | | | |
Collapse
|
5
|
Onoya D, Hendrickson C, Sineke T, Maskew M, Long L, Bor J, Fox MP. Attrition in HIV care following HIV diagnosis: a comparison of the pre-UTT and UTT eras in South Africa. J Int AIDS Soc 2021; 24:e25652. [PMID: 33605061 PMCID: PMC7893145 DOI: 10.1002/jia2.25652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/07/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Policies for Universal Test & Treat (UTT) and same-day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. METHODS We enrolled three cohorts of newly diagnosed HIV-infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre-UTT, N = 144), May-September 2017 (UTT, N = 178) and October-December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow-up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow-up (being >90 days late for the last scheduled appointment) at 12 months post-HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression. RESULTS Overall, 410 of 580 screened HIV-positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre-UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre-UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non-marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time-varying ART initiation status, compared to the pre-ART period of care, the hazard of on-ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre-UTT (aHR 1.9, 95% CI: 1.1 to 2.9). CONCLUSIONS Overall, nearly two-fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on-ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long-term attrition from care.
Collapse
Affiliation(s)
- Dorina Onoya
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | - Jacob Bor
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | - Matthew P. Fox
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| |
Collapse
|
6
|
Stone J, Mukandavire C, Boily M, Fraser H, Mishra S, Schwartz S, Rao A, Looker KJ, Quaife M, Terris‐Prestholt F, Marr A, Lane T, Coetzee J, Gray G, Otwombe K, Milovanovic M, Hausler H, Young K, Mcingana M, Ncedani M, Puren A, Hunt G, Kose Z, Phaswana‐Mafuya N, Baral S, Vickerman P. Estimating the contribution of key populations towards HIV transmission in South Africa. J Int AIDS Soc 2021; 24:e25650. [PMID: 33533115 PMCID: PMC7855076 DOI: 10.1002/jia2.25650] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
Collapse
Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | - Christinah Mukandavire
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUnited Kingdom
| | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | | | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Amrita Rao
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Matthew Quaife
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Alexander Marr
- University of California San FranciscoSan FranciscoCAUSA
| | - Tim Lane
- Equal InternationalWashingtonDCUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Glenda Gray
- South African Medical Research CouncilCape TownSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | | | - Adrian Puren
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Zamakayise Kose
- Research and Innovation OfficeNorth West UniversityPotchefstroomSouth Africa
| | | | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Peter Vickerman
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| |
Collapse
|
7
|
Tukei VJ, Machekano R, Gill MM, Tiam A, Mokone M, Isavwa A, Nyabela M, Mots’oane T, Nchephe S, Letsie M, Kassaye SG, Guay L. 24-Month HIV-free survival among HIV-exposed Infants in Lesotho: the PEAWIL cohort study. J Int AIDS Soc 2020; 23:e25648. [PMID: 33314744 PMCID: PMC7733603 DOI: 10.1002/jia2.25648] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Following the implementation of the provision of lifelong antiretroviral therapy to all HIV-positive pregnant or breastfeeding women for prevention of mother-to-child transmission (PMTCT) of HIV by the Kingdom of Lesotho in 2013, we assessed the effectiveness of this approach by evaluating 24-month HIV-free survival among HIV-exposed infants (HEIs). METHODS We conducted a prospective observational cohort study that enrolled HIV-positive and HIV-negative pregnant women, with follow-up of women and their infants for 24 months after delivery. Participant recruitment started in June 2014 and follow-up ended in September 2018. Trained nurses collected study information through patient interviews and chart abstraction at enrolment and every three to six months thereafter. Maternal HIV testing, infant mortality, HIV transmission and HIV-free survival rates were computed using Kaplan-Meier estimation. Cox regression hazard models were used to identify factors associated with infant HIV infection and death. RESULTS Between June 2014 and February 2016, we enrolled 653 HIV-positive and 941 HIV-negative pregnant women. Twenty-seven HIV-negative women acquired HIV during follow-up. Ultimately, 634 liveborn HEI (382 (52%) male, 303 (48%) female, 3 missing) and 839 who remained HIV-unexposed (HUIs) (409 (49.0%) male, 426 (51.0%) female, 4 missing) were followed; 550 HEIs and 701 HUIs completed the 24-month follow-up period. Of 607 (95.7%) HEIs who were tested for HIV at least once during follow-up, 17 were found to be HIV-positive. Two (9.5%) of 21 infants born to mothers who acquired HIV infection during follow-up were HIV-positive compared to 15 (2.4%) of 613 HEI born to women with known HIV infection. The risk of HIV transmission from HIV-positive mothers to their infants by 24 months of age was 2.9% (95% CI: 1.8 to 4.7). The estimated 24-month mortality rate among HEIs was 6.0% (95% CI: 4.4 to 8.2) compared to 3.8% (95% CI: 2.6 to 5.3) among HUIs (Log-rank p = 0.065). HIV-free survival at 24 months was 91.8% (95% CI: 89.2 to 93.7). Lower maternal age and birth weight were independently associated with increased HIV infection or death of infants. CONCLUSIONS The implementation of lifelong ART for PMTCT in the Lesotho public health system resulted in low HIV transmission, but survival of HEI remains lower than their HIV uninfected counterparts.
Collapse
Affiliation(s)
| | | | | | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
- Centre for International HealthUniversity of BergenNorway
| | | | | | | | | | | | | | - Seble G Kassaye
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Laura Guay
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
- Department of EpidemiologyGeorge Washington University Milken Institute School of Public HealthWashingtonDCUSA
| |
Collapse
|
8
|
Tiwari R, Wang J, Han H, Kalu N, Sims LB, Katz DA, Burke B, Tsegaye AT, Carter KA, Freije S, Guo B, Albirair M, Barr‐DiChiara M, Baggaley R, Jamil MS, Senya K, Johnson C, Khosropour CM. Sexual behaviour change following HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25635. [PMID: 33161636 PMCID: PMC7649006 DOI: 10.1002/jia2.25635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Learning one's HIV status through HIV testing services (HTS) is an essential step toward accessing treatment and linking to preventive services for those at high HIV risk. HTS may impact subsequent sexual behaviour, but the degree to which this varies by population or is true in the setting of contemporary HIV prevention activities is largely unknown. As part of the 2019 World Health Organization Consolidated Guidelines on HTS, we undertook a systematic review and meta-analysis to determine the effect of HTS on sexual behaviour. METHODS We searched nine electronic databases for studies published between July 2010 and December 2019. We included studies that reported on at least one outcome (condom use [defined as the frequency of condom use or condom-protected sex], number of sex partners, HIV incidence, STI incidence/prevalence). We included studies that prospectively assessed outcomes and that fit into one of three categories: (1) those evaluating more versus less-intensive HTS, (2) those of populations receiving HTS versus not and (3) those evaluating outcomes after versus before HTS. We conducted meta-analyses using random-effects models. RESULTS AND DISCUSSION Of 29 980 studies screened, 76 studies were included. Thirty-eight studies were randomized controlled trials, 36 were cohort studies, one was quasi-experimental and one was a serial cross-sectional study. There was no significant difference in condom use among individuals receiving more-intensive HTS compared to less-intensive HTS (relative risk [RR]=1.03; 95% CI: 0.99 to 1.07). Condom use was significantly higher after receiving HTS compared to before HTS for individuals newly diagnosed with HIV (RR = 1.65; 95% CI: 1.36 to 1.99) and marginally significantly higher for individuals receiving an HIV-negative diagnosis (RR = 1.63; 95% CI: 1.01 to 2.62). Individuals receiving more-intensive HTS reported fewer sex partners at follow-up than those receiving less-intensive HTS, but the finding was not statistically significant (mean difference = -0.28; 95% CI: -3.66, 3.10). CONCLUSIONS Our findings highlight the importance of using limited resources towards HTS strategies that focus on early HIV diagnosis, treatment and prevention services rather than resources dedicated to supplementing or enhancing HTS with additional counselling or other interventions.
Collapse
Affiliation(s)
- Ruchi Tiwari
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Jiayu Wang
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Hannah Han
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Ngozi Kalu
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Lee B Sims
- School of Public HealthImperial College LondonLondonUnited Kingdom
| | - David A Katz
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Barbara Burke
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Adino T Tsegaye
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Kayla A Carter
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Sophie Freije
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Boya Guo
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | | | | | - Rachel Baggaley
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
| | - Kafui Senya
- Communicable Diseases ClusterWorld Health OrganizationAccraGhana
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs programmeWorld Health OrganizationGenevaSwitzerland
| | | |
Collapse
|
9
|
Palmer S, Dijkstra M, Ket JCF, Wahome EW, Walimbwa J, Gichuru E, van der Elst EM, Schim van der Loeff MF, de Bree GJ, Sanders EJ. Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis. J Int AIDS Soc 2020; 23 Suppl 6:e25590. [PMID: 33000916 PMCID: PMC7527764 DOI: 10.1002/jia2.25590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. METHODS We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). RESULTS Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. CONCLUSIONS Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
Collapse
Affiliation(s)
- Shaun Palmer
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- International AIDS Vaccine InitiativeAmsterdamthe Netherlands
| | - Maartje Dijkstra
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Johannes CF Ket
- Medical LibraryVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elizabeth W Wahome
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | | | - Evanson Gichuru
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Elise M van der Elst
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Godelieve J de Bree
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- Department of Global Health, and Amsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
| |
Collapse
|
10
|
Stangl AL, Sebany M, Kapungu C, Jessee C, Ricker CL, Chard E. Is HIV index testing and partner notification safe for adolescent girls and young women in low- and middle-income countries? J Int AIDS Soc 2020; 23 Suppl 5:e25562. [PMID: 32869478 PMCID: PMC7459168 DOI: 10.1002/jia2.25562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION While HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15 to 24 and their sexual partners in need of HIV testing services, the potential social harms have not yet been studied. This commentary highlights the risks of this approach, including intimate partner violence (IPV), stigma and discrimination, and outlines an urgent research agenda to fully understand the potential harms of PN for AGYW, calling for the development of mitigation strategies. DISCUSSION A substantial evidence base exists demonstrating the feasibility, acceptability and effectiveness of index testing and partner notification for adults aged 18 years and older in low- and middle-income countries (LMICs), particularly for men, and for adults who are married/cohabiting and referring a current sexual partner. AGYW who are most vulnerable to HIV infection in LMICs do not reflect these demographics. Instead, they are often in age-disparate partnerships, have limited negotiating power within relationships, experience high rates of violence and face economic challenges that necessitate transactional sex. PN services may be particularly difficult for adolescent girls under 18 who face restrictions on their decision making and are at increased risk of rape. Adolescent girls may also face coercion to notify partners due to unequal power dynamics in the provider-adolescent client relationship, as well as judgemental attitudes towards adolescent sexual activity among providers. CONCLUSIONS As index testing and PN with AGYW is already being rolled out in some LMICs, research is urgently needed to assess its feasibility and acceptability. Implementation science studies should assess the availability, accessibility, acceptability and quality of HIV PN services for AGYW. Qualitative studies and routine monitoring with age-disaggregated data are critical to capture potential social harms, PN preferences and support needs for AGYW aged 15 to 17, 18 to 20 and 21 to 24. To mitigate potential harms, PN methods should prioritize confidentiality and avoidance of adverse outcomes. Healthcare providers should be trained to conduct routine enquiry for IPV and provide first-line support. Support services for AGYW living with HIV and survivors of violence should be implemented alongside HIV PN.
Collapse
Affiliation(s)
- Anne L Stangl
- International Center for Research on WomenWashingtonDCUSA
- Hera SolutionsBaltimoreMDUSA
| | - Meroji Sebany
- International Center for Research on WomenWashingtonDCUSA
| | | | - Cassandra Jessee
- International Center for Research on WomenWashingtonDCUSA
- Making Cents InternationalWashingtonDCUSA
| | - Chelsea L Ricker
- International Center for Research on WomenWashingtonDCUSA
- Independent ConsultantWashingtonDCUSA
| | | |
Collapse
|
11
|
Nichols BE, Offorjebe OA, Cele R, Shaba F, Balakasi K, Chivwara M, Hoffman RM, Long LC, Rosen S, Dovel K. Economic evaluation of facility-based HIV self-testing among adult outpatients in Malawi. J Int AIDS Soc 2020; 23:e25612. [PMID: 32909387 PMCID: PMC7507468 DOI: 10.1002/jia2.25612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) in outpatient departments (OPD) is a promising strategy for HIV testing in Malawi, given high OPD patient volumes and substantial wait times. To evaluate the relative cost and expected impact of facility-based HIVST (FB-HIVST) at OPDs in Malawi for increasing HIV status awareness, we conducted an economic evaluation of an HIVST cluster-randomized controlled trial. METHODS A cluster-randomized trial was conducted at 15 sites in Malawi from September 2017 to February 2018 with three arms: 1) Standard provider-initiated-testing-and-counselling (PITC); 2) Optimized PITC (additional provider training and job-aids) and 3) FB-HIVST (HIVST demonstration, distribution and kit use in OPD, private kit interpretation and optional HIV counselling). The total production cost per newly identified positive and per person newly initiated on ART were calculated by study arm. These were calculated as the total cost of testing everyone divided by the number of newly identified positives; and the total cost of testing everyone divided by the number of those initiated on ART. Cost-outcomes were calculated under three cost scenarios: (1) full study costs, (2) routine implementation costs and (3) routine implementation + reduced cost for HIVST kits. RESULTS The average cost per person newly diagnosed in the full study cost scenario was $101, $156 and $189, and cost per person initiated on ART was $121, $156 and $279 for Standard PITC, Optimized PITC and FB-HIVST respectively. In the routine implementation cost scenario, the average cost per person newly diagnosed was reduced to $83, and $93, and cost per person initiated on ART to $83, and $137 for Optimized PITC and FB-HIVST respectively. In the negotiated HIVST cost scenario, the average cost per person newly diagnosed was reduced to $55 and cost per person newly initiated on ART reduced to $81 in the FB-HIVST arm. CONCLUSIONS While the cost per new ART initiation through FB-HIVST was higher than Standard PITC, FB-HIVST could become cost-saving compared to PITC if the cost of kits is reduced or if treatment linkage rate were increased in the FB-HIVST arm. For high volume OPDs, HIVST may increase facility capacity and increase the number of newly diagnosed positives.
Collapse
Affiliation(s)
- Brooke E Nichols
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - O Agatha Offorjebe
- David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
- Charles R. Drew University of Medicine and ScienceLos AngelesCAUSA
| | - Refiloe Cele
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | - Risa M Hoffman
- Partners in HopeLilongweMalawi
- Division of Infectious DiseasesDepartment of MedicineUniversity of California Los AngelesLos AngelesCAUSA
| | - Lawrence C Long
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sydney Rosen
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Kathryn Dovel
- Partners in HopeLilongweMalawi
- Division of Infectious DiseasesDepartment of MedicineUniversity of California Los AngelesLos AngelesCAUSA
| |
Collapse
|
12
|
Sinha P, Singh VK, Saxena RK, Kale SM, Li Y, Garg V, Meifang T, Khan AW, Kim KD, Chitikineni A, Saxena KB, Sameer Kumar CV, Liu X, Xu X, Jackson S, Powell W, Nevo E, Searle IR, Lodha M, Varshney RK. Genome-wide analysis of epigenetic and transcriptional changes associated with heterosis in pigeonpea. Plant Biotechnol J 2020; 18:1697-1710. [PMID: 31925873 PMCID: PMC7336283 DOI: 10.1111/pbi.13333] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 12/26/2019] [Indexed: 05/20/2023]
Abstract
Hybrids are extensively used in agriculture to deliver an increase in yield, yet the molecular basis of heterosis is not well understood. Global DNA methylation analysis, transcriptome analysis and small RNA profiling were aimed to understand the epigenetic effect of the changes in gene expression level in the two hybrids and their parental lines. Increased DNA methylation was observed in both the hybrids as compared to their parents. This increased DNA methylation in hybrids showed that majority of the 24-nt siRNA clusters had higher expression in hybrids than the parents. Transcriptome analysis revealed that various phytohormones (auxin and salicylic acid) responsive hybrid-MPV DEGs were significantly altered in both the hybrids in comparison to MPV. DEGs associated with plant immunity and growth were overexpressed whereas DEGs associated with basal defence level were repressed. This antagonistic patterns of gene expression might contribute to the greater growth of the hybrids. It was also noticed that some common as well as unique changes in the regulatory pathways were associated with heterotic growth in both the hybrids. Approximately 70% and 67% of down-regulated hybrid-MPV DEGs were found to be differentially methylated in ICPH 2671 and ICPH 2740 hybrid, respectively. This reflected the association of epigenetic regulation in altered gene expressions. Our findings also revealed that miRNAs might play important roles in hybrid vigour in both the hybrids by regulating their target genes, especially in controlling plant growth and development, defence and stress response pathways. The above finding provides an insight into the molecular mechanism of pigeonpea heterosis.
Collapse
Affiliation(s)
- Pallavi Sinha
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | - Vikas K. Singh
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
- International Rice Research Institute, South‐Asia HubPatancheruIndia
| | - Rachit K. Saxena
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | - Sandip M. Kale
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
- The Leibniz Institute of Plant Genetics and Crop Plant ResearchGaterslebenGermany
| | | | - Vanika Garg
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | | | - Aamir W. Khan
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | - Kyung Do Kim
- University of GeorgiaAthensUSA
- Myongji UniversityYonginRepublic of Korea
| | - Annapurna Chitikineni
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | - K. B. Saxena
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | - C. V. Sameer Kumar
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| | | | - Xun Xu
- BGI‐ShenzhenShenzhenChina
| | | | | | | | | | - Mukesh Lodha
- Centre for Cellular and Molecular Biology (CSIR)HyderabadIndia
| | - Rajeev K. Varshney
- International Crops Research Institute for the Semi‐Arid Tropics (ICRISAT)PatancheruIndia
| |
Collapse
|
13
|
Golin R, Godfrey C, Firth J, Lee L, Minior T, Phelps BR, Raizes EG, Ake JA, Siberry GK. PEPFAR's response to the convergence of the HIV and COVID-19 pandemics in Sub-Saharan Africa. J Int AIDS Soc 2020; 23:e25587. [PMID: 32767707 PMCID: PMC7405155 DOI: 10.1002/jia2.25587] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemic would have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. This commentary reviews PEPFAR's COVID-19 technical guidance and provides country-specific examples of programme adaptions in sub-Saharan Africa. DISCUSSION The COVID-19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over-burdened health systems. Although there is currently limited understanding of how COVID-19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID-19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in-person home and facility visits and other direct contact when COVID-19 control measures are in effect. PEPFAR-supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID-19 in sub-Saharan Africa. CONCLUSIONS As community transmission of COVID-19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data-driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID-19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.
Collapse
Affiliation(s)
- Rachel Golin
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Catherine Godfrey
- Office of the U.S. Global AIDS Coordinator and Health DiplomacyWashingtonDCUSA
| | - Jacqueline Firth
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Lana Lee
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Thomas Minior
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - B Ryan Phelps
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | | | - Julie A Ake
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | - George K Siberry
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| |
Collapse
|
14
|
Wanga V, Omollo V, Bukusi EA, Odoyo JB, Morton JF, Kidoguchi L, Johnson R, Hughes JP, Celum C, Baeten JM. Uptake and impact of facility-based HIV self-testing on PrEP delivery: a pilot study among young women in Kisumu, Kenya. J Int AIDS Soc 2020; 23:e25561. [PMID: 32820597 PMCID: PMC7441009 DOI: 10.1002/jia2.25561] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION HIV testing is a required part of delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, repeat testing can be challenging in busy, under-staffed clinical settings, which could negatively impact PrEP uptake and continuation. We prospectively evaluated optional facility-based HIV self-testing (HIVST) among young women using PrEP in an implementation programme. METHODS Between February and November 2019, we collected data from young women receiving PrEP at two family planning facilities in Kisumu, Kenya. At each PrEP follow-up visit, women were given the option to choose between provider-initiated testing and HIVST. We assessed factors associated with HIVST uptake and compared satisfaction with HIV testing and clinic experience between acceptors and decliners of HIVST. RESULTS A total of 172 women were offered HIVST at 202 PrEP follow-up visits. The median age was 21 years, 27% had multiple partners and 15% reported previously using HIVST. HIVST was accepted at 34.7% (70/202) of visits. Age (adjusted relative risk (aRR) 1.09 per year, 95% CI (confidence interval) 1.01 to 1.18), never being married (aRR 1.81, 95% CI 1.11 to 2.95) and having more PrEP follow-up visits (aRR 1.13 per visit, 95% CI 1.04 to 1.23) were associated with HIVST uptake. Compared to HIVST decliners, HIVST acceptors were more likely to be very happy with their overall testing experience (73% vs. 47% of visits, p = 0.003) and were more likely to say they would use HIVST in the future (96% vs. 76%, p < 0.001). Women who accepted HIVST had shorter visits than those choosing standard provider-initiated HIV testing (median [IQR]: 33 [32, 38] vs. 54 [41.5, 81] minutes, p = 0.003). CONCLUSIONS In this pilot evaluation in Kenya, about one-third of women using PrEP opted for HIVST over provider-initiated testing, and those choosing HIVST spent less time in the clinic and were generally satisfied with their experience. HIVST in PrEP delivery is feasible and has the potential to simplify PrEP delivery and give clients testing autonomy. Additional studies are needed to explore optimal HIV retesting strategies in PrEP delivery, including the use of HIVST in PrEP at a larger scale and in different settings.
Collapse
Affiliation(s)
- Valentine Wanga
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Victor Omollo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Elizabeth A Bukusi
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
- Departments of Obstetrics and GynecologyUniversity of WashingtonSeattleWAUSA
| | - Josephine B Odoyo
- Centre for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Lara Kidoguchi
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Rachel Johnson
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - James P Hughes
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - Connie Celum
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jared M Baeten
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| |
Collapse
|
15
|
Hur J, West KP, Shamim AA, Rashid M, Labrique AB, Wu LS, Ali H, Ullah B, Schulze KJ, Klemm RD, Christian P. Thinness and fecundability: Time to pregnancy after adolescent marriage in rural Bangladesh. Matern Child Nutr 2020; 16:e12985. [PMID: 32207581 PMCID: PMC7296800 DOI: 10.1111/mcn.12985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 01/22/2023]
Abstract
Undernutrition may affect fecundability, but few studies have quantified this relationship. In rural Bangladesh, where newlywed couples face strong pressures to become pregnant, we assessed fecundability, estimated by time to pregnancy (TTP), and its association with preconceptional thinness among nulligravid, newlywed female adolescents. During 2001-2002, 5,516 newlywed women aged 12-19 years participated in a home-based, 5-weekly surveillance system for 5-6 years to enrol pregnant women into an antenatal vitamin A or β-carotene supplementation trial. Thinness was defined as a left mid-upper arm circumference (MUAC) ≤21.5 versus >21.5 cm. At each visit, staff obtained a monthly history of menstruation. Report of amenorrhea prompted a human chorionic gonadotropin urine test to confirm pregnancy. We derived hazard ratios (with 95% confidence intervals [CI]) for pregnancy and Kaplan-Meier curves for TTP. Ages of women at marriage and pregnancy detection (mean ± standard deviation) were 15.3 ± 1.9 and 17.0 ± 1.9 years, respectively. A total of 82.7% of thinner and 87.3% of better nourished women became pregnant. The unadjusted and multivariable relative hazard of ever becoming pregnant was 0.84 (95% CI [0.78, 0.89]) and 0.86 (95% CI [0.81, 0.92]), respectively, and TTP was 12 weeks longer (median [95% CI]: 63 [58-68] vs. 51 [49-54]) in women whose MUAC was ≤21.5 versus >21.5 cm. In rural Bangladesh, thin adolescent newlywed girls have a lower probability of becoming pregnant and experience a longer time to pregnancy.
Collapse
Affiliation(s)
- Jinhee Hur
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Keith P. West
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | | | - Alain B. Labrique
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Lee S.F. Wu
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | - Barkat Ullah
- Department of NutritionUniversity of California, DavisDavisCalifornia
| | - Kerry J. Schulze
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Rolf D.W. Klemm
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Parul Christian
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| |
Collapse
|
16
|
Fox MP, Brennan AT, Nattey C, MacLeod WB, Harlow A, Mlisana K, Maskew M, Carmona S, Bor J. Delays in repeat HIV viral load testing for those with elevated viral loads: a national perspective from South Africa. J Int AIDS Soc 2020; 23:e25542. [PMID: 32640101 PMCID: PMC7343337 DOI: 10.1002/jia2.25542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/24/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION In South Africa, HIV patients with an elevated viral load (VL) should receive repeat VL testing after adherence counselling. We set out to use a national HIV Cohort to describe time to repeat viral load testing across South Africa and identify predictors of time to repeat testing. METHODS We conducted a cohort study of prospectively collected laboratory data. HIV treatment guidelines have changed over time in South Africa, but call for repeat VL testing within six months if 400 to 1000 copies/mL and two to three months if >1000 copies/mL. We included patients with suppressed viral loads (indicating they are on ART) and a first elevated VL (>400 copies/mL) between April 2004 and December 2014. Follow-up began at first elevated VL and continued until repeat testing, loss to follow-up or December 2016. We calculated adjusted hazard ratios (aHR) using Cox proportional hazard models. RESULTS Of 371,648 patients with a VL > 400, 83.9% (311,790) had a repeat VL, in a median (IQR) of 7.0 (4.1 to 12.2) months. Of those with a first viral load 400 to 1000 copies/mL, 56.4% had a repeat VL within guideline recommended six months (defined as up to nine months), whereas among those >1000 copies/mL only 47.7% had a repeat viral load within guideline recommended two to three months (defined as up to six months). We found a small increase in repeat testing associated with higher VL value (aHR 1.11; 95% CI: 1.10 to 1.12 comparing >1000 vs 400 to 1000 copies/mL) and very low CD4 counts at first elevated VL (aHR 1.16; 95% CI: 1.13 to 1.19 comparing CD4 < 50 vs <500 cells/mm3 ). We also found strong variation in time to repeat VL testing by province. CONCLUSIONS Median time to repeat viral load testing for those with an elevated viral load was longer than guidelines recommend. Future work should identify whether delays are due to patient or provider factors.
Collapse
Affiliation(s)
- Matthew P Fox
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Alana T Brennan
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Cornelius Nattey
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - William B MacLeod
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Alyssa Harlow
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Koleka Mlisana
- National Health Laboratory ServiceJohannesburgSouth Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sergio Carmona
- National Health Laboratory ServiceJohannesburgSouth Africa
| | - Jacob Bor
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| |
Collapse
|
17
|
Virkud AV, Arimi P, Ssengooba F, Mulholland GE, Herce ME, Markiewicz M, Weir S, Edwards JK. Access to HIV prevention services in East African cross-border areas: a 2016-2017 cross-sectional bio-behavioural study. J Int AIDS Soc 2020; 23 Suppl 3:e25523. [PMID: 32602638 PMCID: PMC7325514 DOI: 10.1002/jia2.25523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/11/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION East African cross-border areas are visited by mobile and vulnerable populations, such as men, female sex workers, men who have sex with men, truck drivers, fisher folks and young women. These groups may not benefit from traditional HIV prevention interventions available at the health facilities where they live, but may benefit from services offered at public venues identified as places where people meet new sexual partners (e.g. bars, nightclubs, transportation hubs and guest houses). The goal of this analysis was to estimate availability, access and uptake of prevention services by populations who visit these venues. METHODS We collected cross-sectional data using the Priorities for Local AIDS Control Efforts sampling method at cross-border locations near or along the land and lake borders of Kenya, Rwanda, Tanzania and Uganda from June 2016-February 2017. This bio-behavioural survey captured information from a probability sample of 11,428 individuals at 833 venues across all areas. Data were weighted using survey sampling weights and analysed using methods to account for the complex sampling design. RESULTS Among the 85.6% of persons who had access to condoms, 60.5% did not use a condom at their last anal or vaginal sexual encounter. Venues visited by high percentages of persons living with HIV were not more likely than other venues to offer condoms. In 12 of the 22 cross-border areas, male or female condoms were available at less than 33% of the venues visited by persons having difficulty accessing condoms. In 17 of the 22 cross-border areas, education outreach visits in the preceding six months occurred at less than 50% of the venues where participants had low effective use of condoms. CONCLUSIONS Individuals visiting venues in cross-border areas report poor access to and low effective use of condoms and other prevention services. Availability of HIV prevention services differed by venue and population type and cross-border area, suggesting opportunities for more granular targeting of HIV prevention interventions and transnational coordination of HIV programming.
Collapse
Affiliation(s)
- Arti V Virkud
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Peter Arimi
- U.S. Agency for International DevelopmentKenya/East Africa Regional MissionNairobiKenya
| | - Freddie Ssengooba
- College of Health SciencesSchool of Public HealthMakerere UniversityKampalaUganda
| | - Grace E Mulholland
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael E Herce
- Department of MedicineDivision of Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Milissa Markiewicz
- MEASURE EvaluationCarolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Sharon Weir
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
- MEASURE EvaluationCarolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Jessie K Edwards
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| |
Collapse
|
18
|
Joseph Davey D, Kehoe K, Serrao C, Prins M, Mkhize N, Hlophe K, Sejake S, Malone T. Same-day antiretroviral therapy is associated with increased loss to follow-up in South African public health facilities: a prospective cohort study of patients diagnosed with HIV. J Int AIDS Soc 2020; 23:e25529. [PMID: 32510186 PMCID: PMC7277782 DOI: 10.1002/jia2.25529] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/09/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION South Africa introduced Universal Test and Treat in 2016 including antiretroviral therapy (ART) initiation on the same-day as HIV diagnosis. Our study sought to evaluate the impact of same-day ART initiation on loss to follow-up (LTFU) and mortality comparing with patients who initiated ART after their HIV diagnosis. METHODS We conducted a file review of patients with a HIV diagnosis and ART start date on file between September 2016 and May 2018 in six high HIV burden districts. Our primary outcome was LTFU (>90 days from the last clinical visit or drug pick-up until database closure 31 July 2018). The secondary outcome was mortality after ART initiation. Time to outcome was assessed comparing same-day vs. one to seven, eight to twenty-one and ≥ twenty-two days to ART initiation using Kaplan-Meier estimators stratified by sex. We investigated predictors using univariate and multivariable Cox proportional hazards models, adjusting for a priori characteristics. RESULTS Overall, 92,609 ART patients contributed 43,922 person-years from ART initiation, with a median follow-up time of 246 days (IQR = 112 to 455). Of these patients, 33,399 (36%) initiated ART on the same-day as their HIV diagnosis date and had a median follow-up time of 174 days (IQR = 85 to 349). Same-day patients were predominantly non-pregnant females (56%) and aged 25 to 34 years (40%). Same-day ART initiation increased from 2.8% in September 2016 to 7.1% in April 2018. In same-day patients, 33% (n = 11,114) were classified as LTFU with a median time of 55 days (IQR = 1 to 185), compared to 371 mean days (IQR = 161 to 560) in patients who initiated ≥22 days after diagnosis. A similar proportion of LTFU was observed for patients who initiated later: 31% 1 to 21 day and 33% ≥22 day. Same-day ART patients had an increased risk of LTFU vs. ≥1 day (adjusted hazard ratio (aHR) = 1.28, 95% CI = 1.24 to 1.33) adjusting for covariates. Although all-cause mortality was slightly lower in same-day patients (0.9%) vs. >1 day (1.4%; aHR = 0.87, 95% CI = 0.72 to 1.05) adjusting for covariates. Men had highest risk of mortality and LTFU. CONCLUSIONS Same-day ART increased the risk of LTFU, but same-day patients experienced slightly lower mortality. Same-day patients may require additional counselling and interventions to improve retention. Additional research is needed on targeted interventions, including differentiated care, to reduce LTFU in patients initiating ART same-day.
Collapse
Affiliation(s)
- Dvora Joseph Davey
- Department of EpidemiologyFielding School of Public HealthUniversity of CaliforniaLos AngelesCAUSA
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownSouth Africa
| | - Kathleen Kehoe
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownSouth Africa
| | | | | | | | | | | | | |
Collapse
|
19
|
Wall KM, Inambao M, Kilembe W, Karita E, Chomba E, Vwalika B, Mulenga J, Parker R, Sharkey T, Tichacek A, Hunter E, Yohnka R, Streeb G, Corso PS, Allen S. Cost-effectiveness of couples' voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework. J Int AIDS Soc 2020; 23 Suppl 3:e25522. [PMID: 32602618 PMCID: PMC7325504 DOI: 10.1002/jia2.25522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Couples' voluntary HIV counselling and testing (CVCT) is a high-impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost-per-HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost-effectiveness. METHODS We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling-up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs-per-couple tested were also estimated based on our previous studies. We used these parameters as well as country-specific inputs to model the impact of CVCT over a five-year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs-per-HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. RESULTS We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs-per-HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country's President's Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost-per-couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. CONCLUSIONS Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries' five-year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.
Collapse
Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of EpidemiologyRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologyNdola Central HospitalNdolaZambia
| | - William Kilembe
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Etienne Karita
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | | | - Bellington Vwalika
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Joseph Mulenga
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Rachel Parker
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Tyronza Sharkey
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Eric Hunter
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Pathology & Laboratory MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
- Emory Vaccine CenterYerkes National Primate Research CenterEmory UniversityAtlantaGAUSA
| | - Robert Yohnka
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Gordon Streeb
- Departments of Economics and Political ScienceEmory UniversityAtlantaGAUSA
| | | | - Susan Allen
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| |
Collapse
|
20
|
Beesham I, Welch JD, Heffron R, Pleaner M, Kidoguchi L, Palanee‐Phillips T, Ahmed K, Baron D, Bukusi EA, Louw C, Mastro TD, Smit J, Batting JR, Malahleha M, Bailey VC, Beksinska M, Donnell D, Baeten JM. Integrating oral PrEP delivery among African women in a large HIV endpoint-driven clinical trial. J Int AIDS Soc 2020; 23:e25491. [PMID: 32396700 PMCID: PMC7217491 DOI: 10.1002/jia2.25491] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/17/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Global guidelines emphasize the ethical obligation of investigators to help participants in HIV-endpoint trials reduce HIV risk by offering an optimal HIV prevention package. Oral pre-exposure prophylaxis (PrEP) has increasingly become part of state-of-the-art HIV prevention. Here we describe the process of integrating oral PrEP delivery into the HIV prevention package of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. METHODS ECHO was an open-label randomized clinical trial that compared HIV incidence among women randomized to one of three effective contraceptives. In total, 7830 women aged 16 to 35 years from 12 sites in four African countries (Eswatini, Kenya, South Africa and Zambia) were enrolled and followed for 12 to 18 months, from 2015 to 2018. Part-way through the course of the trial, oral PrEP was provided to study participants either off-site via referral or on site via trained trial staff. PrEP uptake was compared between different contraceptive users using Chi-squared tests or t-tests. HIV seroincidence rates were compared between participants who never versus ever initiated PrEP using exact Poisson regression. RESULTS PrEP access in ECHO began through public availability in Kenya in May 2017 and was available at all sites by June 2018. When PrEP became available, 3626 (46.3%) eligible women were still in follow-up in the study, and of these, 622 (17.2%) initiated PrEP. Women initiating PrEP were slightly older; more likely to be unmarried, not living with their partner, having multiple partners; and less likely to be earning their own income and receiving financial support from partners (all p < 0.05). PrEP initiation did not differ across study randomized groups (p = 0.7). Two-thirds of PrEP users were continuing PrEP at study exit. CONCLUSIONS There is a need for improved HIV prevention services in clinical trials with HIV endpoints, especially trials among African women. PrEP as a component of a comprehensive HIV prevention package provided to women in a large clinical trial is practical and feasible. Provision of PrEP within clinical trials with HIV outcomes should be standard of prevention.
Collapse
Affiliation(s)
- Ivana Beesham
- MatCH Research Unit (MRU)Faculty of Health SciencesUniversity of the WitwatersrandDurbanSouth Africa
| | | | | | - Melanie Pleaner
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Thesla Palanee‐Phillips
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Deborah Baron
- Wits Reproductive Health and HIV InstituteFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elizabeth A Bukusi
- University of WashingtonSeattleWAUSA
- Kenya Medical Research Institute (KEMRI)NairobiKenya
| | - Cheryl Louw
- Madibeng Centre for ResearchBritsSouth Africa
- Department of Family MedicineFaculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
| | | | - Jennifer Smit
- MatCH Research Unit (MRU)Faculty of Health SciencesUniversity of the WitwatersrandDurbanSouth Africa
| | - Joanne R Batting
- Effective Care Research Unit (ECRU)Fort Hare and Eastern Cape Department of HealthUniversities of the WitwatersrandEast LondonSouth Africa
| | | | | | - Mags Beksinska
- MatCH Research Unit (MRU)Faculty of Health SciencesUniversity of the WitwatersrandDurbanSouth Africa
| | | | | |
Collapse
|
21
|
Nyblade L, Addo NA, Atuahene K, Alsoufi N, Gyamera E, Jacinthe S, Leonard M, Mingkwan P, Stewart C, Vormawor R, Kraemer JD. Results from a difference-in-differences evaluation of health facility HIV and key population stigma-reduction interventions in Ghana. J Int AIDS Soc 2020; 23:e25483. [PMID: 32329153 PMCID: PMC7180216 DOI: 10.1002/jia2.25483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. METHODS We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). RESULTS We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. CONCLUSIONS These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.
Collapse
Affiliation(s)
- Laura Nyblade
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Nii A Addo
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | | | - Emma Gyamera
- Educational Assessment Research Centre (EARC)AccraGhana
| | | | - Madeline Leonard
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| | - Pia Mingkwan
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | - Christin Stewart
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Research Triangle Institute (RTI) InternationalResearch Triangle ParkNCUSA
| | | | - John D Kraemer
- Global Health DivisionResearch Triangle Institute (RTI) InternationalWashingtonDCUSA
- Department of Health Systems AdministrationGeorgetown UniversityWashingtonDCUSA
| |
Collapse
|
22
|
Sheu Y, Zurano JP, Ribeiro‐Junior MA, Ávila‐Pires TC, Rodrigues MT, Colli GR, Werneck FP. The combined role of dispersal and niche evolution in the diversification of Neotropical lizards. Ecol Evol 2020; 10:2608-2625. [PMID: 32185006 PMCID: PMC7069304 DOI: 10.1002/ece3.6091] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/23/2023] Open
Abstract
Ecological requirements and environmental conditions can influence diversification across temporal and spatial scales. Understanding the role of ecological niche evolution under phylogenetic contexts provides insights on speciation mechanisms and possible responses to future climatic change. Large-scale phyloclimatic studies on the megadiverse Neotropics, where biomes with contrasting vegetation types occur in narrow contact, are rare. We integrate ecological and biogeographic data with phylogenetic comparative methods, to investigate the relative roles of biogeographic events and niche divergence and conservatism on the diversification of the lizard genus Kentropyx Spix, 1825 (Squamata: Teiidae), distributed in South American rainforests and savannas. Using five molecular markers, we estimated a dated species tree, which recovered three clades coincident with previously proposed species groups diverging during the mid-Miocene. Biogeography reconstruction indicates a role of successive dispersal events from an ancestral range in the Brazilian Shield and western Amazonia. Ancestral reconstruction of climatic tolerances and niche overlap metrics indicates a trend of conservatism during the diversification of groups from the Amazon Basin and Guiana Shield, and a strong signal of niche divergence in the Brazilian Shield savannas. Our results suggest that climatic-driven divergence at dynamic forest-savanna borders might have resulted in adaptation to new environmental niches, promoting habitat shifts and shaping speciation patterns of Neotropical lizards. Dispersal and ecological divergence could have a more important role in Neotropical diversification than previously thought.
Collapse
Affiliation(s)
- Yumi Sheu
- Programa de Pós‐Graduação em GenéticaConservação e Biologia EvolutivaInstituto Nacional de Pesquisas do AmazôniaManausBrasil
- Programa de Pós‐Graduação em Genética e MelhoramentoUniversidade Federal do Espírito SantoEspírito SantoBrasil
| | - Juan P. Zurano
- Departamento de Sistemática e EcologiaUniversidade Federal da ParaíbaJoão PessoaBrasil
| | | | | | - Miguel T. Rodrigues
- Departamento de ZoologiaInstituto de BiociênciasUniversidade de São PauloSão PauloBrasil
| | - Guarino R. Colli
- Departamento de ZoologiaInstituto de Ciências BiológicasUniversidade de BrasíliaBrasíliaBrasil
| | - Fernanda P. Werneck
- Programa de Coleções Científicas BiológicasCoordenação de BiodiversidadeInstituto Nacional de Pesquisas da AmazôniaManausBrasil
- Department of Organismic and Evolutionary BiologyMuseum of Comparative BiologyHarvard UniversityCambridgeMAUSA
| |
Collapse
|
23
|
Simmonds SE, Fritts‐Penniman AL, Cheng SH, Mahardika GN, Barber PH. Genomic signatures of host-associated divergence and adaptation in a coral-eating snail, Coralliophila violacea (Kiener, 1836). Ecol Evol 2020; 10:1817-1837. [PMID: 32128119 PMCID: PMC7042750 DOI: 10.1002/ece3.5977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
The fluid nature of the ocean, combined with planktonic dispersal of marine larvae, lowers physical barriers to gene flow. However, divergence can still occur despite gene flow if strong selection acts on populations occupying different ecological niches. Here, we examined the population genomics of an ectoparasitic snail, Coralliophila violacea (Kiener 1836), that specializes on Porites corals in the Indo-Pacific. Previous genetic analyses revealed two sympatric lineages associated with different coral hosts. In this study, we examined the mechanisms promoting and maintaining the snails' adaptation to their coral hosts. Genome-wide single nucleotide polymorphism (SNP) data from type II restriction site-associated DNA (2b-RAD) sequencing revealed two differentiated clusters of C. violacea that were largely concordant with coral host, consistent with previous genetic results. However, the presence of some admixed genotypes indicates gene flow from one lineage to the other. Combined, these results suggest that differentiation between host-associated lineages of C. violacea is occurring in the face of ongoing gene flow, requiring strong selection. Indeed, 2.7% of all SNP loci were outlier loci (73/2,718), indicative of divergence with gene flow, driven by adaptation of each C. violacea lineage to their specific coral hosts.
Collapse
Affiliation(s)
- Sara E. Simmonds
- Department of Ecology and Evolutionary BiologyUniversity of California Los AngelesLos AngelesCAUSA
| | | | - Samantha H. Cheng
- Department of Ecology and Evolutionary BiologyUniversity of California Los AngelesLos AngelesCAUSA
- Center for Biodiversity and ConservationAmerican Museum of Natural HistoryNew YorkNYUSA
| | - Gusti Ngurah Mahardika
- Animal Biomedical and Molecular Biology LaboratoryFaculty of Veterinary MedicineUdayana University BaliDenpasarIndonesia
| | - Paul H. Barber
- Department of Ecology and Evolutionary BiologyUniversity of California Los AngelesLos AngelesCAUSA
| |
Collapse
|
24
|
Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Women's bargaining power and child feeding in Nepal: Linkages through nutrition information. Matern Child Nutr 2020; 16:e12883. [PMID: 31386796 PMCID: PMC7038888 DOI: 10.1111/mcn.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 12/05/2022]
Abstract
Women's intra-household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross-sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0-23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision-making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision-making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender-related issues that underlie child nutrition outcomes.
Collapse
Affiliation(s)
- Shibani Kulkarni
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Edward A. Frongillo
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | | | - Spencer Moore
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| | - Christine E. Blake
- Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth Carolina
| |
Collapse
|
25
|
Hannan A, Heckert J, James‐Hawkins L, Yount KM. Cognitive interviewing to improve women's empowerment questions in surveys: Application to the health and nutrition and intrahousehold relationships modules for the project-level Women's Empowerment in Agriculture Index. Matern Child Nutr 2020; 16:e12871. [PMID: 31288300 PMCID: PMC7038906 DOI: 10.1111/mcn.12871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/22/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
In 2015, the United Nations adopted the Sustainable Development Goals, which include fostering gender equality and women's empowerment and ending hunger and malnutrition. To monitor progress and evaluate programmes that aim to achieve these goals, survey instruments are needed that can accurately assess related indicators. The project-level Women's Empowerment in Agriculture Index (pro-WEAI) is being developed to address the need for an instrument that is sensitive to changes in empowerment over the duration of an intervention. The pro-WEAI includes new modules with previously untested survey questions, including a health and nutrition module (focused on women's agency in this area) and an intrahousehold relationships module. This study uses cognitive interviewing to identify how new survey questions might be misinterpreted and to understand what experiences women are referencing when they respond to these questions. This was undertaken with the goal of informing revision to the modules. The study was conducted in Bangladesh with women from nuclear, extended, and migrant-sending households and from two regions of the country to identify difficulties with interpretation and response formulation across these groups. Findings revealed that questions were generally understood, but participants occasionally responded to the wrong part of the question, did not understand key phrases, or were uncomfortable with questions. The findings also suggested ways to revise the modules and strengthen the pro-WEAI. The revised pro-WEAI health and nutrition and intrahousehold relationships modules will advance the ability to measure changes in these domains and their relationship with the health and nutritional status of women and their children.
Collapse
Affiliation(s)
- Anika Hannan
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- ICF, International Health and DivisionRockvilleMarylandUSA
| | - Jessica Heckert
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Department of SociologyEmory UniversityAtlantaGeorgiaUSA
| |
Collapse
|
26
|
González Fernández L, Casas EC, Singh S, Churchyard GJ, Brigden G, Gotuzzo E, Vandevelde W, Sahu S, Ahmedov S, Kamarulzaman A, Ponce‐de‐León A, Grinsztejn B, Swindells S. New opportunities in tuberculosis prevention: implications for people living with HIV. J Int AIDS Soc 2020; 23:e25438. [PMID: 31913556 PMCID: PMC6947976 DOI: 10.1002/jia2.25438] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/27/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is a leading cause of mortality among people living with HIV (PLHIV). An invigorated global END TB Strategy seeks to increase efforts in scaling up TB preventive therapy (TPT) as a central intervention for HIV programmes in an effort to contribute to a 90% reduction in TB incidence and 95% reduction in mortality by 2035. TPT in PLHIV should be part of a comprehensive approach to reduce TB transmission, illness and death that also includes TB active case-finding and prompt, effective and timely initiation of anti-TB therapy among PLHIV. However, the use and implementation of preventive strategies has remained deplorably inadequate and today TB prevention among PLHIV has become an urgent priority globally. DISCUSSION We present a summary of the current and novel TPT regimens, including current evidence of use with antiretroviral regimens (ART). We review challenges and opportunities to scale-up TB prevention within HIV programmes, including the use of differentiated care approaches and demand creation for effective TB/HIV services delivery. TB preventive vaccines and diagnostics, including optimal algorithms, while important topics, are outside of the focus of this commentary. CONCLUSIONS A number of new tools and strategies to make TPT a standard of care in HIV programmes have become available. The new TPT regimens are safe and effective and can be used with current ART, with attention being paid to potential drug-drug interactions between rifamycins and some classes of antiretrovirals. More research and development is needed to optimize TPT for small children, pregnant women and drug-resistant TB (DR-TB). Effective programmatic scale-up can be supported through context-adapted demand creation strategies and the inclusion of TPT in client-centred services, such as differentiated service delivery (DSD) models. Robust collaboration between the HIV and TB programmes represents a unique opportunity to ensure that TB, a preventable and curable condition, is no longer the number one cause of death in PLHIV.
Collapse
Affiliation(s)
| | - Esther C Casas
- Southern Africa Medical UnitMédecins Sans FrontièresCape TownSouth Africa
| | | | - Gavin J Churchyard
- Aurum InstituteParktownSouth Africa
- School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
- Advancing Care and Treatment for TB/HIVSouth African Medical Research CouncilParktownSouth Africa
| | - Grania Brigden
- Department of TuberculosisInternational Union Against Tuberculosis and Lung DiseaseGenevaSwitzerland
| | - Eduardo Gotuzzo
- Department of Medicine and Director of the “Alexander von Humboldt” Institute of Tropical Medicine and Infectious DiseasesPeruvian University Cayetano HerediaLimaPeru
| | - Wim Vandevelde
- Global Network of People living with HIV (GNP+)Cape TownSouth Africa
| | | | - Sevim Ahmedov
- Bureau for Global Health, Infectious Diseases, TB DivisionUSAIDWashingtonDCUSA
| | | | - Alfredo Ponce‐de‐León
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | | |
Collapse
|
27
|
Doss CR, Quisumbing AR. Understanding rural household behavior: Beyond Boserup and Becker. Agric Econ 2020; 51:47-58. [PMID: 32322130 PMCID: PMC7161923 DOI: 10.1111/agec.12540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 05/28/2023]
Abstract
New data and new methods have provided many new insights into rural households in the past 50 years. We analyze what we have learned from household models since Boserup and Becker, using this to frame more recent findings about household behavior from three types of studies: observational studies, experimental games, and impact evaluations. More sex-disaggregated data, as well as data that are collected at smaller units, such as agricultural plots, have allowed us to better understand agricultural productivity, risk sharing, and spousal cooperation. However, the focus on bargaining within households has often led us to ignore the cooperation that occurs within households. Many resources are owned and managed jointly by household members and many decisions are made jointly, although not all parties necessarily have equal voice in these decisions. Research demonstrating that households often do not reach efficient outcomes suggests that we still have much to learn about rural household behavior. Understanding both individual roles within households and the levels of cooperation, including joint decision making and ownership of resources, is essential to analysis of households, especially in rural areas where households engage in both production and consumption.
Collapse
Affiliation(s)
- Cheryl R. Doss
- Oxford Department of International DevelopmentUniversity of OxfordOxfordUK
| | | |
Collapse
|
28
|
Pettit AC, Jenkins CA, Blevins Peratikos M, Yotebieng M, Diero L, Do CD, Ross J, Veloso VG, Hawerlander D, Marcy O, Shepherd BE, Fenner L, Sterling TR. Directly observed therapy and risk of unfavourable tuberculosis treatment outcomes among an international cohort of people living with HIV in low- and middle-income countries. J Int AIDS Soc 2019; 22:e25423. [PMID: 31814312 PMCID: PMC6900483 DOI: 10.1002/jia2.25423] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Identification of persons living with human immunodeficiency virus (HIV)-associated tuberculosis (TB) at increased risk for unfavourable TB outcomes would inform efforts to improve such outcomes. We sought to identify factors associated with a decreased risk of unfavourable TB treatment outcomes among people living with HIV-infection (PLHIV) in low- and middle-income countries (LMIC), with a specific focus on directly observed therapy (DOT) compared with self-administered therapy (SAT) during the continuation phase of anti-TB therapy. METHODS We conducted a retrospective cohort study among adults diagnosed with HIV-associated TB in Africa, Asia and the Americas from 2012 to 2013; data were collected from 2012 to 2016. Unfavourable TB treatment outcomes (death during TB treatment, and TB treatment failure or recurrence) were defined according to World Health Organization criteria. Receipt of DOT was obtained at the site level and defined as ≥5 days of DOT per week. The person administering DOT and treatment location varied by site. Lack of receipt of DOT was defined as SAT. Multivariable logistic regression estimated the adjusted odds of unfavourable TB treatment outcomes. RESULTS Among 1862 adults with HIV-associated TB included, 252 (13.5%) had unfavourable TB outcomes (226 deaths, 26 recurrences/failures). Overall, 1825 (98%) received DOT in the intensive phase and 1617 (87%) received DOT in the continuation phase. DOT in the continuation phase was not significantly associated with unfavourable TB outcomes (aOR 1.43, 95% CI 0.86 to 2.38) compared to SAT. Body mass index (BMI) change during anti-TB treatment (per 2 units increase, aOR 0.74, 95% CI 0.68 to 0.82) and CD4+ count at TB diagnosis (200 vs. 50 cells/µL, aOR 0.54, 95% CI 0.39 to 0.73) were both independently associated with decreased odds of unfavourable TB treatment outcomes. CONCLUSIONS In this large, international cohort of people living with HIV-associated TB in LMIC who received intensive phase DOT, DOT during the continuation phase of anti-TB therapy was not associated with a decreased odds of unfavourable TB treatment outcomes compared to SAT. Randomized trials evaluating the effect of continuation-phase DOT on TB outcomes among PLHIV are needed.
Collapse
Affiliation(s)
- April C Pettit
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | | | | | - Lameck Diero
- Academic Model Providing Access To Healthcare (AMPATH)EldoretKenya
| | | | - Jeremy Ross
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrazil
| | - Denise Hawerlander
- Centre Intégré de Recherches Biocliniques d'Abidjan CIRBAAbidjanCôte d'Ivoire
| | - Olivier Marcy
- Centre INSERM U1219Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Lukas Fenner
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Timothy R Sterling
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
| | | |
Collapse
|
29
|
Duncan EM, Broderick AC, Fuller WJ, Galloway TS, Godfrey MH, Hamann M, Limpus CJ, Lindeque PK, Mayes AG, Omeyer LCM, Santillo D, Snape RTE, Godley BJ. Microplastic ingestion ubiquitous in marine turtles. Glob Chang Biol 2019; 25:744-752. [PMID: 30513551 PMCID: PMC6849705 DOI: 10.1111/gcb.14519] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/15/2018] [Indexed: 05/18/2023]
Abstract
Despite concerns regarding the environmental impacts of microplastics, knowledge of the incidence and levels of synthetic particles in large marine vertebrates is lacking. Here, we utilize an optimized enzymatic digestion methodology, previously developed for zooplankton, to explore whether synthetic particles could be isolated from marine turtle ingesta. We report the presence of synthetic particles in every turtle subjected to investigation (n = 102) which included individuals from all seven species of marine turtle, sampled from three ocean basins (Atlantic [ATL]: n = 30, four species; Mediterranean (MED): n = 56, two species; Pacific (PAC): n = 16, five species). Most particles (n = 811) were fibres (ATL: 77.1% MED: 85.3% PAC: 64.8%) with blue and black being the dominant colours. In lesser quantities were fragments (ATL: 22.9%: MED: 14.7% PAC: 20.2%) and microbeads (4.8%; PAC only; to our knowledge the first isolation of microbeads from marine megavertebrates). Fourier transform infrared spectroscopy (FT-IR) of a subsample of particles (n = 169) showed a range of synthetic materials such as elastomers (MED: 61.2%; PAC: 3.4%), thermoplastics (ATL: 36.8%: MED: 20.7% PAC: 27.7%) and synthetic regenerated cellulosic fibres (SRCF; ATL: 63.2%: MED: 5.8% PAC: 68.9%). Synthetic particles being isolated from species occupying different trophic levels suggest the possibility of multiple ingestion pathways. These include exposure from polluted seawater and sediments and/or additional trophic transfer from contaminated prey/forage items. We assess the likelihood that microplastic ingestion presents a significant conservation problem at current levels compared to other anthropogenic threats.
Collapse
Affiliation(s)
- Emily M. Duncan
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
- College of Life and Environmental Sciences: BiosciencesUniversity of ExeterExeterUK
- Marine Ecology and BiodiversityPlymouth Marine LaboratoryPlymouthUK
| | - Annette C. Broderick
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
| | - Wayne J. Fuller
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
- Faculty of Veterinary MedicineNear East UniversityNicosiaNorth CyprusTurkey
- Society for Protection of TurtlesKyreniaNorth CyprusTurkey
| | - Tamara S. Galloway
- College of Life and Environmental Sciences: BiosciencesUniversity of ExeterExeterUK
| | | | - Mark Hamann
- College of Science and EngineeringJames Cook UniversityTownsvilleQLDAustralia
| | - Colin J. Limpus
- Department of Environment and ScienceThreatened Species UnitBrisbaneQLDAustralia
| | | | - Andrew G. Mayes
- School of ChemistryUniversity of East Anglia, Norwich Research ParkNorwichUK
| | - Lucy C. M. Omeyer
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
| | - David Santillo
- Greenpeace Research Laboratories, School of Biosciences, Innovation Centre Phase 2University of ExeterExeterUK
| | - Robin T. E. Snape
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
- Society for Protection of TurtlesKyreniaNorth CyprusTurkey
| | - Brendan J. Godley
- Marine Turtle Research Group, Centre for Ecology and ConservationUniversity of ExeterPenrynUK
| |
Collapse
|
30
|
Schneider K, Masters WA. Orange Fanta versus orange fruit: A novel measure of nutrition knowledge in Malawi. Matern Child Nutr 2019; 15:e12656. [PMID: 30142703 PMCID: PMC7199062 DOI: 10.1111/mcn.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/30/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
This paper introduces a novel survey instrument to identify distinct components of nutrition knowledge and test for links between knowledge and dietary choices in Southern Malawi. Our first aim is to distinguish respondents' familiarity with recommended behaviours, such as when to start breastfeeding or introduce solid foods, from respondents' factual knowledge about mechanisms, such as whether biscuits or papaya and orange fruit or orange Fanta contribute more to future health. We find knowledge of nutrition behaviours to be strongly associated with more schooling, older age, and being female, whereas knowledge of mechanisms is associated only with training and employment as a health professional. We then test whether this expanded definition of nutrition knowledge is associated with dietary intake when controlling for other factors and find no significant links in these data. Results point to the need for knowledge surveys and public health behaviour-change campaigns to address the kinds of information that might have the most influence on actual behaviour, potentially including the mechanisms involved in food composition, food safety, and disease transmission.
Collapse
Affiliation(s)
- Kate Schneider
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - William A. Masters
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| |
Collapse
|
31
|
Nyhus Dhillon C, Sarkar D, Klemm RDW, Neufeld LM, Rawat R, Tumilowicz A, Namaste SML. Executive summary for the Micronutrient Powders Consultation: Lessons Learned for Operational Guidance. Matern Child Nutr 2017; 13 Suppl 1:e12493. [PMID: 28960876 PMCID: PMC5656884 DOI: 10.1111/mcn.12493] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 01/23/2023]
Abstract
Iron deficiency anaemia is estimated to be the leading cause of years lived with disability among children. Young children's diets are often inadequate in iron and other micronutrients, and provision of essential vitamin and minerals has long been recommended. With the limited programmatic success of iron drop/syrup interventions, interest in micronutrient powders (MNP) has increased. MNP are a mixture of vitamins and minerals, enclosed in single-dose sachets, which are stirred into a child's portion of food immediately before consumption. MNP are an efficacious intervention for reducing iron deficiency anaemia and filling important nutrient gaps in children 6-23 months of age. As of 2014, 50 countries have implemented MNP programmes including 9 at a national level. This paper provides an overview of a 3-paper series, based on findings from the "Micronutrient Powders Consultation: Lessons Learned for Operational Guidance" held by the USAID-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. The objectives of the Consultation were to identify and summarize the most recent MNP programme experiences and lessons learned for operationalizing MNP for young children and prioritize an implementation research agenda. The Consultation was composed of 3 working groups that used the following methods: deliberations among 49 MNP programme implementers and experts, a review of published and grey literature, questionnaires, and key informant interviews, described in this overview. The following articles summarize findings in 3 broad programme areas: planning, implementation, and continual programme improvement. The papers also outline priorities for implementation research to inform improved operationalization of MNP.
Collapse
Affiliation(s)
| | - Danya Sarkar
- Strengthening Partnerships, Results, and Innovations in Nutrition GloballyArlingtonVirginiaUSA
- John Snow, Inc.ArlingtonVAUSA
| | - Rolf DW Klemm
- Helen Keller InternationalWashingtonDistrict of ColumbiaUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Rahul Rawat
- International Food Policy Research InstituteDakarSenegal
- Bill and Melinda Gates FoundationSeattleWashingtonUSA
| | | | - Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition GloballyArlingtonVirginiaUSA
- Helen Keller InternationalWashingtonDistrict of ColumbiaUSA
| |
Collapse
|