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  • Liver function test abnormalities in a longitudinal cohort of Thai individuals treated since acute HIV infection
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-17
    Michael J Peluso; Donn J Colby; Suteeraporn Pinyakorn; Sasiwimol Ubolyam; Jintana Intasan; Rapee Trichavaroj; Nitiya Chomchey; Peeriya Prueksakaew; Bonnie M Slike; Shelly J Krebs; Ningbo Jian; Merlin L Robb; Praphan Phanuphak; Nittaya Phanuphak; Serena Spudich; Jintanat Ananworanich; Eugène Kroon;

    Liver disease is a common cause of non‐AIDS morbidity and mortality in people living with HIV (PLHIV), but the prevalence and significance of liver function test (LFT) abnormalities in early HIV infection is unknown. This study aimed to characterize LFTs in a large cohort of participants with acute HIV infection initiating immediate antiretroviral therapy (ART) and examine the association between LFTs and biomarkers of HIV infection and inflammation.

    更新日期:2020-01-21
  • Mortality from HIV‐associated meningitis in sub‐Saharan Africa: a systematic review and meta‐analysis
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-19
    Mark W Tenforde; Alida M Gertz; David S Lawrence; Nicola K Wills; Brandon L Guthrie; Carey Farquhar; Joseph N Jarvis

    HIV‐associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub‐Saharan Africa (SSA). We performed a systematic review and meta‐analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings.

    更新日期:2020-01-21
  • Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-20
    Ram K Shrestha; Pollyanna R Chavez; Meredith Noble; Stephanie L Sansom; Patrick S Sullivan; Jonathan H Mermin; Robin J MacGowan

    HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost‐effectiveness of a self‐testing programme.

    更新日期:2020-01-21
  • Linkages to HIV confirmatory testing and antiretroviral therapy after online, supervised, HIV self‐testing among Thai men who have sex with men and transgender women
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-20
    Nittaya Phanuphak; Jureeporn Jantarapakde; Linrada Himmad; Thanthip Sungsing; Ratchadaporn Meksena; Sangusa Phomthong; Petchfa Phoseeta; Sumitr Tongmuang; Pravit Mingkwanrungruang; Dusita Meekrua; Supachai Sukthongsa; Somporn Hongwiangchan; Nutchanin Upanun; Supunnee Jirajariyavej; Tanate Jadwattanakul; Supphadith Barisri; Tippawan Pankam; Praphan Phanuphak

    Online, supervised, HIV self‐testing has potential to reach men who have sex with men (MSM) and transgender women (TGW) who never tested before and who had high HIV‐positive yield. We studied linkages to HIV confirmatory test and antiretroviral therapy (ART) initiation among Thai MSM and TGW who chose online and/or offline platforms for HIV testing and factors associated with unsuccessful linkages.

    更新日期:2020-01-21
  • HIV seroconcordance among heterosexual couples in rural KwaZulu‐Natal, South Africa: a population‐based analysis
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-08
    Hae‐Young Kim; Guy Harling; Alain Vandormael; Andrew Tomita; Diego F Cuadros; Till Bärnighausen; Frank Tanser

    High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub‐Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa.

    更新日期:2020-01-09
  • Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-08
    Dvora L Joseph Davey; Jillian Pintye; Jared M Baeten; Grace Aldrovandi; Rachel Baggaley; Linda‐Gail Bekker; Connie Celum; Benjamin H Chi; Thomas J Coates; Jessica E Haberer; Renee Heffron; John Kinuthia; Lynn T Matthews; James McIntyre; Dhayendre Moodley; Lynne M Mofenson; Nelly Mugo; Landon Myer; Andrew Mujugira; Steven Shoptaw; Lynda Stranix‐Chibanda; Grace John‐Stewart;

    HIV incidence is high during pregnancy and breastfeeding with HIV acquisition risk more than doubling during pregnancy and the postpartum period compared to when women are not pregnant. The World Health Organization recommends offering pre‐exposure prophylaxis (PrEP) to pregnant and postpartum women at substantial risk of HIV infection. However, maternal PrEP national guidelines differ and most countries with high maternal HIV incidence are not offering PrEP. We conducted a systematic review of recent research on PrEP safety in pregnancy to inform national policy and rollout.

    更新日期:2020-01-08
  • Viral load assay performs comparably to early infant diagnosis assay to diagnose infants with HIV in Mozambique: a prospective observational study
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-08
    Adolfo Vubil; Carina Nhachigule; Osvaldo Loquiha; Bindiya Meggi; Nedio Mabunda; Timothy Bollinger; Jilian A Sacks; Ilesh Jani; Lara Vojnov

    Viral load testing is essential to manage HIV disease, especially in infants and children. Early infant diagnosis is performed using nucleic‐acid testing in children under 18 months. Resource‐limited health systems face severe challenges to scale‐up both viral load and early infant diagnosis to unprecedented levels. Streamlining laboratory systems would be beneficial to improve access to quality testing and to increase efficiency of antiretroviral treatment programmes. We evaluated the performance of viral load testing to serve as an early infant diagnosis assay in children younger than 18 months.

    更新日期:2020-01-08
  • New opportunities in tuberculosis prevention: implications for people living with HIV
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-08
    Lucia González Fernández; Esther C Casas; Satvinder Singh; Gavin J Churchyard; Grania Brigden; Eduardo Gotuzzo; Wim Vandevelde; Suvanand Sahu; Sevim Ahmedov; Adeeba Kamarulzaman; Alfredo Ponce‐de‐León; Beatriz Grinsztejn; Susan Swindells

    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.

    更新日期:2020-01-08
  • Electronic and other new media technology interventions for HIV care and prevention: a systematic review
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2020-01-07
    Kevin M Maloney; Anna Bratcher; Ryan Wilkerson; Patrick S Sullivan

    Electronic and other new media technologies (eHealth) can facilitate large‐scale dissemination of information and effective delivery of interventions for HIV care and prevention. There is a need to both monitor a rapidly changing pipeline of technology‐based care and prevention methods and to assess whether the interventions are appropriately diversified. We systematically review and critically appraise the research pipeline of eHealth interventions for HIV care and prevention, including published studies and other funded projects.

    更新日期:2020-01-07
  • Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-20
    Adam W Carrico; Torsten B Neilands; Samantha E Dilworth; Jennifer L Evans; Walter Gόmez; Jennifer P Jain; Monica Gandhi; Steven Shoptaw; Keith J Horvath; Lara Coffin; Michael V Discepola; Rick Andrews; William J Woods; Daniel J Feaster; Judith T Moskowitz

    In the era of HIV treatment as prevention (TasP), evidence‐based interventions that optimize viral suppression among people who use stimulants such as methamphetamine are needed to improve health outcomes and reduce onward transmission risk. We tested the efficacy of positive affect intervention delivered during community‐based contingency management (CM) for reducing viral load in sexual minority men living with HIV who use methamphetamine.

    更新日期:2019-12-20
  • Estimation of new HIV diagnosis rates among high‐risk, PrEP‐eligible individuals using HIV surveillance data at the Metropolitan Statistical Area level in the United States
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-20
    Robertino Mera; Susan Scheer; Christoph Carter; Moupali Das; Julius Asubonteng; Scott McCallister; Jared Baeten

    New HIV diagnoses have fallen in the past decade due to increased HIV testing, earlier diagnosis, earlier antiretroviral treatment, improved linkage to care and engagement in care, and the recent increased uptake of pre‐exposure prophylaxis (PrEP). We propose a novel method to compute the rate of new HIV diagnoses at the Metropolitan Statistical Area (MSA) level in the US to support the evaluation of comprehensive treatment and prevention efforts over time.

    更新日期:2019-12-20
  • High levels of pretreatment and acquired HIV drug resistance in Nicaragua: results from the first nationally representative survey, 2016
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-20
    Amalia Girón‐Callejas; Claudia García‐Morales; Ricardo Mendizabal‐Burastero; Matilde Román; Daniela Tapia‐Trejo; Marissa Pérez‐García; Verónica S Quiroz‐Morales; Sandra I Juárez; Giovanni Ravasi; Carlos Vargas; René Gutiérrez; Luz Romero; Aleyda Solórzano; Edgar Sajquim; Sanny Northbrook; Santiago Ávila‐Ríos; Gustavo Reyes‐Terán

    A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48).

    更新日期:2019-12-20
  • Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Pich Seekaew; Supabhorn Pengnonyang; Jureeporn Jantarapakde; Ratchadaporn Meksena; Thanthip Sungsing; Sita Lujintanon; Pravit Mingkwanrungruangkit; Waraporn Sirisakyot; Sumitr Tongmuang; Phubet Panpet; Saman Sumalu; Phonpiphat Potasin; Supapun Kantasaw; Pongpeera Patpeerapong; Stephen Mills; Matthew Avery; Sutinee Chareonying; Praphan Phanuphak; Ravipa Vannaki; Nittaya Phanuphak

    Low uptake of HIV testing and services, including pre‐exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self‐risk assessment. This study investigated the discordance between self‐perceived HIV risk and actual risk.

    更新日期:2019-12-19
  • Epidemiological impact and cost‐effectiveness of providing long‐acting pre‐exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Marjolein M van Vliet; Cheryl Hendrickson; Brooke E Nichols; Charles AB Boucher; Remco PH Peters; David AMC van de Vijver

    Although pre‐exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub‐Saharan Africa, likely due to non‐adherence. Adherence may be improved with the use of injectable long‐acting PrEP methods currently being developed. We hypothesize that providing long‐acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy‐to‐reach target population. In this modelling study, we assessed the epidemiological impact and cost‐effectiveness of providing long‐acting PrEP to injectable contraceptive users in Limpopo, South Africa.

    更新日期:2019-12-19
  • Temporal changes in ART initiation in adults with high CD4 counts in Latin America: a cohort study
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Brenda E Crabtree‐Ramírez; Yanink Caro‐Vega; Pablo F Belaunzarán‐Zamudio; Bryan E Shepherd; Peter F Rebeiro; Valdilea Veloso; Claudia P Cortes; Denis Padgett; Eduardo Gotuzzo; Juan Sierra‐Madero; Catherine C McGowan; Anna K Person;

    In 2013, the World Health Organization (WHO) recommended initiating combination ART (cART) in all adults with HIV and CD4+ lymphocyte counts (CD4) <500 cells/mm3. In 2015, this was updated to recommend cART initiation in all patients with HIV, regardless of CD4 count. Implementation of these guidelines in real‐world settings has not been evaluated in Latin America. To assess changes in time to cART initiation during routine care, we estimated trends in time from enrolment in care to cART initiation in HIV‐positive adults with high CD4 counts in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) during 2003 to 2017.

    更新日期:2019-12-19
  • Socio‐behavioural characteristics and HIV: findings from a graphical modelling analysis of 29 sub‐Saharan African countries
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Zofia Baranczuk; Janne Estill; Sara Blough; Sonja Meier; Aziza Merzouki; Marloes H Maathuis; Olivia Keiser

    Socio‐behavioural factors may contribute to the wide variance in HIV prevalence between and within sub‐Saharan African (SSA) countries. We studied the associations between socio‐behavioural variables potentially related to the risk of acquiring HIV.

    更新日期:2019-12-19
  • Pepfar 3.0’s HIV testing policy in Côte d'Ivoire (2014 to 2018): fragmentation, acceleration and disconnection
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Anne Bekelynck; Joseph Larmarange;

    HIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Côte d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services.

    更新日期:2019-12-19
  • Limitations of dual‐fluorescent HIV reporter viruses in a model of pre‐activation latency
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-19
    Youry Kim; Paul U Cameron; Sharon R Lewin; Jenny L Anderson

    HIV latency can be established in vitro following direct infection of a resting CD4+ T cell (pre‐activation latency) or infection of an activated CD4+ T cell which then returns to a resting state (post‐activation latency). We modified a previously published dual‐fluorescent reporter virus seeking to track the establishment and reactivation of pre‐activation latency in primary CD4+ T cells.

    更新日期:2019-12-19
  • Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-18
    Tamara Elliott; Eduard J Sanders; Meg Doherty; Thumbi Ndung'u; Myron Cohen; Pragna Patel; Gus Cairns; Sarah E Rutstein; Jintanat Ananworanich; Colin Brown; Sarah Fidler

    Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV‐status unawareness represents a significant challenge for achieving zero new HIV infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV‐specific antibody point‐of‐care tests (POCT). These POCTs do not detect acute HIV infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre‐exposure prophylaxis (PrEP) or post‐exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of acute HIV infection, may yield false‐negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV infection.

    更新日期:2019-12-19
  • HIV‐associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-18
    Tomer Barak; Dayna T Neo; Neo Tapela; Patricia Mophuthegi; Rebbeca Zash; Ketenga Kalenga; Melissa EO Perry; Mompati Malane; Joseph Makhema; Shahin Lockman; Roger Shapiro

    Antiretroviral therapy (ART) has significantly improved survival in Africa in recent years. In Botswana, where adult HIV prevalence is 21.9%, AIDS‐related mortality is estimated to have declined by 58% between 2005 and 2013 following the initial wide‐spread introduction of ART, and ART coverage has steadily increased reaching 84% in 2016. However, there remains little data about the burden of HIV and its impact on mortality in the hospital setting where most deaths occur. We aimed to describe the burden of HIV and related morbidity and mortality among hospitalized medical patients in a district hospital in southern Botswana in the era of widespread ART coverage.

    更新日期:2019-12-19
  • Development of parallel measures to assess HIV stigma and discrimination among people living with HIV, community members and health workers in the HPTN 071 (PopART) trial in Zambia and South Africa
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-16
    Anne L Stangl; Pamela Lilleston; Hlengani Mathema; Triantafyllos Pliakas; Shari Krishnaratne; Kirsty Sievwright; Nomhle Bell‐Mandla; Redwaan Vermaak; Tila Mainga; Mara Steinhaus; Deborah Donnell; Ab Schaap; Peter Bock; Helen Ayles; Richard Hayes; Graeme Hoddinott; Virginia Bond; James R Hargreaves;

    Integrating standardized measures of HIV stigma and discrimination into research studies of emerging HIV prevention approaches could enhance uptake and retention of these approaches, and care and treatment for people living with HIV (PLHIV), by informing stigma mitigation strategies. We sought to develop a succinct set of measures to capture key domains of stigma for use in research on HIV prevention technologies.

    更新日期:2019-12-17
  • 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. (IF 5.192) Pub Date : 2019-12-08
    April C Pettit, Cathy A Jenkins, Meridith Blevins Peratikos, Marcel Yotebieng, Lameck Diero, Cuong D Do, Jeremy Ross, Valdilea G Veloso, Denise Hawerlander, Olivier Marcy, Bryan E Shepherd, Lukas Fenner, Timothy R Sterling,

    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.

    更新日期:2019-12-09
  • Two‐drug antiretroviral regimens: an assessment of virologic response and durability among treatment‐experienced persons living with HIV in the OPERA® Observational Database
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-04
    Gerald Pierone, Cassidy Henegar, Jennifer Fusco, Vani Vannappagari, Michael Aboud, Leigh Ragone, Gregory Fusco

    Two‐drug regimens (2‐DR) have the potential to be a viable solution to the challenges of treatment complexity, cost, adverse effects and contraindications. We sought to describe the real‐world use and effectiveness of 2‐DR among persons living with HIV (PLHIV) in the United States.

    更新日期:2019-12-05
  • HIV risk among young women who sell sex by whether they identify as sex workers: analysis of respondent‐driven sampling surveys, Zimbabwe, 2017
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-12-03
    Bernadette Hensen, Sungai T Chabata, Sian Floyd, Tarisai Chiyaka, Phillis Mushati, Joanna Busza, Isolde Birdthistle, James R Hargreaves, Frances M Cowan

    Across sub‐Saharan Africa, selling sex puts young women at high risk of HIV. Some young women who sell sex (YWSS) may self‐identify as sex workers, while others may not, having implications for how to reach them with HIV prevention. We describe characteristics, sexual behaviours and health service use of YWSS in Zimbabwe, comparing women who identified as female sex workers (FSW) and women who did not (non‐identifying‐YWSS), and explore factors associated with HIV infection.

    更新日期:2019-12-03
  • HIV pretreatment drug resistance among cisgender MSM and transgender women from Lima, Peru
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-27
    William L Trebelcock, Javier R Lama, Ann Duerr, Hugo Sanchez, Robinson Cabello, Trupti Gilada, Patricia Segura, Sari L Reisner, Kenneth H Mayer, James Mullins, Rachel A Bender Ignacio

    Transmitted, or any pretreatment drug resistance (TDR, PDR) can compromise efficacy of first‐line antiretroviral therapy (ART). In Peru, genotypic resistance testing is not routinely performed before ART initiation, and estimated PDR prevalence prior to 2012 ranged from 1.0% to 4.7%. We aimed to update estimates of PDR prevalence in men who have sex with men (cis‐MSM) and transgender women (TW).

    更新日期:2019-11-28
  • HIV viral resuppression following an elevated viral load: a systematic review and meta‐analysis
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-20
    Nathan Ford, Catherine Orrell, Zara Shubber, Tsitsi Apollo, Lara Vojnov

    Guidelines for antiretroviral therapy recommend enhanced adherence counselling be provided to individuals with an initial elevated viral load before making a decision whether to switch antiretroviral regimen. We undertook this systematic review to estimate the proportion of patients with an initial elevated viral load who resuppress following enhanced adherence counselling.

    更新日期:2019-11-20
  • Comparison of cumulative viraemia following treatment initiation with different antiretroviral regimens: a real‐life study in Brazil
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-19
    Ana R Pascom, Rosana EGG Pinho, Fernanda Rick, Nazle MC Veras, Filipe de Barros Perini, Mariana V Meireles, Gerson F Pereira, Adele S Benzaken, Vivian I Avelino‐Silva

    The relative efficacy of different antiretroviral (ART) regimens has been extensively evaluated in the context of clinical trials, using HIV viral load (VL) measurements at pre‐specified timepoints after ART onset. However, data from real‐life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different ART regimens on HIV cumulative viraemia over the first 12 months after treatment initiation, using programmatic data from the Ministry of Health of Brazil.

    更新日期:2019-11-20
  • What impact could DMPA use have had in South Africa and how might its continued use affect the future of the HIV epidemic?
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-15
    Leo Beacroft, Jennifer A Smith, Timothy B Hallett

    Some studies suggest that use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase susceptibility to HIV infection. We aim to determine the influence that such an association could have had on the HIV epidemic in South Africa.

    更新日期:2019-11-15
  • High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-15
    Hongjing Yan, Wenjing Xiao, Yunting Chen, Yuanfang Chen, Jessica Lin, Zihan Yan, Erin Wilson, Willi McFarland

    Transgender women may face the highest prevalence of HIV of any population, experiencing a disproportionate burden of disease frequently confirmed in surveys throughout the developing and developed world. However, few studies have been conducted specifically for transgender women in China. This study aimed to measure HIV prevalence and explore risk factors for infection in a diverse sample of Chinese transgender women to help advocate for prevention and care interventions for this population.

    更新日期:2019-11-15
  • Stunting and growth velocity of adolescents with perinatally acquired HIV: differential evolution for males and females. A multiregional analysis from the IeDEA global paediatric collaboration
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-08
    Julie Jesson, Michael Schomaker, Karen Malasteste, Dewi K Wati, Azar Kariminia, Mariam Sylla, Kouakou Kouadio, Shobna Sawry, Mwangelwa Mubiana‐Mbewe, Samuel Ayaya, Rachel Vreeman, Catherine C McGowan, Marcel Yotebieng, Valériane Leroy, Mary‐Ann Davies,

    Stunting is a key issue for adolescents with perinatally acquired HIV (APH) that needs to be better understood. As part of the IeDEA multiregional consortium, we described growth evolution during adolescence for APH on antiretroviral therapy (ART).

    更新日期:2019-11-08
  • Transgender women on oral HIV pre‐exposure prophylaxis have significantly lower tenofovir and emtricitabine concentrations when also taking oestrogen when compared to cisgender men
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-06
    Eugenie Shieh, Mark A Marzinke, Edward J Fuchs, Allyson Hamlin, Rahul Bakshi, Wutyi Aung, Jennifer Breakey, Tonia Poteat, Todd Brown, Namandjé N Bumpus, Craig W Hendrix

    Oral HIV Pre‐Exposure Prophylaxis (PrEP) with tenofovir (TFV) disoproxil fumarate (TDF)/emtricitabine (FTC) is highly effective. Transgender women (TGW) have increased HIV risk, but have been underrepresented in trials. For TGW on oestrogens for gender‐affirming hormone treatment (GAHT), TDF/FTC‐oestrogen interactions may negatively affect HIV prevention or gender‐affirming goals. Our aim was to evaluate any pharmacokinetic drug‐drug interaction between GAHT and TDF/FTC.

    更新日期:2019-11-06
  • Differentiated HIV care in South Africa: the effect of fast‐track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-05
    Sophie JS Pascoe, Matthew P Fox, Amy N Huber, Joshua Murphy, Mokgadi Phokojoe, Marelize Gorgens, Sydney Rosen, David Wilson, Yogan Pillay, Nicole Fraser‐Hurt

    In response to suboptimal adherence and retention, South Africa’s National Department of Health developed and implemented National Adherence Guidelines for Chronic Diseases. We evaluated the effect of a package of adherence interventions beginning in January 2016 and report on the impact of Fast‐Track Treatment Initiation Counselling (FTIC) on ART initiation, adherence and retention.

    更新日期:2019-11-06
  • Engaging men in HIV programmes: a qualitative study of male engagement in community‐based antiretroviral refill groups in Zimbabwe
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-11-05
    Joanne E Mantell, Tsitsi B Masvawure, Munyaradzi Mapingure, Tsitsi Apollo, Clorata Gwanzura, Laura Block, Eleanor Bennett, Peter Preko, Godfrey Musuka, Miriam Rabkin

    Suboptimal male engagement in HIV programmes is a persistent challenge, leading to lower coverage of HIV testing, prevention and treatment services, and to worse outcomes for men. Differentiated service delivery models, such as peer‐led community antiretroviral refill groups (CARGs), offer the opportunity to enhance patient satisfaction, retention and treatment outcomes. We conducted an exploratory qualitative study to identify facilitators and barriers to CARG participation by HIV‐positive men, with inputs from recipients of HIV care, community members, healthcare workers (HCWs), donors and policymakers.

    更新日期:2019-11-06
  • Applying the Behavioural and Social Sciences Research (BSSR) Functional Framework to HIV Cure Research
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-10-30
    Karine Dubé, Judith D Auerbach, Michael J Stirratt, Paul Gaist

    The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine. However, the field has yet to tap into the full potential of behavioural and social sciences research (BSSR). In this article, we apply Gaist and Stirratt’s BSSR Functional Framework to the field of HIV cure research.

    更新日期:2019-11-01
  • Longitudinal changes in HIV DNA in HIV controllers: what do they mean?
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-02-16
    Denise C Hsu,John W Mellors

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • Questionable assumptions mar modelling of Kenya home-based testing campaigns.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-01-23
    Reuben Granich,Somya Gupta,Brian G Williams

    更新日期:2019-11-01
  • Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2018-10-24
    Kathryn E Lancaster,Irving F Hoffman,Brett Hanscom,Tran Viet Ha,Kostyantyn Dumchev,Hepa Susami,Scott Rose,Vivian F Go,Sarah A Reifeis,Katie R Mollan,Michael G Hudgens,Estelle M Piwowar-Manning,Paul Richardson,Sergii Dvoriak,Zubairi Djoerban,Tetiana Kiriazova,Oleksandr Zeziulin,Samsuridjal Djauzi,Chu Viet Ahn,Carl Latkin,David Metzger,David N Burns,Jeremy Sugarman,Steffanie A Strathdee,Susan H Eshleman,William Clarke,Deborah Donnell,Lynda Emel,Lisa E Sunner,Laura McKinstry,Nirupama Sista,Erica L Hamilton,Jonathan P Lucas,Bui D Duong,Nguyen Van Vuong,Riza Sarasvita,William C Miller,

    INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

    更新日期:2019-11-01
  • Erratum.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-04-16

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  • Long term outcomes of antiretroviral therapy in a large HIV/AIDS care clinic in urban South Africa: a prospective cohort study.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2009-12-19
    Ian M Sanne,Daniel Westreich,Andrew P Macphail,Dennis Rubel,Pappie Majuba,Annelies Van Rie

    BACKGROUND Clinical, immunologic and virologic outcomes at large HIV/AIDS care clinics in resource poor settings are poorly described beyond the first year of highly active antiretroviral treatment (HAART). We aimed to prospectively evaluate long-term treatment outcomes at a large scale HIV/AIDS care clinic in South Africa. METHODS Cohort study of patients initiating HAART between April 1, 2004 and March 13, 2007, and followed up until April 1, 2008 at a public HIV/AIDS care clinic in Johannesburg, South Africa. We performed time to event analysis on key treatment outcomes and program impact parameters including mortality, retention in care, CD4 count gain, virologic success and first line regimen durability. RESULTS 7583 HIV-infected patients initiated care and contributed to 161,000 person months follow up. Overall mortality rate was low (2.9 deaths per 100 person years, 95% CI 2.6-3.2), but high in the first three months of HAART (8.4 per 100 person years, 95% CI 7.2-9.9). Long-term on-site retention in care was relatively high (74.4% at 4 years, 95%CI 73.2-75.6). CD4 count was above 200 cells/mm(3 )after 6 months of treatment in almost all patients. By the fourth year of HAART, the majority (59.6%, 95%CI 57.8-61.4) of patients had at least one first line drug (mainly stavudine) substituted. Women were twice as likely to experience drug substitution (OR 1.97, 95% CI 1.80-2.16). By 6 months of HAART, 90.8% suppressed virus below 400 copies. Among those with initial viral suppression, 9.4% (95% CI 8.5-10.3%) had viral rebound within one year of viral suppression, 16.8% (95% CI 15.5-18.1) within 2 years, and 20.6% (95% CI 18.9-22.4) within 3 years of initial suppression. Only 10% of women and 13% of men initiated second line HAART. CONCLUSION Despite advanced disease presentation and a very large-scale program, high quality care was achieved as indicated by good long-term clinical, immunologic and virologic outcomes and a low rate of second line HAART initiation. High rates of single drug substitution suggest that the public health approach to HAART could be further improved by the use of a more durable first line regimen.

    更新日期:2019-11-01
  • Optimal timing of viral load monitoring during pregnancy to predict viraemia at delivery in HIV-infected women initiating ART in South Africa: a simulation study.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2017-11-25
    Maia Lesosky,Tracy Glass,Elton Mukonda,Nei-Yuan Hsiao,Elaine J Abrams,Landon Myer

    INTRODUCTION HIV viral load (VL) monitoring is a central tool to evaluate ART effectiveness and transmission risk. There is a global movement to expand VL monitoring following recent recommendations from the World Health Organization (WHO), but there has been little research into VL monitoring in pregnant women. We investigated one important question in this area: when and how frequently VL should be monitored in women initiating ART during pregnancy to predict VL at the time of delivery in a simulated South African population. METHODS We developed a mathematical model simulating VL from conception through delivery using VL data from the Maternal and Child Health - Antiretroviral Therapy (MCH-ART) cohort. VL was modelled based on three major compartments: pre-ART VL, viral decay immediately after ART initiation and viral maintenance (including viral suppression and viraemic episodes). Using this simulation, we examined the performance of various VL monitoring schema in predicting elevated VL at delivery. RESULTS AND DISCUSSION If WHO guidelines for non-pregnant adults were used, the majority of HIV-infected pregnant women (69%) would not receive a VL test during pregnancy. Most models that based VL monitoring in pregnancy on the time elapsed since ART initiation (regardless of gestation) performed poorly (sensitivity <50%); models that based VL measures in pregnancy on the woman's gestation (regardless of time on ART) appeared to perform better overall (sensitivity >60%). Across all permutations, inclusion of pre-ART VL values had a negligible impact on predictive performance (improving test sensitivity and specificity <6%). Performance of VL monitoring in predicting VL at delivery generally improved at later gestations, with the best performing option a single VL measure at 36 weeks' gestation. CONCLUSIONS Development and evaluation of a novel simulation model suggests that strategies to measure VL relative to gestational age may be more useful than strategies relative to duration on ART, in women initiating ART during pregnancy, supporting better integration of maternal and HIV health services. Testing turnaround times require careful consideration, and point-of-care VL testing may be the best approach for measuring VL at delivery. Broadening the scope of this simulation model in the light of current scale up of VL monitoring in high burden countries is important.

    更新日期:2019-11-01
  • Returning HIV-1 viral load results to participant-selected health facilities in national Population-based HIV Impact Assessment (PHIA) household surveys in three sub-Saharan African Countries, 2015 to 2016.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2017-11-25
    Suzue Saito,Yen T Duong,Melissa Metz,Kiwon Lee,Hetal Patel,Katrina Sleeman,Julius Manjengwa,Francis M Ogollah,Webster Kasongo,Rick Mitchell,Owen Mugurungi,Frank Chimbwandira,Crispin Moyo,Vusumuzi Maliwa,Helecks Mtengo,Tepa Nkumbula,Clement B Ndongmo,Nora Skutayi Vere,Geoffrey Chipungu,Bharat S Parekh,Jessica Justman,Andrew C Voetsch

    INTRODUCTION Logistical complexities of returning laboratory test results to participants have precluded most population-based HIV surveys conducted in sub-Saharan Africa from doing so. For HIV positive participants, this presents a missed opportunity for engagement into clinical care and improvement in health outcomes. The Population-based HIV Impact Assessment (PHIA) surveys, which measure HIV incidence and the prevalence of viral load (VL) suppression in selected African countries, are returning VL results to health facilities specified by each HIV positive participant within eight weeks of collection. We describe the performance of the specimen and data management systems used to return VL results to PHIA participants in Zimbabwe, Malawi and Zambia. METHODS Consenting participants underwent home-based counseling and HIV rapid testing as per national testing guidelines; all confirmed HIV positive participants had VL measured at a central laboratory on either the Roche CAP/CTM or Abbott m2000 platform. On a bi-weekly basis, a dedicated data management team produced logs linking the VL test result with the participants' contact information and preferred health facility; project staff sent test results confidentially via project drivers, national courier systems, or electronically through an adapted short message service (SMS). Participants who provided cell phone numbers received SMS or phone call alerts regarding availability of VL results. RESULTS AND DISCUSSION From 29,634 households across the three countries, 78,090 total participants 0 to 64 years in Zimbabwe and Malawi and 0 to 59 years in Zambia underwent blood draw and HIV testing. Of the 8391 total HIV positive participants identified, 8313 (99%) had VL tests performed and 8245 (99%) of these were returned to the selected health facilities. Of the 5979 VL results returned in Zimbabwe and Zambia, 85% were returned within the eight-week goal with a median turnaround time of 48 days (IQR: 33 to 61). In Malawi, where exact return dates were unavailable all 2266 returnable results reached the health facilities by 11 weeks. CONCLUSIONS The first three PHIA surveys returned the vast majority of VL results to each HIV positive participant's preferred health facility within the eight-week target. Even in the absence of national VL monitoring systems, a system to return VL results from a population-based survey is feasible, but it requires developing laboratory and data management systems and dedicated staff. These are likely important requirements to strengthen return of results systems in routine clinical care.

    更新日期:2019-11-01
  • Botswana should consider expansion of free antiretroviral therapy to immigrants.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-06-14
    Daniel J Escudero,Tafireyi Marukutira,Alethea McCormick,Joseph Makhema,George R Seage

    更新日期:2019-11-01
  • The case for viral load testing in adolescents in resource-limited settings.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2017-11-25
    Rebecca Marcus,Rashida A Ferrand,Katharina Kranzer,Linda-Gail Bekker

    INTRODUCTION The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, particularly in sub-Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90-90-90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. DISCUSSION Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second-line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third-line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. CONCLUSIONS Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale-up.

    更新日期:2019-11-01
  • Disability and HIV/AIDS - a systematic review of literature on Africa.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2009-11-17
    Jill Hanass-Hancock

    This systematic review focuses on empirical work on disability and HIV/AIDS in Africa in the past decade and considers all the literature currently accessible. The review presents data from different surveys and summarizes the findings. In this way, it convincingly reveals that people with disabilities are very vulnerable to contracting HIV, and lack access to information, testing and treatment. The review further reveals gaps in the research and areas of concern. While vulnerability and accessibility have been investigated, there are few prevalence studies or evaluations available. A certain amount of work has focused on the deaf population, but little has been done for other disability groups. A growing area of concern is sexual abuse and exploitation of people with disabilities. Only a few studies or interventions focus on this crucial area.

    更新日期:2019-11-01
  • Variables that influence HIV-1 cerebrospinal fluid viral load in cryptococcal meningitis: a linear regression analysis.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2009-11-13
    Diego M Cecchini,Ana M Cañizal,Haroldo Rojas,Alicia Arechavala,Ricardo Negroni,María B Bouzas,Jorge A Benetucci

    BACKGROUND The central nervous system is considered a sanctuary site for HIV-1 replication. Variables associated with HIV cerebrospinal fluid (CSF) viral load in the context of opportunistic CNS infections are poorly understood. Our objective was to evaluate the relation between: (1) CSF HIV-1 viral load and CSF cytological and biochemical characteristics (leukocyte count, protein concentration, cryptococcal antigen titer); (2) CSF HIV-1 viral load and HIV-1 plasma viral load; and (3) CSF leukocyte count and the peripheral blood CD4+ T lymphocyte count. METHODS Our approach was to use a prospective collection and analysis of pre-treatment, paired CSF and plasma samples from antiretroviral-naive HIV-positive patients with cryptococcal meningitis and assisted at the Francisco J Muñiz Hospital, Buenos Aires, Argentina (period: 2004 to 2006). We measured HIV CSF and plasma levels by polymerase chain reaction using the Cobas Amplicor HIV-1 Monitor Test version 1.5 (Roche). Data were processed with Statistix 7.0 software (linear regression analysis). RESULTS Samples from 34 patients were analyzed. CSF leukocyte count showed statistically significant correlation with CSF HIV-1 viral load (r = 0.4, 95% CI = 0.13-0.63, p = 0.01). No correlation was found with the plasma viral load, CSF protein concentration and cryptococcal antigen titer. A positive correlation was found between peripheral blood CD4+ T lymphocyte count and the CSF leukocyte count (r = 0.44, 95% CI = 0.125-0.674, p = 0.0123). CONCLUSION Our study suggests that CSF leukocyte count influences CSF HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans.

    更新日期:2019-11-01
  • Anonymous HIV workplace surveys as an advocacy tool for affordable private health insurance in Namibia.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2009-11-13
    Ingrid de Beer,Hannah M Coutinho,Peter J van Wyk,Esegiel Gaeb,Tobias Rinke de Wit,Michèle van Vugt

    BACKGROUND With an estimated adult HIV prevalence of 15%, Namibia is in need of innovative health financing strategies that can alleviate the burden on the public sector. Affordable and private health insurances were recently developed in Namibia, and they include coverage for HIV/AIDS. This article reports on the efficacy of HIV workplace surveys as a tool to increase uptake of these insurances by employees in the Namibian formal business sector. In addition, the burden of HIV among this population was examined by sector. METHODS Cross-sectional anonymous HIV prevalence surveys were conducted in 24 private companies in Namibia between November 2006 and December 2007. Non-invasive oral fluid-based HIV antibody rapid tests were used. Anonymous test results were provided to the companies in a confidential report and through presentations to their management, during which the advantages of affordable private health insurance and the available insurance products were discussed. Impact assessment was conducted in October 2008, when new health insurance uptake by these companies was evaluated. RESULTS Of 8500 targeted employees, 6521 were screened for HIV; mean participation rate was 78.6%. Overall 15.0% (95% CI 14.2-15.9%) of employees tested HIV positive (range 3.0-23.9% across companies). The mining sector had the highest percentage of HIV-positive employees (21.0%); the information technology (IT) sector had the lowest percentage (4.0%). Out of 6205 previously uninsured employees, 61% had enrolled in private health insurance by October 2008. The majority of these new insurances (78%) covered HIV/AIDS only. CONCLUSION The proportion of HIV-positive formal sector employees in Namibia is in line with national prevalence estimates and varies widely by employment sector. Following the surveys, there was a considerable increase in private health insurance uptake. This suggests that anonymous HIV workplace surveys can serve as a tool to motivate private companies to provide health insurance to their workforce. Health insurance taken up by those who are able to pay the fees will alleviate the burden on the public sector.

    更新日期:2019-11-01
  • The fields of HIV and disability: past, present and future.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2009-11-11
    Jill Hanass-Hancock,Stephanie A Nixon

    This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years.

    更新日期:2019-11-01
  • Building effective multilevel HIV prevention partnerships with Black men who have sex with men: experience from HPTN 073, a pre-exposure prophylaxis study in three US cities.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2018-10-20
    Darrell P Wheeler,Jonathan Lucas,Leo Wilton,LaRon E Nelson,Christopher Hucks-Ortiz,C Chauncey Watson,Craig Hutchinson,Kenneth H Mayer,Irene Kuo,Manya Magnus,Geetha Beauchamp,Steven Shoptaw,Lynda Marie Emel,Ying Q Chen,Lisa Hightow-Weidman,Sheldon D Fields

    更新日期:2019-11-01
  • Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068).
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2018-02-28
    Kelly N Kilburn,Audrey Pettifor,Jessie K Edwards,Amanda Selin,Rhian Twine,Catherine MacPhail,Ryan Wagner,James P Hughes,Jing Wang,Kathleen Kahn

    INTRODUCTION Evidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12 months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV. METHODS HPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13-20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N = 2,448) were interviewed at baseline, then at annual follow-up visits at 12, 24 and 36 months. The total effect of the CCT on IPV was estimated using a GEE log-binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures. RESULTS We found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59-0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48-0.65] or under no sexual partner in the last 12 months [RR 0.53, CI(95%):0.46-0.60]. CONCLUSIONS Results indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.

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  • Community engagement in the provision of culturally competent HIV and STI prevention services: lessons from the French experience in the era of PrEP.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-08-31
    Daniela Rojas Castro,Rosemary M Delabre,Stéphane Morel,David Michels,Bruno Spire

    更新日期:2019-11-01
  • Adjusting HIV prevalence estimates for non-participation: an application to demographic surveillance.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2015-11-29
    Mark E McGovern,Giampiero Marra,Rosalba Radice,David Canning,Marie-Louise Newell,Till Bärnighausen

    INTRODUCTION HIV testing is a cornerstone of efforts to combat the HIV epidemic, and testing conducted as part of surveillance provides invaluable data on the spread of infection and the effectiveness of campaigns to reduce the transmission of HIV. However, participation in HIV testing can be low, and if respondents systematically select not to be tested because they know or suspect they are HIV positive (and fear disclosure), standard approaches to deal with missing data will fail to remove selection bias. We implemented Heckman-type selection models, which can be used to adjust for missing data that are not missing at random, and established the extent of selection bias in a population-based HIV survey in an HIV hyperendemic community in rural South Africa. METHODS We used data from a population-based HIV survey carried out in 2009 in rural KwaZulu-Natal, South Africa. In this survey, 5565 women (35%) and 2567 men (27%) provided blood for an HIV test. We accounted for missing data using interviewer identity as a selection variable which predicted consent to HIV testing but was unlikely to be independently associated with HIV status. Our approach involved using this selection variable to examine the HIV status of residents who would ordinarily refuse to test, except that they were allocated a persuasive interviewer. Our copula model allows for flexibility when modelling the dependence structure between HIV survey participation and HIV status. RESULTS For women, our selection model generated an HIV prevalence estimate of 33% (95% CI 27-40) for all people eligible to consent to HIV testing in the survey. This estimate is higher than the estimate of 24% generated when only information from respondents who participated in testing is used in the analysis, and the estimate of 27% when imputation analysis is used to predict missing data on HIV status. For men, we found an HIV prevalence of 25% (95% CI 15-35) using the selection model, compared to 16% among those who participated in testing, and 18% estimated with imputation. We provide new confidence intervals that correct for the fact that the relationship between testing and HIV status is unknown and requires estimation. CONCLUSIONS We confirm the feasibility and value of adopting selection models to account for missing data in population-based HIV surveys and surveillance systems. Elements of survey design, such as interviewer identity, present the opportunity to adopt this approach in routine applications. Where non-participation is high, true confidence intervals are much wider than those generated by standard approaches to dealing with missing data suggest.

    更新日期:2019-11-01
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  • Improving care for sexually transmitted infections.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-08-31
    Cornelis A Rietmeijer

    INTRODUCTION Rising rates of reported sexually transmitted infections (STIs) in the US and Europe are a public health priority and require a public health response. The diagnosis and treatment of STIs have been the cornerstone of STI control and prevention for many decades and, historically, publicly funded STI clinics have played a central role in the provision of STI care. Innovations in non-invasive diagnostic techniques, especially nucleic acid amplification tests in the mid-1990s, have facilitated the expansion of STI testing and treatment outside traditional STI clinics, including primary care, family planning, school-based health, outreach, corrections, emergency departments and HIV prevention and care settings. As a result, the continued need for categorical STI clinics has been debated. In this Commentary, we discuss how practice can be improved at each level of STI care. DISCUSSION STI practice improvement plans should be tailored to the strengths of each care setting. Thus, in primary care, the focus should be on improving STI screening rates, the provision of hepatitis B and human papillomavirus vaccines and, in jurisdictions where this is legal, expedited partner therapy for gonorrhoea and chlamydia. Extragenital (pharyngeal and rectal) testing for gonorrhoea and chlamydia should be available in settings serving populations more vulnerable to STI acquisition at these anatomical sites, including men who have sex with men. In family planning settings with a mostly female patient population, there are opportunities to serve male partners with both contraceptive and STI services. STI screening rates can also be improved in other settings serving populations at increased risk for STIs, including school-based clinics, emergency departments, correctional health facilities and providers of HIV care and prevention. These improvements are predominantly logistical in nature and not dependent on extensive STI clinical expertise. While some providers in these settings may have the clinical knowledge and skills to evaluate symptomatic patients, many do not, and STI speciality clinics must be available for consultation and referral and evolve from "safety net" providers of last resort to STI centres of excellence. CONCLUSIONS A tailored practice improvement plan can be envisioned to achieve an optimally functioning STI care continuum.

    更新日期:2019-11-01
  • Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-08-31
    Myron S Cohen,Olivia D Council,Jane S Chen

    INTRODUCTION HIV is a unique sexually transmitted infection (STI) that is greatly affected by other concomitant "classical" bacterial and viral STIs that cause genital ulcers and/or mucosal inflammation. STIs also serve as a marker for risky sexual behaviours. STIs increase infectiousness of people living with HIV by increasing the viral concentration in the genital tract, and by increasing the potential for HIV acquisition in people at risk for HIV. In addition, some STIs can increase blood HIV concentration and promote progression of disease. This review is designed to investigate the complex relationship between HIV and classical STIs. DISCUSSION Treatment of STIs with appropriate antibiotics reduces HIV in blood, semen and female genital secretions. However, community-based trials could not reliably reduce the spread of HIV by mass treatment of STIs. Introduction of antiretroviral agents for the treatment and prevention of HIV has led to renewed interest in the complex relationship between STIs and HIV. Antiretroviral treatment (ART) reduces the infectiousness of HIV and virtually eliminates the transmission of HIV in spite of concomitant or acquired STIs. However, while ART interrupts HIV transmission, it does not stop intermittent shedding of HIV in genital secretions. Such shedding of HIV is increased by STIs, although the viral copies are not likely replication competent or infectious. Pre-exposure prophylaxis (PrEP) of HIV with the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prevents HIV acquisition in spite of concomitant STIs. CONCLUSIONS STIs remain pandemic, and the availability of ART may have led to an increase in STIs, as fear of HIV has diminished. Classical STIs present a huge worldwide health burden that cannot be separated from HIV, and they deserve far more attention than they currently receive.

    更新日期:2019-11-01
  • The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission.
    J. Int. AIDS Soc. (IF 5.192) Pub Date : 2019-08-31
    Eric Pf Chow,Christopher K Fairley

    INTRODUCTION Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for gonorrhoea and chlamydia at the oropharynx and anorectum among MSM. RESULTS AND DISCUSSION New evidence suggests that oropharyngeal gonorrhoea can be transmitted by kissing in addition to through the established route of condomless oral sex; and anorectal gonorrhoea can be acquired when saliva is used as a lubricant for anal sex and rimming in addition to the established route of condomless penile-anal sex in MSM. In contrast, condomless penile-anal sex remains the major route for chlamydia transmission. CONCLUSIONS Substantial transmission of gonorrhoea may occur with practices other than the established routes of condomless oral and/or anal sex and hence condoms may not be effective in preventing gonorrhoea transmission to extragenital sites. In contrast, condoms are effective for chlamydia control because it is mainly transmitted through condomless penile-anal sex. Novel interventions for gonorrhoea that reduce the risk of transmission at extragenital site are required.

    更新日期:2019-11-01
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