25 results on '"Timothy D. Mastro"'
Search Results
2. HIV comprehensive knowledge and prevalence among young adolescents in Nigeria: evidence from Akwa Ibom AIDS indicator survey, 2017
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Titilope Badru, Jefferson Mwaisaka, Hadiza Khamofu, Chinedu Agbakwuru, Oluwasanmi Adedokun, Satish Raj Pandey, Patrick Essiet, Ezekiel James, Annie Chen-Carrington, Timothy D. Mastro, Sani H. Aliyu, and Kwasi Torpey
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Comprehensive HIV knowledge ,Stigma ,Risk perceptions ,Young adolescents ,Nigeria ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Despite the recent increase in HIV infections among adolescents, little is known about their HIV knowledge and perceptions. This study, therefore, sought to examine the factors associated with comprehensive HIV knowledge, stigma, and HIV risk perceptions among young adolescents aged 10–14 years in Akwa Ibom State, Nigeria. Additionally, consenting parents and assenting young adolescents were tested for HIV. Methods We used cross-sectional data from the 2017 Akwa Ibom AIDS Indicator Survey to analyze comprehensive HIV knowledge, stigma, and HIV risk perceptions among young adolescents. Demographic characteristics of young adolescents were summarized using descriptive statistics. Chi-square test (or Fisher’s exact test in cases of small subgroup sample sizes) was used to elicit associations between demographics and study outcomes. Separate multivariable logistic regression models were then conducted to determine associations with the study outcomes. Sampling weights were calculated in order to adjust for the sample design. P-values less than 0.05 were considered to be significant. Results A total of 1818 young adolescents were interviewed. The survey highlighted significant low levels of comprehensive HIV knowledge (9.4%) among young adolescents. Adolescent-parent discussions [AOR = 2.19, 95% C.I (1.10–4.38), p = 0.03], schools as sources of HIV information [AOR = 8.06, 95% C.I (1.70–38.33), p
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- 2020
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3. High HIV incidence among young women in South Africa: Data from a large prospective study
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Thesla Palanee-Phillips, Helen V. Rees, Kate B. Heller, Khatija Ahmed, Joanne Batting, Ivana Beesham, Renee Heffron, Jessica Justman, Heeran Makkan, Timothy D. Mastro, Susan A. Morrison, Nelly Mugo, Gonasagrie Nair, James Kiarie, Neena M. Philip, Melanie Pleaner, Krishnaveni Reddy, Pearl Selepe, Petrus S. Steyn, Caitlin W. Scoville, Jenni Smit, Katherine K. Thomas, Deborah Donnell, Jared M. Baeten, and for the ECHO Trial Consortium
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Medicine ,Science - Abstract
Introduction South Africa has the highest national burden of HIV globally. Understanding drivers of HIV acquisition in recently completed, prospective studies in which HIV was an endpoint may help inform the strategy and investments in national HIV prevention efforts and guide the design of future HIV prevention trials. We assessed HIV incidence and correlates of incidence among women enrolled in ECHO (Evidence for Contraceptive Options and HIV Outcomes), a large, open-label randomized clinical trial that compared three highly effective. reversible methods of contraception and rates of HIV acquisition. Methods During December 2015 to October 2018, ECHO followed sexually active, HIV-seronegative women, aged 16–35 years, seeking contraceptive services and willing to be randomized to one of three contraceptive methods (intramuscular depot medroxyprogesterone acetate, copper intrauterine device, or levonorgestrel implant) for 12–18 months at nine sites in South Africa. HIV incidence based on prospectively observed HIV seroconversion events. Cox proportional hazards regression models were used to define baseline cofactors related to incident HIV infection. Results 5768 women were enrolled and contributed 7647 woman-years of follow-up. The median age was 23 years and 62.5% were ≤24 years. A total of 345 incident HIV infections occurred, an incidence of 4.51 per 100 woman-years (95%CI 4.05–5.01). Incidence was >3 per 100 woman-years at all sites. Age ≤24 years, baseline infection with sexually transmitted infections, BMI≤30, and having new or multiple partners in the three months prior to enrollment were associated with incident HIV. Conclusions HIV incidence was high among South African women seeking contraceptive services. Integration of diagnostic management of sexually transmitted infections alongside delivery of HIV prevention options in health facilities providing contraception services are needed to mitigate ongoing risks of HIV acquisition for this vulnerable population. Clinical trial registration ClinicalTrials.gov, number NCT02550067 was the main Clinical Trial from which this secondary, non-randomized / observational analysis was derived with data limited to just South African sites.
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- 2022
4. Social, economic, and political events affect gender equity in China, Nepal, and Nicaragua: a matched, interrupted time-series study
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Tuan T. Nguyen, Ashley Darnell, Amy Weissman, Edward A. Frongillo, Roger Mathisen, Karin Lapping, Timothy D. Mastro, and Mellissa Withers
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china ,gender equity ,gender gap index (ggi) ,health disparities/inequities ,interrupted time-series analysis ,nepal ,nicaragua ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Progress in gender equity can improve health at the individual and country levels. Objectives: This study’s objective was to analyze recent trends in gender equity and identify historical and contextual factors that contributed to changes in gender equity in three countries: China, Nepal, and Nicaragua. Methods: To assess gender equity trends, we used the Gender Gap Index (GGI) from the World Economic Forum’s Global Gender Gap Report (2006–2017). The GGI incorporated data on economic participation, educational attainment, health, and political empowerment for almost 150 countries. We selected China, Nepal, and Nicaragua because of their major changes in GGI and diversity in geographical location and economic status. We reviewed major social, economic, and political events during 2006–2017, and identified key events in each country. We compared countries’ GGI with matched controls average using interrupted time-series analysis. Results: Nepal and Nicaragua both had dramatic increases in GGI (improvement in equity), Nepal (β = 0.029; 95% CI: 0.003, 0.056) and Nicaragua (β = 0.035; 95% CI: 0.005, 0.065). This was strongly influenced by political empowerment, which likely impacted access to education and employment opportunities. Despite major economic growth and new policies to address gender inequities (e.g. the One-Child Policy), China saw a significant decline in GGI between 2010 and 2017 (β = −0.014; 95% CI: −0.024, −0.004), largely resulting from decreased gender equity in educational attainment, economic participation, and health/survival sub-indices. Conclusions: Key social, economic, and political events helped explain trends in countries’ gender equity. Our study suggested that supportive social and political environments would play important roles in empowering women, which would advance human rights and promote health and well-being of individuals, households, communities, and countries.
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- 2020
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5. Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission
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Timothy D Mastro, Michael M. Cassell, Reshmie Ramautarsing, Rose Wilcher, and Nittaya Phanuphak
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Acquired Immunodeficiency Syndrome ,Sexual transmission ,Transmission (medicine) ,business.industry ,virus diseases ,HIV Infections ,Viremia ,General Medicine ,medicine.disease ,Virus ,Men who have sex with men ,Social support ,Relative risk ,Commentary ,medicine ,Humans ,Epidemics ,business ,Viral load ,Demography - Abstract
Essentially all HIV transmission is from people living with HIV who are not virally suppressed. An HIV micro-epidemic control approach that differentiates treatment support and prevention services for people living with HIV and their network members according to viral burden could optimize the impact of epidemic control efforts., Key Messages Essentially all HIV transmission is from people living with HIV (PLHIV) who do not know their infection status or have not yet achieved viral suppression, making support for these individuals and their risk contacts a priority for treatment and prevention efforts.Proven approaches exist to reduce viral burden and interrupt HIV transmission from PLHIV who are not yet virally suppressed, but these approaches must be implemented with enhanced focus and scale to maximize benefit.Improved diagnostic approaches offer new opportunities to increase public health impact by prioritizing support for unserved or underserved individuals with the greatest viral burdens and among members of their risk networks.Policy makers should pursue the implementation and evaluation of diagnostic approaches that can focus services among individuals and networks with the greatest viral burdens.Program managers should treat viral burden as a primary consideration in the provision of differentiated HIV services, applying an HIV micro-epidemic control framework to prioritize and tailor services for PLHIV and their risk contacts along a continuum of progression to viral suppression.
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- 2020
6. Managing amphetamine use is critical to achieving HIV control
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Steven Shoptaw, Timothy D Mastro, and Christopher Akolo
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medicine.medical_specialty ,business.industry ,Sexual Behavior ,Immunology ,Control (management) ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Article ,Methamphetamine ,Infectious Diseases ,Vietnam ,medicine ,Humans ,Immunology and Allergy ,Amphetamine use ,Substance Abuse, Intravenous ,Psychiatry ,business - Abstract
OBJECTIVE: We assessed the association between methamphetamine use and lack of viral suppression among a cohort of HIV seropositive persons who inject drugs (PWID) in Hai Phong, Vietnam. DESIGN: Cohort study with random effects logit modeling and mediation analysis for ART adherence. METHODS: PWID were recruited from October 2016-October 2017; HIV seropositive PWID were enrolled in a cohort to assess HIV viral loads, changes in drug use, risk behaviors, and ART adherence during 24-month follow-up. Methamphetamine use in last 30 days was divided into three categories: 0 days (no use), 1–19 days (intermediate), and 20 or more days (heavy). Bivariate and a multivariable random effects logit models were used to assess the relationship between methamphetamine use and not being virally suppressed. We also assessed self-reported ART adherence as a mediating factor. RESULTS: A total of 645 HIV seropositive PWID were included at baseline; 95% male, average age 40 (SD=6.4). At baseline, methamphetamine use in last 30 days was 64% no use, 32% intermediate use, 4% heavy use. Approximately 74% of PWID reported high/complete adherence; 76% were at viral suppression. In random effects analysis, recent methamphetamine use was associated with not being virally suppressed during follow-up (AOR: 1.84, 95% CI: 1.06, 3.17); the effect was not explained by a mediating effect of self-reported adherence to ART. CONCLUSIONS: Recent methamphetamine use is associated with not being virally suppressed among PWID. The results of this study indicate the need for targeted interventions for methamphetamine use with special focus on those with HIV infection.
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- 2020
7. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial
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Helen Rees, Khatija Ahmed, Katherine K. Thomas, Kate B. Heller, Kavita Nanda, Julia D Welch, Douglas Taylor, Charles S. Morrison, Cheryl Louw, James Kiarie, Gonasagrie Nair, Petrus S. Steyn, Thesla Palanee-Phillips, Peter Gichangi, Jeffrey S. A. Stringer, Zelda Nhlabatsi, Kathleen Shears, Timothy D. Mastro, Sydney Sibiya, Mandisa Singata-Madliki, Jessica Justman, G Justus Hofmeyr, Jennifer A. Smit, Mags Beksinska, Caitlin W Scoville, Raesibe Agnes Pearl Selepe, Linda-Gail Bekker, Jared M. Baeten, Deborah Donnell, Melanie Pleaner, Margaret P Kasaro, Elizabeth A. Bukusi, Maricianah Onono, and Nelly Mugo
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Obstetrics ,Hazard ratio ,Population ,General Medicine ,030204 cardiovascular system & hematology ,Intrauterine device ,medicine.disease ,Discontinuation ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Medicine ,Medroxyprogesterone acetate ,Observational study ,Levonorgestrel ,030212 general & internal medicine ,business ,education ,medicine.drug - Abstract
Summary Background Observational and laboratory studies suggest that some hormonal contraceptive methods, particularly intramuscular depot medroxyprogesterone acetate (DMPA-IM), might increase women's susceptibility to HIV acquisition. We aimed to compare DMPA-IM, a copper intrauterine device (IUD), and a levonorgestrel (LNG) implant among African women seeking effective contraception and living in areas of high HIV incidence. Methods We did a randomised, multicentre, open-label trial across 12 research sites in eSwatini, Kenya, South Africa, and Zambia. We included HIV-seronegative women aged 16–35 years who were seeking effective contraception, had no medical contraindications to the trial contraceptive methods, agreed to use the assigned method for 18 months, and reported not using injectable, intrauterine, or implantable contraception for the previous 6 months. Participants were randomly assigned (1:1:1) to receive an injection of 150 mg/mL DMPA-IM every 3 months, a copper IUD, or a LNG implant with random block sizes between 15 and 30, stratified by site. Participants were assigned using an online randomisation system, which was accessed for each randomisation by study staff at each site. The primary endpoint was incident HIV infection in the modified intention-to-treat population, including all randomised participants who were HIV negative at enrolment and who contributed at least one HIV test. The primary safety endpoint was any serious adverse event or any adverse event resulting in method discontinuation, until the trial exit visit at 18 months and was assessed in all enrolled and randomly assigned women. This study is registered with ClinicalTrials.gov, number NCT02550067. Findings Between Dec 14, 2015, and Sept 12, 2017, 7830 women were enrolled and 7829 were randomly assigned to the DMPA-IM group (n=2609), the copper IUD group (n=2607), or the LNG implant group (n=2613). 7715 (99%) participants were included in the modified intention-to-treat population (2556 in the DMPA-IM group, 2571 in the copper IUD group, and 2588 in the LNG implant group), and women used their assigned method for 9567 (92%) of 10 409 woman-years of follow-up time. 397 HIV infections occurred (incidence 3·81 per 100 woman-years [95% CI 3·45–4·21]): 143 (36%; 4·19 per 100 woman-years [3·54–4·94]) in the DMPA-IM group, 138 (35%: 3·94 per 100 woman-years [3·31–4·66]) in the copper IUD group, and 116 (29%; 3·31 per 100 woman-years [2·74–3·98]) in the LNG implant group. In the modified intention-to-treat analysis, the hazard ratios for HIV acquisition were 1·04 (96% CI 0·82–1·33, p=0·72) for DMPA-IM compared with copper IUD, 1·23 (0·95–1·59, p=0·097) for DMPA-IM compared with LNG implant, and 1·18 (0·91–1·53, p=0·19) for copper IUD compared with LNG implant. 12 women died during the study: six in the DMPA-IM group, five in the copper IUD group, and one in the LNG implant group. Serious adverse events occurred in 49 (2%) of 2609 participants in the DMPA-IM group, 92 (4%) of 2607 participants in the copper IUD group, and 78 (3%) of 2613 participants in the LNG implant group. Adverse events resulting in discontinuation of the randomly assigned method occurred in 109 (4%) women in the DMPA-IM group, 218 (8%) women in the copper IUD group, and 226 (9%) women in the LNG implant group (p Interpretation We did not find a substantial difference in HIV risk among the methods evaluated, and all methods were safe and highly effective. HIV incidence was high in this population of women seeking pregnancy prevention, emphasising the need for integration of HIV prevention within contraceptive services for African women. These results support continued and increased access to these three contraceptive methods. Funding Bill & Melinda Gates Foundation, US Agency for International Development and the President's Emergency Plan for AIDS Relief, Swedish International Development Cooperation Agency, South African Medical Research Council, and UN Population Fund. Contraceptive supplies were donated by the Government of South Africa and US Agency for International Development.
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- 2019
8. Planning for Outcomes (P4O) Modeling Tool: Estimating the Impact of Changing the Proportion of Injectable Progestins in the Contraceptive Method Mix
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Abdulmumin Saad, Timothy D Mastro, Lauren Y. Maldonado, Xiaoming Gao, Elena Lebetkin, Kavita Nanda, Douglas Taylor, Markus J. Steiner, and Laneta J. Dorflinger
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Adult ,Male ,Adolescent ,Maternal Health ,HIV Infections ,Hiv risk ,law.invention ,Condoms ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Procurement ,Condom ,Pregnancy ,law ,Environmental health ,Health care ,Contraceptive Agents, Female ,Humans ,Medicine ,Infant Health ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Contraception Behavior ,Africa South of the Sahara ,030219 obstetrics & reproductive medicine ,Transmission (medicine) ,business.industry ,Hazard ratio ,Child Health ,Infant ,General Medicine ,Middle Aged ,medicine.disease ,Infectious Disease Transmission, Vertical ,Health Planning ,Contraception ,Policy ,Family Planning Services ,Female ,Observational study ,Technical Notes ,Progestins ,business - Abstract
The interactive deterministic online modeling tool P4O allows users to estimate how changing the proportion of injectable progestins in the contraceptive method mix might affect HIV and maternal and child health outcomes. With careful consideration for women's individual choices, policy makers and program planners may use country-specific results to help inform programming and policy decisions., Background: Observational studies raise concern about a potential link between injectable progestin contraceptive use and HIV acquisition risk. This possible link is particularly relevant in sub-Saharan Africa where HIV risk is high and the method mix is skewed toward injectables. We developed the Planning for Outcomes (P4O) model (https://planning4outcomes.ctiexchange.org/) to predict changes in maternal and child health (MCH) and HIV outcomes that could occur if the proportion of injectables in the method mix is changed. Methods: P4O incorporates evidence-based assumptions to predict yearly changes in unintended pregnancies, morbidity/mortality, HIV infections (women and infants), and anticipated health care costs associated with changing the proportions of injectable users in 22 selected countries. Users of this model designate all countries or a subset and adjust inputs including percentage of injectable users who discontinue, percentage of discontinuers who begin use of an alternative method, hazard ratio for HIV infection with injectable use, method mix used by injectable discontinuers, annual probabilities of method-specific pregnancy and mother-to-child transmission of HIV, condom effectiveness against HIV, risk of HIV during pregnancy, and HIV incidence among women of reproductive age. Results: Illustrative results from all sub-Saharan African countries combined and from selected countries demonstrate the potential of P4O to inform program planning and procurement decisions. In countries with high use of long-acting reversible contraception, the removal of injectables from the method mix is associated with improvement in MCH and HIV indicators if most injectable users switch to more effective methods (e.g., implants). In countries with high use of short-acting methods (e.g., condoms), the model predicts mostly negative MCH outcomes. Conclusions: Policy makers and program planners may use P4O to inform programming and policy decisions. In all scenarios, programmatic preparation to accommodate changes to the contraceptive method mix, considerations of how the individual desires of women will be addressed, and potential burden of anticipated MCH-related costs warrant advanced consideration.
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- 2019
9. Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria using the limiting antigen avidity recency assay
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Oluseyi Balogun, Timothy D Mastro, Akan Etuk, Edward Adekola Oladele, Kwasi Torpey, Olubunmi Ruth Negedu-Momoh, Ibrahim Dafa, Hadiza Khamofu, Janet Robinson, Ezekiel James, Oluwasanmi Adedokun, Titi Badru, and Satish Raj Pandey
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Adult ,Male ,Adolescent ,Anti-HIV Agents ,HIV Antigens ,Population ,Antibody Affinity ,Psychological intervention ,Nigeria ,HIV Infections ,HIV Antibodies ,recent infection ,Immunoenzyme Techniques ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Antigen ,Surveys and Questionnaires ,HIV Seropositivity ,Humans ,Medicine ,Avidity ,030212 general & internal medicine ,Young adult ,education ,Research Articles ,education.field_of_study ,030505 public health ,business.industry ,Incidence ,Incidence (epidemiology) ,HIV‐1 ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Middle Aged ,Viral Load ,medicine.disease ,limiting antigen avidity ,Cross-Sectional Studies ,Infectious Diseases ,HIV-1 ,Female ,0305 other medical science ,business ,Viral load ,Research Article ,Demography - Abstract
Introduction HIV incidence estimates are important to characterize the status of an epidemic, identify locations and populations at high risk and to guide and evaluate HIV prevention interventions. We used the limiting antigen avidity assay (LAg) as part of a recent infection testing algorithm to estimate HIV incidence in the Akwa Ibom AIDS Indicator Survey (AKAIS), Nigeria. Methods In 2017, AKAIS, a cross‐sectional population‐based study was conducted at the household (HH) level in 31 local government areas (LGAs) of Akwa Ibom state. Of the 8963 participants aged ≥15 years who were administered questionnaires for demographic and behavioural data, 8306 consented to HIV rapid testing. Whole‐blood specimens were collected from 394 preliminary HIV‐seropositive individuals for CD4+ cell count determination and plasma storage. Samples were shipped to a central quality laboratory for HIV confirmatory testing and viral load determination. A total of 370 HIV‐positive specimens were tested for the recent HIV infection using the LAg assay. Results Of the 8306 consenting adults, the HIV prevalence was 4.8%. Of the 370 HIV‐positive samples tested for HIV recency, the median age was 35 years, 48.8% had CD4+ cell count >500/mm3 and 81.3% was not virally suppressed. Viral suppression was greater among females (21%) than for males (13%). A total of 11 specimens were classified as recent based on the LAg assay and HIV viral load ≥1000 copies/mL. The weighted, adjusted HIV‐1 incidence was 0.41/100 person‐years (95% CI 0.16 to 0.66); translating to 13,000 new cases of HIV infections annually in Akwa Ibom, a state with a population of 5.5 million. The HIV incidence rate was similar in females and males (0.41% and 0.42% respectively). The incidence rate was the highest among participants aged 15 to 49 years (0.44%, 95% CI 0.15 to 0.74) translating to 11,000 new infections annually, about 85% of all new infections in the state. Conclusions The finding of the high HIV incidence among the 15 to 49‐year age group calls for renewed and innovative efforts to prevent HIV infection among young adults in Akwa Ibom state.
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- 2021
10. The Need to Optimize Human Immunodeficiency Virus Test-and-Treat Programs in Africa
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Moses Bateganya, Hally Mahler, and Timothy D Mastro
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Human immunodeficiency virus test ,MEDLINE ,HIV ,HIV Infections ,Virology ,Infectious Diseases ,Africa ,Immunology and Allergy ,Medicine ,Humans ,business ,Developing Countries - Published
- 2021
11. Social, economic, and political events affect gender equity in China, Nepal, and Nicaragua: a matched, interrupted time-series study
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Timothy D Mastro, Edward A. Frongillo, Ashley Darnell, Tuan T Nguyen, Mellissa Withers, Karin Lapping, Amy Weissman, and Roger Mathisen
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Male ,interrupted time-series analysis ,Human Rights ,media_common.quotation_subject ,gender equity ,gender gap index (ggi) ,03 medical and health sciences ,Politics ,0302 clinical medicine ,Political science ,Humans ,030212 general & internal medicine ,Location ,China ,Empowerment ,Socioeconomics ,Developing Countries ,Socioeconomic status ,media_common ,Equity (economics) ,Human rights ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Interrupted Time Series Analysis ,Educational attainment ,health disparities/inequities ,nepal ,Policy ,Socioeconomic Factors ,Female ,Original Article ,nicaragua ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,china - Abstract
Background: Progress in gender equity can improve health at the individual and country levels. Objectives: This study’s objective was to analyze recent trends in gender equity and identify historical and contextual factors that contributed to changes in gender equity in three countries: China, Nepal, and Nicaragua. Methods: To assess gender equity trends, we used the Gender Gap Index (GGI) from the World Economic Forum’s Global Gender Gap Report (2006–2017). The GGI incorporated data on economic participation, educational attainment, health, and political empowerment for almost 150 countries. We selected China, Nepal, and Nicaragua because of their major changes in GGI and diversity in geographical location and economic status. We reviewed major social, economic, and political events during 2006–2017, and identified key events in each country. We compared countries’ GGI with matched controls average using interrupted time-series analysis. Results: Nepal and Nicaragua both had dramatic increases in GGI (improvement in equity), Nepal (β = 0.029; 95% CI: 0.003, 0.056) and Nicaragua (β = 0.035; 95% CI: 0.005, 0.065). This was strongly influenced by political empowerment, which likely impacted access to education and employment opportunities. Despite major economic growth and new policies to address gender inequities (e.g. the One-Child Policy), China saw a significant decline in GGI between 2010 and 2017 (β = −0.014; 95% CI: −0.024, −0.004), largely resulting from decreased gender equity in educational attainment, economic participation, and health/survival sub-indices. Conclusions: Key social, economic, and political events helped explain trends in countries’ gender equity. Our study suggested that supportive social and political environments would play important roles in empowering women, which would advance human rights and promote health and well-being of individuals, households, communities, and countries.
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- 2020
12. Incorporating oral PrEP into standard prevention services for South African women: a nested interrupted time-series study
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Katherine K. Thomas, Jessica Justman, Margaret P Kasaro, James Kiarie, Joanne Batting, Charles S. Morrison, Kate B. Heller, Elizabeth A. Bukusi, Kathleen Shears, Mookho Malahleha, Cheryl Louw, Jared M. Baeten, Deborah Donnell, Lara Kidoguchi, Nelly Mugo, Veronique C Bailey, Raesibe Agnes Pearl Selepe, Julia D Welch, Timothy D Mastro, Sydney Sibiya, G Justus Hofmeyr, Zelda Nhlabatsi, Renee Heffron, Gonasagrie Nair, Linda-Gail Bekker, Khatija Ahmed, Kavita Nanda, Thesla Palanee-Phillips, Ivana Beesham, Petrus S. Steyn, Deborah Baron, Mandisa Singata-Madliki, Douglas Taylor, Helen Rees, Caitlin W Scoville, Nomthandazo Mbandazayo, Jeffrey S. A. Stringer, Peter Gichangi, Mags Beksinska, Melanie Pleaner, and Jennifer A. Smit
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0301 basic medicine ,Adult ,Adolescent ,Epidemiology ,Immunology ,Population ,Psychological intervention ,Administration, Oral ,HIV Infections ,Rate ratio ,03 medical and health sciences ,South Africa ,Young Adult ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Virology ,medicine ,Humans ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Interrupted time series ,Emergency plan ,Articles ,medicine.disease ,030112 virology ,Clinical trial ,Infectious Diseases ,Female ,Pre-Exposure Prophylaxis ,business ,Demography - Abstract
Summary Background As oral pre-exposure prophylaxis (PrEP) becomes the standard of prevention globally, its potential effect on HIV incidence in clinical trials of new prevention interventions is unknown, particularly for trials among women. In a trial measuring HIV incidence in African women, oral PrEP was incorporated into the standard of prevention in the trial's last year. We assessed the effect of on-site access to PrEP on HIV incidence in this natural experiment. Methods We did a nested interrupted time-series study using data from the ECHO trial. At 12 sites in four countries (Eswatini, Kenya, South Africa, and Zambia), women (aged 16–35 years) were randomly assigned to receive one of three contraceptives between Dec 14, 2015, and Sept 12, 2017, and followed up quarterly for up to 18 months to determine the effect of contraceptive method on HIV acquisition. Women were eligible if they wanted long-acting contraception, were medically qualified to receive study contraceptives, and had not used any of the study contraceptives in the past 6 months. The present analyses are limited to nine South African sites where on-site access to oral PrEP was implemented between March 13 and June 12, 2018. Using an interrupted time-series design, we compared HIV incidence before versus after PrEP access, limited to quarterly study visits at which on-site PrEP access was available to at least some participants and, in a sensitivity analysis, to the 180 days before and after access. The outcome was incident HIV infection, detected using two rapid HIV tests done in parallel for each participant at every scheduled follow-up visit. This study is registered on ClinicalTrials.gov, NCT02550067. Findings 2124 women were followed up after on-site PrEP access began, of whom 543 (26%) reported PrEP use. A total of 12 HIV seroconversions were observed in 556 person-years (incidence 2·16%) after on-site PrEP access, compared with 133 HIV seroconversions in 2860 person-years (4·65%) before PrEP access (adjusted incidence rate ratio [IRR] 0·45, 95% CI 0·25–0·82, p=0·0085). Similar results were also observed when limiting the analysis to 180 days before versus after PrEP access. A total of 46 HIV seroconversions were observed in 919 person-years within 180 days before PrEP access, compared with 11 seroconversions in 481 person-years in the 180 days following PrEP access (incidence 5·00 vs 2·29 per 100 person-years; IRR 0·43, 95% CI 0·22–0·88, p=0·012). Interpretation On-site access to PrEP as part of standard of prevention in a clinical trial among women in South Africa was associated with halving HIV incidence, when approximately a quarter of women started PrEP. Providing access to on-site PrEP could decrease incidence in HIV prevention trials. These data are also among the first to show in any setting that access to PrEP is associated with decreased HIV acquisition among South African women. Funding Bill & Melinda Gates Foundation, United States Agency for International Development, President's Emergency Plan for AIDS Relief, the Swedish International Development Cooperation Agency, South African Medical Research Council, and United Nations Population Fund.
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- 2020
13. Sexually transmitted infections among women randomised to depot medroxyprogesterone acetate, a copper intrauterine device or a levonorgestrel implant
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Helen Rees, Kavita Nanda, Khatija Ahmed, Margaret Lind, Nelly Mugo, Maricianah Onono, Neena M. Philip, Joanne Batting, Cheryl Louw, Jared M. Baeten, Deborah Donnell, Mags Beksinska, Charles S. Morrison, Jennifer A. Smit, Thesla Palanee-Phillips, Jennifer Deese, Vinodh A. Edward, and Timothy D Mastro
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Adult ,medicine.medical_specialty ,Adolescent ,chlamydia trachomatis ,Context (language use) ,Dermatology ,Levonorgestrel ,Medroxyprogesterone Acetate ,Lower risk ,medicine.disease_cause ,Intrauterine device ,urologic and male genital diseases ,03 medical and health sciences ,Gonorrhea ,Young Adult ,Clinical ,0302 clinical medicine ,medicine ,Contraceptive Agents, Female ,Prevalence ,Medroxyprogesterone acetate ,Humans ,030212 general & internal medicine ,Drug Implants ,Pregnancy ,clinical trials ,030219 obstetrics & reproductive medicine ,Chlamydia ,business.industry ,Obstetrics ,Chlamydia Infections ,medicine.disease ,Intrauterine Devices, Copper ,female genital diseases and pregnancy complications ,neisseria gonorrhoeae ,Infectious Diseases ,Contraception ,Delayed-Action Preparations ,Africa ,Female ,Disease Susceptibility ,Chlamydia trachomatis ,business ,medicine.drug - Abstract
ObjectivesReproductive aged women are at risk of pregnancy and sexually transmitted infections (STI). Understanding drivers of STI acquisition, including any association with widely used contraceptives, could help us to reduce STI prevalence and comorbidities. We compared the risk of STI among women randomised to three contraceptive methods.MethodsWe conducted a secondary analysis to assess the risk of chlamydia and gonorrhoea in a clinical trial evaluating HIV risk among 7829 women aged 16–35 randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) or a levonorgestrel (LNG) implant. We estimated chlamydia and gonorrhoea prevalences by contraceptive group and prevalence ratios (PR) using log-binomial regression.ResultsAt baseline, chlamydia and gonorrhoea prevalences were 18% and 5%, respectively. Final visit chlamydia prevalence did not differ significantly between DMPA-IM and copper IUD groups or between copper IUD and LNG implant groups. The DMPA-IM group had significantly lower risk of chlamydia compared with the LNG implant group (PR 0.83, 95% CI 0.72 to 0.95). Final visit gonorrhoea prevalence differed significantly only between the DMPA-IM and the copper IUD groups (PR 0.67, 95% CI 0.52 to 0.87).ConclusionsThe findings suggest that chlamydia and gonorrhoea risk may vary with contraceptive method use. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use.
- Published
- 2020
14. Development and deployment of COVID-19 vaccines for those most vulnerable
- Author
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Ted M. Ross, Gabriele Neumann, Matthew B. Friemann, Jaap Goudsmit, Julia T. Ostrowsky, Adrian B. McDermott, Timothy D Mastro, Michael T. Osterholm, Alyson A. Kelvin, Ralph S. Baric, Kristine A. Moore, Theodore Schenkelberg, Yoshihiro Kawaoka, Mark J. Cameron, Cheryl M. Cameron, Frances Priddy, Stacey Schultz-Cherry, Tere Williams, and Wayne C. Koff
- Subjects
0301 basic medicine ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Immune senescence ,medicine.disease_cause ,03 medical and health sciences ,Disease susceptibility ,0302 clinical medicine ,Pandemic ,medicine ,Animals ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Phylogeny ,business.industry ,SARS-CoV-2 ,COVID-19 ,General Medicine ,Immune dysregulation ,Disease Models, Animal ,030104 developmental biology ,Software deployment ,Disease Susceptibility ,business - Abstract
Development of safe and effective COVID-19 vaccines is a global priority and the best hope for ending the COVID-19 pandemic. Remarkably, in less than 1 year, vaccines have been developed and shown to be efficacious and are already being deployed worldwide. Yet, many challenges remain. Immune senescence and comorbidities in aging populations and immune dysregulation in populations living in low-resource settings may impede vaccine effectiveness. Distribution of vaccines among these populations where vaccine access is historically low remains challenging. In this Review, we address these challenges and provide strategies for ensuring that vaccines are developed and deployed for those most vulnerable.
- Published
- 2020
15. National nutrition strategies that focus on maternal, infant, and young child nutrition in Southeast Asia do not consistently align with regional and international recommendations
- Author
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Tuan T Nguyen, Mellissa Withers, Karin Lapping, Edward A. Frongillo, Timothy D Mastro, Amy Weissman, Jennifer Cashin, Roger Mathisen, and Ashley Darnell
- Subjects
0301 basic medicine ,Philippines ,Psychological intervention ,Breastfeeding ,Context (language use) ,Myanmar ,Southeast asian ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Environmental health ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Wasting ,Asia, Southeastern ,Breastfeeding promotion ,030109 nutrition & dietetics ,Nutrition and Dietetics ,plan of action for nutrition ,business.industry ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Obstetrics and Gynecology ,Infant ,Monitoring and evaluation ,Southeast Asia ,maternal, infant, and young child nutrition (MIYCN) ,Breast Feeding ,Community mobilization ,Indonesia ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Supplement Article ,Female ,medicine.symptom ,business ,national nutrition strategy ,Child Nutritional Physiological Phenomena ,ASEAN - Abstract
We examined the consistency of national nutrition strategies and action plans (NNS) focusing on maternal, infant, and young child nutrition in Southeast Asia with regional and international recommendations. Between July and December 2017, we identified and extracted information on context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNS in nine Southeast Asian countries. All NNS described context, objectives, and the following interventions: antenatal care, micronutrient supplementation during pregnancy, breastfeeding promotion, improved complementary feeding, nutrition in emergencies, and food fortification or dietary diversity. Micronutrient supplementation for young children was included in eight NNS; breastfeeding promotion during pregnancy and support at birth in seven; and school feeding, deworming, and treatment of severe acute malnutrition in six. All NNS contained programme monitoring and evaluation plans with measurable indicators and targets. Not all NNS covered wasting, exclusive breastfeeding, low birthweight, and childhood overweight. Strategies for achieving NNS goals and objectives were health system strengthening (nine), social and behaviour change communication (nine), targeting vulnerable groups (eight), and social or community mobilization (four). All addressed involvement, roles and responsibilities, and collaboration mechanisms among sectors and stakeholders. There was a delay in releasing NNS in Indonesia, Myanmar, and the Philippines. In conclusion, although Southeast Asian NNS have similarities in structure and contents, some interventions and indicators vary by country and do not consistently align with regional and international recommendations. A database with regularly updated information on NNS components would facilitate cross‐checking completeness within a country, comparison across countries, and knowledge sharing and learning.
- Published
- 2020
16. Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants on Early HIV Disease Progression
- Author
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Mags Beksinska, Khatija Ahmed, Maricianah Onono, Renee Heffron, Maggie Lind, Jen Deese, Jeffrey S. A. Stringer, Ivana Beesham, Echo Trial Team, Charles S. Morrison, Kavita Nanda, Helen Rees, Vinodh A. Edward, Katherine K. Thomas, Thesla Palanee-Phillips, Jared M. Baeten, G Justus Hofmeyr, Neena M. Philip, Timothy D Mastro, and Gonasagrie Nair
- Subjects
0301 basic medicine ,Adult ,viral suppression ,Adolescent ,Depot ,Immunology ,implants ,Physiology ,HIV Infections ,Levonorgestrel ,Medroxyprogesterone Acetate ,Intrauterine device ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,disease progression ,Virology ,Medicine ,Medroxyprogesterone acetate ,Humans ,030212 general & internal medicine ,Viral suppression ,Clinical Trials/Clinical Studies ,Proportional Hazards Models ,business.industry ,hormonal contraception ,Disease progression ,HIV ,Viral Load ,intrauterine device ,Intrauterine Devices, Copper ,CD4 Lymphocyte Count ,DMPA ,030104 developmental biology ,Infectious Diseases ,Hormonal contraception ,Female ,business ,Hiv disease ,medicine.drug - Abstract
Limited data exist on the effects of contraceptives on HIV disease progression. We studied the association between intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD), and the levonorgestrel (LNG) implant on markers of HIV disease progression at the time of HIV detection and 3 months postdetection and time from detection to CD4 count
- Published
- 2020
17. Integrating oral PrEP delivery among African women in a large HIV endpoint‐driven clinical trial
- Author
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Mags Beksinska, Veronique C Bailey, Deborah Baron, Thesla Palanee-Phillips, Jared M. Baeten, Deborah Donnell, Cheryl Louw, Joanne Batting, Elizabeth A. Bukusi, Mookho Malahleha, Jennifer A. Smit, Renee Heffron, Julia D Welch, Timothy D Mastro, Ivana Beesham, Lara Kidoguchi, Khatija Ahmed, and Melanie Pleaner
- Subjects
Adult ,medicine.medical_specialty ,Multiple Partners ,Referral ,Adolescent ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,Administration, Oral ,Zambia ,HIV Infections ,Hiv risk ,medicine.disease_cause ,law.invention ,03 medical and health sciences ,Pre-exposure prophylaxis ,symbols.namesake ,South Africa ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,Research Articles ,pre‐exposure prophylaxis ,clinical trials ,030505 public health ,business.industry ,Incidence ,Public Health, Environmental and Occupational Health ,HIV ,Kenya ,Clinical trial ,Infectious Diseases ,Sexual Partners ,standard of care ,Family medicine ,symbols ,Female ,Pre-Exposure Prophylaxis ,women ,0305 other medical science ,business ,Eswatini ,Research Article - 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
- Published
- 2020
18. HIV comprehensive knowledge and prevalence among young adolescents in Nigeria: evidence from Akwa Ibom AIDS indicator survey, 2017
- Author
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Chinedu Agbakwuru, Timothy D Mastro, Ezekiel James, Patrick Essiet, Jefferson Mwaisaka, Annie Chen-Carrington, Satish Raj Pandey, Titilope Badru, Kwasi Torpey, Sani H. Aliyu, Hadiza Khamofu, and Oluwasanmi Adedokun
- Subjects
Comprehensive HIV knowledge ,Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Risk perceptions ,Adolescent ,Psychological intervention ,Nigeria ,HIV Infections ,Logistic regression ,Social issues ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,Surveys and Questionnaires ,Epidemiology ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Child ,030505 public health ,Descriptive statistics ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,medicine.disease ,Stigma ,Cross-Sectional Studies ,Young adolescents ,Female ,Biostatistics ,0305 other medical science ,business ,Research Article - Abstract
Background Despite the recent increase in HIV infections among adolescents, little is known about their HIV knowledge and perceptions. This study, therefore, sought to examine the factors associated with comprehensive HIV knowledge, stigma, and HIV risk perceptions among young adolescents aged 10–14 years in Akwa Ibom State, Nigeria. Additionally, consenting parents and assenting young adolescents were tested for HIV. Methods We used cross-sectional data from the 2017 Akwa Ibom AIDS Indicator Survey to analyze comprehensive HIV knowledge, stigma, and HIV risk perceptions among young adolescents. Demographic characteristics of young adolescents were summarized using descriptive statistics. Chi-square test (or Fisher’s exact test in cases of small subgroup sample sizes) was used to elicit associations between demographics and study outcomes. Separate multivariable logistic regression models were then conducted to determine associations with the study outcomes. Sampling weights were calculated in order to adjust for the sample design. P-values less than 0.05 were considered to be significant. Results A total of 1818 young adolescents were interviewed. The survey highlighted significant low levels of comprehensive HIV knowledge (9.4%) among young adolescents. Adolescent-parent discussions [AOR = 2.19, 95% C.I (1.10–4.38), p = 0.03], schools as sources of HIV information [AOR = 8.06, 95% C.I (1.70–38.33), p p = 0.02] were associated with comprehensive HIV knowledge. Majority (93%) of young adolescents perceived themselves not to be at risk of HIV. Overall, 81.5% of young adolescents reported stigmatizing tendencies towards people living with HIV. HIV prevalence among young adolescents was 0.6%. Conclusions Results indicate low comprehensive HIV knowledge among young adolescents. Our findings suggest that there is a need for increased attention towards young adolescents particularly in the provision of comprehensive, functional sexuality education, including HIV at the family- and school-levels. Consequently, age appropriate interventions are needed to address the epidemiological risks of young adolescents that are influenced by a myriad of social issues.
- Published
- 2020
19. Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015
- Author
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Adebobola Bashorun, Jonathan E. Kaplan, Yen Ngoc Le, Deborah Carpenter, Peter Preko, Beth A. Tippett Barr, Gideon Kwesigabo, Hank Tomlinson, Mahesh Swaminathan, Henry Debem, Fred Wabwire-Mangen, Joelle D eas Van Onacker, Solomon Odafe, Ermane G. Robin, Eduardo Samo Gudo, Nhan T Do, Modest Mulenga, Sheryl B. Lyss, Mayer Antoine, Shirish Balachandra, Chris Delcher, E. Kainne Dokubo, Alice Namale, Kwasi Torpey, Thomas J. Spira, Gram Mutandi, Eric van Praag, Elizabeth Gonese, Francisco Mbofana, Jean Wysler Domercant, Elliot Raizes, Carla Xavier, Sebastian Hachizovu, Timothy D Mastro, Mark Griswold, Helen Chun, Nirva Duval, Oseni Abiri, Christine Ross, Owen Mugurungi, George Bicego, Velephi Okello, Kesner Francois, Julie A. Denison, Isaac Zulu, Angela A Ramadhani, Duncan A. MacKellar, Robert Colebunders, Olivier Koole, Moses Bateganya, Kiren Mitruka, Harriet Nuwagaba-Biribonwoha, Simon Agolory, Kahemele Ng'wangu, Ramadhani Gongo, David W. Lowrance, Tedd V. Ellerbrock, Caroline Ryan, Charity Alfredo, Julius N Kalamya, Melissa Briggs, Carol Dukes Hamilton, Ikwo Oboho, Gracia Desforges, Spencer Lloyd, Ibrahim Dalhatu, Mohamed Mfaume, Sundeep Gupta, Dennis Onotu, Harrison Kamiru, Souleymane Sawadogo, Trista Bingham, Trong Ao, Varough M. Deyde, Bridget Mugisa, Andrew F. Auld, Yrvel Desir, Ndapewa Hamunime, Tsitsi Mutasa-Apollo, Naemi Shoopala, Andrew L. Baughman, Seymour G. Williams, Rituparna Pati, Michelle R. Adler, Aleny Couto, Nadjy Joseph, Valerie Pelletier, Alfredo Vergara, Jacob Dee, Ishani Pathmanathan, Ray W. Shiraishi, Peter Ehrenkranz, Abu S. Abdul-Quader, Patrick Swai, Stephanie Behel, Duc B. Nguyen, and Sharon Tsui
- Subjects
medicine.medical_specialty ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,Art initiation ,030231 tropical medicine ,MEDLINE ,HIV Infections ,Disease ,Hiv testing ,World health ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Advanced disease ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Full Report ,business.industry ,General Medicine ,Antiretroviral therapy ,Haiti ,CD4 Lymphocyte Count ,Anti-Retroviral Agents ,Vietnam ,Africa ,Physical therapy ,business ,Demography ,Hiv disease - Abstract
Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count
- Published
- 2017
20. ECHO: context and limitations - Authors' reply
- Author
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Nelly Mugo, Helen Rees, Timothy D Mastro, James Kiarie, and Jared M. Baeten
- Subjects
business.industry ,Speech recognition ,Echo (computing) ,Medicine ,Context (language use) ,General Medicine ,business - Published
- 2019
21. HIV Incidence and Risk Behaviours of People Who Inject Drugs in Bangkok, 1995-2012
- Author
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Suphak Vanichseni, Manoj Leethochawalit, Philip A. Mock, Sithisat Chiamwongpaet, Somyot Kittimunkong, Jordan W. Tappero, Janet M. McNicholl, Kachit Choopanya, Frits van Griensven, Udomsak Sangkum, Punnee Pitisuttithum, Jaranit Kaewkungwal, Timothy D. Mastro, and Michael Martin
- Subjects
Placebo ,01 natural sciences ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,medicine ,030212 general & internal medicine ,Poisson regression ,0101 mathematics ,Prospective cohort study ,Tenofovir ,business.industry ,Incidence (epidemiology) ,010102 general mathematics ,Vaccine trial ,Hiv incidence ,virus diseases ,HIV ,General Medicine ,medicine.disease ,Thailand ,HIV pre-exposure prophylaxis ,symbols ,business ,People who inject drugs ,Cohort study ,Research Paper - Abstract
Background Three consecutive prospective studies were conducted among people who inject drugs (PWID) from May 1995 through June 2012 in Bangkok, Thailand. We examined data from these studies to evaluate HIV incidence and explore trends in risk behaviours. Methods We used data from a 1995–1998 cohort study, a 1999–2004 HIV vaccine trial, and a 2005–2012 HIV pre-exposure prophylaxis (PrEP) study to examine per-quarter trends in HIV incidence, using a restricted cubic spline function for time in a Poisson regression. We also examined temporal trends in HIV-associated risk behaviours. Findings HIV incidence declined from 5.7 per 100 person-years during the cohort study, to 2.7 per 100 person-years in the vaccine trial, to 0.7 per 100 person-years among PrEP study placebo recipients. Incidence peaked at 12.1 per 100 person-years in 1996 and declined to
- Published
- 2018
22. Assays for estimating HIV incidence: updated global market assessment and estimated economic value
- Author
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Stefano Ongarello, Natasha Mack, Peter Dailey, Neil Parkin, Jennifer Osborn, E. Megan Davidson Averill, Rick Homan, Jamilah Taylor, Charles S. Morrison, Pairin Seepolmuang, and Timothy D Mastro
- Subjects
0301 basic medicine ,Cross-sectional study ,Cost-Benefit Analysis ,Population ,HIV Infections ,Global Health ,HIV incidence ,03 medical and health sciences ,0302 clinical medicine ,surveys ,Market analysis ,Environmental health ,laboratory assays ,Global health ,Humans ,Medicine ,030212 general & internal medicine ,Epidemics ,education ,Research Articles ,Estimation ,education.field_of_study ,Cost–benefit analysis ,business.industry ,Incidence ,Incidence (epidemiology) ,Public Health, Environmental and Occupational Health ,HIV ,030112 virology ,HIV testing ,Cross-Sectional Studies ,Infectious Diseases ,Sample size determination ,surveillance ,business ,Forecasting ,Research Article - Abstract
Introduction Accurate incidence estimates are needed to characterize the HIV epidemic and guide prevention efforts. HIV Incidence assays are cost-effective laboratory assays that provide incidence estimates from cross-sectional surveys. We conducted a global market assessment of HIV incidence assays under three market scenarios and estimated the economic value of improved incidence assays. Methods We interviewed 27 stakeholders, and reviewed journal articles, working group proceedings, and manufacturers’ sales figures. We determined HIV incidence assay use in 2014, and estimated use in 2015 to 2017 and in 5 to 10-years under three market scenarios, as well as the cost of conducting national and key population surveys using an HIV incidence assay with improved performance. Results Global 2014 HIV incidence assay use was 308,900 tests, highest in Asia and mostly for case- and population-based surveillance. Estimated 2015 to 2017 use was 94,475 annually, with declines due to China and the United States discontinuing incidence assay use for domestic surveillance. Annual projected 5 to 10 year use under scenario 1 – no change in technology – was 94,475. For scenario 2 – a moderately improved incidence assay – projected annual use was 286,031. Projected annual use for scenario 3 – game-changing technologies with an HIV incidence assay part of (a) standard confirmatory testing, and (b) standard rapid testing, were 500,000 and 180 million, respectively. As HIV incidence assay precision increases, decreased sample sizes required for incidence estimation resulted in $5 to 23 million annual reductions in survey costs and easily offset the approximately $3 million required to develop a new assay. Conclusions Improved HIV incidence assays could substantially reduce HIV incidence estimation costs. Continued development of HIV incidence assays with improved performance is required to realize these cost benefits.
- Published
- 2017
23. The evolving HIV epidemic among people who inject drugs in India and the need for a heightened response
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Bitra George, Timothy D Mastro, and Kevin Osborne
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Immunology ,Hiv epidemic ,HIV Infections ,Virology ,Article ,Infectious Diseases ,Family medicine ,medicine ,Immunology and Allergy ,Humans ,Female ,business ,Substance Abuse, Intravenous - Published
- 2015
24. PrEP in the real world
- Author
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Timothy D, Mastro
- Subjects
Drug Combinations ,Organophosphorus Compounds ,Anti-HIV Agents ,Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination ,Humans ,HIV Infections ,Deoxycytidine - Published
- 2014
25. Determining the Incidence of Hepatitis C Virus Infection in Populations: An Important Tool for Epidemic Control
- Author
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Charles S. Morrison, Carol Dukes Hamilton, and Timothy D Mastro
- Subjects
education.field_of_study ,Incidence (epidemiology) ,Hepatitis C virus ,Population ,Psychological intervention ,Hepatitis C ,Biology ,medicine.disease_cause ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Environmental health ,Immunology ,medicine ,Immunology and Allergy ,030211 gastroenterology & hepatology ,Hcv prevalence ,030212 general & internal medicine ,Hiv treatment ,education ,Epidemic control - Abstract
persons. These logistically complicated studies often yield results that are not representative of the larger population of interest as the interventions involved may alter behaviors and subsequent HCV infection incidence. Use of mathematical models to estimate incidence on the basis of HCV prevalence has a role, but input parameters are often not available for specific locations and key populations, resulting in imprecise estimates. Accurate determinations of the incidence of HCV infection are essential to characterize and monitor the epidemic, identify populations currently at highest risk, and assess the effectiveness of interventions. Fortunately, we are in the midst of a
- Published
- 2016
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