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1. High recent PrEP adherence with point‐of‐care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort

Author

Brenda Gati Mirembe, Deborah Donnell, Meighan Krows, Zinhle Zwane, Elizabeth Bukusi, Ravindre Panchia, Cheryl Louw, Noluthando Mwelase, Pearl Selepe, Melissa Senne, Logashvari Naidoo, Rachel Chihana, Margaret Kasaro, Harriet Nuwagaba‐Biribonwoha, Philip Kotze, Katherine Gill, Pippa MacDonald, Alastair vanHeerden, Shannon Bosman, Manjeetha Jaggernath, Phillip du Preez, Amy Ward, Remco P. H. Peters, Sinead Delany‐Moretlwe, Sue Peacock, Rachel Johnson, Jason Caucutt, Susan Morrison, Guohong Wang, Monica Gandhi, Jennifer Velloza, Renee Heffron, Connie Celum, and the INSIGHT Study Team

Subjects
adherence, Africa, point‐of‐care, PrEP, tenofovir, women, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Adolescent girls and young women (AGYW) account for two‐thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre‐exposure prophylaxis (PrEP) but low adherence, which might be improved by point‐of‐care adherence monitoring with tailored counselling. Methods From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16−30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir‐based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point‐of‐care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real‐time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. Results Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21−27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0−96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point‐of‐care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27−1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41−1.98). Observed HIV incidence was 1.38/100 person‐years (95% CI 0.97−2.08). Conclusions Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow‐up. The use of a novel point‐of‐care tenofovir assay with tailored real‐time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study. Clinical trials registration clinicaltrials.gov NCT05746065

Published
2024
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2. Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART)

Author

Wendy Grant‐McAuley, Estelle Piwowar‐Manning, William Clarke, Autumn Breaud, Kidist Belay Zewdie, Ayana Moore, Helen Mary Ayles, Barry Kosloff, Kwame Shanaube, Peter Bock, Sue‐Ann Meehan, Gerald Maarman, Sarah Fidler, Richard Hayes, Deborah Donnell, Susan H. Eshleman, and for the HPTN 071 (PopART) Study Team

Subjects
HIV, controller, population, HPTN 071, Zambia, South Africa, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community‐randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013–2018). Methods VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non‐controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV‐2) status at study enrolment. Conclusions To our knowledge, this report presents the first large‐scale, population‐level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self‐reported data). This study identified a large cohort of HIV controllers and non‐controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.

Published
2023
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3. Partner testing with HIV self‐test distribution by Ugandan pregnant women living with HIV: a randomized trial

Author

Andrew Mujugira, Agnes Nakyanzi, Deborah Donnell, Jade Boyer, Gabrielle Stein, Michelle Bulterys, Faith Naddunga, Juliet Kyomugisha, Juliet E. Birungi, Paul Ssendiwala, Rogers Nsubuga, Timothy R. Muwonge, Joshua Musinguzi, Monisha Sharma, and Connie L. Celum

Subjects
HIVST, secondary distribution, PrEP, ART, male partners, Africa, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Secondary distribution of HIV self‐tests (HIVST) by HIV‐negative pregnant women to male partners increases men's testing rates. We examined whether this strategy promotes male partner testing for pregnant women living with HIV (PWLHIV). Methods We conducted an open‐label individually randomized trial in Kampala, Uganda, in which PWLHIV ≥18 years who reported a partner of unknown HIV status were randomized 2:1 to secondary distribution of HIVST for male partner(s) or standard‐of‐care (SOC; invitation letter to male partner for fast‐track testing). Women were followed until 12 months post‐partum. Male partners were offered confirmatory HIV testing and facilitated linkage to antiretroviral treatment (ART) or oral pre‐exposure prophylaxis (PrEP). Using intention‐to‐treat analysis, primary outcomes were male partner testing at the clinic and initiation on PrEP or ART evaluated through 12 months post‐partum (ClinicalTrials.gov, NCT03484533). Results From November 2018 to March 2020, 500 PWLHIV were enrolled with a median age of 27 years (interquartile range [IQR] 23–30); 332 were randomized to HIVST and 168 to SOC with 437 PWLHIV (87.4%) completing 12 months follow‐up post‐partum. Of 236 male partners who tested at the clinic and enrolled (47.2%), their median age was 31 years (IQR 27–36), 45 (88.3%) men with HIV started ART and 113 (61.1%) HIV‐negative men started PrEP. There was no intervention effect on male partner testing (hazard ratio [HR] 1.04; 95% confidence interval [CI]: 0.79–1.37) or time to ART or PrEP initiation (HR 0.96; 95% CI: 0.69–1.33). Two male partners and two infants acquired HIV for an incidence of 0.99 per 100 person‐years (95% CI: 0.12–3.58) and 1.46 per 100 person‐years (95% CI: 0.18%–5.28%), respectively. Social harms related to study participation were experienced by six women (HIVST = 5, SOC = 1). Conclusions Almost half of the partners of Ugandan PWLHIV tested for HIV with similar HIV testing rates and linkage to ART or PrEP among the secondary distribution of HIVST and SOC arms. Although half of men became aware of their HIV serostatus and linked to services, additional strategies to reach male partners of women in antenatal care are needed to increase HIV testing and linkage to services among men.

Published
2023
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4. Community‐ and individual‐level correlates of HIV incidence in HPTN 071 (PopART)

Author

Timothy Skalland, Helen Ayles, Peter Bock, Justin Bwalya, Kwame Shanaube, Nkatya Kasese, Michelle Dupré, Barry Kosloff, Sian Floyd, Ethan Wilson, Ayana Moore, Susan Eshleman, Sarah Fidler, Richard Hayes, Deborah Donnell, and the HPTN 071 (PopART) Study Team

Subjects
PopART, HIV, incidence, cluster trial, PDV, correlates, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Universal HIV testing and treatment aims to identify all people living with HIV and offer them treatment, decreasing the number of individuals with unsuppressed HIV and thus reducing HIV transmission. Longitudinal follow‐up of individuals with and without HIV in a cluster‐randomized trial of communities allowed for the examination of community‐ and individual‐level measures of HIV risk and HIV incidence. Methods HPTN 071 (PopART) was a three‐arm cluster‐randomized trial conducted between 2013 and 2018 that evaluated the use of two combination HIV prevention strategies implemented at the community level to reduce HIV incidence compared to the standard of care. The trial, conducted in 21 communities in Zambia and South Africa, measured HIV incidence over 36 months in a population cohort of ∼2000 randomly selected adults per community aged 18–44. Multilevel models were used to assess the association between HIV incidence and community‐ and individual‐level socio‐demographic and behavioural risk factors, as well as prevalence of detectable virus (PDV) defined as the estimated proportion of the community with unsuppressed viral load. Results Overall HIV incidence was 1.49/100 person‐years. Communities with less financial wealth and communities with more individuals reporting having sex partners outside of the community or two or more sexual partners had higher HIV incidence. PDV at 2 years of study was 6.8% and was strongly associated with HIV incidence: for every 50% relative reduction in community PDV, there was a 49% (95% confidence interval [CI]: 37%–58%, p < 0.001) relative decrease in HIV incidence. At the individual level; socio‐economic status, AUDIT score, medical male circumcision and certain sexual behaviours were associated with HIV risk. Conclusions Using data from the PopART randomized trial, we found several associations of HIV incidence with community‐level measures reflecting the sexual behaviour and socio‐economic make‐up of each community. We also found a strong association between community PDV and HIV incidence supporting the use of PDV as a tool for monitoring progress in controlling the epidemic. Lastly, we found significant individual‐level factors of HIV risk that are generally consistent with previous HIV epidemiological research. These results have the potential to identify high high‐incidence communities, inform structural‐level interventions, and optimize individual‐level interventions for HIV prevention. Clinical Trial Number ClinicalTrials.gov number, NCT01900977, HPTN 071 [PopArt]

Published
2023
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5. A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial

Author

Connie Celum, Dominika Seidman, Danielle Travill, Christine Dehlendorf, Sanele Gumede, Kidist Zewdie, Whitney Wilson, Jennifer F. Morton, Jared M. Baeten, Deborah Donnell, and Sinead Delany‐Moretlwe

Subjects
choice, decision support tool, HIV prevention, pre‐exposure prophylaxis, South Africa, women, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre‐exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients’ risk perception, knowledge about PrEP, informed decision‐making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics. Methods We designed MyPrEP, a client‐facing DST about PrEP and HIV prevention, with youth‐friendly information and images. The impact of the MyPrEP tool was assessed among HIV‐negative women aged 18–25 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records. Results Of 386 AGYW screened, 353 were randomized (DST n = 172, control n = 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199/353) attending the clinic for HIV testing, 46% (164/353) using contraception, 15% (53/353) using condoms consistently and 37% (108/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79–1.53), of whom two‐thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08–3.69). Ninety‐nine percent randomized to the DST reported satisfaction with MyPrEP. Conclusions Among AGYW attending a South African PHC clinic, PrEP uptake was >90% with two‐fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.

Published
2023
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6. Counterfactual estimation of efficacy against placebo for novel PrEP agents using external trial data: example of injectable cabotegravir and oral PrEP in women

Author

Deborah Donnell, Fei Gao, James P. Hughes, Brett Hanscom, Lawrence Corey, Myron S. Cohen, Srilatha Edupuganti, Nyaradzo Mgodi, Helen Rees, Jared M. Baeten, Glenda Gray, Linda‐Gail Bekker, Mina Hosseinipour, and Sinead Delany‐Moretlwe

Subjects
counterfactual placebo, cabotegravir, emtricitabine/tenofovir disoproxil fumarate, HIV, pre‐exposure prophylaxis, efficacy trial design, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Multiple antiretroviral agents have demonstrated efficacy for human immunodeficiency virus (HIV) pre‐exposure prophylaxis (PrEP). As a result, clinical trials of novel agents have transitioned from placebo‐ to active‐controlled designs; however, active‐controlled trials do not provide an estimate of efficacy versus no use of PrEP. Counterfactual placebo comparisons using other data sources could be employed to provide this information. Methods We compared the active‐controlled study (HPTN 084) of injectable cabotegravir (CAB‐LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) among women from seven countries in Africa to three external, contemporaneous randomized HIV prevention trials from which we constructed counterfactual placebo estimates. We used direct standardization via analysis weights to achieve the same distribution of person‐years between the external study and HPTN 084, across strata predictive of HIV risk (country and selected risk covariates). We estimated prevention efficacy against a counterfactual placebo to provide information on the use of CAB‐LA and FTC/TDF compared to no intervention. We compared the counterfactual placebo findings for FTC/TDF to previous placebo‐controlled trials, adjusted for observed adherence to daily pills. Results Distribution of age and baseline prevalence of gonorrhoea and chlamydia were similar among matched counterfactual placebo and observed HPTN 084 arms after standardization. Counterfactual estimates of CAB‐LA versus placebo in all three settings showed a consistent risk reduction of 93%–94%, with lower bounds of the confidence intervals above 72%. Observed adherence (quantifiable tenofovir in plasma) in HPTN 084 was 54%–56%, and estimated efficacy of daily oral FTC/TDF against a counterfactual placebo was consistent with a predicted risk reduction of 39%–40% for this level of daily pill use. Conclusions Counterfactual placebo rates of HIV acquisition derived from external trial data in similar locations and time can be used to support estimates of placebo‐based efficacy of a novel HIV prevention agent. External trial data must be standardized to be representative of the clinical trial cohort testing the novel HIV prevention agent, accounting for confounders.

Published
2023
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7. Facilitating Next‐Generation Pre‐Exposure Prophylaxis Clinical Trials Using<scp>HIV</scp>Recent Infection Assays: A Consensus Statement from the Forum<scp>HIV</scp>Prevention Trial Design Project

Author

Neil, Parkin, Fei, Gao, Eduard, Grebe, Amy, Cutrell, Moupali, Das, Deborah, Donnell, Ann, Duerr, David V, Glidden, James P, Hughes, Jeffrey, Murray, Michael N, Robertson, Joerg, Zinserling, Joseph, Lau, Veronica, Miller, and Sally, Hodder

Subjects
Pharmacology, Pharmacology (medical)
Abstract

Standard-of-care HIV pre-exposure prophylaxis (PrEP) is highly efficacious, but uptake of and persistence on a daily oral pill is low in many settings. Evaluation of alternate PrEP products will require innovation to avoid the unpractically large sample sizes in noninferiority trials. We propose estimating HIV incidence in people not on PrEP as an external counterfactual to which on-PrEP incidence in trial subjects can be compared. HIV recent infection testing algorithms (RITAs), such as the limiting antigen avidity assay plus viral load used on specimens from untreated HIV positive people identified during screening, is one possible approach. Its feasibility is partly dependent on the sample size needed to ensure adequate power, which is impacted by RITA performance, the number of recent infections identified, the expected efficacy of the intervention, and other factors. Screening sample sizes to support detection of an 80% reduction in incidence for 3 key populations are more modest, and comparable to the number of participants in recent phase III PrEP trials. Sample sizes would be significantly larger in populations with lower incidence, where the false recency rate is higher or if PrEP efficacy is expected to be lower. Our proposed counterfactual approach appears to be feasible, offers high statistical power, and is nearly contemporaneous with the on-PrEP population. It will be important to monitor the performance of this approach during new product development for HIV prevention. If successful, it could be a model for preventive HIV vaccines and prevention of other infectious diseases.

Published
2023
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8. PrEP use and HIV seroconversion rates in adolescent girls and young women from Kenya and South Africa: the POWER demonstration project

Author

Connie L, Celum, Elizabeth A, Bukusi, Linda Gail, Bekker, Sinead, Delany-Moretlwe, Lara, Kidoguchi, Victor, Omollo, Elzette, Rousseau, Danielle, Travill, Jennifer F, Morton, Felix, Mogaka, Gabrielle, O'Malley, Gena, Barnabee, Ariane, van der Straten, Deborah, Donnell, Urvi M, Parikh, Lauren, Kudrick, Peter L, Anderson, Jessica E, Haberer, Linxuan, Wu, Renee, Heffron, Rachel, Johnson, Susan, Morrison, Jared M, Baeten, and Nomhle, Khoza

Subjects
Adult, Adolescent, Anti-HIV Agents, Public Health, Environmental and Occupational Health, HIV Infections, Kenya, Medication Adherence, South Africa, Young Adult, Infectious Diseases, Seroconversion, HIV Seropositivity, Humans, Female, Pre-Exposure Prophylaxis, Prospective Studies
Abstract

HIV incidence remains high among African adolescent girls and young women (AGYW). The primary objective of this study is to assess pre-exposure prophylaxis (PrEP) initiation, use, persistence and HIV acquisition among African AGYW offered PrEP in order to inform PrEP scale-up.POWER was a prospective implementation science evaluation of PrEP delivery for sexually active HIV-negative AGYW ages 16-25 in family planning clinics in Kisumu, Kenya and youth and primary healthcare clinics in Cape Town and Johannesburg, South Africa. Follow-up visits occurred at month 1 and quarterly for up to 36 months. PrEP users were defined based on the month 1 refill. PrEP persistence through month 6 was assessed using Kaplan-Meier survival analysis among AGYW with a month 1 visit, defining non-persistence as an ≥15 day gap in PrEP availability for daily dosing. PrEP execution was evaluated in a subset with PrEP supply from the prior visit sufficient for daily dosing by measuring blood tenofovir diphosphate (TFV-DP) levels.From June 2017 to September 2020, 2550 AGYW were enrolled (1000 in Kisumu, 787 in Cape Town and 763 in Johannesburg). Median age was 21 years, 66% had a sexual partner of unknown HIV status, and 29% had chlamydia and 10% gonorrhoea. Overall, 2397 (94%) initiated PrEP and 749 (31%) had a refill at 1 month. Of AGYW who could reach 6 months of post-PrEP initiation follow-up, 128/646 (20%) persisted with PrEP for 6 months and an additional 92/646 (14%) had a gap and restarted PrEP. TFV-DP levels indicated that 47% (91/193) took an average of ≥4 doses/week. Sixteen HIV seroconversions were observed (incidence 2.2 per 100 person-years, 95% CI 1.2, 3.5); 13 (81%) seroconverters either did not have PrEP dispensed in the study interval prior to seroconversion or TFV-DP levels indicated4 doses/week in the prior 6 weeks.In this study of PrEP integration with primary care and reproductive health services for African AGYW, demand for PrEP was high. Although PrEP use decreased in the first months, an important fraction used PrEP through 6 months. Strategies are needed to simplify PrEP delivery, support adherence and offer long-acting PrEP options to improve persistence and HIV protection.

Published
2022
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9. Improvements in the HIV care continuum needed to meaningfully reduce HIV incidence among men who have sex with men in Baltimore, US: a modelling study for HPTN 078

Author

James P. Hughes, Robert H. Remien, Chris Beyrer, Colin Flynn, Marcy Gelman, Kate M. Mitchell, Dobromir T. Dimitrov, Jason E. Farley, Deborah Donnell, Gabriela Paz-Bailey, Adeola Adeyeye, Danielle German, Brooke E. Hoots, Marie-Claude Boily, National Institutes of Health, and Medical Research Council (MRC)

Subjects
Male, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, PROPHYLAXIS, Men who have sex with men, INITIATION, 0302 clinical medicine, DISPARITIES, Prevalence, RETENTION, 030212 general & internal medicine, theoretical, Hiv transmission, Research Articles, ACTIVE ANTIRETROVIRAL THERAPY, Transmission (medicine), Incidence, Incidence (epidemiology), Hiv incidence, virus diseases, homosexuality, Continuity of Patient Care, Middle Aged, Care Continuum, 3. Good health, Infectious Diseases, 0305 other medical science, Life Sciences & Biomedicine, Research Article, Adult, TRANSMISSION, Anti-HIV Agents, Immunology, UNITED-STATES, forecasting, models, 03 medical and health sciences, TARGETS, medicine, Humans, Science & Technology, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Models, Theoretical, PREVENTION, United States, homosexuality, male, Baltimore, Pre-Exposure Prophylaxis, INFECTED PERSONS, Serostatus, business, 1199 Other Medical and Health Sciences, Demography
Abstract

Introduction HIV prevalence is high among men who have sex with men (MSM) in Baltimore, Maryland, United States, and the levels of viral suppression among HIV‐positive MSM are relatively low. The HIV Prevention Trials Network 078 trial seeks to increase the levels of viral suppression among US MSM by increasing the rates of diagnosis and linkage to care and treatment. We estimated the increases in viral suppression needed to reach different HIV incidence reduction targets, and the impact of meeting diagnosis and treatment targets. Methods We used a mathematical model of HIV transmission among MSM from Baltimore, US, parameterised with behavioural data and fitted to HIV prevalence and care continuum data for Baltimore wherever possible, to project increases in viral suppression needed to reduce the HIV incidence rate among Baltimore MSM by 10, 20, 30 or 50% after 2, 5 and 10 years. We also projected HIV incidence reductions achieved if US national targets – 90% of people living with HIV (PLHIV) know their HIV serostatus, 90% of those diagnosed are retained in HIV medical care and 80% of those diagnosed are virally suppressed – or UNAIDS 90‐90‐90 targets (90% of PLHIV know their status, 90% of those diagnosed receive antiretroviral therapy (ART), 90% of those receiving ART are virally suppressed) are each met by 2020. Results To reduce the HIV incidence rate by 20% and 50% after five years (compared with the base‐case at the same time point), the proportion of all HIV‐positive MSM who are virally suppressed must increase above 2015 levels by a median 13 percentage points (95% uncertainty interval 9 to 16 percentage points) from median 49% to 60%, and 27 percentage points (22 to 35) from 49% to 75% respectively. Meeting all three US or 90‐90‐90 UNAIDS targets results in a 48% (31% to 63%) and 51% (38% to 65%) HIV incidence rate reduction in 2020 respectively. Conclusions Substantial improvements in levels of viral suppression will be needed to achieve significant incidence reductions among MSM in Baltimore, and to meet 2020 US and UNAIDS targets. Future modelling studies should additionally consider the impact of pre‐exposure prophylaxis for MSM.

Published
2019
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10. The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users

Author

David S. Metzger, Ting Yuan Liu, David D. Celentano, Melissa Davey-Rothwell, Deborah Donnell, and Carl A. Latkin

Subjects
Needle sharing, Social network, business.industry, Behavior change, Psychological intervention, Medicine (miscellaneous), Social environment, medicine.disease, law.invention, Substance abuse, Psychiatry and Mental health, Randomized controlled trial, law, medicine, Psychology, business, Peer education, Clinical psychology
Abstract

Aims Social norms are a key source of influence on health behaviors. This study examined changes in social norms and relationships between HIV injection risk behaviors and social norms among injection drug users (IDUs) involved in an experimental intervention. Design Randomized clinical trial. Setting An HIV Prevention Trials Network study, Philadelphia, USA. Participants IDUs, called indexes, and their social network members, who were drug or sex partners, were recruited for an HIV prevention intervention and followed for up to 30 months (n = 652). Indexes were randomized into a peer education intervention or control condition. Measurements Outcomes of injection-related HIV risk behaviors (sharing needles, sharing cookers, sharing cotton, front-/back-loading) were measured every 6 months and the social norms of these four risk behaviors were assessed every 12 months. Findings There was a statistically significant intervention effect on all four social norms of injection behaviors, with participants in the intervention reporting less risky social norms compared with controls (changes in mean score: needles, −0.24, P = 0.007; cookers, −0.33, P = .004; cottons, −0.28, P = .0165; front-/back-loading, −0.23, P = .002). There was also a statistically significant bidirectional association with social norms predicting injection risk behaviors at the next assessment and risk behaviors predicting social norms at the subsequent visit. Conclusions Through social network interventions it is feasible to change both injection risk behaviors and associated social norms. However, it is critical that social network interventions focus on publically highlighting behavior changes, as changing social norms without awareness of behaviors change may lead to relapse of risk behaviors.

Published
2013
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11. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

Author

David N. Burns, Jeremy Sugarman, Scott Rose, Susan H. Eshleman, Oleksandr Zeziulin, William Clarke, Lisa E. Sunner, Tran Viet Ha, Irving F. Hoffman, Samsuridjal Djauzi, Michael G. Hudgens, Sergii Dvoriak, Paul G. Richardson, Carl A. Latkin, Nguyen Van Vuong, Estelle Piwowar-Manning, Kostyantyn Dumchev, Zubairi Djoerban, Steffanie A. Strathdee, Nirupama Sista, Kathryn E. Lancaster, Brett Hanscom, Katie R. Mollan, Laura McKinstry, Jonathan Lucas, Deborah Donnell, Erica L. Hamilton, Vivian F. Go, Bui D Duong, Tetiana Kiriazova, Sarah A. Reifeis, Hptn (PopART) Study Team, Chu Viet Ahn, Lynda Emel, Hepa Susami, William C. Miller, Riza Sarasvita, and David S. Metzger

Subjects
Male, Psychological intervention, HIV Infections, law.invention, Heroin, Cohort Studies, 0302 clinical medicine, injection drug use, Randomized controlled trial, law, Medicine, 030212 general & internal medicine, Substance Abuse, Intravenous, Research Articles, Alcohol Use Disorders Identification Test, Substance Abuse, Viral Load, Middle Aged, 3. Good health, Infectious Diseases, Cohort, Public Health and Health Services, Female, treatment as prevention, Intravenous, 0305 other medical science, Psychosocial, ART, Research Article, medicine.drug, Adult, Adolescent, Sexual Behavior, Clinical Sciences, HPTN 074 Study Team, substance use treatment, Young Adult, 03 medical and health sciences, Humans, PWID, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, HIV, Treatment as prevention, CD4 Lymphocyte Count, Other Medical And Health Sciences, business, Demography, Methadone
Abstract

Author(s): Lancaster, Kathryn E; Hoffman, Irving F; Hanscom, Brett; Ha, Tran Viet; Dumchev, Kostyantyn; Susami, Hepa; Rose, Scott; Go, Vivian F; Reifeis, Sarah A; Mollan, Katie R; Hudgens, Michael G; Piwowar-Manning, Estelle M; Richardson, Paul; Dvoriak, Sergii; Djoerban, Zubairi; Kiriazova, Tetiana; Zeziulin, Oleksandr; Djauzi, Samsuridjal; Ahn, Chu Viet; Latkin, Carl; Metzger, David; Burns, David N; Sugarman, Jeremy; Strathdee, Steffanie A; Eshleman, Susan H; Clarke, William; Donnell, Deborah; Emel, Lynda; Sunner, Lisa E; McKinstry, Laura; Sista, Nirupama; Hamilton, Erica L; Lucas, Jonathan P; Duong, Bui D; Van Vuong, Nguyen; Sarasvita, Riza; Miller, William C; HPTN 074 Study Team | Abstract: IntroductionPeople 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.MethodsWe 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.ResultsThe 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.ConclusionsWhile 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.

Published
2018
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12. Track C Epidemiology and Prevention Science

Author

E. Munyi, P. Iracheta, W. El Sadr, Thomas L. Patterson, N. McGrath, W. Areekul, J. Konikoff, J.S. Graff-Zivin, J. Valladares, O. Levina, A. Wohl, G. Kirk, C. Nhlapo, S. Hoffman, A. Hughes, S. Bertagnolio, S. Gari, B. Grinsztejn, L. Sherr, C. Mattson, T. Finlayson, M. Schim van der Loeff, J.M. Wekesa, R. Qazi, B. Elul, D. Nsona, B. Le, Margaret Hellard, L. Cottle, G. Kwesigabo, P. Mushati, M. Sangeeth, J.T. Maricato, S. Kippax, W. Aung, M. Yu, A. Ochieng, A. Bennani, I. Massud, K. Kardos, K. Muessig, M. Kato, D.N. Raugi, A. Mkhwanazi, M. Roehler, J. Casillas, G. Rutherford, S.J. Gange, N. Kumarasamy, O. Abaza, H.C. Johnson, J.B.F. de Wit, K. Brady, K. Sigaloff, Colleen F. Kelley, J. Kuruc, Supriya D. Mehta, M. Thrun, G. Likatavicius, K. Muldoon, P. Cherutich, M. Siminyu, C. Scanlon, B. Rodriguez, T. Okeyo Adipo, C. Nyamukapa, D. Reach, M. Morris, I. N'Doye, B. Engelsmann, V. Suwanvanichkij, S. Khobragade, J. Nielsen-Bobbit, J. Mitchell, S. Phillips, C.B. Borkowf, C. Nitrahally Mallachar, D.L. Sodora, T. Guadamuz, Christopher K Fairley, G. Phatedi, V. Tepper, J. Willig, Han-Zhu Qian, K. Underhill, E.R.M. Nunes, E. Machakaire, J. Bouscaillou, M. Boyes, L.D. Chava, M. Taylor, X. Zhang, Charles S. Morrison, V. Sharma, R. Firestone, M.R. Lamb, H. James, S.M. Cohen, H. Crane, J. Coleman, K.W. Ranby, H. Van Renterghem, J. Eckenrode, S. Mwalili, M.H. Ngolobe, J. Mitty, S. Sivalenka, T. Bhatnagar, S. Abel, I. Oumzil, J.R. Lama, E. Connick, S. Kennedy, K. Nielsen-Saines, H. Muyinda, Y.M. Nakamura, P. Thomas, R. Salata, I. Kuo, F. Sall, J. Menten, G. Mkandawire, E. Mills, K.A. Gebo, Rob J. Fredericksen, P. Kasonde, S. Braunstein, Erin M. Kahle, B. Kilama, L. Beer, I. de Beer, N. Elkot, C.K. Cunningham, G. Peytavin, T.-Y. Liu, J.W. Eaton, T. Chuenchitra, Jorge Sanchez, N. Hamunime, R. Grant, J.E. Mantell, T. Mashigo, N. Nazim, N.N. Zheng, B. Cutler, R. Rangsin, N. Knight, A.M. Malone, J. Zaidi, P. Edwards, J.T. Brooks, K. Alami, M.K. Mainkar, A. Kowalski, N. Jack, D. Pieterse, Mark Stoove, M. Mirira, C. Schumacher, A.J. Schmidt, W. Jaoko, C.M. Lowndes, S. Atallah, B. Yang, M. Fox, R. Lebelonyane, B. Feldman, S. Caffe, James Kiarie, A. Simo, E. Kajawo, L. Thomas, T.B. Masvawure, R. Staub, C. Ngoloyi, S. Galea, E.L. Ross, F. Noubary, J. Vanhommerig, S. Patel, S. Khanakwa, L. Hightow-Weidman, S. Braithwaite, P. Perchal, J. Mulilo, C.S. Meade, M. Tsepe, A. Suthar, W. Zule, B. Singh, B. Panchia, L. Yin, J. Skinner, S. Ramanathan, K.M. Gray, H. Ramy, S.M. Graham, M.T. Schechter, H. Zhang, R. Harrison, J.P. Zukurov, A. Gonzalez-Rodríguez, L. Johnston, Maria Prins, T. Smith, S. Stoelzl, N. Siegfried, D. De Angelis, G. Paz-Bailey, D. Taljaard, D. Operario, J.D. Fishel, Dobromir T. Dimitrov, Jared M. Baeten, K.J. Sikkema, A. Urbina, S. Birnel-Henderson, Deborah Donnell, J. Borders, R. Killian, G. Mavise, H. Gamieldien, S. Isac, D. Yang, J. Gunthorp, A. Lansky, K.N. Althoff, M. Vincent, J. Lingappa, Patrick S. Sullivan, M.E.E. Kretzschmar, W. Hanekom, M. De Klerk, C. Odhiambo, J. Shafi, V. Kodali, H. Jackson, S. Bharat, Michael Pickles, R. Geskus, R. Jones, L. Vu, P. Messeri, W. Duffus, R. Limaye, M. Collumbien, G. Allen, E. Elghamrawy, R. Spijker, F. Traore, N. Abdallar, K. Lythgoe, Eli S. Rosenberg, M. van de Laar, S. Stromdahl, A. Bowring, P. Schmid, Grant Colfax, S. Duncan, V. Elharrar, T. Madidimalo, H. Tran Viet, M. Tran Thi, K.E. Nelson, D.C. Sokal, S. Mathew, M. Baum, R. Hari Kumar, Sonia Napravnik, J. Lou, Paula M. Frew, M. Alary, Mari M. Kitahata, Tsungai Chipato, R.C. Berg, I. Maclean, D. Kimanga, Y.T. Duong, L. Jacobson, David R. Bangsberg, F. Odhiambo, A. Malone, G. Wang, E. Schiff, Y. Ding, C. Mlambo, D. Wheeler, J. Martin, A. Kwon, X. Xia, R. Granich, Yuhua Ruan, L.-G. Bekker, Stephen L. Boswell, S. Johnson, F. Njenga, F. Gardner, S. Sherman, Q. Abdool Karim, A. Hoare, K. Thomas, Connie Celum, A. Balaji, L. Metsch, M.J. Mugavero, J. Hahn, J. Denison, M. Kretzschmar, M.R. Lozada, A. Zee, J. Frohlich, P.-L. Chen, D. Vyas, Z.A. Stein, I. Hoffman, S. Weber, S. Abou Elmagd, J. Kriebs, D. Skinner, H. Cross, E. Piwowar-Manning, R. Wiegand, B. Furness, A.C. Voetsch, Q. Awori, S. Kapiga, V. Mugisha, R. Nkambule, F. Tanser, S.E. Hawes, R. Ochai, C. Mathews, Myron Essex, M. Chilila, P. MacPhail, P. Michel, J.H. McMahon, V. Sharp, P. Dupas, M. Schaan, Tonia Poteat, S.A. Kaplan, J. Peinado, L. Zhang, P. Weatherburn, N.M. Fernandes, I. Nieves-Rivera, M. Eberhart, A. Presanis, J. Tejero, A. Pettifor, N. Wadonda, R. Adhikary, S. Shoptaw, K. Page, Nelly Mugo, C. Kuo, D. Cohan, V. Delpech, G.D. Kirk, J. Stover, M. Cohen, V. Cummings, C. Johnson, J. Pilotto, J. Tiffany, S. Rajaram, F. Assouab, V. Akelo, Jeanne M. Marrazzo, Y. Shao, J. Schulden, M. Mahy, Z. Hennessey, A. Sunantarod, S. Meesiri, T. Hallett, J.R. Williams, K. Hayashi, M. Barone, A. La Marca, T. Gamble, J. Moguche, S.Y. Hong, K. Kana, B.R. Santos, Mary S. Campbell, B. Auvert, C.H. Watts, P. Ntshangase, A.M. Foss, A. Anglemyer, P. Li, S.P. Ravi, T.J. Smith, Mark N. Lurie, L. Laurenco, A. Chaturvedula, A.C. Justice, J. Sayles, K. Rou, S. Behel, G. de Bruyn, A. Cescon, S. Pont, Till Bärnighausen, R.A. Willis, D. Forrest, P. Vickerman, A. Cope, M. Eliya, J. Mellors, H.B. Jaspan, J. Grinsdale, Y. Dong, James I. Mullins, R. Detels, N. Roth, J.-A.S. Passmore, S.E. Bradley, R. King, C. Latkin, S. Kandula, E. Wahome, D. Celentano, P. Goswami, B. Tee, A. Thiongo, K. Kaplan, J. Pienaar, M.W. Ross, P. Kaleebu, S. Chariyalertsak, K.F. Kelley, E. Valverde, Susan Scheer, M. Bhattacharya, J. Kinuthia, R. Brookmeyer, E. Mwamburi, A. Castel, G. Trapence, R. Helmy, G. Bicego, Carol El-Hayek, P. Chavez, E. Brown, C. Frangakis, E. Rodríguez-Nolasco, M. Colvin, Stefan Baral, A. Delgado-Borrego, J. Kessler, M.C. Weinstein, H. Shasulwe, B. Koblin, M. Magnus, W. Zhou, M.H. Watt, David Moore, J.B. Reed, C. Debaulieu, M.R. Jordan, F. Martinson, K. Nucifora, P.W. Young, L. Kayla, W. Matthews, M. Motamedi, J. Gweshe, B. El Omari, R. Ondondo, C. Kahlert, X. Cao, J. Okanda, G. Makana, V. Go, R. Colebunders, R. Simba, I. Hall, R. Bakker, P. Vernazza, D. Exner-Cortens, A. Brown, L. Kurtz, K.R. Amico, H. Ntalasha, R. Baggaley, N. Song, T. Aragon, R.S. Hogg, J. Nikisi, F. Mwanga, C. Shepard, O. Koole, K. Buchacz, P. Gonzales, A. Martin, B. Santos, D. Lewis, G. Anderson, C. Polis, S. Derendinger, K. Mayer, S. Vermund, A. Griffin, Samuel R. Friedman, M.S. Cohen, F.J. Muro, D. Patel, A. Sugarbaker, M. Musheke, C. Beyrer, C. Kwok, B.P. Yadav, J. Kaplan, R. Zulz, C. Mullis, R. Bailey, R. Dickson, T. Subramaniam, Katerina A. Christopoulos, K.A. Webb, J. Mbwambo, A. Phillips, M.A. Lampe, M. Muthui, R. Washington, T. Abdalla, J. Margolick, Matthew J. Mimiaga, Helen Rees, H.M.J.P. Vidanapathirana, R. Kamwi, Z. Yin, E.L. Frazier, M. Orkin, M. Beksinska, S.A. Strathdee, Andrea L. Wirtz, S. Elkamhawi, C. Soliman, T. Kerr, G. Pappas, Renee Heffron, S. Bachman, N. Forster, C. Mapanje, M. Goldstein, J. McMahon, P. Nair, J. Banda, M. Kall, R. Fichorova, Nelson K. Sewankambo, W. Zhu, D. Nicca, J.A. Moss, N. Habarta, E.J. Sanders, B. Riggan, P. Roberts, W. Heneine, D. Shabangu, J.L. Burgos, R. Ducharme, M. Toure, G.P. Garnett, R. Arafat, C. Ryan, E. Grapsa, P.M. Spittal, Kenneth Ngure, J. Waldura, M. Hosseinipour, N. Mensah, J. Ellard, T. Tang, R. Smith, J. Grund, R. Wood, Dean Murphy, M.-P. Sy, S. Gregson, R.A. Coutinho, D. Burns, Robert W. Coombs, N. Rafif, J.G. Hakim, S. Sahay, M.-L. Newell, M.L. Ngeruka, S.P. Fiorillo, C.-P. Pau, M. Decker, M. Getahun, E. Eduardo, L. Dumba, Joseph Makhema, T. Crea, J. Schillinger, Y. Jia, M. Sulkowski, Grace John-Stewart, F. Mbofana, Sam Phiri, N.B. Kiviat, B.P.X. Grady, V. Cambiano, T. Friel, David E Leslie, Y. Gebre, N. Muraguri, L. Valleroy, J. Skarbinski, P. Nadol, C. Kerr, T. Brewer, A. Ghani, M. Chen, L. Mills, S. Mital, C. Qiu, A.D. Paltiel, Janet J. Myers, C. van Gemert, R. Panchia, S. Agolory, A. Koler, P. Dietze, A. Jonas, N. Taruberekera, N. Philip, S.R. Nesheim, S. Tsui, J.P. Bitega, R. Abdool, C. Nekesa, J.G. Kahn, S. Townsell, S. Chan, A. Mujugira, V. Capo-Chichi, P. Rebeiro, Y. van Weert, J. Limba, K. Morrow, J. Birungi, E. Van Praag, L. Juárez-Figueroa, W. Miller, L.X. Deng, D. MacKellar, D. Kiima, V.D. Ojeda, P.L. Chu, S. Ohaga, J. Bradley, T. Sripaipan, C. Nguyen, R. Coutinho, E. Gardner, K.L. Vincent, A. Surendera Babu, A. Pharris, N. He, M. Maskew, S. Moses, A. Khan, H. Wang, M. Akello, Brandon O'Hara, J. Evans, D.E. Bennett, G.F. Webb, U. Abbas, C. Pretorius, M. Egger, R.S. Gupta, M. Mulenga, M. Odiit, C.E. Jones, M.F. Schim van der Loeff, I. Shaikh, A.D. Smith, D. Mark, G. Otieno, M. van Rooijen, T. Exner, A. Aghaizu, A. Vu, T. Ahmed, M. Wolverton, L. Seemann, Gustavo F. Doncel, A. Kharsany, C. Botao, J. Brown, J. Eaton, D. Krakower, J. Justman, Sheryl A. McCurdy, J. Otchere Darko, I. Denham, S. Fields, T. Taha, V. Jumbe, Z. Mwandi, K. Sey, T. Webster-León, M.A. Chiasson, W. Burman, E. Daniel, F. Deyounks, R. Willis, C. Kunzel, B. Greenberg, M. Lalota, B. George, R. Sitta, S. Abdool Karim, M. Kganakga, N. van der Knaap, S. Griffith, Z. Wu, C. del Rio, A. Briceno, R.P. Walensky, M.G. Anderson, Q. Vu Minh, R. Cabello, J.R.S. Malungo, H.J. Prudden, M. Mulatu, Y.Q. Chen, M.M. Baum, F. Mawazini, G. Phillips, B. Williams, F. van Aar, T. Noori, K. Curtis, L. Cluver, S. Huang, S. Safren, N. Westercamp, M. Pereyra, B. Nichols, L. Robertson, A. Oster, G. Kamanga, I. Butkyavichene, S. Ketende, W. Dothi, T. van de Laar, S. Bodika, L. Pang, S.J. de Vlas, B. Bearnot, M. Wallace, E. Duflo, F.M. Chimbwandira, L. Ramakrishnan, W. Kanjipite, A. Del Riego, S. Willis, S.L. Cherne, S. Merten, D. Hoover, A.K. Hesseling, E. Daniloff, K. Agot, L. Wang, Y. Ma, T. Heijman, Marie-Claude Boily, Susan Buchbinder, N. Luhmann, A.E. Phillips, D. Kamba, E. Op de Coul, L.M.R. Janini, M. Kolber, D. Reirden, G. Osorio, S.C. Kalichman, S. Combes, A. Auld, J. Rosenberger, H. Lin, A.S. de Vos, M. Paczkowski, E. Pouget, W. Davis, C. Mauck, M. Berry, S. Godbole, S. Mannheimer, N. Bock, C. Sexton, O. Whiteside, A. Bocour, S.K. Mohammed, J.G. Garcia-Lerma, T. Quinn, E. Losina, J.H.d.S. Pilotto, L. Werner, D. Newman, K. Russell, M. Chakela, S. Rowan, E. Wood, K.M. Mitchell, D. Novak, S. Rao, S. Roux, L. Ti, Edwin Were, J. Moss, G. Seage, A. Wongthanee, A. Muadinohamba, A. Crooks, X. Li, W. Motta, Noah Kiwanuka, M. McCauley, M.G. Rangel, G. Ravasi, B. Pick, T. West, R.N. Rimal, K. Bowa, J. Xu, P. Rhodes, J. Thorne, C. Avila, Michael S. Saag, E.A. Kelvin, A. Nqeketo, G.-M. Santos, H. El Rhilani, G.S. Gottlieb, N. Wang, S. Williams, I. Halldorsdottir, L.P. Jacobson, O. Mellouk, M. Sweat, L.R. Metsch, K. Sabin, S. Philip, S. Badal-Faesen, G. Sal y Rosas, D.H. Evans, R. Kumari, B. Tempalski, H.S. Okuku, I. Sanne, R.D. Moore, Y. Wang, A. Mbandi, S. Messinger, I. Balan, K. Kahuure, D. Kerrigan, J.J. van der Helm, D.L. Ellenberger, S.E. Kellerman, M. Sweeney, J. Opoku, H. Ginindza, D. Suryawanshi, N. Kikumbih, B.S. Parekh, J. Heffelfinger, C. Hart, B. Marshall, M. Jordan, O. Laeyendecker, O.N. Gill, S. Lee, G.R. Seage, C.-C. Udeagu, Travis Sanchez, J. White, J. Mwambi, J. Gilman, J. Talley, R. Baltussen, P. Galatowitsch, Kenneth H. Fife, T.R. Sterling, C. Mao, T. Frasca, A. Speksnijder, M. Nguyen Le, E. Dinenno, S. Kawichai, S. Hong, A. Gagner, L. Ouarsas, J. Goller, C. Watson, E. White, R. Monasch, N. Chotirosniramit, L. McNamara, D. van de Vijver, V. Hu, Sarah E. Rutstein, R. Glaubius, R.S. Paranjape, J. Peterson, P. Swain, Johnstone Kumwenda, Elizabeth A. Bukusi, F. Wabwire-Mangen, A. Buchanan, K.A. Freedberg, K. Shannon, J.C. Makoni, N. Rosenberg, J. Montaner, R. Koul, J. Zhang, E. Shihepo, J. Wang, H. Tran Vu, J.A. Smit, M. Sinunu, K. Chesang, G. Muzaaya, E.J. Schouten, V. Joseph, C. Karema, B.M. Ramesh, J.A.C. Hontelez, K. Torpey, G. Guillon, R. Taljaard, J. Elliott, R. Rao, D. Wilson, T.B. Hallett, Y.D. Mukadi, D.R. Holtgrave, K. Yotruean, M. Rasi, K.H. Mayer, M. Horberg, C. Chariyalertsak, C.-S. Leu, S. Billy, R. Lee, P. Suwannawong, Barrot H. Lambdin, R. Heimer, J. Tosswill, Marsha Rosengarten, A. Tripathi, M. Williams-Sherlock, C. Dolezal, M. Makhanya, A.T. Urbanus, C. Hendrix, C. Mwangi, P. Srikantiah, W. Jimbo, A. Puren, T. Smolskaia, M. Kamal, H. Li, G. Murphy, P. Masson, N. Benbow, E. Umar, A. Binagwaho, Papa Salif Sow, P. Lissouba, G. Olilo, P. Pathela, M. Mugavero, M. Cousins, S. Swindells, D. Callander, Z. Mabude, G. Cardenas, M.B. Klein, D. Sherard, C. Toohey, M. Holt, A. Pandey, D. Hedeker, Kimberly A. Powers, J. Astemborski, R. Gregg, M. Cribbin, Edith Nakku-Joloba, C. Furlow-Parmley, A. Abadie, Joseph J. Eron, D. Stéphanie, E. Kersh, P. Oyaro, P. Kohler, D.B. Hanna, H. Götz, H.I. Hall, S. Eshleman, K. Eritsyan, A. Carballo-Diéguez, G. Mujaranji, R. Needle, L. Lacroix, S. Singh, L. Wilton, J. Gallant, A. Howard, H.A. Pollack, J. Mermin, J. Schinkel, and S. Lovelace

Subjects
medicine.medical_specialty, 030505 public health, business.industry, Gonorrhea, Public Health, Environmental and Occupational Health, Human immunodeficiency virus (HIV), Miami, medicine.disease_cause, medicine.disease, Virology, 03 medical and health sciences, Cross matching, 0302 clinical medicine, Infectious Diseases, Family medicine, Medicine, 030212 general & internal medicine, 0305 other medical science, business
Published
2012
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