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Background: The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. Materials and Methods: All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. Results: Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. Conclusion: Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as “high-risk” patients and treated accordingly.

SETTING Community health screenings in KwaZulu-Natal Province, South Africa. OBJECTIVE To study the synergism between diabetes mellitus (DM) and human immunodeficiency virus (HIV) infection in increasing the risk of tuberculosis (TB). DESIGN In this cross-sectional study, we analyzed data from two community health projects, one at congregate settings, and one at household settings (n = 7708), in a rural resource-limited region where integrated communicable and non-communicable disease screening services were offered. Odds ratios (ORs) for demographic factors, socio-economic factors, DM status, and HIV positivity were calculated using multivariate analysis, and the statistical interaction between HIV and DM was tested. The primary outcome was the presence of TB symptoms. RESULTS Among 7708 individuals, age >65 years (OR 1.72, 95%CI 1.47-2.02), HIV infection (OR 1.66, 95%CI 1.40-1.97) and DM (OR 1.36, 95%CI 1.11-1.67) were independently associated with increased odds of TB symptoms. Receiving monthly grants (OR 0.78, 95%CI 0.66-0.91), access to a toilet (OR 0.54, 95%CI 0.35-0.83), and access to solar or electric energy (OR 0.86, 95%CI 0.77-0.97) reduced the odds. There was evidence of significant interaction between DM and HIV on the multiplicative scale. CONCLUSION DM and HIV synergistically increased the odds of TB symptoms according to these retrospective data. Future studies should prospectively evaluate synergism between HIV and DM in increasing the risk of active TB.

Introduction: Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected. Materials and Methods: A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed. Results: HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy. Conclusion: Maternal literacy status favorably influences vertical transmission of HIV.

Objective To identify risk factors for and understanding of anal cancer and associated screening tests among transgender persons. Methods An anonymous survey was designed and distributed with SurveyMonkey.com to transgender persons recruited at health fairs, surgical clinics, and self-referral by word of mouth. Descriptive statistical analysis was performed. Results 24 transgender women (TGW), age 23–67 years old (mean=42) and 13 transgender men (TGM), age 18–59 years old (mean=29) participated. The majority were Caucasian [TGW, 15 (63%); TGM, 12 (92%)], and insured [17(71%) TGW; 10 (77%) TGM]. Reported risk factors for anal cancer included smoking history [(14 (58%) TGW; 7(54%) TGM], past STI diagnosis [9(38%) TGW; 1(8%) TGM], HIV positivity (1(4%) TGW), receptive anal intercourse [17(71%) TGW, 7(54%) TGM], and inconsistent condom use [10(42%) TGW; 7(54%) TGM]. Only 4(17%) TGW perceived themselves to be at risk for anal cancer. Most TGW reported little to no knowledge of anal cancer (16, 67%) or anal pap smears (18, 75%). While five (21%) reported past screening, most expressed willingness to undergo future testing (n=19, 79%). Among TGM, only two (15%) perceived themselves to be at risk for anal cancer; five (38%)were familiar with anal pap smears; and only one (8%) person reported past testing. Eight (62%) reported willingness for future screening. Conclusion Transgender persons have multiple risk factors for anal cancer, yet self-perceived risk is low. Most are unfamiliar with anal cancer screening and have not been tested. This suggests transgender persons would benefit from increased awareness of anal cancer risk and screening methods.

Introduction Although HIV testing services (HTS) have been successfully task‐shifted to lay counsellors, no model has tested the franchising of HTS to lay counsellors as independent small‐scale business owners. This paper evaluates the effectiveness of a social franchisee (SF) HTS‐managed pilot project compared to the Foundation for Professional Development (FPD) employee‐managed HTS programme in testing and linking clients to care. Methods Unemployed, formally employed or own business individuals were engaged as franchisees, trained and supported to deliver HTS services under a common brand in high HIV‐prevalent communities in Tshwane district between 2016 and 2017. SFs were remunerated per‐HIV test and received larger payments per‐HIV‐positive client linked to care. In the standard HTS, FPD employed counsellors received similar training and observed similar standards as in the SF HTS, but were remunerated through the normal payroll. We assessed the proportion of clients tested, HIV positivity, linkage to care and per‐counsellor cost of HIV test and linkage to care in the two HTS groups. Results The SF HTS had 19 HIV counsellors while FPD HTS employed 20. A combined total of 84,556 clients were tested by SFs (50.5%: 95% confidence interval (CI) 50.2 to 50.8)) and FPD (49.5%: 49.2 to 49.8). SFs tested more females than FPD (54.1%: 53.6 to 54.6 vs. 48%: 47.7 to 48.7). SFs identified more first‐time testers than FPD (21.5%: 21.1 to 21.9 vs. 8.9%: 8.6 to 9.1). Overall, 8%: 7.9 to 8.2 tested positive with more clients testing positive in the SF (10.2%: 9.9 to 10.5) than FPD (5.9%: 5.6 to 6.1) group. The SFs identified more female HIV‐positive clients (11.1%: 10.7 to 11.6) than FPD (6.5%: 6.2 to 6.9). The SFs linked fewer clients to HIV care and treatment (60.0%: 58.5 to 61.5) than FPD (80.3%: 78.7 to 81.9%). It cost four times less to conduct an HIV test using SFs ($3.90 per SF HIV test) than FPD ($13.98) and five times less to link a client to care with SFs ($62.74) than FPD ($303.13). Conclusions SF HTS was effective in identifying more clients, first‐time HIV testers and more HIV‐positive people, but less effective in linking clients to care than FPD HTS. The SF HTS model was cheaper than the FPD‐employee model. We recommend strengthening SFs particularly their linkage to care activities.

BACKGROUND In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk. STUDY DESIGN AND METHODS In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations. RESULTS The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%. CONCLUSION ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.

BackgroundInformation on extrapulmonary TB (EPTB) patients is limited in many African countries including Ghana. The study objective was to describe the epidemiology of EPTB patients diagnosed from different categories of health facilities in Accra, Ghana compared to pulmonary TB (PTB) patients and identify risk factors for mortality among EPTB patients.MethodWe conducted retrospective analyses of demographic and clinical data accessed from medical records of EPTB and PTB patients from different types of health facilities from June 2010 to December 2013. Factors at diagnosis associated with EPTB compared to pulmonary TB (PTB) and factors associated with treatment outcome death among EPTB patients were assessed using logistic regression.ResultsOut of 3,342 new TB patients ≥15 years diagnosed, 728 (21.8%) had EPTB with a male: female ratio of 1.17. The EPTB sites commonly affected were disseminated 32.8%, pleura 21%, spine 13%, and Central Nervous System (CNS) 11%. Treatment success rate for EPTB was 70.1% compared to 84.2% for PTB (pConclusionEPTB patients in Accra have a worse treatment outcome compared to PTB patients with mortality of EPTB being associated with HIV, older age and CNS TB. Being HIV positive and female gender were found to be significantly associated with EPTB. Increased awareness of these factors may facilitate early case finding and better management outcomes for these patients.

Background and aim As a consequence of socioeconomic and political crises in many parts of the world, many European Union/European Economic Area (EU/EEA) countries have faced an increasing number of migrants. In the German federal state of Bavaria, a mandatory health screening approach is implemented, where individuals applying for asylum have to undergo a medical examination that includes serological testing for HIV and hepatitis B, screening for tuberculosis, and until September 2015, stool examination for Salmonella spp. and Shigella spp.. Methods: Data from mandatory screening of all first-time asylum seekers in Bavaria in 2015 was extracted from the mandatory notification and laboratory information system and evaluated. Results: The HIV positivity and hepatitis B surface antigen (HBsAg) positivity rate of tested samples from asylum seekers were 0.3% and 3.3%, respectively, while detection rate of active tuberculosis was between 0.22% and 0.38%. The rates for HIV, hepatitis B, and tuberculosis among asylum seekers were similar to the corresponding prevalence rates in most of their respective countries of birth. Only 47 Salmonella spp. (0.1%) were isolated from stool samples: 45 enteric and two typhoid serovars. Beyond mandatory screening, louse-borne relapsing fever was found in 40 individuals. Conclusions: These results show that mandatory screening during 2015 in Bavaria yielded overall low positivity rates for all tested infectious diseases in asylum seekers. A focus of mandatory screening on specific diseases in asylum seekers originating from countries with higher prevalence of those diseases could facilitate early diagnosis and provision of treatment to affected individuals while saving resources.

Indonesia has had low uptake of HIV testing and treatment. We did a study to estimate the cascade of HIV care in key populations and identify predictors of outcomes at key cascade steps.We used an observational cohort study design to recruit and follow up men who have sex with men (MSM), female sex workers, transgender women (known as waria in Indonesia), and people who inject drugs (PWID) diagnosed with HIV in four locations in Indonesia: Bali, Bandung, Jakarta, and Yogyakarta. Recruitment, baseline, and follow-up visits were done at collaborating clinical services, including both primary care sites and hospitals. Inclusion criteria for participants included identifying as a member of a key population, age 16 years or older, not previously tested positive for HIV, and HIV positivity at baseline. All participants were offered treatment as per national guidelines, with the addition of viral load testing and completion of study-specific forms. Estimates were calculated of proportions of participants linked to care, commencing treatment, adherent to treatment, and who achieved virological suppression. We used logistic regression to investigate characteristics associated with antiretroviral therapy (ART) initiation and viral suppression and Cox regression to identify factors associated with loss to follow-up. This study is registered with ClinicalTrials.gov, NCT03429842.Between Sept 15, 2015, and Sept 30, 2016, 831 individuals were enrolled in the study, comprising 637 (77%) MSM, 116 (14%) female sex workers, 27 (3%) waria, and 51 (6%) PWID. Of those enrolled, 703 (84·6%, 95% CI 82·1-87·1) were linked to HIV care and 606 (86·2%, 83·7-88·8) who were linked with care started ART. Among participants who started treatment, 457 (75·4%, 71·8-78·9) were retained in care, of whom 325 (71·1%, 66·7-75·2) had a viral load test about 6 months after enrolment, with 294 (90·5%, 86·7-93·4) of those tested (294 [35%, 32·1-38·7] of the original cohort) virally suppressed. 146 (24%) of 606 who started treatment were lost to follow-up. People who enrolled at sites that offered both testing and treatment had a higher likelihood of treatment initiation than those who enrolled at sites offering testing only (p0·0001 by multivariate analysis), and participants who had been linked to care and had a high school or university education were significantly more likely to achieve viral suppression than those with a primary school or lower level of education (p≤0·029 by mulivariate analysis).HIV cascade data among key populations in Indonesia show very poor rates of retention in treatment and viral suppression. Site and individual characteristics associated with initiating and continuing treatment suggest an urgent need to develop and implement effective interventions to support patients in achieving viral suppression among all people with HIV.Australian Government Department of Foreign Affairs and Trade, WHO, and Indonesian Government.

Introduction : a pregnant woman who is HIV positive can transmit the virus to the baby during pregnancy, labour, birth, and breastfeeding; the likelihood ranging from 15% to 45% without antiretroviral treatment and highest in breastfeeding situations. The Early Infant Diagnosis program of the Uganda Ministry of Health is responsible for the diagnosis of HIV in infants and children at the earliest possible opportunity, usually any time from 6 weeks from birth. Diagnosis of HIV in infants and mothers should be followed by prompt ART initiation under the policy of Elimination of Mother to Child Transmission of HIV. Methods : the report covers the period of January to December 2015 in which blood samples from infants and children were collected nation-wide and tested for HIV infection from the molecular Biology laboratories at the Central Public Health Laboratories in Kampala. The test method of HIV-1 DNA PCR was used to test specimens comprising Dried Blood spots on filter paper. Bivariate analysis using cross-tabulation of dependent (health outcome) and independent variables (exposure factors) generated crude risk ratios which were used to interpret the likelihood of HIV infection in exposed infants. Significant factors at the bivariate level were subjected to multiple logistic regression models to correct for confounding factors and to generate adjusted Odds Ratios of HIV infection in the exposed infants. Results : monthly infant HIV positivity rates varied from 4% to 5.5% and were lower towards the end of the year. The distribution of the positivity rates across the country varied from 4% to 8% and was higher around the Central and the Eastern regions. At least 50% of the children tested at PCR1 (first testing) were 2 months of age, the rest testing later than scheduled. HIV positivity rates also increased with the age of the child. Children born to mothers on life-long ART at antepartum (AOR=0.11, 95% CI 0.09-0.12) and intrapartum (AOR=0.16, 95% CI 0.14-0.18) were less likely to be HIV positive. Infants on the recommended ARV prophylaxis of daily nevirapine from birth to 6 weeks were less likely to be HIV positive (AOR=0.19, 95% CI 0.17-0.21) especially when the mother is on life-long ART. Conclusion : breastfeeding was protective for the infant (AOR=0.34, 95% CI 0.28-0.41) if the mother was on life-long ART postpartum, but posed risks of HIV infection for the child (AOR=2.71, 95% CI 2.39-3.09) if the mother was ARV naive postpartum. Children born to ARV naive mothers were more likely to be HIV positive (AOR=6.18, 95% CI 5.46-6.99), and children who were never given ARV prophylaxis were more likely to be HIV positive (AOR=7.62, 95% CI 6.89-8.44). Test results turn-around times were longest for the process of specimen collection at the health facility and delivery to the central testing lab (10-12 days), and shortest for specimen reception and testing (2 days). The use of ART by mothers and infants should be stepped up, and there is need to reduce the number of children testing late for HIV infection.

ObjectivesThe objectives of this study were: (1) to examine the correlates of HIV positivity among participants who injected drugs and engaged in sex work (PWID-SWs) in the SurvUDI network between 2004 and 2016, after stratification by sex, and (2) to compare these correlates with those of sexually active participants who did not engage in sex work (PWID non-SWs).Design and settingThis biobehavioural survey is an open cohort of services where participants who had injected in the past 6 months were recruited mainly through harm reduction programmes in Eastern Central Canada.ParticipantsData from 5476 participants (9223 visits in total; 785 not included in multivariate analyses due to missing values) were included.MethodsParticipants completed an interviewer-administered questionnaire and provided saliva samples for anti-HIV antibody testing. Generalised estimating equations taking into account multiple participations were used.ResultsBaseline HIV prevalence was higher among SWs compared with non-SWs (women: 13.0% vs 7.7%; PConclusionThese results suggest that sex work has an impact on the risk of HIV acquisition and that risk behaviours vary according to gender. Public health practitioners should take those specificities into account when designing HIV prevention interventions aimed at PWIDs.

Background Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. Methods Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. Results Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. Conclusions Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease.

Objectives. We evaluated HIV testing and service delivery in Centers for Disease Control and Prevention (CDC)–funded sexually transmitted disease (STD) clinics. Methods. We assessed HIV testing, HIV positivity, receipt of HIV test results, linkage to medical care, and referral services from 61 health department jurisdictions from 2011 to 2013. Results. In 2013, 18.6% (621 010) of all CDC-funded HIV-testing events were conducted in STD clinics, and 0.8% were newly identified as HIV-positive. In addition, 27.3% of all newly identified HIV-positive persons and 30.1% of all newly identified HIV-positive men who have sex with men were identified in STD clinics. Linkage to care within any time frame was 63.8%, and linkage within 90 days was 55.3%. Although there was a decrease in first-time HIV testers in STD clinics from 2011 to 2013, identification of new positives increased. Conclusions. Although linkage to care and referral to partner services could be improved, STD clinics appear successful at serving populations disproportionately affected by HIV. These clinics may reach persons who may not otherwise seek HIV testing or medical services and provide an avenue for service provision to these populations.

Objectives Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. Methods Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. Results In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. Conclusions Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.

The synergy between Mycobacterium tuberculosis infection and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is well established but not so in Buruli ulcer (BU). We screened confirmed BU cases for HIV infection and followed seven BU/HIV-coinfected patients. Management of BU/HIV was based on the World Health Organization guidelines and patient condition. The HIV positivity among BU patients (8.2%; 11/134) was higher compared with that of general patients attending the facility (4.8%; 718/14,863; P = 0.07) and that of pregnant women alone (2.5%; 279/11,125; P = 0.001). All seven BU/HIV-coinfected cases enrolled in the study presented with very large (category III) lesions with four having multiple lesions compared with 54.5% of category III lesions among HIV-negative BU patients. During the recommended BU treatment with streptomycin and rifampicin (SR) all patients developed immune infiltrates including CD4 T cells in their lesions. However, one patient who received antiretroviral therapy (ART) 1 week after beginning SR treatment developed four additional lesions during antibiotic treatment, while two out of the four who did not receive ART died. Further evidence is required to ascertain the most appropriate time to commence ART in relation to SR treatment to minimize paradoxical reactions.

Zimbabwe introduced the early infant diagnosis (EID) for human immunodeficiency virus (HIV) exposed infants in 2007. Data captured through this initiative has never been analysed in detail. A detailed EID data analysis was carried out to evaluate the effectiveness of the prevention of mother to child transmission (PMTCT) of HIV in reducing HIV transmission. A retrospective record review of the national EID dataset for the period of January, 2007 to August, 2011 was conducted. Secondary data analysis was done to calculate EID population coverage and HIV positivity amongst samples tested, to compare effectiveness of PMTCT regimens among tested children, and to determine the correlation between mode of delivery and infant outcomes. EID population coverage increased from 1% in January, 2007 to 38% by August, 2011, far below universal access target of 80%. Of the samples tested, HIV positivity showed an apparent decline from 38% in 2007 to 11% in 2011. HIV positivity in infants born vaginally was comparable to those delivered by caesarean section for the years 2010 (p-trend 0.427) and 2011 (p-trend 0.99). Both maternal and infant antiretroviral (ARV) prophylactic regimens were found to reduce HIV positivity significantly (p-trend < 0.001). The national EID database is an important and readily available tool for monitoring and evaluating the PMTCT program and paediatric HIV trends. The Ministry of Health through its PMTCT programme should regularly use this data to inform prioritization of PMTCT interventions. Increased access to both maternal and infant ARV prophylactic drug regimens is critical, if the target of eliminating paediatric HIV by 2015 is to be met in Zimbabwe. Key words: Early infant diagnosis, PMTCT, ARV prophylaxis, Zimbabwe.

Sub-Saharan African countries are heavily burdened with HIV, which disproportionately affects women of reproductive age. Extant literature is inconsistent regarding the link between intimate partner violence and HIV. Data from the 2007 Zambian Demographic Health Survey of women aged 15–49 (n = 5014) were analysed. The influence of abuse by a current or former husband on consent to HIV testing and HIV positivity were evaluated. The unadjusted analysis showed a statistically significant association between intimate partner violence and consent to testing for HIV. Stratified analysis showed that there was a statistically significant association between intimate partner violence and HIV testing in rural areas but not in urban areas. However, the association lost its significance when adjusted for confounding factors. No statistically significant association was found between intimate partner violence and HIV-positive status. It is encouraging that women who experienced intimate partner were testing for HIV. Prevention efforts should continue addressing the needs of this population.

The primary objective of this study was to estimate the individual and combined impacts of socio-demographic and sexual behaviours on HIV diagnosis among 523 female sex workers who participated in the Papua New Guinea and Australia Sexual Health Improvement Project. Logistic regression models were used to identify the factors associated with HIV positivity. We estimated their population level impacts in order to quantify the proportion of HIV seropositivity is attributed to these factors. Less than 40 % of women consented to get tested for HIV. HIV prevalence was 7 % (95 % CI 4-11 %); lack of education and knowledge/awareness of HIV accounted for ~70 % of the HIV diagnoses. A major obstacle is lack of interest for testing. Our study underscored the major challenges in this culturally, linguistically heterogeneous country. The epidemic in Papua New Guinea requires targeted prevention interventions among those at highest risk of acquiring or transmitting infection.

The aim of the research is to examine the HIV risk factors affecting poor health in Ethiopia by epidemiological perspectives. The Demographic and Health Survey 2011 and other secondary data were used. Ethiopian population growth has slowed dramatically or stopped due to HIV and AIDS. A logistic regression and correlation between HIV positive towards AIDS, high risk factors leading to exposure to HIV infection was adopted with selected variables. The study confirmed that the high level of HIV positivity and poor health was highly affected by socio-economic and demographic factors.

Human immunodeficiency virus (HIV) diagnosis in infants born to seropositive mothers is one of the challenges of HIV epidemics in children. No data are currently available on the risk of HIV positivity among children who are exposed to HIV through their parents in Papua New Guinea (PNG). The primary aim of this study was to measure the prevalence of HIV infection among infants born to HIV-infected mothers who attended antenatal clinic of PNG General Hospital. We also determined the factors associated with mother-to-child transmission (MTCT) and hypothetically estimated their population-level impacts. Study population was determined by reviewing the Papua New Guinea General Hospital paediatric clinic HIV registry books and antenatal hospital charts. Univariable and multivariable logistic regression models were used to determine the risk factors associated with the HIV seropositivity of the infants. We also assessed their individual and combined population-level impacts to prevent MTCT using novel statistic...

BACKGROUND: People Living with HIV (PLHIV) after detection of HIV positivity at Integrated Counseling and Testing Centre (ICTC) are referred to the Anti-Retroviral Treatment (ART) center for registration and Treatment services. However, significant numbers of patients are not registering at ART in time. OBJECTIVE: To analyze the reasons for delay in registering at ART after confirming HIV +ve at ICTC. METHODS: Five hundred consecutive new PLHIV registrations at ART center of this institution from 1 st May to 30 th Nov 2011 were included. Date of confirmation as HIV +ve at ICTC & date of registration at ART are recorded. Reasons for delay of more than 5 days for registration are collected through structured questionnaire by a single medical officer and analyzed. RESULTS: Of 500 new registrations at ART at this institution, 220 are from ICTC of this institution & 280 are from other ICTC centers. Out of 500 patients, 184 patients reported on the same day, 40 patients within 5 days and 276 patients beyond 5 days after confirmation at ICTC. The reasons for delay in reporting beyond 5 days are: Lack of motivation 123 (44.57%), Specific obstacles 92(33.33%) and Lack of awareness 61 (22.10%). CONCLUSIONS: On analysis of the factors for delaying registration, in Indian scenario, no single intervention will be able to address all the factors. A combination of interventions by all the stake holders including Out Reach Workers, Nurses, NGO's, General Physicians, play a key role in retention & effective treatment for PLHIV.

Introduction. Burden of HIV in pregnant women follows overall epidemic in India. Hence, it is imperative that prevalence calculations in this group be accurate. The present study was carried out to determine prevalence of HIV in pregnant women attending our hospital, to determine trend of HIV infection and to compare our results with reported prevalence. Methods. All pregnant women are routinely counselled for HIV testing using opt-out strategy. Year-wise positivity and trend were determined in these patients over a period of five years. The positivity in different age groups was determined. Results. 31,609 women were tested of which 279 (0.88%) were positive. Positivity showed a declining trend over study period and significant quadratic trend (biphasic, P<0.05) was observed. The positivity in older age group ≥35 years (1.64%) was significantly more than younger age groups (0.76% in 15–24-year and 0.94% in 25–34-year age group) (P=0.0052). Conclusion. A significant decline in HIV positivity was seen over the study period. Taking into account heterogeneous nature of HIV epidemic even within the same district, analysis at local levels especially using the prevention of parent to child transmission of HIV program data is critical for HIV programming and resource allocation.

Background: Although there has been significant reduction in HIV prevalence and new HIV infections in India, some of the low/moderate prevalence states have been showing long term increase in HIV prevalence and new HIV infections. Assam, a state in northeast India is one such low HIV prevalence state where HIV prevalence and new HIV infections have almost doubled in the last few years. This study examined the trend of HIV prevalence across districts/regions of Assam and its association with developmental and program indicators. Materials and Methods: A retrospective descriptive analysis of secondary data from the National AIDS Control Program, Census of India-2011, and District Level Household and Facility Survey-3 was conducted. The time period covered under the secondary data analysis was 2007 to 2012. Correlation and Chi-square for trend tests were also used in this paper. Results: During 2007 and 2012, HIV positivity (%) increased relatively in North Assam (46.9%) followed by South Assam (11.5%) while there has been a relative decline in West Assam (﹣51.5%). Correlation analysis showed statistically significant association between HIV prevalence and female literacy, population using mobile phone, population using internet, women (15 - 49 years) seeking treatment for any STI/RTI, proportion of brothel based FSWs, FSWs having

In India, transfusion transmissible infections (TTIs) are monitored for trends at the blood bank level, but limited efforts have been made to analyze data from a large number of blood banks and present it at the national, regional and state levels. The Computerized Management Information System (CMIS), National AIDS Control Organization’s (NACO) online data capturing system, systematically collects information on TTIs in a monthly aggregated format from blood banks across the country. This information is being captured in NACO’s annual reports, but a systematic scientific analysis and publication of the same have not been attempted so far. Hence, the objective of this study is to analyze and report TTIs among blood donors in India at three different levels—national, regional and state—from 497 consistent blood banks reporting through CMIS during 2008-2012. National level analysis shows an increasing trend in voluntary blood donation from 9.28 lakh to 19.02 lakh, and a decreasing trend in TTIs, with female donors constituting only 6% of the entire pool of donors. Of the five TTIs studied, in 2012 Hepatitis-B-surface Antigen (HBsAg) positivity was highest (0.9%), followed by Hepatitis C Virus (HCV) (0.45%), syphilis (0.23%), HIV (0.17%) and malaria (0.03%). Regional analysis indicated that voluntary donation was high in the Eastern and Western regions, with 11% of female donors in Eastern India in 2012. All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions. The level of positivity for all the five TTIs was higher than the national average in the Eastern region. Among the TTIs, HIV positivity among voluntary donors was below the national average, while in Mizoram both HBsAg and HCV of more than 1% seropositivity and VDRL of 1.7% in Arunachal Pradesh had been reported. Malaria has the lowest national positivity, with Nagaland reporting a high positivity of 0.4%. Although the national and regional trends in TTI positivity are declining, regional level variations in TTIs, especially in hepatitis, suggest the importance of advocating for pre-donation counseling and educating donors on self-exclusion.

Efficacy of Treatment as Prevention Strategy depends on a variety of factors including individuals’ likelihood to test and initiate treatment, viral load and sexual behaviour. We tested the hypothesis that people with higher risk sexual behaviour are less likely to know their HIV-positive status and be virologically suppressed. A cross-sectional population-based survey of individuals aged 15–59 years old was conducted in 2013 in KwaZulu-Natal, South Africa. A two-stage cluster probability sampling was used. After adjustment for age and sex, lack of awareness of HIV-positivity was strongly associated with having more than one sexual partner in the preceding year (aOR: 2.1, 95%CI: 1.5–3.1). Inconsistent condom use was more common in individuals with more than one sexual partner (aOR: 16.6, 95%CI: 7.6–36.7) and those unaware (aOR: 3.7, 95%CI: 2.6–5.4). Among people aware of their HIV-positivity, higher risk sexual behaviour was associated with lack of viral suppression (aOR: 2.2, 95%CI: 1.1–4.5). Risky sexual behaviour seems associated with factors linked to poor health-seeking behaviour which may have negative implications for HIV testing and Treatment as Prevention. Innovative strategies, driven by improved epidemiological and anthropological understanding, are needed to enable comprehensive approaches to HIV prevention.

Introduction : We describe the overall accuracy and performance of a serial rapid HIV testing algorithm used in community-based HIV testing in the context of a population-based household survey conducted in two sub-districts of uMgungundlovu district, KwaZulu-Natal, South Africa, against reference fourth-generation HIV-1/2 antibody and p24 antigen combination immunoassays. We discuss implications of the findings on rapid HIV testing programmes. Methods : Cross-sectional design: Following enrolment into the survey, questionnaires were administered to eligible and consenting participants in order to obtain demographic and HIV-related data. Peripheral blood samples were collected for HIV-related testing. Participants were offered community-based HIV testing in the home by trained field workers using a serial algorithm with two rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using two fourth-generation immunoassays with all positives in the confirmatory test considered true positives. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and false-positive and false-negative rates were determined. Results : Of 10,236 individuals enrolled in the survey, 3740 were tested in the home (median age 24 years (interquartile range 19–31 years), 42.1% males and HIV positivity on RDT algorithm 8.0%). From those tested, 3729 (99.7%) had a definitive RDT result as well as a laboratory immunoassay result. The overall accuracy of the RDT when compared to the fourth-generation immunoassays was 98.8% (95% confidence interval (CI) 98.5–99.2). The sensitivity, specificity, positive predictive value and negative predictive value were 91.1% (95% CI 87.5–93.7), 99.9% (95% CI 99.8–100), 99.3% (95% CI 97.4–99.8) and 99.1% (95% CI 98.8–99.4) respectively. The false-positive and false-negative rates were 0.06% (95% CI 0.01–0.24) and 8.9% (95% CI 6.3–12.53). Compared to true positives, false negatives were more likely to be recently infected on limited antigen avidity assay and to report antiretroviral therapy (ART) use. Conclusions : The overall accuracy of the RDT algorithm was high. However, there were few false positives, and the sensitivity was lower than expected with high false negatives, despite implementation of quality assurance measures. False negatives were associated with recent (early) infection and ART exposure. The RDT algorithm was able to correctly identify the majority of HIV infections in community-based HIV testing. Messaging on the potential for false positives and false negatives should be included in these programmes. Keywords HIV; antibody testing; sensitivity; specificity; misdiagnosis (Published: 29 August 2017) Kufa T et al. Journal of the International AIDS Society 2017, 20 :21753 http://www.jiasociety.org/index.php/jias/article/view/21753 | http://dx.doi.org/10.7448/IAS.20.7.21753

Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world’s largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.

CONTEXT: Partner services are a broad array of services that should be offered to persons with human immunodeficiency virus (HIV) and that are based on a process through which HIV-infected persons are interviewed to elicit information about their sex and needle-sharing partners. Human immunodeficiency virus testing of partners can result in a high yield of newly diagnosed HIV positivity, but despite this yield and the benefits of partners knowing their exposures and HIV status, partner services are often not conducted. OBJECTIVE: We sought to determine the newly diagnosed HIV positivity and benefits to 2 health departments that conducted demonstration projects that focused on statewide HIV partner services. DESIGN: The main sources of information used for this case study analysis included the health department funding applications, progress reports and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between Centers for Disease Control and Prevention and the health departments. Required quantitative reporting included the number of partners tested and the number of partners with newly diagnosed confirmed HIV infection. Required qualitative reporting included how health departments benefited from their demonstration project activities. SETTING: Hawaii and New Mexico. PARTICIPANTS: Sex and needle-sharing partners of persons who were newly diagnosed with HIV infection. INTERVENTION: The use of HIV surveillance data to initiate statewide HIV partner services. MAIN OUTCOME MEASURE: Newly diagnosed HIV positivity. RESULTS: During 2012–2015, the newly diagnosed HIV positivity among partners was 18% (78/427): 16% (17/108) in Hawaii and 19% (61/319) in New Mexico. The health departments benefited from improved collaborations among HIV prevention program and surveillance staff and among the health departments, providers, and AIDS service organizations. CONCLUSIONS: Hawaii and New Mexico each achieved a high newly diagnosed HIV positivity and benefited from improved local collaborations. As a result of the success of these projects, both health departments have continued the activities since the end of category C funding by securing alternative funding sources.

Background To avoid or mitigate potential project-related adverse health effects, the Trident copper project in Kalumbila, northwestern Zambia, commissioned a health impact assessment. HIV was identified a priority health issue based on the local vulnerability to HIV transmission and experience from other mining projects in Africa. Hence, an HIV/AIDS management plan was developed, including community and workplace interventions, with HIV testing and counselling (HTC) being one of the key components. We present trends in HTC data over a 4-year period. Methods In 13 communities affected by the Trident project, HTC was implemented from 2012 onwards, using rapid diagnostic tests, accompanied by pre- and post-test counselling through trained personnel. In addition, HTC was initiated in the project workforce in 2013, coinciding with the launch of the mine development. HTC uptake and HIV positivity rates were assessed in the study population and linked to demographic factors using regression analysis. Results In total, 11,638 community members and 5564 workers have taken up HTC with an increase over time. The HIV positivity rate in the community was 3.0% in 2012 and 3.4% in 2015, while positivity rate in the workforce was 5.2% in 2013 and 4.3% in 2015. Females showed a significantly higher odds of having a positive test result than males (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.55–2.50 among women in the community and OR = 2.90, 95% CI: 1.74–4.84 among women in the workforce). HTC users in the 35–49 years age group were most affected by HIV, with an average positivity rate of 6.6% in the community sample and 7.9% in the workforce sample. These study groups had 4.50 and 4.95 higher odds of being positive, respectively, compared to their younger counterparts (15–24 years). Conclusions While HTC uptake increased five-fold in the community and almost three-fold in the workplace, the HIV positivity rates were insignificantly higher in 2015 compared to 2012. Our data can be used alongside other surveillance data to track HIV transmission in this specific context. Guided by the health impact assessment, the HIV prevention and control programme was readily adapted to the current setting through the identification of socioeconomic and environmental determinants of health. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0320-4) contains supplementary material, which is available to authorized users.

Introduction Midwestern Brazil is a significant route and market for cocaine in South America. The consumption of illicit drugs has contributed to HIV dissemination worldwide. Despite this scenario there is little information on the epidemiology of HIV among crack cocaine users in this region. The aims of this study were to estimate the prevalence, risk factors and HIV-1 subtypes among crack users in Goiania, a city in Midwestern Brazil. Methods A total of 600 crack users were interviewed and blood samples were collected for detection of anti-HIV-1. HIV-RNA was detected in positive samples, the HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. HIV-subtypes were assigned by REGA. Univariate and multivariate analysis were carried out to identify predictors of HIV infection. This study was analysed and approved by the Committee on Ethics in Human Research of Hospital das Clinicas, Universidade Federal de Goias. Results The median age of participants was 30 years old, and the majority were male, mixed race, single, and unemployed. Of the total, 2.8% were HIV-positive. Having sex with an HIV carrier, irregular condom use during sexual intercourse, and experience of living on the streets were predictors of HIV positivity (p Conclusion A high HIV prevalence was observed among crack users in Midwestern Brazil, a region far from the epicentre of HIV epidemiology. The predictors of HIV infection identified are concerning, and necessitate preventive strategies for HIV infection specifically directed toward this population. HIV-1 subtype C seems to have emerged over the last few years in this population at the centre of the country. Support: This work was supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico – CNPq, and Fundacao de Amparo a Pesquisa do Estado de Goias – FAPEG

Introduction Current South African syndromic management guidelines for vaginal discharge syndrome (VDS), recommend only metronidazole and clotrimazole therapy for women 35 years or older, whose partners have no urethral discharge. This guidance assumes the older women have bacterial vaginosis or candidiasis without STIs and that their partners are not asymptomatic. We describe demographic, behavioural and clinical characteristics of women with VDS comparing those with BV and candida to those infected with STI pathogens. Methods Cross sectional study, in which women≥18 years presenting with VDS to five primary healthcare centres between January 2015 - September 2016 were enrolled. Demographic and clinical data were collected using a nurse-administered questionnaire. Vaginal smears, endocervical swabd and venous blood specimens were collected for laboratory testing. Presence of BV in the genital specimens was assessed using Gram stain smear and Nugent scoring while that of Candida was assessed using microscopy. In-house multiplex PCR was used to detect the following STI pathogens – Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (CT ) and Mycoplasma genitalium (MG) . HIV positivity was determined using commercial rapid tests.Data was captured into a Microsoft Access 2010 database and exported into Stata 14 for analysis using descriptive statistics, comparing four groups Group 1- women with BV or Candida infection only, Group 2 – women with BV or Candida with an STI, Group 3 – women with an STI infection only and Group 4 – women with no pathogens detected in the laboratory. Results A total of 771 women – median age 27 years [interquartile range (IQR) 23–32 years], 140 (19.5%) ≥35 years and 326 (45.4%) HIV positive- were enrolled. Of these: 253 (35.3%) were in Group 1, 238 (33.2%) in Group 2, 99 (13.8%) in Group 3, and 127 (17.7%) in Group 4. The proportions of women who were 35 years or older were 20.2%, 13.9%, 19.2% and 29.1% in Groups 1, 2, 3 and 4 respectively (p=0.006) while the HIV positivity was 43.1%, 55.9%, 43.4% and 32.3% in the groups (p Conclusion There were smaller but significant proportions of women 35 years or older had STIs with or without BV or Candida. The use of this age-specific threshold to guide syndromic treatment should be reconsidered, and HIV/STI integration promoted for women with VDS. Support: The Centre for HIV and STIs at National Institute of Communicable Diseases in South Africa is funded by the South Africa’s National Department of Health. No pharmaceutical grants were received in the development of this study.

Introduction Bacterial vaginosis (BV) is the most common cause of non-specific vaginal discharge syndrome (VDS) in South African women. BV has been implicated in the acquisition of STIs and HIV. We sought to determine STI co-infection rates and associated factors in women presenting with BV-associated VDS to primary healthcare facilities (PHCs) in South Africa. Methods Consenting adult women, presenting with VDS to PHCs in five South African provinces, were recruited in 2015–2016. Vaginal swabs were assessed for BV using Nugent scoring; and endocervical swab-extracted DNA was tested by multiplex real-time PCR for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and Mycoplasma genitalium. Serum specimens were tested for HIV. Data were analysed using Stata version14 using descriptive statistics and binomial regression. Results From 717 women enrolled, 403 (56.2%) had BV. Of the 403 women with BV (median age 26[IQR 22–32], 201 [52.1%] HIV positive), 215 (53.4%) were co-infected with non-ulcerative STIs, the most common being CT [96 (23.8%)] followed by GC [86 (21.3%)].Univariable analysis for factors associated with STI co-infection showed a significant association with HIV infection, and a protective effect for condom use at last sex and attending a rural facility. In a multivariable model adjusting for the age, condom use at last sex, previous STI syndrome, HIV positivity and residence only age Conclusion A significant proportion of BV infected women had STI co-infections and associated risk factors. This has implications for syndromic management of VDS, and suggests that the strategy of stratification into STI and non-STI treatment groups should be reviewed.

Objective: Human immunodeficiency virus (HIV) partner services are an integral part of comprehensive HIV prevention programs. We examined the patterns of HIV testing and positivity among partners of HIV-diagnosed people who participated in partner services programs in CDC-funded state and local health departments. Methods: We analyzed data on 21 484 partners submitted in 2013-2014 by 55 health departments. We conducted descriptive and multivariate analyses to examine patterns of HIV testing and positivity by demographic characteristics and geographic region. Results: Of 21 484 partners, 16 275 (75.8%) were tested for HIV; 4503 of 12 886 (34.9%) partners with test results were identified as newly HIV-positive. Compared with partners aged 13-24, partners aged 35-44 were less likely to be tested for HIV (adjusted odds ratio [aOR] = 0.86; 95% confidence interval [CI], 0.78-0.95) and more likely to be HIV-positive (aOR = 1.35; 95% CI, 1.20-1.52). Partners who were male (aOR = 0.89; 95% CI, 0.81-0.97) and non-Hispanic black (aOR = 0.68; 95% CI, 0.63-0.74) were less likely to be tested but more likely to be HIV-positive (male aOR = 1.81; 95% CI, 1.64-2.01; non-Hispanic black aOR = 1.52; 95% CI, 1.38-1.66) than partners who were female and non-Hispanic white, respectively. Partners in the South were more likely than partners in the Midwest to be tested for HIV (aOR = 1.56; 95% CI, 1.35-1.80) and to be HIV-positive (aOR = 2.18; 95% CI, 1.81-2.65). Conclusions: Partner services programs implemented by CDC-funded health departments are successful in providing HIV testing services and identifying previously undiagnosed HIV infections among partners of HIV-diagnosed people. Demographic and regional differences suggest the need to tailor these programs to address unique needs of the target populations.

Our objectives were to examine trends in the incidence of chlamydia over an extended period and compare the epidemiology of the infection between two distinct ethnic groups in Israel: Jews and Arabs. We examined the incidence rate of Chlamydia trachomatis infection among residents of Haifa District, northern Israel from 2001 to 2015, by reviewing archives of the Department of Epidemiology, Ministry of Health. Notified cases were stratified by age group, gender, and ethnic group. The overall incidence rate of Chlamydia was 10.8 cases per 100,000 population per year. The annual rate increased dramatically from 5.1 per 100,000 population in 2001, to an all-time high of 18.5 cases per 100,000 population in 2015 (P

Problem. Factors related to MDRTB mortality in Tanzania have not been adequately explored and reported. Objectives. To determine demographic, clinical, radiographic, and laboratory factors associated with MDRTB mortality in a Tanzanian TB Referral Hospital. Methodology. This was a cross-sectional study with 193 participants. Demographic, clinical, laboratory, and radiological data were collected, and their associations with mortality among MDRTB patients were determined. Results and Conclusions. Cough was the commonest finding among these MDRTB patients, with 179 (92.75%) of them presenting with cough, followed by chest X-ray consolidation in 156 patients (80.83%) and history of previous TB treatment in 151 patients (78.24%). Cigarette smoking, HIV positivity, and low CD4 counts were significantly associated with MDRTB mortality, p values of 0.034, 0.044, and 0.048, respectively. Fever on the other hand was at the borderline with p value of 0.059. We conclude that cigarette smoking and HIV status are significant risk factors for mortality among MDRTB patients. HIV screening should continually be emphasized among patients and the general community for early ARTs initiation. Based on the results from our study, policy makers and public health personnel should consider addressing tobacco cessation as part of national TB control strategy.

Introduction: Ano-Genital Warts (AGW) like other Sexually Transmitted Diseases (STD) is associated with Human Immunodeficiency Virus (HIV) infection. This study of AGW was done in HIV positive and HIV negative patients. Aim: To study the risk factors and clinical presentations of anogenital warts in HIV positive and negative patients. Materials and Methods: A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Dr. D. Y. Patil Hospital and Research Centre from July 2014 to July 2016. Results: Significant association of HIV positivity (p0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein Tumour (BLT). Conclusion: HIV positivity was significantly associated with the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant ano-genital warts. Follow up of these patients with Human Papilloma Virus (HPV) sub-typing is necessary.

Introduction: Microcephaly is a congenital anomaly associated with a wide range of etiological factors such as infections, medications/substances, genetic abnormalities and radiation. Environmental factors that are teratogenic must also be included in the differential diagnosis as common etiologies. In this report we describe a neonate with microcephaly whose molecular tests showed conflicting results in regards to the etiology of the condition. Case Report: We describe a case of a term female neonate that was admitted for work up of microcephaly in a nursery in South Brazil. The maternal history was significant for HIV positivity, on irregular antiretroviral therapy, substance abuse (crack) and previous incomplete treatment for neurosyphilis. The initial investigations for the neonate were significant for toxoplasmosis IgG (45,000) and the cerebrospinal fluid analisys revealed a positive real time PCR for toxoplasmosis. Triple treatment for neurotoxoplasmosis was instituted (Sulfadiazine, Pyrimethamine and Folinic Acid). As complementary exams came all negative including cerebrospinal DNA sequencing for Toxoplasma gondii and the baby became constantly neutropenic, treatment was discontinued and the infant was sent home for follow-up with serologies and ophthalmological monitoring. Discussion: This case described a new-born with microcephaly that was initially thought to be secondary to congenital neurotoxoplasmosis with a positive PCR in the CSF. However, the diagnosis was refuted with the absence of other clinical signs and once the DNA sequencing for Toxoplasma gondii was negative in the cerebrospinal fluid. The highlight of this report lies on the fact that two very accurate molecular tests showed divergent results. Although there were multiple risk factors for microcephaly in this patient, the definitive cause cannot be determined.

To offer a rapid investigation on potential source of infection in case of worker exposure (needle stick) to reduce anxiety and to offer an accurate assessment we stressed the analytical performances of two commercial HIV point of Care (POCT). This strategy could suggest to give or not a retroviral therapy in less than 4 hours, the expected time to have the optimal infection’s prophylaxis. 60 selected serum samples were previously analyzed, confirmed and classified for HIV positivity/negativity by conventional laboratory procedure: HIV Combo Ag/Ab Abbott diagnostic®, USA; Western Blot Matrix HIV 1/2 Abbott®, USA. Suddenly we investigated all samples by the new POCT test (HIV 1/2 Ag/Ab Combo InvernessMedical®, Chiba Japan) 60 selected serum are classified 40 as negative and 20 as positive. We analyzed our data by quantify agreement with kappa (Choen’s kappa coefficient) and we registered a poor strength of agreement between two immunocromatographic HIV tests but a perfect strength of agreement (Kappa=1.000) between CMIA test and Immunocromatographic Ag/Ab HIV and PNV, VVP, sensitivity and specificity are 100%. All acute healthcare settings should expect to have an access to an urgent HIV screening assay result ideally within four hours, and definitely within 24 h, to provide optimal support for exposure incidents. POCT can give a rapidly diagnostic evaluation on a possible source of infection enabling to give an accurate indication for a prophilactic treatment.

Men who have sex with men (MSM) are at high risk for anorectal chlamydia and gonorrhoea infections. Many MSM use rectal douches in preparation for sex, which might break down the mucosal barrier function and facilitate the acquisition of STI. We determined whether rectal douching or sharing douching equipment was associated with anorectal chlamydia and gonorrhoea. In a cross-sectional study among 994 MSM attending the STI outpatient clinic of Amsterdam between February and April 2011, data were collected on rectal douching, sexual behaviour and STI. We used multivariable logistic regression analysis to determine the association between rectal douching, including sharing of douching equipment, and anorectal chlamydia and gonorrhoea for those reporting receptive anal sex. We adjusted for other risk behaviour, that is, condom use, number of partners and HIV status. Of 994 MSM, 46% (n=460) practised rectal douching, of whom 25% (n=117) shared douching equipment. Median age was 39 years (IQR 30-47), median number of sex partners in the 6 months prior to consult was five (IQR 3-10) and 289 (29.0%) participants were HIV positive. The prevalence of anorectal chlamydia and/or gonorrhoea for those reporting receptive anal sex was 9.6% (n=96). In multivariable analysis, HIV positivity (aOR=2.2, 95% CI 1.3 to 3.6), younger age (aOR=2.5, CI 1.4 to 4.5 for those aged

Men who have sex with men (MSM) and transgender women (TW) are key populations in the HIV epidemic. HIV status communication between sex partners can inform decisions regarding sexual behavior. MSM and TW were asked about HIV status communication with sex partners at baseline, 9- and 18-months. GEE models assessed associations with HIV status communication at baseline using prevalence ratios (PRs) and longitudinally using odds ratios (ORs). At baseline, those who had previously had an HIV test, disclosed their HIV status to 42% of their sex partners. HIV status communication was associated with knowing their sex partner's HIV status at baseline (aPR 5.20) and longitudinally (aOR 1.86). HIV positivity at baseline was negatively associated with HIV status communication during follow-up (aOR 0.55). All reported aPRs and aORs have p&nbsp

Although the introduction of highly active antiretroviral therapy has radically improved the life expectancy of patients with HIV, HIV positivity is still considered a major barrier to oncological treatment for patients with cancer because of their worse prognosis and increased susceptibility to toxic effects compared with patients who are immunocompetent. The use of radiotherapy with or without chemotherapy, immunotherapy, or molecular targeted therapy is the standard of care for several cancers. These new drugs and substantial improvements in radiotherapy techniques, including intensity-modulated radiotherapy, image-guided radiotherapy, and stereotactic ablative radiotherapy, are optimising the feasibility of such anticancer treatments and are providing new opportunities for patients with cancer and HIV. In this Review, we discuss the role of radiotherapy, with or without chemotherapy or new drugs, in the treatment of cancer in patients with HIV, with a focus on the efficacy and tolerability of this approach on the basis of available evidence. Moreover, we analyse and discuss the biological basis of interactions between HIV and radiotherapy, evidence from preclinical studies, and immunomodulation by radiotherapy in the HIV setting.

Objectives Men diagnosed with rectal gonorrhoea (GC) and chlamydia (CT) have engaged in unprotected receptive anal intercourse. We reviewed the HIV positivity and HIV viral loads (VLs) of men who had rectal GC and CT testing to evaluate potential HIV acquisition and transmission risk. Methods Rectal GC and CT testing data for men attending the Maricopa County STD clinic during the period from 1 October 2011 to 30 September 2013 were cross-matched with HIV surveillance data to identify men with HIV coinfection. We examined HIV status, HIV diagnosis date, and the values of VL collected nearest to the date of reported rectal infection. Results During the 2-year time period, 1591 men were tested for rectal GC and CT. Of the men tested, 506 (31.8%) were positive for GC (13.2%), CT (12.2%) or both (6.4%); 119 (23.5%) of those with rectal GC or CT were coinfected with HIV. Among the 275 men with HIV at the time of rectal testing, 54 (19.6%) had no reported VL; 63 (22.9%) had an undetectable VL (

In sub-Saharan Africa, research on intimate partner violence (IPV) has largely failed to consider men’s experiences as victims by female perpetrators—particularly within ongoing heterosexual relationships such as marriage. The objectives of this study were to document the prevalence of sexual coercion among men, to describe the characteristics of male victims, and to test for an association between sexual coercion and HIV positivity. In 2010, cross-sectional data on HIV risk behaviors, HIV status, and IPV was collected from a sample of 684 mostly-married men in rural Malawi. Bivariate analyses were used to examine differences in HIV risk characteristics between victims and non-victims of sexual coercion. Multivariate logistic regression was used to determine the association between sexual coercion and HIV positivity. Over one-tenth (10.4%) of men reported being a victim of sexual coercion. Male victims of sexual coercion were more likely to be married (p

HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or >5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Dade County and New York City). Those who reported repeat/recent testing were more likely to have incomes over $30,000, speak English predominately, and have visited and disclosed same-sex behavior to a health care provider (HCP) in the past year. Those who were classified as test avoiders were less likely to have incomes over $10,000 and to have seen an HCP in the past year. The main reason for not testing (in both groups) was fear of HIV positivity; however, twice as many test avoiders considered this their main reason, and more test avoiders had confidentiality concerns. Results suggest that messages to encourage testing among Hispanic/Latino MSM may be most effective if past testing patterns and reasons for not testing are considered. HCPs can play an important role by consistently offering HIV tests to MSM and tailoring messages based on prior testing histories.

Background and Aims The epidemiology of non-tuberculous mycobacteria (NTM) infection is not well defined. We evaluated the trends in incidence of NTM infections at San Francisco General Hospital (SFGH), a large metropolitan county hospital. Methods We performed a retrospective review of microbiologic and clinical records of all patients with a positive NTM culture reported from 1993 to 2001. NTM infection was defined by the isolation of >1 NTM from any clinical specimen. Patients were stratified by human immunodeficiency virus (HIV) status. Univariate and multivariate logistic regression were used to identify factors that were independently associated with NTM infection. Trends over time were assessed using Poisson test for trend. Results During the study period, 25 736 samples from 7395 patients were cultured for mycobacteria. Of these samples, 2853 (11.1%) from 1345 patients (18.2%) were culture positive for NTM. Patient characteristics associated with infection included younger age (P

Human immune deficiency virus (HIV) infection is associated with a higher risk of human papillomavirus (HPV) positivity and cervical intraepithelial neoplasia (CIN) which may progress to cancer. Hence, it is important to screen all HIV positive women for this cancer which is amenable to cure in early stages. A cross sectional case-control study was conducted on 100 HIV seropositive women and matched seronegative controls attending Lok Nayak Hospital, New Delhi to study the prevalence of HPV infection and abnormal cervical cytopathology. A detailed cervical evaluation including a per-speculum examination, pap smear, cervical scrape for HPV DNA polymerase chain reaction (PCR), visual inspection of cervix with acetic acid, colposcopy and guided biopsy were done. Abnormal pap smears were found in 63% women of which 10% were squamous intraepithelial lesions. Biopsy revealed cervical intraepithelial neoplasia in 2% of all cases (5.6% of all patients biopsied). Prevalence of HPV in HIV positives was 24% compared to 4% in controls (p value 0.001), also bearing a significant correlation with CIN, thus placing HIV positives at a higher risk for cervical dysplasias and cancer. The sensitivity of HPV DNA test for detection of cervical dysplasias was 86.3% and specificity 64.2%. HIV positivity predisposes to invasive cervical cancer on account of immunosuppression and co-existing HPV infection, thereby the need for aggressive screening for cervical intraepithelial lesions. Both HPV DNA PCR and pap smear are optimal screening tools in these women. Key words: Human immune deficiency virus (HIV), cervical human papillomavirus (HPV) infection, cervical intraepithelial neoplasia, pap smear, human papillomavirus (HPV) DNA polymerase chain reaction (PCR).

Background: Blood transfusion carries the risk of transmission of several infectious agents. The latest method for blood screening, nucleic acid testing is not affordable in developing countries. Aim: The study was aimed to find response to post-donation counseling for reactive markers among the voluntary blood donors donating in blood donation camps. Material and Methods: This 1 year study was conducted in 2011. Transfusion transmitted infections testing was performed by routine enzyme linked immunosorbent assay method. The initial human immunodeficiency virus (HIV) reactive donors who returned back to the blood bank were confidentially counseled and referred to the Integrated Counseling Cum Testing Center (ICTC). The hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) reactive donors were referred to the gastroenterology department for confirmation by qualitative polymerase chain reaction (PCR, Roche Diagnostics, Germany) and followed-up. Results: Twenty seven thousand two hundred forty six 27,246 units were collected during the survey. One hundred twenty nine129 units were reactive for HIV 1 and 2, 99 were reactive for HCV, 206 for hepatitis B virus (HBV). Of these reactive donors, 138 could be personally communicated. Out of 47, 27 donors who returned for counseling were initially reactive for HIV 1 and 2, 8 for HBsAg and 12 for anti-HCV. Two were positive for HBV deoxyribonucleic acid and one was positive for HCV ribonucleic acid. The HIV positivity was detected in 1 of 27 donors at ICTC. Conclusion: The response to the post-donation counseling appears in this study to be only 34% (47/138), which is still a challenge.

Introduction. Chronic liver disease (CLD) is becoming a major cause of mortality in patients who are positive with human immunodeficiency virus (HIV). Our aim was to assess the prevalence of CLD in HIV+ individuals. Material and methods. We utilized the National Health and Nutrition Examination Survey (1999-2008) to assess the association of CLD with HIV infection. In eligible participants (18-49 years), HIV infection was defined as positive anti-HIV by enzyme immunoassay further confirmed by Western blot. The diagnosis of CLD included chronic hepatitis C (CH-C), alcohol-related liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Clinic-demographic and laboratory parameters were used to assess differences between those with and without HIV infection. Results. 14,685 adults were included. Of those, 0.43 ± 0.08% were HIV-positive and 13.8% had evidence of CLD, including 26.3% in HIV-positive individuals and 13.7% in HIV-negative controls (p = 0.0341). In the U.S. population, independent predictors of CLD included HIV positivity [OR = 1.96 (1.02-3.77), p = 0.04], older age [OR = 1.03 (1.02-1.03), p < 0.0001], male gender [OR = 2.15 (1.892.44), p < 0.0001] and obesity [OR = 2.10 (1.82-2.43), p < 0.0001], while African American race/ethnicity was associated with lower risk for CLD [OR = 0.68 (0.58-0.80), p < 0.0001]. Conclusions. CLD is common in HIV positive individuals. With successful long term treatment of HIV, management of CLD will continue to remain very important in these patients.

Background: Plasmablastic lymphoma (PBL) is a rare type of aggressive large B - cell Non Hodgkin Lymphoma (NHL) which was initially described in HIV positive individuals and later was also described in immune competent individuals. It constitutes about 2-3% of HIV associated malignancies. It was included as a distinct entity in WHO lymphoma classification in 2008. Methods: The clinical features, HIV status, treatment details and outcomes of patients diagnosed with plasmablastic lymphoma during the period of January 2012 to December 2018 were retrospectively collected from the patient records and analyzed. The survival analysis was done by Kaplan Meier analysis and the comparison was done by Log Rank test. Results: Median age of 25 patients, included in the study was 41 years (Range 13 - 71 years). Males constituted 76% (n=19). HIV positivity was 72% (n=18). Stage 4 disease was present in 76% (n=19). Extra nodal involvement was seen in 96% (n=24), of which the common sites were gastrointestinal tract and bone. Out of 25 patients, 7 did not receive any treatment and 3 received metronomic oral chemotherapy due to poor performance status at presentation. Fifteen patients received chemotherapy on a curative intent. Infusional EPOCH chemotherapy was given in 13 patients. CHOP and CHOPE chemotherapy was given in one patient each. The median number of cycles was 6 (Range: 3 - 8). The overall response rate of patients treated on a curative intent was 80% (Complete response and partial response in 8 and 4 respectively). Three patients underwent high dose chemotherapy with autologous stem cell rescue at first remission (2 HIV patients and 1 Non HIV patient). The median overall survival (OS) of the whole study population was 12.4 months with a median follow of 15.9 months. The Medial OS was not reached in the curative intent group and the 2 year OS of the curative group was 55% with a median follow up of 22.8 months. The factors adversely influencing the OS were Age > 40 years and High IPI (International prognostic index). Conclusion: Plasmablastic lymphoma commonly presents as stage 4 disease with extra nodal involvement. It is more common in immunodeficient individuals especially HIV positive patients. Infusional EPOCH chemotherapy is a promising option which induces long term remission in fit patients. Figure Disclosures No relevant conflicts of interest to declare.

Background: Enzyme linked immunosorbent assay (ELISA) is a widely employed method for detecting HIV. Following its successful detection of HIV, the fourth generation ELISA was approved by FDA. The advantage of the FDA approved fourth generation ELISA is it detects p24 antigen, HIV 1&2 antibodies simultaneously and that too 5-7 days prior to conventional tests so that it detects HIV seroconversion earlier reducing its further spread.Methods: The study was conducted in a tertiary level medical centre after obtaining ethical approval. 200 patients from high risk group and their contacts were selected after a thorough physical examination and tests were done using fourth generation ELISA and rapid assay and these results were compared.Results: As per our observations, the percentage of patients tested positive by fourth generation ELISA out of 200 subjects was 37% and negative was 63%. The detection rate of HIV positivity by rapid assay in high risk group was 11% and negative was 89%. The detection rate was also higher with fourth generation ELISA when various other parameters were compared.Conclusions: In this study, the percentage of HIV positivity detected by fourth generation ELISA was higher than that detected by rapid assay showing that fourth generation ELISA is a more sensitive test than rapid assay as well as a better diagnostic modality to opt for when coming to early detection in HIV.