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Background:HIV positivity and stigmatization among the mentally ill appears to be a complex subject of discuss among researchers. The prevalence of HIV among the mentally ill appears to be higher in some population and lower in others with varying patterns of stigmatization. Aim:This study determined the prevalence of HIV positivity and pattern of stigmatization among a population of mentally ill patients attending the University of Port Harcourt Teaching Hospital. Materials and Methods:This was a descriptive cross-sectional study conducted among attendees of Neuropsychiatric Outpatient Clinic of the University of Port Harcourt Teaching Hospital. A structured questionnaire covering socio-demographic characteristics and other factors were self-administered to 75 mentally ill patients attending the out-patient clinic following ethical clearance. Systematic random sampling technique was used to select the study participants. Descriptive statistics was used to analyze the data. Results:Majority of the respondents were male (81%), single (76.0%), and between the ages of 21 and 30 (44%). Majority (86.7%) had knowledge about HIV counseling and testing while those with no knowledge about HIV counseling and testing constituted 9.3%. Majority (76%) tested for HIV, while a minority (17.3%) did not. Within the last two years, majority (52%) had tested for HIV. Majority (25.3%) felt normal, 5.3% sad, while 1.3% felt very sad on learning about their HIV-positive status. HIV positive individuals, who have not been stigmatized because of their status constituted the majority (32%), while those that have been stigmatized constituted 4.0%. Conclusion:Majority of the mentally ill patients had knowledge about HIV counseling and testing, got tested, felt normal on learning about their HIV positive status, and were not stigmatized because of their status.

Human immunodeficiency virus (HIV) partner services are an essential component of comprehensive HIV prevention and care. We examined factors associated with partner notification, HIV testing, and HIV positivity among partners of HIV-diagnosed persons (index persons) contacted by Centers for Disease Control and Prevention (CDC)-funded state and local health departments.We analyzed partner service data submitted to the CDC by 61 state and local health departments from 2013 to 2017. Using multivariate Poisson regression-adjusted for clustering effects among partners reported by a common index person-we assessed associations between 3 outcomes of interest (partner notification, HIV testing, and HIV positivity) and the demographic characteristics, risk behaviors, geographic region, and service year of index persons and their partners.A total of 51,368 sexual and/or needle-sharing partners were matched with 33,524 index persons. Of notifiable partners, 97.2% were notified of their potential HIV exposure, and 52.3% were tested for HIV. Among 21,842 notified and tested partners, 23.8% were newly diagnosed with an HIV infection. Partner notification, HIV testing, and HIV positivity were associated with both partner and index person characteristics (individually and interactively), geographic region, and year of service.Partner service programs provided through CDC-funded health departments were effective in both partner notification and identification of undiagnosed HIV infection among partners. However, HIV testing rate among notified partners remained low. Implementing strategies to address gaps in HIV testing can contribute toward ending the HIV epidemic in the United States.

Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.This was a cohort study involving secondary programme data.Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common.STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.Neuf centres de traitement de la TB pharmacorésistante, dont certains sont financés par Action Damien au Népal où80% des patients atteints de TB multirésistante/résistante à la rifampicine (MDR/RR-TB) sont traités.Évaluer l’utilisation, l’efficacité et l’innocuité d’un schéma thérapeutique plus court (STR) de 9-12 mois chez les patients atteints de MDR/RR-TB enregistrés de janvier 2018 à décembre 2019.Étude de cohorte comprenant des données programmatiques secondaires.Sur 631 patients, 301 (48,0%) ont démarré et poursuivi un STR. Les raisons principales d’inéligibilité à l’instauration/la poursuite d’un STR étaient une résistance initiale ou une exposition aux médicaments de deuxième intention (62,0%), un contact avec des patients atteints de TB ultrarésistante (XDR-TB) ou de pré-XDR-TB (7,0%) et la non-disponibilité des médicaments pour le STR (6,0%). Le taux de réussite thérapeutique était de 79,6%. Les résultats liés à la non-réussite thérapeutique étaient décès (12,0%), perte de vue (5,3%), échec thérapeutique (2,7%) et absence d’évaluation (0,7%). Les résultats liés à la non-réussite thérapeutique étaient significativement associés à l’infection par le VIH et aux patients âgés ⩾55 ans avec un risque relatif ajusté de 2,39 (IC 95% 1,52–3,77) et de 3,86 (IC 95% 2,30–6,46), respectivement. Le taux de récidive post-traitement à 6 et 12 mois était de 0,5% et 2,4%, respectivement. Des évènements indésirables graves (SAE) ont été observés chez 15,3% des patients, le plus souvent hépatotoxicité et ototoxicité.Le STR a été associé à une utilisation modérée, à une réussite thérapeutique élevée et à un faible taux de récidive post-traitement. Pour une détection et une prise en charge adéquates des SAE, l’amélioration de la pharmacovigilance peut être envisagée. La disponibilité de tests diagnostiques rapides pour les médicaments de deuxième intention est essentielle à une prise en charge adéquate des patients.

There has been improvement in the control of HIV/AIDS in Nigeria. The 2018 national prevalence was 1.4%, a decline from previous surveys. The gains are however not uniform; a gap still exists in the response to key populations (KP) due to socio-cultural barriers and unfavourable legislative environment. The demographic correlates of HIV among KP in Nigeria were examined. Society for Family Health provided HIV Testing services for KP and data from the intervention between 2019 and 2020 was analysed using SPSS version 20. Total of 132,838 were tested, 88.4% were 20-39 years, 65.6% were females and 63.5% were female sex workers (FSW). HIV positive KP were 7,962 (6.0% prevalence), prevalence of HIV was high among those ≥40 years, KP identified as males and men who have sex with men (MSM; p

Mobile community HIV testing can effectively reach undiagnosed people living with HIV in southern Africa. Variable yield in HIV test positivity has been a challenge with high- and low-yield sites often being closely situated. We sought to test whether easy-to-identify, site-level characteristics were associated with HIV positivity yield in a routine mobile HIV testing program.We used routine testing program test data augmented with site-level characterization, either of the community or shopping site at which HIV testing was offered. Specifically, we described the local environment and interviewed key informants to gain additional information regarding the availability of HIV and other services in the locale.We included 122 residential and 26 shopping sites with median HIV-positive test yields of 7.6% and 6.9%, respectively. The range for community sites was from 2 to 55% with high and low yields at geographically proximal sites. Factors related to lower income and marginalization, including informal housing and the absence of name-brand stores in shopping venues, were associated with higher HIV-positive testing yield.Characterization of sites, particularly identifying factors related to marginalization, lack of services, and poverty, can aid in identifying sites with higher HIV-positive yield.Le dépistage communautaire mobile du VIH est un moyen efficace pour atteindre les personnes vivant avec le VIH non diagnostiquées en Afrique australe. Les taux de positivité variables aux tests de dépistage du VIH constituent un défi puisque certains sites aux taux de positivité élevés sont souvent géographiquement proches de sites dont les taux de positivité sont faibles. Nous avons cherché à tester si certaines caractéristiques faciles à identifier et propres aux sites étaient associées aux taux de positivité des tests de dépistage du VIH dans un programme de dépistage du VIH mobile systématique.Nous avons utilisé les données des tests du programme de dépistage systématique et procédé à une caractérisation des sites, soit de la communauté soit de la zone commerciale où le dépistage du VIH était proposé. Plus précisément, nous avons décrit l’environnement local et interrogé des informateurs clés afin d’obtenir des informations supplémentaires sur la disponibilité de services anti-VIH et autres dans cette zone.Nous avons inclus 122 résidents et 26 zones commerciales avec un taux médian de positivité aux tests de dépistage du VIH de 7,6% et 6,9%, respectivement. L’étendue allait de 2% à 55% pour les sites communautaires, avec des taux de positivité faibles ou élevés dans des sites géographiquement proches. Les facteurs liés à de faibles revenus et à une marginalisation (par ex., logement informel et absence de magasins de marque dans les zones commerciales) étaient associés à de plus forts taux de positivité aux tests de dépistage du VIH.La caractérisation des sites, notamment l’identification des facteurs liés à la marginalisation, au manque de services et à la pauvreté, peut aider à identifier les sites où les taux de positivité aux tests de dépistage du VIH sont plus élevés.

Ibrahim Jahun,1 Emilio Dirlikov,2 Solomon Odafe,1 Aminu Yakubu,1 Andrew T Boyd,2 Pamela Bachanas,2 Charles Nzelu,3 Gambo Aliyu,4 Tedd Ellerbrock,2 Mahesh Swaminathan1 On behalf of CDC Nigeria ART Surge Team1US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria; 2US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA; 3Federal Ministry of Health (FMOH), Abuja, Nigeria; 4National Agency for the Control of AIDS (NACA), Abuja, Federal Capital Territory, NigeriaCorrespondence: Ibrahim JahunCenters for Disease Control and Prevention (CDC)-Nigeria, Embassy of the United States of America, Central Business District, Abuja, Federal Capital Territory, NigeriaTel +234 8037013715Email drjahun@yahoo.co.ukPurpose: The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect.Methods: ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed.Results: Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7– 90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8– 6.4%).Conclusion: Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.Keywords: ART Surge, small area estimation, HIV risk assessment tool, index partner testing

Summary A higher proportion of CD68-positive tumour associated macrophages (TAMs) has been associated with poorer outcomes in HIV-negative patients with Hodgkin lymphoma (HL), but whether this is true in HIV-positive patients with HL is not known. In this study, we investigated the number of CD68-positive TAMs and expression of programmed cell death-ligand 1 (PD-L1) in lymph node specimens from HL patients and correlated expression with clinical features (HIV status, disease severity and survival) and histopathological features (EBV latent positivity and subtype of HL). We stained archived lymph node specimens from 77 patients diagnosed with HL for CD68 and PD-L1. Stains were graded as: CD68 low (≤25%), CD68 high (>25%), PD-L1 low (≤50%), and PD-L1 high (>50%). Expression levels were correlated with the clinical and histopathological features using bivariate and multivariate analyses. Survival was analysed by overall and progression-free survival. Thirty-four of the 77 included patients (44%) were HIV-positive. EBV latency was detected in 97% of HIV-positive HL patients and in 14% of HIV-negative HL patients. A high CD68 score was associated with lower median haemoglobin levels (9.4 vs 11.4 g/dL; p=0.02), platelet numbers (262 vs 424 cells ×109/L; p=0.01), and lymphocyte numbers (0.99 vs 1.70 cells ×109/L, p=0.01) and a trend towards advanced disease (international prognostic score ≥4; hazard ratio 2.4; confidence interval 0.89–6.47; p=0.08). HIV status did not affect CD68 or PD-L1 expression. A higher proportion of CD68-positive TAMs was found in samples that were EBV-positive. HIV positivity and EBV negativity correlated with poorer survival. CD68 and PD-L1 expression were not predictive of survival. High CD68 expression was associated with EBV positivity but not HIV positivity and did not predict adverse outcomes. PD-L1 expression was unaffected by HIV status or EBV positivity and did predict adverse outcomes.

The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate-severe diarrhea (p

Human T-lymphotropic virus-I/II (HTLV-I/II) and human immun viruses (HIVs), that have similar genomic characteristics also share the same transmission routes and infect T lymphocytes. Regarding this epidemiological similarity, HIV and HTLV infections can be seen together. HIV and HTLV-I/II coinfection occurs with variable frequencies in different populations and geographic regions. There are not any population-based studies carried out defining the number of individuals coinfected with HIV and HTLV-I/II in Turkey. The aim of this study was to determine the seropositivity rates of HTLV-I/II in patients whose HIV viral load was monitored in Gazi University Faculty of Medicine Medical Virology Laboratory Forty-seven HIV positive cases followed-up in Medical Virology Laboratory for HIV viral load monitoring between May 2017-January 2019 were included in the study. HIV seropositivity of the samples was confirmed by the chemiluminescence microparticle immunoassay method. HIV viral load values of the samples were evaluated by real-time reverse transcriptase polymerase chain reaction. The samples were screened for antibodies against HTLV-I/II using chemiluminescent microparticle immunoassay. The study population range was between 19 to 60 years of age. Among the study population, 39 (83%) patients were male and 8 (17%) patients were female. Of 47 samples, 18 samples (38.3%) had viral load of = 10000 copies/ml. HTLV serology was negative in all samples included in the study. CD4+ results were available for 42 patients and the CD4+ results of five patients could not be studied. Co-infection with different retroviruses is a well-known fact which should be thoroughly examined. HTLV-I co-infection leads to faster progression of the disease in HIV-1 positive patients. Although it is known that the co-infection has a significant effect on the progression of the disease, there are very few centers in the world and in our country that routinely perform HTLV testing in HIV-positive patients. We think that in order to evaluate the clinical and microbiological importance of the coinfection of retroviruses with each other and to determine the frequency of these infections together, there is a need for studies involving a larger number of patients, including detailed clinical backgrounds of individuals, and that the importance of this issue should be realized at the same time.

As The Proportions Of People Living With HIV Who Do Not Know Their HIV Infection Status Decrease, Reaching The Last Mile Of Those Who Are Asymptomatic And Not In Contact With The Health Care System Becomes A Critical Challenge. This Project Will Use An Explanatory Sequential Mixed-Methods Study Design. It Will Be Conducted In Three High-Volume Health Facilities In Matero Sub-District 3 Of Lusaka District In Zambia Over A Period Of One Year. The Specific Objectives Are: To Understand The Perceived Facilitators And Barriers To HIV Partner Testing From The Perspective Of The Health-Care Provider; To Propose Interventions Necessary For Improved HIV Case Finding; And To Reach High Risk But Hard To Reach Populations In HIV Programs Such As Middle-Aged Men And Adolescent Girls And Young Women (AGYW). The Permission To Conduct This Study Will Be Obtained From The Lusaka Provincial Health Office Before Its Commencement. Ethical Clearance Will Be Sought And Obtained From The ERES Converge Research Ethical Committee. The Authority To Conduct Research Will Be Sought From The National Health Research Authority. The Expected Main Findings Following The Address Of The Identified Challenges Are: Increased Number Of Recipients Of Care Indexed, Increased Index Contact Elicitation Ration From 1:1 To At Least 1:2, Improved Rate Of Contacts Tested On Time, Improved HIV Case Finding Through Index Testing, And Overall, Increased HIV Index Testing Positivity Rate From Below 25% (Baseline) To Above 40% (At The End Of The Project).

Objective We used data from a routine HIV testing program to develop risk scores to identify patients with undiagnosed HIV infection while reducing the number of total tests performed. Design Multivariate logistic regression. Methods We included demographic factors from HIV testing data collected in 134 Botswana Ministry of Health & Wellness facilities during two periods (1 October 2018- 19 August 2019 and 1 December 2019 to 30 March 2020). In period 2, the program collected additional demographic and risk factors. We randomly split each period into prediction/validation datasets and used multivariate logistic regression to identify factors associated with positivity; factors with adjusted odds ratios at least 1.5 were included in the risk score with weights equal to their coefficient. We applied a range of risk score cutoffs to validation datasets to determine tests averted, test positivity, positives missed, and costs averted. Results In period 1, three factors were significantly associated with HIV positivity (coefficients range 0.44-0.87). In period 2, 12 such factors were identified (coefficients range 0.44-1.37). In period 1, application of risk score cutoff at least 1.0 would result in 50% fewer tests performed and capture 61% of positives. In period 2, a cutoff at least 1.0 would result in 13% fewer tests and capture 96% of positives; a cutoff at least 2.0 would result in 40% fewer tests and capture 83% of positives. Costs averted ranged from 12.1 to 52.3%. Conclusion Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.

ObjectivesGeneral practitioners (GPs) and sexual health centres (SHCs) are the main providers of HIV testing and diagnose two-thirds of HIV infections in the Netherlands. We compared regional HIV testing and positivity by GPs versus SHCs to gain insight into strategies to improve HIV testing, to enable timely detection of HIV infections.MethodsLaboratory data (2011–2018) on HIV testing by GPs and SHCs in five Dutch regions with varying levels of urbanisation were evaluated. Regional HIV testing rates per 10 000 residents ≥15 years (mean over period and annual) were compared between providers using negative binomial generalised additive models and additionally stratified by sex and age (15–29 years, 30–44 years, 45–59 years, ≥60 years). χ2 tests were used to compare positivity percentage between the two groups of providers.ResultsIn the study period, 505 167 HIV tests (GP 36%, SHC 64%) were performed. The highest HIV testing rates were observed in highly urbanised regions, with large regional variations. The HIV testing rates ranged from 28 to 178 per 10 000 residents by GPs and from 30 to 378 per 10 000 by SHCs. Testing rates by GPs were lower than by SHCs in three regions and comparable in two. In all regions, men were tested less by GPs than by SHCs; for women, this varied by region. Among those aged 15–29 years old, GPs’ testing rates were lower than SHCs’, while this was reversed in older age categories in four out of five regions. The overall mean HIV positivity was 0.4%. In contrast to other regions, positivity in Amsterdam was significantly higher among individuals tested by GPs than by SHCs.ConclusionsThis retrospective observational study shows that besides SHCs, who perform opt-out testing for key groups, GPs play a prominent role in HIV testing, especially in non-key populations, such as women and older individuals. Large regional variation exists, requiring region-specific interventions to improve GPs’ HIV testing practices.

BACKGROUND Transgender persons are at high risk for HIV infection. Testing is a key component of the national effort to end the HIV epidemic in the United States. SETTING Sixty-one local and state health departments and 150 community-based organizations funded by the Centers for Disease Control and Prevention to conduct HIV testing programs. METHODS We analyzed HIV testing data submitted to the Centers for Disease Control and Prevention by funded health departments and community-based organizations during 2012-2017. Descriptive analysis examined patterns of HIV testing and key outcomes (diagnosis of HIV infection, linkage to HIV medical care, and interview for partner services) among transgender persons. Multivariate robust Poisson regression was used to assess associations between HIV testing outcomes and demographic characteristics, census region, and test setting. RESULTS A total of 82,818 HIV tests were provided to transgender persons. Of these, 2280 (2.8%) transgender persons were diagnosed with HIV infection; 1556 (1.9%) received a new and 724 (0.9%) a previous diagnosis with HIV infection. The highest percentage of new HIV diagnosis was found among persons tested in correctional settings (4.6%), non-Hispanic Blacks (3.5%) and transgender women (2.4%). Among newly diagnosed persons, 85.0% were linked to HIV medical care ≤90 days after diagnosis and 63.5% were interviewed for partner services. CONCLUSIONS HIV positivity was high, and the delivery of partner services was low, among transgender persons. HIV testing outcomes among transgender persons varied significantly by demographic characteristics and test setting. HIV prevention programs that are responsive to the needs of transgender persons may address gender-related disparities in HIV testing outcomes.

BackgroundEarly infant diagnosis (EID) of HIV, followed by effective care including antiretroviral therapy (ART), reduces infant mortality by 76% and HIV progression by 75%. In 2015, 50% of 1.2 million HIV-exposed infants (HEI) in 21 priority countries received a virologic test within the recommended 2 months of birth. We sought to identify factors associated with timely uptake of virologic EID among HEI and gain insight into missed opportunities.MethodsThis was a cross-sectional study that used de-identified data from electronic medical records of 54 health facilities within the Christian Health Association of Kenya (CHAK) HIV Project database. All HEI who had their first HIV virologic test done between January 2015 and December 2017 were included in the study and categorized as either having the test within or after 8 weeks of birth. Multivariate linear mixed effects regression model was used to determine factors associated with uptake of the first HIV EID polymerase chain reaction (PCR). Predictor variables studied include sex, birth weight, the entry point into care, provision of ART prophylaxis for the infant, maternal ART at time of EID, mode of delivery, and place of delivery.ResultsWe included 2020 HEI of whom 1018 (50.4%) were female. A majority, 1596 (79.0%) had their first HIV PCR within 2 months of birth at a median age of 6.4 weeks (interquartile range 6–7.4). Overall, HIV positivity rate at initial test among this cohort was 1.2%. Delayed HIV PCR testing for EID was more likely to yield a positive result [adjusted odds ratio (aOR) = 1.29 (95% confidence interval (CI) 1.09–1.52)p = 0.003]. Infants of mothers not on ART at the time of HIV PCR test and infants who had not received prophylaxis to prevent vertical HIV transmission had significant increased odds of a delayed initial test [aOR = 1.27 (95% CI = 1.18–1.37)p = p = ConclusionAn initial HIV PCR test done after 8 weeks of birth is likely to yield a positive result. Barriers to accessing ART for treatment among HIV-infected pregnant and breastfeeding women, and prophylaxis for the HEI were associated with delayed EID. In order to ensure timely EID, programs need to incorporate both facility and community strategy interventions to ensure all pregnant women seek antenatal care and deliver within health facilities.

Background: Index testing is a voluntary process whereby HIV seropositive clients are counselled and, after obtaining consent, their sexual and needle sharing partners are offered HIV testing services. Index testing has been associated with high HIV positivity yield. The aim of this study is to determine the positivity yield and identify factors influencing the yield from index testing strategy in selected healthcare facilities in Ondo State, southwest Nigeria. Methodology: Six public hospitals in Ondo State with the highest HIV clients currently on treatment were selected. Records of all clients newly diagnosed to be HIV positive at the selected facilities from June 2018 to September 2019, and who had an outcome for index testing services were reviewed. Data were collected using a chart abstraction template from the index testing registers. Information collected included age and gender of the index clients and their partners, method of referral and notification of partners, HIV test results of partners and linkage status of new HIVpositive partners. Data analyses were done using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Chi-square was used to test association between variables at a significance level of p

To assess HIV positivity as an apoptotic confounding variable in pregnancies complicated by preeclampsia.Using a Bio-plex Multiplex Immunoassay, Smac and Lamin B concentrations (ng/ml) were analyzed in a buffy coat collected from 128 pregnant women attending a large regional hospital in Durban, South Africa. Study groups consisted of Normotensive and Preeclamptic pregnant women stratified according to their HIV status. All HIV positive groups received highly active antiretroviral therapy (HAART).Our findings showed significant (These results could be associated with the fact that apoptosis promotes deregulation of mitochondrial dynamics, contributing to the associated severe obstetric events observed in pregnancies among HIV-infected women on HAART.

Background We conducted a systematic review and network meta-analysis to identify which human immunodeficiency virus (HIV) self-testing (HIVST) distribution strategies are most effective. Methods We abstracted data from randomized controlled trials and observational studies published between 4 June 2006 and 4 June 2019. Results We included 33 studies, yielding 6 HIVST distribution strategies. All distribution strategies increased testing uptake compared to standard testing: in sub-Saharan Africa, partner HIVST distribution ranked highest (78% probability); in North America, Asia, and the Pacific regions, web-based distribution ranked highest (93% probability), and facility based distribution ranked second in all settings. Across HIVST distribution strategies HIV positivity and linkage was similar to standard testing. Conclusions A range of HIVST distribution strategies are effective in increasing HIV testing. HIVST distribution by sexual partners, web-based distribution, as well as health facility distribution strategies should be considered for implementation to expand the reach of HIV testing services., We conducted a systematic review and network meta-analysis to assess effectiveness of human immunodeficiency virus self-test (HIVST) distribution strategies. HIVST distribution by sexual partners in sub-Saharan Africa and web-based in North America, Asia and the Pacific region resulted in the highest uptake.

Aim: This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians. Methods: Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ2 and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer’s V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance. Results: In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33–41) years (ranges 18–81). Patients with invasive OSSN were more likely to present with pain (p = 0.007), redness (p = 0.034), excessive tearing (p = 0.0001), discharge (p = 0.011), bleeding (p = 0.007), reduced vision (p = 0.0001), fungating lesion (p = 0.001), and blindness (p = 0.005); location at temporal limbus (p = 0.0001), inferior limbus (p = 0.0001), or circumlimbal (p = 0.001); and extension to cornea (p = 0.006) and forniceal palpebral conjunctiva (p = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (p = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; p = 0.0001; phi: 0.237 [p = 0.0001]). Conclusion: OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.

Background Antiretroviral therapy has improved the life expectancy of HIV patients, leading to an increase in total joint replacement for age-related osteoarthritis. HIV patients are inherently hypercoagulable at baseline. The goal of our study was to compare the incidence of venous thromboembolism (VTE) in HIV patients with HIV-negative controls after total joint replacement. Methods A multicenter, retrospective cohort study of 110 HIV patients (85 hips and 25 knees) and 240 HIV-negative controls (180 hips and 85 knees) between 2000 and 2018. Prophylactic anticoagulation was used in 98% of patients postoperatively-low-molecular weight heparin (73%), warfarin (19%), aspirin (6%), and clopidogrel (1%). Results The VTE rate was 3.6% in the HIV-positive group (2.5% total hip arthroplasty [THA] and 8.0% total knee arthroplasty [TKA]) and 0.4% in the control group (0% THA and 1.7% TKA). VTEs occurred at the median (interquartile range) time of 40 days (1 to 52) post-op in the HIV group and 3 days post-op in the one control. Multivariable logistic regression adjusting for sex, smoking, history of VTE, and joint replaced identified HIV as an independent predictor of VTE (odds ratio 10.9, 95% confidence interval 1.1 to 114.0, P = 0.046). All patients with VTE were treated with warfarin (5 to 9 months); two cases were complicated by hemarthrosis and excessive bleeding at the insulin injection site. Conclusion We observed increased rates of symptomatic VTE in HIV patients after THA (2.5%) and TKA (8%) compared with HIV-negative control patients (0% and 1.7%, respectively). HIV positivity was identified as an independent predictor of perioperative VTE. Our data suggests that HIV patients may be at higher risk for post-op VTE than HIV-negative patients. Surgeons may want to consider the use of more potent anticoagulation (ie, warfarin or novel anticoagulants) for a longer duration in HIV-positive patients. However, further studies are necessary to form evidence-based guidelines regarding this practice. Level of evidence Level III, prognostic.

Identify the treatment effects and risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under the Directly Observed Treatment Short-Course (DOTS) program to reduce the mortality rate of tuberculosis. A retrospective cohort analysis was conducted on the outcomes of antituberculosis treatment of 7,032 patients with tuberculosis in the DOTS program, in the Tuberculosis Management Information System from 2014 to 2017 in Tianjin, China. The Kaplan–Meier method and multifactor Cox proportional risk regression model were used to analyze the risk factors for mortality during antituberculosis treatment under DOTS. The success rate of antituberculosis treatment was 90.24% and the mortality rate was 4.56% among 7,032 cases of tuberculosis in Tianjin. Cox regression analysis showed that advanced age, male sex, human immunodeficiency virus (HIV) positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) were risk factors for mortality in patients with pulmonary tuberculosis receiving antituberculosis treatment under DOTS. The treatment effects in patients with pulmonary tuberculosis during antituberculosis treatment under DOTS were positive in Tianjin. Advanced age, male sex, HIV positivity, first sputum positivity, retreated tuberculosis, and a delayed visit (≥14 days) increased the risk for mortality during antituberculosis treatment.

Background Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

Introduction: Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. Tubercular lymphadenitis is one of the most common causes of lymphadenopathy in developing countries like India. Materials and Methods: An observational study was carried out at the pathology department of teaching hospital in Delhi NCR from March 2013 to April 2017. A total of 3392 patients presented in the FNAC OPD of the hospital, out of which 1730 had lymphadenopathies. Smears were stained with Giemsa and categorised into the cytological pattern. Zheil Neelson (ZN) stain was done in all clinically suspicious cases to tuberculosis. Data regarding brief history, site, age, sex, the gross appearance of aspirate and cytomorphologic features were collected and analysed. Results: Out of the 1730 cases of consecutive lymph node aspirations, 17 were excluded from the study due to inadequate material, 979 cases (57.15%) showed features of Tubercular Lymphadenitis followed by Reactive Lymphadenitis, 524 cases (30.58%). Out of the 20 cases which showed HIV positivity 18 showed the presentation of tubercular lymphadenitis. TB was prevalent in all age groups, with the majority of cases affecting people more than 50 years of age. Conclusion: FNAC of lymphadenopathy is of particular importance in view of the high prevalence of tuberculosis in our country, atypical presentation of tuberculosis and because AFB are seen mostly in purulent aspirate smears which do not show granulomas, necrosis or epithelioid cells and which in the absence of Ziehl-Neelsen staining can be dismissed as acute suppurative lymphadenitis. FNAC is a simple, reliable, quick and economical diagnostic tool for peripheral lymph node lesions especially in the quick and simple diagnosis of Tubercular Lymphadenitis. Keywords: Lymph node, Fine needle aspiration cytology FNAC, Tubercular lymphadenitis, Reactive lymphadenitis, Lymphoma.

Background There are large knowledge gaps on the transmission dynamics of Mycobacterium tuberculosis in settings where both tuberculosis and human immunodeficiency virus (HIV) are endemic. We aimed to assess the infectiousness of tuberculosis patients coinfected with HIV. Methods We systematically searched for studies of contacts of both HIV-positive and HIV-negative tuberculosis index cases. Our primary outcome was Mycobacterium tuberculosis infection in contacts. Data on sputum smear and lung cavitation status of index cases were extracted from each study to assess effect modification. Secondary outcomes included prevalent tuberculosis and HIV in contacts of HIV-positive and HIV-negative index cases. Results Of 5255 original citations identified, 32 studies met inclusion criteria, including 25 studies investigating M. tuberculosis infection (Nparticipants = 36 893), 13 on tuberculosis (Nparticipants = 18 853), and 12 on HIV positivity (Nparticipants = 18 424). Risk of M. tuberculosis infection was lower in contacts of HIV-positive index cases (odds ratio [OR], 0.67, 95% confidence interval [CI], .58–.77) but was heterogeneous (I2 = 75.1%). Two factors modified this relationship: the lung cavitary status of the index case and immunosuppression (measured through CD4 counts or HIV or acquired immunodeficiency syndrome diagnoses) among index people living with HIV. Rates of HIV were consistently higher in contacts of coinfected index cases (OR, 4.9; 95% CI, 3.0–8.0). This was modified by whether the study was in sub-Saharan Africa (OR, 2.8; 95% CI, 1.6–4.9) or in another global region (OR, 9.8; 95% CI, 5.9–16.3). Conclusions Tuberculosis patients coinfected with HIV are less infectious than HIV-uninfected cases when they have severe immunosuppression or paucibacillary disease. Contacts of coinfected index cases are almost 5 times more likely to also have HIV.

Introduction For patients with diffuse large B‐cell lymphoma (DLBCL), standard‐care is rituximab administered with CHOP or CHOP‐like chemotherapy (R‐CHOP). However, the effectiveness and safety of R‐CHOP among DLBCL patients with human immunodeficiency virus (HIV) infection is less clear, as HIV+ patients were omitted from most clinical trials and population‐level data from unselected patients are limited. R‐CHOP was funded for HIV‐associated DLBCL patients with CD4 >50/mm3 in Ontario in February 2015. Methods Patients with a new diagnosis of DLBCL were identified from the Ontario Cancer Registry between April 2010 and March 2018. HIV diagnosis and chemotherapy regimen were ascertained using administrative databases at Ontario Health. The effect of rituximab and HIV on overall survival was assessed in the HIV+ subgroup (R‐CHOP vs CHOP) and in the R‐CHOP subgroup (HIV+ vs HIV−). Results Among HIV+ patients, receipt of R‐CHOP was associated with a fivefold improvement in overall survival (hazard ratio [HR] 0.29 (0.13‐0.66) compared with CHOP), after adjustment. Among patients who received R‐CHOP (n = 6106), older age, male sex, lower neighborhood income, and higher comorbidity were associated with worse overall survival, after adjustment (P, The standard of care for patients with aggressive‐histology B‐cell lymphoma is rituximab in addition to a CHOP or CHOP‐like chemotherapy regimen. For HIV+ patients, there are less data available on the effectiveness of this treatment, but in 2015, policy changes in Ontario extended this treatment modality to this subgroup of patients. In the present study, we demonstrate that rituximab with CHOP is as safe and effective for HIV+ patients as it is for HIV− patients.

Background HIV testing at birth may improve early treatment, but concerns remain about feasibility and retention of infants in care. In 2017, point-of-care (POC) HIV birth testing was introduced into routine care at 3 high-volume maternity health facilities in Eswatini. Methods POC birth testing was offered to HIV-exposed infants (HEI) born at, or presenting to, 3 maternities within 3 days of birth. Data were collected from a project-specific EID test request form and routine registers on all tests conducted from August 1, 2017 to November 30, 2018, including retesting at 6-8 weeks for infants testing negative at birth and six-month retention in HIV care and viral load suppression among infants testing HIV-positive at birth. Results Of 4322 eligible HEI, 3311 (76.6%) were tested. Twenty-six HIV-infected infants were identified (positivity rate 0.8%) and 25 initiated on antiretroviral therapy (ART) (96.1%). The median time from sample collection to ART initiation was 20.50 days (IQR 14-45). Twenty-one (84%) ART-initiated infants were on ART at 6 months after initiation. Nineteen infants (90.5%) had viral load test information at 6 months and 16 (84.2%) were virally suppressed. Of 3126 HEI testing negative at birth, 3004 (96.1%) were linked to laboratory databases and 2744 (91.3%) were retested at 6-8 weeks, with 9 (0.3%) additional infants testing HIV-positive. Conclusions Uptake of POC birth testing was high in Eswatini with low HIV positivity. Almost all infants identified HIV-positive at birth were initiated on ART, with high retention in care and viral suppression. Birth testing did not seem to significantly reduce subsequent 6-8-week testing.

BACKGROUND Most HIV-exposed infants access early infant diagnosis (EID) through the prevention of mother-to-child transmission (PMTCT) service points. However, there are limited data on HIV positivity in non-PMTCT health care settings (pediatric wards, emergency departments, outpatient departments, tuberculosis clinics, etc.). The introduction of point-of-care testing provided an opportunity to describe HIV positivity at alternative health service points and associated risk factors. METHODS We performed a cross-sectional subanalysis with data from 58 health facilities in Cameroon. The risk of a child being HIV positive at a health service point was considered as a dependent variable, and exploratory variables were assessed using multivariate models with a significance level of 0.05. RESULTS Overall, 2254 HIV-exposed infants identified by clinical or biological screening were tested by polymerase chain reaction using point-of-care EID. Approximately 74.3% of the infants were tested at a PMTCT entry point, whereas 25.7% were tested at non-PMTCT service points. The positivity yield was 5.7% (95 of the 1674) at the PMTCT service point and 17.6% (102 of the 580) at non-PMTCT service points. Non-PMTCT service points [adjusted odds ratio (aOR): 1.95; 95% confidence interval (CI): 1.36 to 2.80] and vaginal delivery (aOR: 2.56; 95% CI: 1.25 to 5.25) were independently associated with HIV positivity. In a separate analysis (infants aged 0-6 months), mixed feeding mode (aOR: 3.68; 95% CI: 2.00 to 6.77) was also associated with HIV positivity. CONCLUSIONS More than half of children newly identified as HIV-positive were tested at non-PMTCT service points. The highest EID positivity yields were found in non-PMTCT service points. Strengthening HIV testing in non-PMTCT service points may help to identify additional infected children and improve timely initiation of treatment and care.

Objective: We examined the role played by four psychosocial conditions: forced sex, early sexual initiation, and misuse of alcohol and illicit drugs on the risk of HIV and sexually transmitted infections in Cali-Colombia between 2013 and 2015. Methods: Using data from an HIV counseling and testing campaign in Cali, Colombia, we tested the effect of the accumulation and interactions of the four psychosocial conditions on both outcomes. Results: A total of 604 participants were representative subjects from key affected communities: men who have sex with men, transgender women and female sex workers. A total of 733 participants were heterosexual women and men. Only drug abuse was associated with HIV positivity (Prevalence ratio=2.3, CI 95%: 1.3–4.1), while all psychosocial conditions were associated with sexually transmitted infection history. The accumulation of the syndemic conditions was related to a higher likelihood of sexually transmitted infection history. None of the interactions tested was significant. Conclusions: Our findings highlight the importance of comprehensive mental health interventions in addressing HIV epidemics in Colombia.

Objectives: To investigate the prevalence of high-risk (HR) human papillomavirus (HPV) and factors associated with HR-HPV infection among women from rural Eastern Cape, South Africa. Methods: HPV prevalence was determined by Hybrid Capture 2 assay in cervical specimens from 417 women aged >= 30 years (median 46 years) recruited from the community health clinic in the Eastern Cape. Results: HR-HPV prevalence was 28.5% (119/417), and HIV-positive women had significantly higher HR-HPV prevalence than HIV-negative women (40.6%, 63/155 vs 21.4%, 56/262, respectively; p = 0.001). HIV-positive status (odds ratio (OR) 2.52, 95% confidence interval (CI) 1.63-3.90), having >= 3 lifetime sexual partners (OR 2.12, 95% CI 1.16-3.89), having >= 1 sexual partner in the last month (OR 1.89, 95% CI 1.21-2.92), >= 4 times frequency of vaginal sex in the past 1 month (OR 2.40, 95% CI 1.32-4.35), and having a vaginal discharge currently/in the previous week (OR 2.13, 95% CI 1.18-3.85) increased the risk of HR-HPV infection. In the multivariate analysis, HIV positivity remained strongly associated with HR-HPV infection (OR 1.94, 95% CI 1.17-3.22). Conclusions: Risk factors related to sexual behaviors play a significant role in HR-HPV infection in this population. This report will inform health policymakers on HPV prevalence and contribute to discussions on the use of HPV testing as the primary cervical cancer screening test in South Africa. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

BackgroundGiven the growing number of people worldwide living with human immunodeficiency virus (HIV), a larger subset of these patients are now susceptible to sustaining a traumatic injury. However, the impact of HIV on outcomes in trauma with modern antiretroviral treatment remains unclear.We hypothesized mortality and rates of infectious and inflammatorycomplicationswould be higher in HIV positive (HIV+) trauma patients.MethodsThe Trauma Quality Improvement Programwas queriedtoidentify trauma patients ≥ 18years of age with HIV.Due to the imbalance between HIV+ and HIV negative(HIV-)trauma patients, a 1:2 propensity-matched model was utilized. Matched variables included age, injury severity score, mechanism of injury, systolic blood pressure, pulse rate, Glasgow Coma Scale score, and patient comorbidities.Results84 HIV+ patients were matched to 168 HIV- patients.Compared toHIV-patients, HIV+ patientshad no significant differences in mortality rate (9.5% vs.4.8%, p = 0.144) or infectious complications, including pneumonia (6.0% vs.4.2%, p = 0.530), urinary tract infection (1.2% vs. 1.2%, p = 1.000), or severe sepsis (1.2% vs.0.0%, p = 0.156). However, higher rates of acute respiratory distress syndrome (ARDS) (9.5% vs.0.6%, p

A study of 4 partner notification approaches in Côte d'Ivoire found that the provider approach is a successful and acceptable strategy for bringing in sex partners for human immunodeficiency virus testing., Background Four partner notification approaches were introduced in health facilities in Côte d'Ivoire to increase human immunodeficiency virus (HIV) testing uptake among the type of contacts (sex partners and biological children younger than 15 years). The study assessed the 4 approaches: client referral (index cases refer the contacts for HIV testing), provider referral (health care providers refer the contacts), contract referral (index case-provider hybrid approach), and dual referral (both the index and their partner are tested simultaneously). Methods Program data were collected at 4 facilities from October 2018 to March 2019 from index case files and HIV testing register. We compared uptake of the approaches, uptake of HIV testing, and HIV positivity percentages, stratified by contact type and gender. Results There were 1089 sex partners and 469 children from 1089 newly diagnosed index cases. About 90% of children were contacted through client referral: 85.2% of those were tested and 1.4% was positive. Ninety percent of the children came from female index cases. The provider referral brought in 56.3% of sex partners, of whom 97.2% were HIV-tested. The client referral brought in 30% of sex partners, of whom only 81.5% were HIV-tested. The HIV positivity percentages were 75.5% and 72.7%, respectively, for the 2 approaches. Male index cases helped to reach twice as many HIV-positive sexual contacts outside the household (115) than female index cases (53). The contract and dual referrals were not preferred by index cases. Conclusions Provider referral is a successful and acceptable strategy for bringing in sex partners for testing. Client referral is preferred for children.

Background Gay and bisexual men (GBM) are disproportionately affected by anal cancer. Prevention is hindered by incomplete understanding of the natural history of its precursor, anal high-grade squamous intraepithelial lesions (HSIL). Methods The Study of the Prevention of Anal Cancer, conducted between 2010 and 2018, enrolled human immunodeficiency virus (HIV)-positive and HIV-negative GBM aged ≥35 years. Anal cytology and high-resolution anoscopy (HRA) were performed at baseline and 3 annual visits. A composite HSIL diagnosis (cytology ± histology cHSIL) was used. Cytological high-grade squamous intraepithelial lesions (cHSIL) incidence and clearance rates were calculated with 95% confidence intervals (CIs). Predictors were calculated using Cox regression with hazard ratios (HRs) and 95% CIs. Results Among 617 men, 220 (35.7%) were HIV-positive, median age 49 years. And 124 incident cHSIL cases occurred over 1097.3 person-years (PY) follow-up (11.3, 95% CI 9.5–13.5 per 100 PY). Significant bivariate predictors of higher incidence included age Conclusion These data strongly suggest that not all anal HSIL detected in screening requires treatment. Men with persistent HPV16 were less likely to clear HSIL and are more likely to benefit from effective HSIL treatments. Clinical Trials Registration Australia New Zealand Clinical Trials Registry (ANZCTR365383).

Herpes Simplex Virus type 2 (HSV-2) is a significant public health problem being one of the most prevalent sexually transmitted infections worldwide and the leading cause of genital ulcerative disease that is common both in industrialized and developing countries. Therefore, a study on the serological survey of Immunoglobulins G antibody among different populations with asymptomatic shedding of genital herpes in Katsina State, north-western Nigeria was carried out. A total of 460 (86 HIV, 136 feverish patients, 125 pregnant women and 113 normal Individuals) blood samples were collected from six hospitals located across the three senatorial zones of the State. The serum was separated from the blood and used for the analysis. The participant’s socio-demographic information and clinical presentations were also noted with the aid of a questionnaire. Viral antibodies were detected by HSV-2 IgG ELISA Kits. The HSV-2 IgG was detected in 72.8% of the serum tested. The prevalence among patients presenting with fever was 70.6%, and it was 74.4% in the pregnant women. The prevalence in HIV positive patients was 75.6% while it was 73.5% in the apparently healthy individuals. There was a significant association between HIV positivity, feverish condition and HSV-2 prevalence. Higher prevalence was recorded at General Hospital Dutsinma 89.6% and there was a statistically significant association between prevalence and hospital studied. Generally, older participants were more vulnerable to HSV-2 infection than younger ones. There was no statistical significant association between sex of the participants and HSV-2 infection. None of the sociodemographic factors was significantly associated with HSV-2 infection except marital status. There was no significant association between socio-economic status, sexual activity, use of protection, number of sexual partners, clinical manifestation, level of education, and occupation of the participants with HSV-2 infection. The present study indicates that prevalence of HSV-2 appears to be relatively high and older participants were more vulnerable to HSV-2 infection in Katsina State. There is need for educating populace on HSV-2 infection and its mode of transmission to reduce the level of its spread between individuals in the population. Keywords: HSV-2; IgG; Genital; Serum; Antibody

Growing demand for use of Health Facility (HF) HIV testing data, in addition to other testing data to obtain district level HIV prevalence requires understanding the comparability of these various sources. We analysed the 2011 Uganda AIDS indicator survey data to assess: the proportion of people tested for HIV across Uganda by venue of testing; HIV prevalence ratio for those tested in a HF compared to those tested in community setting; [Katz, D., Baptista, J., Azen, S. P., & Pike, M. C. (1978). Obtaining confidence intervals for the risk ratio in cohort studies. International Biometric Society, 34(3), 469-474. https://doi.org/10.2307/2530610] and factors associated with HIV positivity in each subgroup. Of the 11,685 individuals, 8978 (77.1%) had ever tested for HIV in a HF. Fifty nine per cent tested in a HF in the 12 months preceding the survey (female: 5507, 72.7% versus male: 1413, 34.9%). HIV prevalence ratio was 1.8 times among those tested in a HF compared to those tested at community setting (10.9% [95% CI: 10.0-11.7] versus 6.2% [95% CI: 5.4-7.0]). Among HF testers, older age group, previously married and having no sexual partner was associated with significantly higher HIV prevalence. Using facility testing data for planning and decisions should take into consideration the elevated and varying HIV prevalence among individuals accessing HIV testing services at HFs as well as differences in their social-demographic characteristics.

Introduction and aims Gay and bisexual men (GBM) who inject drugs are disproportionately affected by human immunodeficiency virus (HIV) because of dual transmission risks. New Zealand has a progressive history of harm reduction and was the first country to publicly fund needle exchange programs in 1988 for people who inject drugs (PWID). We combine national HIV epidemiological and bio-behavioural surveillance data to understand HIV risk among this subpopulation. Design and methods We examine trends in new HIV diagnoses 1996-2018 by mode of transmission, and compare HIV cases attributed to sex between men (MSM-only), MSM/injecting drug use (IDU) and IDU-only. IDU among GBM in a national HIV behavioural surveillance survey was also examined. We compare GBM by IDU status (never, 'recent', previous) and identified predictors of recent IDU. Results Of 1653 locally-acquired HIV diagnoses 1996-2018, 77.4% were MSM-only, 1.5% MSM/IDU, 1.4% IDU-only and 14.2% heterosexual mode of transmission. On average, just one HIV diagnosis attributed to MSM/IDU and IDU, respectively, occurred per annum. MSM/IDU cases were more likely than MSM-only cases to be indigenous Māori ethnicity. Of 3163 GBM survey participants, 5.4% reported lifetime IDU and 1.2% were recent IDU. Among GBM, HIV positivity was 20% among recent IDU and 5.3% among never injectors. Predictors of recent IDU were: age under 30; more than 20 male partners; female partner; condomless intercourse; HIV positivity. Discussion and conclusion New Zealand has averted high endemic HIV rates seen among GBM and PWID in other countries and results have been sustained over 30 years.

Most studies on survival sex, defined as sex trading for money, drugs, or other needs, have limited their focus to adolescents. The current study reports about the relationships between survival sex trading (SST) and high-risk behaviors in a sample of adults. Bivariate analysis shows that HIV-positive status, use of cocaine, ketamine, methamphetamine, heroin, having received drug treatment, and having received medical services are associated with SST. SST are more likely to not use condoms with partners other than their main partner, to have partners who inject drugs and are more likely to use drugs with sex. A logistic regression model included unwanted sexual touching, partner abuse, identifying as bisexual, African American, higher age, gender (women more likely), homelessness, a higher number of sexual partners, having anal sex, injection drug use, HIV seropositivity, crack use, and the likelihood of injecting drugs. The model was retested on independently collected Risk Behavior Assessment (RBA) data and showed significant relationships between survival sex and crack use, gender (women more likely), HIV positivity, identifying as bisexual, having anal sex, African American, and a higher number of sex partners. These findings make it imperative to integrate victimization counseling and HIV education into substance abuse treatment programs.