381 results on '"Hayes RJ"'
Search Results
2. Selling Water in the New Environment of 'Refurbishing Pipes and Personnel'
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IPENZ (1992 : Christchurch, N.Z.) and Hayes, RJ
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- 1992
3. lmproving Traditional Grape Drying Technology Using Solar Energy
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Agricultural Engineering Conference (1990 : Toowoomba, Qld.), Fuller, RJ, Schache, MJ, Morey, BG, Hayes, RJ, Gould, IV, and Goldsmith, CA
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- 1990
4. Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition
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Sturt, AS, primary, Webb, EL, additional, Francis, SC, additional, Hayes, RJ, additional, and Bustinduy, AL, additional
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- 2020
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5. Sexually transmitted bedfellows: exquisite association between HIV and HSV2 in 21 communities in Southern Africa in the HPTN 071 (PopART) study
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Bradley, J, Floyd, S, Piwowar-Manning, E, Laeyendecker, O, Young, A, Bell-Mandla, N, Bwalya, J, Bock, P, Fidler, S, Ayles, H, Hayes, RJ, and HPTN 071 (PopART) Study Team
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11 Medical And Health Sciences ,06 Biological Sciences ,HPTN 071 (PopART) Study Team ,Microbiology - Abstract
Background: HIV and Herpes simplex virus type-2 (HSV2) are strongly associated, although mechanisms are not fully understood. An HIV prevention trial allowed re-examination of this association at individual and community levels. Methods: HPTN 071 (PopART) evaluates a combination prevention intervention in 21 urban communities in Zambia and South Africa. To measure impact on HIV incidence, a cohort of ~2,000 adults (18-44y) was selected randomly from each community. Baseline data on socio-demographic characteristics, behaviour and HIV/HSV2 serology were used to examine the association between HIV and HSV2. At community-level, HIV prevalence was plotted against HSV2 prevalence. Results: 38,691 adults participated. HSV2 prevalence in women/men was 50%/22% (Zambia) and 60%/27% (South Africa). Estimated HSV2 incidence in those aged 18-24y was 8.06 (95%:CI:6.76-9.35) and 1.76 (95%CI:1.30-2.22) per 100/py in women and men, respectively. Six-fold higher odds of HIV were seen in HSV2-infected individuals in both sexes, after adjustment for confounders (Women:OR:6.66,95%CI: 6.07-7.31;Men:OR:6.57,95%CI:5.56-7.77). At community-level there was a strong linear relationship between HIV and HSV2 prevalence (ρ = 0.92,p
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- 2018
6. ‘Allocation concealment’: the evolution and adoption of a methodological term
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Schulz, Kenneth F, primary, Chalmers, I, additional, Altman, DG, additional, Grimes, DA, additional, Moher, D, additional, and Hayes, RJ, additional
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- 2018
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7. 1988 National Water Conference, Dunedin: Water in Society - Policy and Practice - a Summary
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Institution of Professional Engineers New Zealand (1989: Dunedin, New Zealand), Hamilton, DJ, and Hayes, RJ
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- 1989
8. Reticulation Pipeline Asset Management Systems: Current Progress in Dunedin City
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Institution of Professional Engineers New Zealand (1989: Dunedin, New Zealand), Hayes, RJ, Read, NSL, and Robinson, DL
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- 1989
9. P03.14 High prevalence oflactobacillis crispatusamong adolescent girls attending secondary school in tanzania
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Francis, SC, primary, Jespers, V, additional, Hansen, C, additional, Irani, J, additional, Baisley, K, additional, Andreasen, A, additional, Nnko, S, additional, Crucitti, T, additional, Changalucha, C, additional, Hayes, RJ, additional, Watson-Jones, D, additional, and Buve, A, additional
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- 2015
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10. PP68 Sexual risk behaviours among young people in rural mwanza, tanzania: is marriage protective?
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Doyle, AM, primary, Changalucha, J, additional, Weiss, HA, additional, Watson-Jones, D, additional, Hayes, RJ, additional, and Ross, DA, additional
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- 2015
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11. Can behavior change explain increases in the proportion of genital ulcers attributable to herpes in sub-Saharan Africa? A simulation modeling study
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Korenromp, Eline, Bakker, Roel, de Vlas, Sake, Robinson, JS, Hayes, RJ, Habbema, Dik, and Public Health
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- 2002
12. Population-level effect of HSV-2 therapy on the incidence of HIV in sub-Saharan Africa
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White, RG, Freeman, EE, Orroth, KK, Bakker, Roel, Weiss, HA, O'Farrell, N, Buve, A, Hayes, RJ, Glynn, JR, White, RG, Freeman, EE, Orroth, KK, Bakker, Roel, Weiss, HA, O'Farrell, N, Buve, A, Hayes, RJ, and Glynn, JR
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Background: Herpes simplex virus type 2 (HSV-2) infection increases acquisition and transmission of HIV, but the results of trials measuring the impact of HSV-2 therapy on HIV genital shedding and HIV acquisition are mixed, and the potential impact of HSV-2 therapy on the incidence of HIV at the population level is unknown. Methods: The effects of episodic and suppressive HSV-2 therapy were simulated using the individual-level model STDSIM fitted to data from Cotonou, Benin (relatively low HIV prevalence) and Kisumu, Kenya (high HIV prevalence). Clinician- and patient-initiated episodic therapy, started when symptomatic, were assumed to reduce ulcer duration. Suppressive therapy, given regardless of symptoms, was also assumed to reduce ulcer frequency and HSV-2 infectiousness. Results: Clinician- initiated episodic therapy in the general population had almost no effect on the incidence of HIV. The impact of patient-initiated therapy was higher because of earlier treatment initiation, but still low (< 5%) unless symptom recognition and treatment-seeking behaviour were very high. Suppressive therapy given to female sex workers (FSW) in Kisumu had little effect on population HIV incidence. In Cotonou, suppressive therapy in FSW with high coverage and long duration reduced population HIV incidence by > 20% in the long term. Impact was increased in both cities by also treating a proportion of their clients. Long-term suppressive therapy with high coverage in the general population could reduce HIV incidence by more than 30%. Conclusions: These results show that HSV-2 therapy could potentially have a population-level impact on the incidence of HIV, especially in more concentrated epidemics. However, a substantial impact requires high coverage and long duration therapy, or very high symptom recognition and treatment-seeking behaviour.
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- 2008
13. Tuberculosis and immunodeficiency in HIV-1-infected patients in Africa
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Elliott, A.M., primary, Hayes, Rj, additional, Luo, N., additional, Pobee, J.O.M., additional, and McAdam, K.P.W.J., additional
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- 1993
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14. Exploring the potential impact of a reduction in partnership concurrency on HIV incidence in rural Uganda: a modeling study.
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McCreesh N, Obrien K, Nsubuga RN, Shafer LA, Bakker R, Seeley J, Hayes RJ, White RG, McCreesh, Nicky, OʼBrien, Katie, Nsubuga, Rebecca N, Shafer, Leigh Anne, Bakker, Roel, Seeley, Janet, Hayes, Richard J, and White, Richard G
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- 2012
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15. Evaluation of respondent-driven sampling.
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McCreesh N, Frost SD, Seeley J, Katongole J, Tarsh MN, Ndunguse R, Jichi F, Lunel NL, Maher D, Johnston LG, Sonnenberg P, Copas AJ, Hayes RJ, White RG, McCreesh, Nicky, Frost, Simon D W, Seeley, Janet, Katongole, Joseph, Tarsh, Matilda N, and Ndunguse, Richard
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Background: Respondent-driven sampling is a novel variant of link-tracing sampling for estimating the characteristics of hard-to-reach groups, such as HIV prevalence in sex workers. Despite its use by leading health organizations, the performance of this method in realistic situations is still largely unknown. We evaluated respondent-driven sampling by comparing estimates from a respondent-driven sampling survey with total population data.Methods: Total population data on age, tribe, religion, socioeconomic status, sexual activity, and HIV status were available on a population of 2402 male household heads from an open cohort in rural Uganda. A respondent-driven sampling (RDS) survey was carried out in this population, using current methods of sampling (RDS sample) and statistical inference (RDS estimates). Analyses were carried out for the full RDS sample and then repeated for the first 250 recruits (small sample).Results: We recruited 927 household heads. Full and small RDS samples were largely representative of the total population, but both samples underrepresented men who were younger, of higher socioeconomic status, and with unknown sexual activity and HIV status. Respondent-driven sampling statistical inference methods failed to reduce these biases. Only 31%-37% (depending on method and sample size) of RDS estimates were closer to the true population proportions than the RDS sample proportions. Only 50%-74% of respondent-driven sampling bootstrap 95% confidence intervals included the population proportion.Conclusions: Respondent-driven sampling produced a generally representative sample of this well-connected nonhidden population. However, current respondent-driven sampling inference methods failed to reduce bias when it occurred. Whether the data required to remove bias and measure precision can be collected in a respondent-driven sampling survey is unresolved. Respondent-driven sampling should be regarded as a (potentially superior) form of convenience sampling method, and caution is required when interpreting findings based on the sampling method. [ABSTRACT FROM AUTHOR]- Published
- 2012
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16. Role of acute infection in HIV transmission.
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Hayes RJ, White RG, Hayes, Richard J, and White, Richard G
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- 2011
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17. HIV infection does not affect active case finding of tuberculosis in South African gold miners.
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Lewis JJ, Charalambous S, Day JH, Fielding KL, Grant AD, Hayes RJ, Corbett EL, Churchyard GJ, Lewis, James J, Charalambous, Salome, Day, John H, Fielding, Katherine L, Grant, Alison D, Hayes, Richard J, Corbett, Elizabeth L, and Churchyard, Gavin J
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Rationale: Gold miners in South Africa undergo annual radiological screening for tuberculosis in an occupational health center of a gold mining company, but the optimal screening algorithm is unclear.Objectives: To evaluate methods for active case detection of tuberculosis.Methods: A sequential sample of miners attending annual medical examination was screened for tuberculosis using a symptom questionnaire, chest radiograph, and two sputum specimens for microscopy and culture.Measurements and Main Results: There were 1,955 miners included in this study; all were male with a median age of 41 years (range, 20-61 yr). Presence of at least one of a trio of symptoms (new or worsening cough, night sweats, or weight loss) had similar sensitivity (29.4%) to either chest radiograph (25.5%) or sputum smear (25.5%). These sensitivities did not differ by HIV status. Presence of one or more elements of the symptom trio and/or new radiological abnormality substantially increased sensitivity to 49.0%. Specificity of the symptom trio was higher in HIV-uninfected (91.8%) than in HIV-infected persons (88.2%; P = 0.018). Specificity of chest radiography and smear were similar (98.7% and 99.0%, respectively) and did not differ by HIV status (both P values > 0.8).Conclusions: In a population of gold miners who undergo regular radiological screening, the addition of chest radiography to symptom screening substantially improved the sensitivity and positive predictive value. HIV infection did not alter the sensitivity of the screening tool. [ABSTRACT FROM AUTHOR]- Published
- 2009
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18. The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi-component community-based HIV prevention intervention for rural youth in Zimbabwe--study design and baseline results.
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Cowan FM, Pascoe SJ, Langhaug LF, Dirawo J, Chidiya S, Jaffar S, Mbizvo M, Stephenson JM, Johnson AM, Power RM, Woelk G, Hayes RJ, Cowan, Frances M, Pascoe, Sophie J S, Langhaug, Lisa F, Dirawo, Jeffrey, Chidiya, Samson, Jaffar, Shabbar, Mbizvo, Michael, and Stephenson, Judith M
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Objective: To assess the effectiveness of a community-based HIV prevention intervention for adolescents in terms of its impact on (1) HIV and Herpes simplex virus type 2 (HSV-2) incidence and on rates of unintended pregnancy and (2) reported sexual behaviour, knowledge and attitudes.Methods: Cluster randomised trial of a multi-component HIV prevention intervention for adolescents based in rural Zimbabwe. Thirty communities were selected and randomised in 2003 to early or deferred intervention implementation. A baseline bio-behavioural survey was conducted among 6791 secondary school pupils (86% of eligibles) prior to intervention implementation.Results: Baseline prevalences were 0.8% (95% CI: 0.6-1.0) for HIV and 0.2% (95% CI: 0.1-0.3%) for HSV-2. Four girls (0.12%) were pregnant. There was excellent balance between study arms. Orphans who made up 35% of the cohort were at increased risk of HIV [age-sex adjusted odds ratio 3.4 (95% CI: 1.7-6.5)]. 11.9% of young men and 2.9% of young women reported that they were sexually active (P < 0.001); however, there were inconsistencies in the sexual behaviour data. Girls were less likely to know about reproductive health issues than boys (P < 0.001) and were less likely to have used and to be able to access condoms (P < 0.001).Conclusion: This is one of the first rigorous evaluations of a community-based HIV prevention intervention for young people in southern Africa. The low rates of HIV suggest that the intervention was started before this population became sexually active. Inconsistency and under-reporting of sexual behaviour re-emphasise the importance of using externally validated measures of sexual risk reduction in behavioural intervention studies. [ABSTRACT FROM AUTHOR]- Published
- 2008
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19. Microbicides development program, Tanzania-baseline characteristics of an occupational cohort and reattendance at 3 months.
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Vallely A, Kasindi S, Hambleton IR, Knight L, Chirwa T, Balira R, Changalucha J, Watson-Jones D, Everett D, Gavyole A, Moyes J, Pujades-Rodríguez M, Ross DA, Hayes RJ, Vallely, Andrew, Kasindi, Stella, Hambleton, Ian R, Knight, Louise, Chirwa, Tobias, and Balira, Rebecca
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- 2007
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20. A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme.
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Plummer ML, Wight D, Obasi AIN, Wamoyi J, Mshana G, Todd J, Mazige BC, Makokha M, Hayes RJ, and Ross DA
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- 2007
21. 'The man who believed he had AIDS was cured': AIDS and sexually-transmitted infection treatment-seeking behaviour in rural Mwanza, Tanzania.
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Plummer ML, Mshana G, Wamoyi J, Shigongo ZS, Hayes RJ, Ross DA, and Wight D
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Most people living with AIDS in sub-Saharan Africa have had neither a biomedical diagnosis nor antiretroviral medication, leading to the question of how individuals understand and treat AIDS. This study examined general illness, sexually-transmitted infection (STI) and AIDS treatment-seeking behaviour in rural Mwanza, Tanzania. From 1999-2002, participant observation was carried out in nine villages for a total of 158 person-weeks. Treatments were pluralistic and opportunistic, usually beginning with home remedies (western or traditional), followed by visits to traditional healers (THs) and/or health facilities (HFs). THs were sometimes preferred over HFs because of familiarity, trust, accessibility, expense, payment plans, and the perceived cause, nature and severity of the illness, e.g. only THs were believed to successfully treat bewitchment. Some people, particularly young girls, delayed or avoided seeking treatment for STIs for fear of stigma. Most STIs were attributed to natural causes, but AIDS was sometimes attributed to witchcraft. Locally available biomedical care of people with AIDS-like symptoms consisted of basic treatment of opportunistic infections. Most such individuals repeatedly visited THs and HFs, but many stopped attending HFs because they came to believe they could not be cured there. Some THs claimed to cure witchcraft-induced, AIDS-like illnesses. There is an urgent need for improved biomedical services, and TH interventions could be important in future HIV/AIDS education and care. [ABSTRACT FROM AUTHOR]
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- 2006
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22. Development of Geminivirus-Based Gene Vectors for Dicotyledonous Plants
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Coutts, RHA, primary, Buck, KW, additional, and Hayes, RJ, additional
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- 1990
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23. Human immunodeficiency virus and the prevalence of undiagnosed tuberculosis in African gold miners.
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Corbett EL, Charalambous S, Moloi VM, Fielding K, Grant AD, Dye C, De Cock KM, Hayes RJ, Williams BG, and Churchyard GJ
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We hypothesized that rapid presentation may be a general feature of tuberculosis (TB) associated with human immunodeficiency virus (HIV) that limits the impact of HIV on the point prevalence of TB. To investigate this, we performed a cross-sectional HIV and TB disease survey with retrospective and prospective follow-up. HIV prevalence among 1,773 systematically recruited miners was 27%. TB incidence was much more strongly HIV associated (incidence rate ratio, 5.5; 95% confidence interval [CI], 3.5-8.6) than the point prevalence of undiagnosed TB disease (odds ratio, 1.7; 95% CI, 0.9-3.3). For smear-positive TB, 7 of 9 (78%) prevalent cases were HIV negative, and point prevalence was nonsignificantly lower in miners who were HIV positive (odds ratio, 0.8; 95% CI, 0.1-4.2). The calculated mean duration of smear positivity before diagnosis (point prevalence/incidence) was substantially shorter for HIV-positive than HIV-negative TB patients (0.17 and 1.15 years, respectively; ratio, 0.15; 95% CI, 0.00-0.73). HIV has considerably less impact on the point prevalence of TB disease than on TB incidence, probably because rapid disease progression increases presentation and case-finding rates. The difference in mean duration of smear positivity was particularly marked and, if generalizable, will have major implications for TB control prospects in high HIV prevalence areas. [ABSTRACT FROM AUTHOR]
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- 2004
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24. Stable incidence rates of tuberculosis (TB) among human immunodeficiency virus (HIV)-negative South African gold miners during a decade of epidemic HIV-associated TB.
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Corbett EL, Charalambous S, Fielding K, Clayton T, Hayes RJ, De Cock KM, and Churchyard GJ
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During the last decade, annual tuberculosis (TB) case-notification rates increased 4-fold, to >4000 cases/100000 person-years, in the study workforce, among whom prevalence of human immunodeficiency virus (HIV) was 30% in 2000. Three separate cohort studies, totalling 6454 HIV-negative participants, were combined and analyzed for time trends. Observed incidence of TB varied between 962 (1991-1994) and 1589 (1999-2000) cases/100000 person-years (P=.17, test for trend). There was, however, a progressive increase in age, and, for each period, older age was associated with increased incidence rates of TB (P<.001). Having adjusted for age differences, there was no significant association between incidence of TB and calendar period (P=.81, test for trend). Relative to 1991-1994, multivariate-adjusted incidence-rate ratios were 0.94, for 1995-1997, 0.96, for 1998-1999, and 1.05, for 1999-2000. Preventing a secondary epidemic of TB among HIV-negative individuals may be achievable with conventional means, even in settings with a high burden of HIV-associated TB. Copyright © 2003 The University of Chicago [ABSTRACT FROM AUTHOR]
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- 2003
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25. Simple sample size calculation for cluster-randomized trials.
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Hayes, RJ and Bennett, S
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Background Cluster-randomized trials, in which health interventions are allocated randomly to intact clusters or communities rather than to individual subjects, are increasingly being used to evaluate disease control strategies both in industrialized and in developing countries. Sample size computations for such trials need to take into account between-cluster variation, but field epidemiologists find it difficult to obtain simple guidance on such procedures. [ABSTRACT FROM PUBLISHER]
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- 1999
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26. An analysis of the geographical distribution of severe malaria in children in Kilifi District, Kenya.
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Schellenberg, JA, Newell, JN, Snow, RW, Mung'ala, V, Marsh, K, Smith, PG, Hayes, RJ, Schellenberg, J A, Newell, J N, Snow, R W, Smith, P G, and Hayes, R J
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Background: Although malaria is known to be a major cause of child mortality and morbidity throughout sub-Saharan Africa there are few detailed studies of malaria mortality rates and incidence of severe malarial disease in defined communities. We have studied the geographical pattern of admissions to hospital with severe malaria and the stability of this pattern over time in Kilifi District on the Kenyan Coast.Methods: Over a 2-year period all children under 5 years of age with severe malaria admitted to the district hospital and living in a rural study population of about 50,000 people were identified. Annual censuses were carried out in the study area, and all households were mapped using a hand-held satellite navigation system. The resulting databases were linked using a geographical information system (GIS).Results: Using methods originally developed for the study of the geographical distribution of childhood leukaemia we assessed the spatial pattern of hospital admission rates for severe malaria. As expected, admission rates were significantly higher in children with easier access to the hospital. For example, those living more than 25 km from the hospital had admission rates which were about one-fifth of those for children living within 5 km of the hospital. Those living more than 2.5 km from the nearest road had admission rates that were about half of those for children living within 0.5 km of a road. We also investigated short-term local fluctuations in severe malaria and found evidence of space-time clustering of severe malaria.Conclusions: Hospital admission rates for severe malaria are higher in households with better access to hospital than in those further away. The finding of space-time clusters of severe malaria suggests that it would be of value to conduct case-control studies of environmental, genetic and human behavioural factors involved in the aetiology of the disease. [ABSTRACT FROM AUTHOR]- Published
- 1998
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27. Proportion of HIV infections attributable to other sexually transmitted diseases in a rural Ugandan population: simulation model estimates.
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Robinson, NJ, Mulder, DW, Auvert, B, Hayes, RJ, Robinson, N J, Mulder, D W, and Hayes, R J
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Background: Unprotected heterosexual contact in the presence of other sexually transmitted diseases (STD) enhances the probability of HIV transmission. The objective of this study was to estimate the proportion of HIV infections attributable to STD in rural Uganda.Methods: Simulation modelling scenarios of the transmission dynamics of HIV infection and of ulcerative and non-ulcerative STD were employed to address this objective, drawing on data from a specific rural population cohort of 10,000 in south-west Uganda.Results: In simulations of the initial 10-year period of the HIV epidemic (1980-1990), over 90% of HIV infections were attributed to STD. Even given conservative assumptions about the prevalence of STD and about their enhancing effects on HIV transmission, STD played a critical role in the rapid and extensive spread of HIV infection. The role of STD decreased with progression of the HIV epidemic.Conclusions: In developing countries, control of the spread of HIV infection may benefit substantially from successful STD intervention programmes, and particularly in areas where HIV infection is not already well established. [ABSTRACT FROM AUTHOR]- Published
- 1997
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28. Cash transfer scheme for reducing HIV and herpes simplex type 2.
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Webb EL, Hayes RJ, and Glynn JR
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- 2012
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29. INFORMAL DISCUSSION. PRACTICAL TRAINING: CAN WE MATCH INTAKE TO FORECAST?
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SOPER, NA and HAYES, RJ
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- 1978
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30. Development of Geminivirus-Based Gene Vectors for Dicotyledonous Plants
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Coutts, RHA, Buck, KW, and Hayes, RJ
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Geminiviruses are small icosahedral plant viruses that contain circular single-stranded DNA as their genome. In tomato golden mosaic virus (TGMV), a geminivirus that infects dicotyledonous hosts, several genes involved in replication, spread of virus or DNA in plants, and possibly insect transmission have been identified. Gene replacement experiments suggest that useful plant gene expression vectors can be constructed from TGMV. Following the integration of stable master copies of vectors based on TGMV DNA into plant chromosomal DNA, heritable gene amplification of a number of bacterial genes has been demonstrated, suggesting exciting possibilities for similar amplification of plant genes in the future.
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- 1990
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31. INFORMAL DISCUSSION. PRACTICAL TRAINING: CAN WE MATCH INTAKE TO FORECAST?
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SOPER, NA, primary and HAYES, RJ, additional
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- 1978
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32. ZAMSTAR, The Zambia South Africa TB and HIV Reduction Study: design of a 2 x 2 factorial community randomized trial.
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Ayles HM, Sismanidis C, Beyers N, Hayes RJ, Godfrey-Faussett P, Ayles, Helen M, Sismanidis, Charalambos, Beyers, Nulda, Hayes, Richard J, and Godfrey-Faussett, Peter
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Background: TB and HIV form a deadly synergy in much of the developing world, especially Africa. Interventions to reduce the impact of these diseases at community level are urgently needed. This paper presents the design of a community randomised trial to evaluate the impact of two complex interventions on the prevalence of tuberculosis (TB) in high HIV prevalence settings in Zambia and South Africa.Methods: The interaction between TB and HIV is reviewed and possible interventions that could reduce the prevalence of TB in HIV-endemic populations are discussed. Two of these interventions are described in detail and the design of a 2 x 2 factorial community randomised trial to test these interventions is presented. The limitations and challenges of the design are identified and discussed.Conclusion: There is an urgent need to reduce the prevalence of TB in communities highly affected by HIV. Potential interventions are complex and require innovative trial designs to provide the rigorous evidence needed to inform health policy makers and to ensure that resources are used optimally.Trial Registration: Number: ISRCTN36729271. [ABSTRACT FROM AUTHOR]- Published
- 2008
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33. Use of Prednisolone in the Treatment of HIV-positive Tuberculosis Patients
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ELLIOTT, AM, HALWIINDI, B, BAGSHAWE, A, HAYES, RJ, LUO, N, POBEE, JOM, and McADAM, KPWJ
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Corticosteroids are beneficial in the treatment of some forms of tuberculosis, but their role in TB affecting HIV-positive patients is not clear. During a cohort study of tuberculosis patients in Lusaka, Zambia, prednisolone was prescribed for specific indications. Six of 47 (13 per cent) of patients who received prednisolone early in treatment developed herpes zoster, compared with 2 of 118 (2 per cent) of those who did not. Three patients who received prednisolone developed Kaposi's sarcoma, compared with none who did not. At 2 months patients who had received prednisolone showed a greater improvement in generalized lymphadenopathy and cough. Controlled studies of the risks and benefits of administration of corticosteroids to HIV-positive TB patients are urgently needed.
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- 1992
34. Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections.
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Schmid GP, Buvé A, Mugyenyi P, Garnett GP, Hayes RJ, Williams BG, Calleja JG, De Cock KM, Whitworth JA, Kapiga SH, Ghys PD, Hankins C, Zaba B, Heimer R, and Boerma JT
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- 2004
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35. AIDS in Africa III. HIV-1/AIDS and the control of other infectious diseases in Africa.
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Corbett EL, Steketee RW, ter Kuile FO, Latif AS, Kamali A, and Hayes RJ
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- 2002
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36. Factors associated with the uptake of HIV testing and treatment in the first year of the HPTN 071 (PopART) intervention
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Sabapathy, K and Hayes, RJ
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3. Good health - Abstract
Introduction:\ud The HPTN 071 (PopART) trial is a community randomised trial in Zambia and South Africa, examining the impact of combination prevention, including treatment as prevention using Universal Test and Treat (UTT), on community level HIV-incidence. This PhD evaluates the factors associated with uptake of the key interventions, during the first year of the trial.\ud Methods:\ud Two systematic reviews were conducted on home-based HIV testing and counselling (HB-HTC), and the cascade-of-care following community-based HTC, respectively. In addition, two case-control (CC) studies were nested within PopART, to examine factors associated with the uptake of the door-to-door home-based universal testing (CC study 1), and universal treatment (CC study 2) interventions.\ud Results:\ud Our results suggest that HB-HTC in sub-Saharan Africa is widely accepted – uptake among those offered HB-HTC was 83% in a systematic review and meta-analysis of studies (2000-2012). The second systematic review found considerable variability in measures used to report linkage-to-care and ART initiation and in outcomes reported, even for similar time periods following HIV-detection (studies between 2006-2016).\ud CC1 found no differences between acceptors and non-acceptors of HB-HTC by demographic and behavioural characteristics. CC2 identified that the more lifetime sexual partners participants reported, the more likely they were to achieve timely linkage and ART initiation (TLA). Negative perceptions about clinic infra-structure were associated with failure to achieve TLA.\ud Both CC studies found that favourable views about the Community HIV-care Providers was associated with uptake of interventions, while neither stigma nor unfavourable views about clinic staff were associated with uptake.\ud Conclusion:\ud This PhD contributes to knowledge on the cascade-of-care and UTT. It suggests that PopART interventions are acceptable across population sub-groups, providing optimism for achieving universal coverage using the PopART model to implement UTT. If individuals with high-risk sexual behaviour embrace interventions as we observed, there is great promise for treatment as prevention.
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- 2018
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37. Feasibility and Effectiveness of Integrating HIV Prevention and Testing into Family Planning Services in North West Province, South Africa: A cluster randomised trial
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Mullick, S and Hayes, RJ
- Abstract
Background:\ud South Africa has one of the highest HIV prevalence rates in the world and high\ud contraceptive use among women aged 15–49 (65.3%). Family planning (FP) services\ud remain a missed opportunity to integrate services for HIV. Recent reviews highlighted the\ud lack of rigorously conducted studies of the effectiveness of integrated services. A cluster\ud randomised trial (CRT) was conducted to evaluate the effectiveness of a model of\ud integrating HIV into FP services compared with standard practice. The study sought to\ud measure the effect of integrated services (Balanced Counselling Strategy Plus) on HIV\ud testing in the previous year; use of dual protection and quality of HIV and FP care.\ud Methods: \ud A CRT was conducted in 12 clinics in North West province, South Africa. Structured clientprovider\ud observations (CPOs) and client exit interviews (EIs) were conducted preintervention\ud and one year later with FP clients aged >=18 years. Primary outcomes were\ud condom use at last sex and testing for HIV in last year. The quality of care scores were\ud constructed to assess HIV and FP quality of care. Analysis of effectiveness used statistical\ud methods for CRTs.\ud Findings: \ud A total of 1,111 CPOs and 1,111 EIs were completed at baseline and 1,223 CPOs and\ud 1,264 EIs at follow-up. At follow-up 33.2% of women in the intervention arm had tested for\ud HIV in the last year compared with 21.4% in the control arm; RR=1.56 (95%CI: 1.13– 2.15;\ud p=0.01). Condom use at last sex was 43.7% in the intervention arm and 39.4% in the\ud control arm; RR=1.10 (95%CI: 0.85–1.43; p=0.14).\ud Interpretation\ud There was strong evidence of higher frequency of HIV testing among FP clients at\ud intervention clinics. However, condom use at last sex was similar across intervention and\ud control arms. All QOC scores were higher in intervention clinics, but there was substantial\ud variation across clinics and these differences were not significant.
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- 2017
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38. The impact of improved STD case management on HIV infection and sexually transmitted diseases in Mwanza region, Tanzania
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Grosskurth, H and Hayes, RJ
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Observational studies have suggested that the transmission of the human immunodeficiency virus (HIV) is enhanced in the presence of other sexually transmitted diseases (STDs). Based on this STD/HTV co-factor hypothesis it has been suggested that interventions aimed at reducing the prevalence of STDs may be able to reduce the incidence of HTV infection. This thesis presents the results of a community based randomised controlled trial of the impact of improved STD case management on the incidence of HTV infection. The trial was earned out in the Mwanza Region of North-Western Tanzania between 1991 and 1995. It involved 12 rural communities which were formed into six matched pairs. Within each pair, one community was randomised to receive the intervention which comprised improved STD case management services integrated into the existing primary health care (PHC) structure, and health education campaigns to improve treatment seeking behaviour for STDs. The impact of the intervention was studied in a cohort of about 1000 adults aged 15 to 54 years from each of the communities. Over the 2 years of follow-up, there were 130 HIV seroconversions, 48 (1.16%) in the intervention group and 82 (1.86%) in the comparison group, equivalent to annual incidences of 0.58% and 0.93%. The crude relative risk (RR) for seroconversion in intervention compared to comparison communities was 0.57 (95% Cl 0.42- 0.76, p=0.004) After adjustment for potential confounders, the RR was 0.62 (95% Cl 0.45- 0 85, p=0.013), equivalent to a reduction of 38%.There was also a reduction in the prevalence of active syphilis (adjusted RR = 0.67; 95% Cl: 0 47-0.96, p=0.04 at RPR titre of >=1:8), and of symptomatic urethritis in men (adjusted RR = 0.51, 95%C1: 0.25-1.03,p=0.06). No impact was observed for gonococcal / chlamydial infection or overall urethritis in men. There was no impact on the prevalence of STDs in pregnant women, studied by means of two consecutive cross-sectional studies at antenatal clinics. The results of this trial provide additional strong evidence for the STD/H1V co-factor hypothesis, and demonstrate that improving STD services can substantially reduce the incidence of HTV infection in populations with high STD prevalences. They suggest that the control of STDs should form an important component of HIV prevention programmes Reliable drug supply and frequent support supervision to health facilities are essential prerequisites for such STD control programmes.
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- 1999
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39. Methodological quality and bias in randomised controlled trials
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Schulz, KF and Hayes, RJ
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To evaluate the methodological quality of randomised trials in recently published articles and to examine the associations between methodological quality and bias, three related investigations were undertaken. First, to ensure the development of useful measures for the adequacy of randomisation, approaches to allocation were assessed as reported in 206 parallel group trials published in recent volumes of journals of obstetrics and gynaecology. Next, a study was conducted of associations between methodological quality and treatment effects. The material analysed came from 250 trials in 33 meta-analyses on pregnancy and childbirth topics. Finally, the reported approaches to blinding and handling of exclusions were assessed from a random sample of 110 of the 206 previously identified reports. In the 206 published trials, 77% reported either inadequately or unclearly concealed treatment allocation. Additional analyses suggest that non-random manipulation of comparison groups may have occurred. In the next study. compared with trials in which authors reported adequately concealed treatment allocation, trials in which authors reported inadequately or unclearly concealed allocation yielded larger estimates of treatment effects (p
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- 1994
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40. The association of HIV-1 and other sexually transmitted diseases, and its relevance to intervention programmes in rural Uganda : a simulation modelling exercise
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Robinson, NJ and Hayes, RJ
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virus diseases ,urologic and male genital diseases ,female genital diseases and pregnancy complications - Abstract
Since the heterosexual transmission of HIV may be enhanced in the presence of other sexually transmitted diseases (STDs), high STD prevalences in some African populations may contribute substantially to the HIV epidemic, but the magnitude of this effect is uncertain. A stochastic simulation model, SimulAIDS, was extended, and used to simulate the transmission dynamics of HIV infection and of ulcerative and non-ulcerative STDs in an attempt to mirror the development of the HIV epidemic in a rural population cohort of 10,000 under study by the MRC Programme on AIDS in Uganda.\ud Three scenarios were compared, assuming different STD cofactor effects. Simulation results were most consistent with empirical data for a scenario that assumed enhancing effects on HIV transmission per sexual contact of 100 for ulcerative STDs and S for non-ulcerative STDs in females. A scenario assuming no STD cofactor effects was not consistent with results from the study population. By sampling from the simulated population, it was possible to assess the influence of various factors on associations between HIV and other STDs in observational studies. The most important included type of study design, choice of study sample, prevalence of STDs, misclassification of STDs, period over which STD history is recorded, and sexual behaviour characteristics. Further simulations were conducted to estimate the fraction of HIV infections in this population attributable to the cofactor effect of STDs, and to assess the relative effectiveness of differing intervention strategies. Results were consistent with STDs playing a critical role in establishing an HIV epidemic, their role decreasing as the epidemic progresses. Reducing the incidence of HIV infection in short-term sexual partnerships, through improved STD treatment, increased condom use, and a reduction in one-off sexual encounters, was found to have a substantial impact on HIV incidence in the general population.
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- 1994
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41. Without directly observed sex, what's a microbicide trialist to do? Adherence and adherence measurement as a\ud clinical trial design issue in vaginal microbicide\ud trials for HIV prevention
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Miller, L and Hayes, RJ
- Abstract
Background: This research examined past microbicide effectiveness trials to better understand how adherence\ud and adherence assessment could be improved in future vaginal microbicide trial\ud design. No product is currently available despite decades of clinical trials of candidate\ud microbicides, yet the need for women to have a method to reduce their risk of sexual\ud transmission of HIV that does not rely on male partner agreement remains urgent. Low\ud product adherence and inaccurate adherence reporting has inhibited the ability of trials\ud to accurately assess the biological efficacy of candidate products.\ud Methods:\ud Three different studies were conducted to examine adherence as a clinical trial design issue.\ud The comparative study examined how five trials measured, calculated, and reported\ud microbicide adherence. The quantitative study used latent class and latent profile analysis\ud and multinomial logistic regression to examine if patterns of adherence could be identified in four trials and, if so, what individual-level factors were associated with the patterns.\ud The qualitative study sought opinions from former trial participants about how\ud to improve adherence and adherence reporting in future microbicide trials through focus\ud group discussion workshops in South Africa and Tanzania.\ud Results:\ud There was diversity in methods used to collect and calculate adherence among the included\ud trials. Two methods to calculate averages of overall adherence were identified. Trial\ud documentation and publications lacked clarity in exact methods used to calculate adherence\ud estimates.\ud Latent structure analysis identified different patterns of adherence in all included trials,\ud and these patterns were similar. Multinomial logistic regression identified factors associated\ud with adherence patterns in all trials.\ud Women join and stay in microbicide trials for their own needs, which are not necessarily\ud related to interest in using the investigational product. Key reasons for joining and staying\ud in trials included access to health care and financial reimbursements. Fear of adverse\ud effects from the investigational product was the most important reason why participants\ud did not use the gel. Participants reported that male partners can act as barriers to gel use\ud and the key reason for inaccurate reporting of gel use was fear of removal from the trial.\ud This study demonstrated that trial teams and participants can work together to develop\ud improved trial designs.\ud Recommendations:\ud There are improvements to be made in how trialists plan, conduct, analyse and report results\ud of microbicide trials. Trial teams can improve the clarity of their trial materials, and\ud use analysis methods to identify patterns of adherence. To improve adherence and trial\ud implementation, trials can test applicators for evidence of vaginal insertion and report results\ud to participants, better engage male partners, develop a less watery gel, and create an\ud atmosphere of transparency and respect between research teams and participants.\ud Identifying HIV prevention products for women requires better understanding of the\ud lives of women asked to join these trials, and application of that understanding to collaboratively\ud develop innovative trial designs that meet both the needs of the research and the\ud needs of participants.
42. Differential Sources of Resistance from Lactuca serriola Against Three Races of Xanthomonas hortorum pathovar vitians (Brown, 1918) Morinière et al. 2020 Causing Bacterial Leaf Spot of Lettuce.
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Sandoya Miranda GV, Trent M, Hayes RJ, Lebeda A, Rosenthal E, Simko I, and Bull CT
- Abstract
Bacterial leaf spot (BLS) of lettuce ( Lactuca sativa L.) is caused by the bacterium Xanthomonas hortorum pv. vitians which is hypothesized to have at least three races of the pathogen present in North America as defined by their differential resistance phenotypes in lettuce cultivars/accessions. Though resistance to X. hortorum pv. vitians race 1 has been identified in cultivated lettuce, numerous other X. hortorum pv. vitians strains cause disease on cultivars carrying this resistance locus. Thus far, resistance to these 'additional' X. hortorum pv. vitians strains has not been adequately described in L. sativa or in any other wild Lactuca species sexually compatible with cultivated lettuce. We have performed an extensive screening of approximately 500 Lactuca accessions from L. sativa, L. serriola, L. saligna, L. virosa, L. aculeata, L. altaica , and L. perennis species to identify accessions resistant to these additional X. hortorum pv. vitians races. Following the initial screenings, greenhouse tests confirmed that X. hortorum pv. vitians race 2 and race 3 could be defined using Lactuca sativa accessions. Race 2 strain BS3217 had an incompatible response (hypersensitive response) on ten Lactuca serriola accessions including PI491114 and PI491108, while race 1 (BS0347) and race 3 (BS2861) strains of X. hortorum pv. vitians showed a compatible response (disease) on these genotypes. L. serriola accession ARM09-161 (and selections derived from it) was the only genotype resistant to the race 3 strain BS2861. L. serriola accessions identified in this study to be resistant to race 2 and race 3 of X. hortorum pv. vitians , together with race 1 resistant cultivars, can be used for pyramiding resistance loci against the three races of the BLS-causing pathogen.
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- 2024
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43. Prevalence and risk of burnout among HIV service providers in South Africa and Zambia: findings from the HPTN 071 (PopART) trial.
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Steinhaus MC, Nicholson TJ, Pliakas T, Harper A, Lilleston P, Mainga T, Milimo D, Jennings K, Grobbelaar N, Louis F, Liebenberg H, Hayes RJ, Fidler S, Ayles H, Bock P, Hoddinott G, Hargreaves JR, Bond V, and Stangl AL
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- Humans, Zambia epidemiology, Female, Male, South Africa epidemiology, Adult, Prevalence, Risk Factors, Middle Aged, Community Health Workers psychology, Depersonalization, Burnout, Professional epidemiology, HIV Infections psychology, HIV Infections epidemiology, Health Personnel psychology
- Abstract
Background: In the high disease burden and resource-constrained contexts of sub-Saharan Africa (SSA), health workers experience a range of psychosocial stressors that leave them vulnerable to developing burnout, which can reduce service quality and negatively impact their own health and wellbeing. As universal testing and treatment (UTT) for HIV scales up across SSA, we sought to understand the implications of this human resource-intensive approach to HIV prevention to inform decision-making about health workforce staffing and support needs., Methods: Using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), we assessed the prevalence of three domains of burnout-emotional exhaustion, depersonalization, and personal accomplishment-among three cadres of health workers delivering health services in areas receiving a UTT intervention in Zambia and South Africa. These cadres included health facility workers (n = 478), community health workers (n = 159), and a study-specific cadre of community HIV care providers (n = 529). We used linear regression to assess risk factors associated with emotional exhaustion, the only domain with sufficient variation in our sample., Results: The MBI-HSS was completed by 1499/2153 eligible participants (69.6% response rate). Less than 1% of health workers met Maslach's definition for burnout. All groups of health workers reported lower levels of emotional exhaustion than found in previous studies of this type (mean score scores ranged from 10.7 to 15.4 out of 54 across health cadres). Higher emotional exhaustion was associated with higher educational attainment (βadj = 2.24, 95% CI 0.76 to 3.72), greater years providing HIV services (βadj = 0.20, 95% CI 0.03 to 0.36), and testing negative for HIV at last HIV test (βadj = - 3.88 - 95% CI 5.69 to - 2.07). Working as a CHW was significantly associated with lower emotional exhaustion (βadj = - 2.52, 95% CI - 4.69 to - 0.35). Among all health workers, irrespective of HIV status, witnessing stigmatizing behaviors towards people living with HIV among their co-workers was associated with significantly increased emotional exhaustion (βadj = 3.38, 95% CI 1.99 to 4.76)., Conclusions: The low level of burnout detected among health workers is reassuring. However, it remains important to assess how UTT may affect levels of emotional exhaustion among health workers over time, particularly in the context of emerging global pandemics, as burnout may impact the quality of HIV services they provide and their own mental health and wellbeing. Interventions to reduce HIV stigma in health facilities may protect against emotional exhaustion among health workers, as well as interventions to increase mindfulness and resilience among health workers at risk of burnout. Trial registration ClinicalTrials.gov number: NCT01900977., (© 2024. The Author(s).)
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- 2024
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44. Risk factors for curable sexually transmitted infections among youth: findings from the STICH population survey in Zimbabwe.
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Martin K, Dauya E, Simms V, Bandason T, Azizi S, Machiha A, Shamu T, Musiyandaka P, Mwaturura T, Francis SC, Mackworth-Young CRS, Busza J, Mavodza C, Tembo M, Hayes RJ, Kranzer K, Ferrand RA, and Dziva Chikwari C
- Abstract
Objectives: Youth are at high risk of sexually transmitted infections (STIs) in Africa. We aimed to determine the risk factors for curable STIs in youth in Zimbabwe., Methods: A population-based survey was conducted among randomly selected 18-24 year-olds in 16 communities across two provinces in Zimbabwe to ascertain outcomes for a cluster randomised trial investigating the impact of community-based STI screening for youth on population prevalence of STIs. Participants underwent an interviewer-administered questionnaire, HIV testing and screening for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV). Risk factors for curable STIs were explored through multivariable logistic regression., Results: Of the 5601 participants, 62.5% (n=3500) were female, and the median age was 20 (IQR 19-22) years. HIV prevalence was 6.3% (351/5556), and 55.4% (1939/3501) reported condomless sex at last intercourse. Only 7.2% (401/5599) reported STI symptoms, but CT/NG/TV prevalence was 19.8% (1107/5601). On multivariable analysis, factors associated with STI diagnosis included being aged 21-24 years (adjusted OR (aOR) 1.37, 95% CI 1.17 to 1.61); female sex (aOR 2.11, 95% CI 1.76 to 2.53); being unemployed/informally employed (compared with in education/formal employment) (aOR 1.35, 95% CI 1.13 to 1.61); increasing number of sexual partners in the preceding 12 months (one partner: aOR 2.23, 95% CI 1.73 to 2.88; two partners: aOR 2.39, 95% CI 1.69 to 3.39); living with HIV (aOR 1.44, 95% CI 1.07 to 1.94); and previous attempted suicide (aOR 1.58, 95% CI 1.08 to 2.32)., Conclusions: The prevalence of STIs among youth in Zimbabwe is high, particularly among those with HIV. In addition to moving away from syndromic STI management and strengthening implementation of existing prevention tools, there is a need for a more holistic focus on broader risk factors such as mental health and employment opportunities, and of integration of HIV and STI programming., Trial Registration Number: ISRCTN15013425, NCT03719521., Competing Interests: Competing interests: KM is a current editorial fellow at the Sexually Transmitted Infections journal., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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45. Incidence of self-reported tuberculosis treatment with community-wide universal testing and treatment for HIV and tuberculosis screening in Zambia and South Africa: A planned analysis of the HPTN 071 (PopART) cluster-randomised trial.
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Telisinghe L, Floyd S, MacLeod D, Schaap A, Dunbar R, Bwalya J, Bell-Mandla N, Piwowar-Manning E, Donnell D, Shaunaube K, Bock P, Fidler S, Hayes RJ, and Ayles HM
- Subjects
- Humans, Zambia epidemiology, South Africa epidemiology, Adult, Incidence, Female, Male, Young Adult, Self Report, Adolescent, HIV Testing, HIV Infections epidemiology, HIV Infections diagnosis, HIV Infections drug therapy, Tuberculosis epidemiology, Tuberculosis diagnosis, Mass Screening methods
- Abstract
Background: HIV is a potent risk factor for tuberculosis (TB). Therefore, community-wide universal testing and treatment for HIV (UTT) could contribute to TB control, but evidence for this is limited. Community-wide TB screening can decrease population-level TB prevalence. Combining UTT with TB screening could therefore significantly impact TB control in sub-Saharan Africa, but to our knowledge there is no evidence for this combined approach., Methods and Findings: HPTN 071 (PopART) was a community-randomised trial conducted between November 2013 to July 2018; 21 Zambian and South African communities (with a total population of approximately 1 million individuals) were randomised to arms A (community-wide UTT and TB screening), B (community-wide universal HIV testing with treatment following national guidelines and TB screening), or C (standard-of-care). In a cohort of randomly selected adults (18 to 44 years) enrolled between 2013 and 2015 from all 21 communities (total size 38,474; 27,139 [71%] female; 8,004 [21%] HIV positive) and followed-up annually for 36 months to measure the population-level impact of the interventions, data on self-reported TB treatment in the previous 12 months (self-reported TB) were collected by trained research assistants and recorded using a structured questionnaire at each study visit. In this prespecified analysis of the trial, self-reported TB incidence rates were measured by calendar year between 2014 and 2017/2018. A p-value ≤0.05 on hypothesis testing was defined as reaching statistical significance. Between January 2014 and July 2018, 38,287 individuals were followed-up: 494 self-reported TB during 104,877 person-years. Overall incidence rates were similar across all arms in 2014 and 2015 (0.33 to 0.46/100 person-years). In 2016 incidence rates were lower in arm A compared to C overall (adjusted rate ratio [aRR] 0.48 [95% confidence interval (95% CI) 0.28 to 0.81; p = 0.01]), with statistical significance reached. In 2017/2018, while incidence rates were lower in arm A compared to C, statistical significance was not reached (aRR 0.58 [95% CI 0.27 to 1.22; p = 0.13]). Among people living with HIV (PLHIV) incidence rates were lower in arm A compared to C in 2016 (RR 0.56 [95% CI 0.29 to 1.08; p = 0.08]) and 2017/2018 (RR 0.50 [95% CI 0.26 to 0.95; p = 0.04]); statistical significance was only reached in 2017/2018. Incidence rates in arms B and C were similar, overall and among PLHIV. Among HIV-negative individuals, there were too few events for cross-arm comparisons. Study limitations include the use of self-report which may have been subject to under-reporting, limited covariate adjustment due to the small number of events, and high losses to follow-up over time., Conclusions: In this study, community-wide UTT and TB screening resulted in substantially lower TB incidence among PLHIV at population-level, compared to standard-of-care, with statistical significance reached in the final study year. There was also some evidence this translated to a decrease in self-reported TB incidence overall in the population. Reduction in arm A but not B suggests UTT drove the observed effect. Our data support the role of UTT in TB control, in addition to HIV control, in high TB/HIV burden settings., Trial Registration: ClinicalTrials.gov: NCT01900977., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Telisinghe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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46. Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management.
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Ayieko P, Kisanga E, Mshana G, Nkosi S, Hansen CH, Parry CDH, Weiss HA, Grosskurth H, Hayes RJ, Morojele NK, and Kapiga S
- Subjects
- Humans, Male, Young Adult, Adult, Middle Aged, Aged, Female, Case Management, Cross-Sectional Studies, Tanzania epidemiology, Medication Adherence, HIV Infections complications, HIV Infections drug therapy, HIV Infections epidemiology, Alcoholism complications, Alcoholism epidemiology, Anti-HIV Agents therapeutic use
- Abstract
Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%-15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10-7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92-9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence.
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- 2024
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47. Comparing one dose of HPV vaccine in girls aged 9-14 years in Tanzania (DoRIS) with one dose in young women aged 15-20 years in Kenya (KEN SHE): an immunobridging analysis of randomised controlled trials.
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Baisley K, Kemp TJ, Mugo NR, Whitworth H, Onono MA, Njoroge B, Indangasi J, Bukusi EA, Prabhu PR, Mutani P, Galloway DA, Mwanzalime D, Kapiga S, Lacey CJ, Hayes RJ, Changalucha J, Pinto LA, Barnabas RV, and Watson-Jones D
- Abstract
Background: The first randomised controlled trial of single-dose human papillomavirus (HPV) vaccine efficacy, the Kenya single-dose HPV-vaccine efficacy (KEN SHE) trial, showed greater than 97% efficacy against persistent HPV16 and HPV18 infection at 36 months among women in Kenya. We compared antibody responses after one dose of HPV vaccine in the Dose Reduction Immunobridging and Safety Study (DoRIS), the first randomised trial of the single- dose regimen in girls aged 9-14 years, the target age range for vaccination, with those after one dose of the same vaccine in KEN SHE., Methods: In the DoRIS trial, 930 girls aged 9-14 years in Tanzania were randomly assigned to one, two, or three doses of the 2-valent vaccine (Cervarix) or the 9-valent vaccine (Gardasil-9). The proportion seroconverting and geometric mean concentrations (GMCs) at month 24 after one dose were compared with those in women aged 15-20 years who were randomly assigned to one dose of the same vaccines at the same timepoint in KEN SHE. Batched samples were tested together by virus-like particle ELISA for HPV16 and HPV18 IgG antibodies. Non-inferiority of GMC ratios (DoRIS trial:KEN SHE) was predefined as a lower bound of the 95% CI less than 0·50., Findings: Month 24 HPV16 and HPV18 antibody GMCs in DoRIS were similar or higher than those in KEN SHE. 2-valent GMC ratios were 0·90 (95% CI 0·72-1·14) for HPV16 and 1·02 (0·78-1·33) for HPV18. 9-valent GMC ratios were 1·44 (95% CI 1·14-1·82) and 1·47 (1·13-1·90), respectively. Non-inferiority of antibody GMCs and seropositivity was met for HPV16 and HPV18 for both vaccines., Interpretation: HPV16 and HPV18 immune responses in young girls 24 months after a single dose of 2-valent or 9-valent HPV vaccine were comparable to those in young women who were randomly assigned to a single dose of the same vaccines and in whom efficacy had been shown. A single dose of HPV vaccine, when given to girls in the target age range for vaccination, induces immune responses that could be effective against persistent HPV16 and HPV18 infection at least two years after vaccination., Funding: The UK Department of Health and Social Care, the Foreign, Commonwealth, & Development Office, the Global Challenges Research Fund, the UK Medical Research Council and Wellcome Trust Joint Global Health Trials scheme, the Bill and Melinda Gates Foundation, the US National Cancer Institute; the US National Institutes of Health, and the Francis and Dorothea Reed Endowed Chair in Infectious Diseases., Translation: For the KiSwahili translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests KB reports grants from the Bill & Melinda Gates Foundation during the conduct of the DoRIS trial, and a grant and vaccine donations from Merck Pharmaceuticals outside the submitted work. DW-J reports grants from the Gates Foundation and the UK Research and Innovation Medical Research Council during the DoRIS trial, and a grant and vaccine donations from Merck outside the submitted work. HW reports grants from the Gates Foundation and the UK Research and Innovation Medical Research Council during the DoRIS trial, and vaccine donations from Merck outside the submitted work. JC reports grant support from the Gates Foundation and the UK Research and Innovation Medical Research Council during the DoRIS trial. RJH reports a grant from the UK Research and Innovation Medical Research Council during the DoRIS trial. RVB reports grants from the Gates Foundation during the conduct of the KEN SHE trial, and data monitoring committee honorarium from Gilead Sciences and manuscript and abstract writing support from Regeneron Pharmaceuticals outside the submitted work. NRM reports grant support from Merck Pharmaceuticals outside the submitted work. DAG reports grants from the Gates Foundation during the conduct of the KEN SHE trial, and grants and personal fees from Merck outside the submitted work. EAB reports grants from the National Institutes of Health, the Centers for Disease Control and Prevention, and the European and Developing Countries Clinical Trials Partnership during the conduct of the KEN SHE trial; and personal fees from Gilead Sciences and personal fees from Merck outside the submitted work. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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48. Prevalence of hypertension and high-normal blood pressure among young adults in Zimbabwe: findings from a large, cross-sectional population-based survey.
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Sabapathy K, Mwita FC, Dauya E, Bandason T, Simms V, Dziva Chikwari C, Doyle AM, Ross D, Shah A, Hayes RJ, Schutte AE, Kranzer K, and Ferrand RA
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- Adolescent, Humans, Female, Male, Young Adult, Pregnancy, Adult, Blood Pressure, Cross-Sectional Studies, Prevalence, Zimbabwe epidemiology, Hypertension epidemiology
- Abstract
Background: Hypertension is the greatest driver of cardiovascular mortality and onset might be in youth. We aimed to investigate the prevalence of and risk factors for elevated blood pressure (hypertension ≥140 mm Hg systolic, ≥90 mm Hg diastolic, or both) and high-normal blood pressure (130-139 mm Hg systolic, 85-89 mm Hg diastolic, or both) among youth in Zimbabwe., Methods: A population-based, cross-sectional survey of randomly sampled youth aged 18-24 years from 24 urban and peri-urban communities in three provinces (Harare, Bulawayo, and Mashonaland East) in Zimbabwe was conducted between Oct 4, 2021, and June 2, 2022. Standardised questionnaires were used by research assistants to collect sociodemographic, behavioural, and clinical data. Height, bodyweight, and blood pressure were recorded. Three seated blood pressure measurements were taken at standardised timepoints during participant interview using a digital sphygmomanometer and cuffs sized on mid-upper arm circumference. The association of potential risk factors with elevated blood pressure was examined using multivariable logistic regression., Findings: 17 682 (94·4%) of 18 729 eligible participants were recruited, 17 637 (99·7%) of whom had complete data, and 16 883 (95·7%) of whom were included in the final study sample after excluding 754 (4·3%) pregnant women. The median age was 20 years (IQR 19-22), 9973 (59·1%) participants were female, and 6910 (40·9%) were male. The prevalence of hypertension was 7·4% (95% CI 7·0-7·8) and high-normal blood pressure was 12·2% (11·7-12·7). Overall, prevalence of hypertension was higher in men (8·7% [95% CI 8·2-9·6]) than in women (6·6% [6·0-6·9]), but with age increased to similar levels (at age 18 years 7·3% [6·2-8·6] and 4·3% [3·5-5·2]; at age 23-24 years 10·9% [9·3-12·6] and 9·5% [8·4-10·7] in men and women, respectively). After adjusting for factors associated with hypertension in the crude analysis, hypertension was associated with male sex (adjusted odds ratio 1·53 [95% CI 1·36-1·74]), increasing age (age 19-20 years 1·20 [1·00-1·44]; age 21-22 years 1·45 [1·20-1·75]; age 23-24 years 1·90 [1·57-2·30], vs age 18 years), and BMI of 30·0 kg/m
2 or more (1·94 [1·53-2·47] vs 18·5-24·9 kg/m2 ). A BMI of 18·5 kg/m2 or less (0·79 [0·63-0·98] vs 18·5-24·9 kg/m2 ) and living with HIV (0·71 [0·55-0·92]) were associated with lower odds of hypertension., Interpretation: Prevalence of elevated blood pressure is high among urban and peri-urban youth in Zimbabwe and increases rapidly with age. Further research is needed to understand drivers of blood pressure elevation and the extent of target organ damage in youth in Zimbabwe and similar sub-Saharan African settings, to guide implementation of prevention and management strategies., Funding: Wellcome Trust., Competing Interests: Declaration of interests RAF's institution received a grant from the Wellcome Trust. Salary support for VS and RJH was in part from a grant from the Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat (MR/K012126/1). All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2024
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49. Cluster randomized controlled trial analysis at the cluster level: The clan command.
- Author
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Thompson JA, Leurent B, Nash S, Moulton LH, and Hayes RJ
- Abstract
In this article, we introduce a new command, clan, that conducts a cluster-level analysis of cluster randomized trials. The command simplifies adjusting for individual- and cluster-level covariates and can also account for a stratified design. It can be used to analyze a continuous, binary, or rate outcome.
- Published
- 2023
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50. Evaluation of a community-based aetiological approach for sexually transmitted infections management for youth in Zimbabwe: intervention findings from the STICH cluster randomised trial.
- Author
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Chikwari CD, Simms V, Kranzer K, Dauya E, Bandason T, Tembo M, Mavodza C, Machiha A, Mugurungi O, Musiyandaka P, Mwaturura T, Tshuma N, Bernays S, Mackworth-Young C, Busza J, Francis SC, Hayes RJ, and Ferrand RA
- Abstract
Background: Young people are at high risk of sexually transmitted infections (STIs). We report STI testing uptake, prevalence and incidence within a community-based integrated HIV and sexual and reproductive health service for youth, being evaluated in a cluster randomised trial in Zimbabwe., Methods: This paper reports the intervention findings of the cluster randomised trial whereby STI testing was offered to all service attendees (16-24 years) in 12 intervention clusters over 12 months between October 5, 2020, and December 17, 2021, in Zimbabwe. Testing for Chlamydia trachomatis [CT] and Neisseria gonorrhoeae [NG] was offered to males and females with results available in one week and follow-up of test-positive clients by telephone. Trichomonas vaginalis [TV] testing was offered to females only with same day results and treatment. Youth testing positive for any STI were offered partner notification slips and free treatment for partners. This trial was registered with ISRCTN Registry, ISRCTN15013425., Findings: Overall, 8549/9891 (86.1%) eligible youth accepted CT/NG testing. Prevalence of CT and NG was 14.7% (95% CI 13.6-15.8) and 2.8% (95% CI 2.2-3.6) respectively. Combined prevalence of CT, NG or TV in women was 23.2% (95% CI 21.5-25.0). After adjusting for cluster, age and sex, the odds of NG were increased in those living with HIV (aOR 3.14, 95% CI 2.21-4.47). The incidence rate among those who initially tested negative for CT or NG was 25.6/100PY (95% CI 20.6-31.8). CT/NG treatment uptake was 924/1526 (60.6%). TV treatment uptake was 483/489 (98.8%). A partner returned for treatment for 103/1807 clients (5.7%)., Interpretation: Our findings show high acceptability of STI testing among youth. STI prevalence was high particularly among females and youth with HIV, underscoring the need for integration of HIV and STI services., Funding: MRC/ESRC/DFID/NIHR (MR/T040327/1) and Wellcome Trust (206316/Z/17/Z)., Competing Interests: Authors declare no competing interests., (© 2023 The Author(s).)
- Published
- 2023
- Full Text
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