119 results on '"Hladik W"'
Search Results
2. Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti
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Hallett, T B, Aberle-Grasse, J, Bello, G, Boulos, L-M, Cayemittes, M P A, Cheluget, B, Chipeta, J, Dorrington, R, Dube, S, Ekra, A K, Garcia-Calleja, J M, Garnett, G P, Greby, S, Gregson, S, Grove, J T, Hader, S, Hanson, J, Hladik, W, Ismail, S, Kassim, S, Kirungi, W, Kouassi, L, Mahomva, A, Marum, L, Maurice, C, Nolan, M, Rehle, T, Stover, J, and Walker, N
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- 2006
3. HIV/AIDS in Ethiopia: where is the epidemic heading?
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Hladik, W, Shabbir, I, Jelaludin, A, Woldu, A, Tsehaynesh, M, and Tadesse, W
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- 2006
4. Epidemiology of HIV and selected blood-borne infections in East-Africa
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Hladik, W., Borgdorff, M.W., van Hest, N.A.H., and Faculteit der Geneeskunde
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- 2013
5. HIV and syphilis infection among gold and diamond miners--Guyana, 2004
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Seguy N, Denniston M, Hladik W, Edwards M, Lafleur C, Singh-Anthony S, and Theresa Diaz
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Adult ,Aged, 80 and over ,Male ,Health Knowledge, Attitudes, Practice ,Adolescent ,Data Collection ,Health Behavior ,HIV Infections ,Middle Aged ,Mining ,Young Adult ,Cross-Sectional Studies ,Risk-Taking ,Confidence Intervals ,Odds Ratio ,Prevalence ,Cluster Analysis ,Humans ,Gold ,Guyana ,Syphilis ,Diamond ,Aged - Abstract
Guyana had an estimated HIVprevalence of 1.5% among pregnant women in 2006 (95% confidence interval [CI] = 1.1-1.9). However, a survey of miners in one mine found a 6.5% HIV prevalence in 2002. To determine whether Guyanese miners are at high risk for HIV infection we conducted a HIV and syphilis prevalence survey of miners in several mines.Adult male consenting miners in 45 Guyanese mines were interviewed, counselled, tested for HIV and syphilis with rapid tests and provided onsite test results. The survey was cross-sectional and used a multi-stage cluster sampling design; population estimates were calculated using SUDAAN.Of 651 miners approached, 539 (83%) were interviewed and 509 (78%) tested. The estimated prevalence for HIV was 3.9% (CI = 2.1, 7.1) and for life-time syphilis exposure was 6.4% (CI = 4.5, 9.1). Fifty-four per cent (CI = 41.3, 66.7) of miners had casual sex during the preceding year, of whom 44.4% (CI = 34.3, 55.0) had always used condoms with these partners.The estimated HIV prevalence among Guyanese miners was higher than that of the general population. Targeted interventions including condom promotion are recommended to prevent further spread of HIV and other sexually transmitted infections among miners.
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- 2009
6. Association Between Transfusion With Human Herpesvirus 8 Antibody-Positive Blood and Subsequent Mortality
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Hladik, W., primary, Pellett, P. E., additional, Hancock, J., additional, Downing, R., additional, Gao, H., additional, Packel, L., additional, Mimbe, D., additional, Nzaro, E., additional, and Mermin, J., additional
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- 2012
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7. Sex and geographic patterns of human herpesvirus 8 infection in a nationally representative population‐based sample in Uganda.
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Biryahwaho B, Dollard SC, Pfeiffer RM, Shebl FM, Munuo S, Amin MM, Hladik W, Parsons R, Mbulaiteye SM, Biryahwaho, Benon, Dollard, Sheila C, Pfeiffer, Ruth M, Shebl, Fatma M, Munuo, Stella, Amin, Minal M, Hladik, Wolfgang, Parsons, Ruth, and Mbulaiteye, Sam M
- Abstract
Background: Human herpesvirus 8 (HHV8), the infectious cause of Kaposi sarcoma, varies dramatically across Africa, suggesting that cofactors correlated with large-area geographic or environmental characteristics may influence risk of infection. Variation in HHV8 seropositivity across small-area regions within countries in Africa is unknown. We investigated this issue in Uganda, where Kaposi sarcoma distribution is uneven and well described.Methods: Archival samples from individuals aged 15-59 years randomly selected from a nationally representative 2004-2005 human immunodeficiency virus-AIDS serobehavioral survey were tested for HHV8 seropositivity with use of enzyme immunoassays based on synthetic peptides from the K8.1 and orf65 viral genes. Adjusted odds ratios and 95% confidence intervals (CIs) of association of HHV8 seropositivity with demographic risk factors were estimated.Results: Among 2681 individuals tested, HHV8 seropositivity was 55.4%. HHV8 seropositivity was lower in female than in male persons (adjusted odds ratio, 0.82 [95% CI, 0.69-0.97]) and increased 2.2% (95% CI, 1.0%-3.6%) in female persons and 1.2% (95% CI, 1.0%-2.3%) in male persons per year of age. HHV8 seropositivity was inversely associated with education ( P = .01, for trend) and was elevated in the West Nile region, compared with the Central region (adjusted odds ratio, 1.49 [95% CI, 1.02-2.18]) but not with other regions.Conclusions: Our findings suggest that HHV8 seropositivity in Uganda may be influenced by cofactors correlated with small-area geography, age, sex, and education. [ABSTRACT FROM AUTHOR]- Published
- 2010
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8. Quantitation of human herpesvirus 8 (HHV-8) antibody in patients transfused with HHV-8-seropositive blood.
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Fowlkes AL, Brown C, Amin MM, Roback JD, Downing R, Nzaro E, Mermin J, Hladik W, and Dollard SC
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- 2009
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9. HIV and Syphilis Infection among Gold and Diamond Miners - Guyana, 2004.
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Seguy, N., Denniston, M., Hladik, W., Edwards, M., Lafleur, C., Singh-Anthony, S., and Diaz, T.
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Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2008
10. Transmission of human herpesvirus 8 by blood transfusion.
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Hladik W, Dollard SC, Mermin J, Fowlkes AL, Downing R, Amin MM, Banage F, Nzaro E, Kataaha P, Dondero TJ, Pellett PE, and Lackritz EM
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- 2006
11. Development of a radiopharmaceutical information database.
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Blaine P, Spicer J, Generali J, Hladik W, and Johnson G
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- 1999
12. One hundred digitalis blood levels.
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Hladik, W. and Dujovne, C.
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One hundred consecutive digitalis serum level determination requests and results were analyzed to evaluate the rational of ordering the test and utilizing the results at his hospital. Sixty-six percent of the reasons given for ordering the test were categorized as 'acceptable'. As many as 25% of physicians requesting the test considered digitalis levels as 'routine' diagnostic tests in a patient taking these drugs. There were 12 levels within the potentially toxic range, 19 below the usual therapeutic range. The physicians modified their therapeutic management in 38 patients as a result of their knowledge of the digitalis level in blood. It is concluded that digitalis level determinations at this hospital are reasonably well utilized and that knowledge of the digitalis levels improve the accuracy of digitalis utilization in at least one third of the patients in whom this test is done. [ABSTRACT FROM AUTHOR]
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- 1979
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13. The effect of HIV on morbidity and mortality in children with severe malarial anaemia
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Nzaro Esau, Mimbe Derrick, Rutherford George, McFarland Willi, Banage Flora, Reingold Arthur, Hladik Wolfgang, Malamba Samuel, Downing Robert, and Mermin Jonathan
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Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Malaria and HIV are common causes of mortality in sub-Saharan Africa. The effect of HIV infection on morbidity and mortality in children with severe malarial anaemia was assessed. Methods Children Findings Of 847 children, 78 (9.2%) were HIV-infected. Median follow-up time was 162 days (inter-quartile range: 111, 169). HIV-infected children were more likely to die within 7 days (Hazard ratio [HR] = 2.86, 95% Confidence interval [CI] 1.30–6.29, P = 0.009) and within 28 days (HR = 3.70, 95% CI 1.91–7.17, P < 0.001) of an episode of severe malarial anaemia, and were more likely to die in the 6 months post-transfusion (HR = 5.70, 95% CI 3.54–9.16, P < 0.001) compared to HIV-uninfected children. HIV-infected children had more frequent re-admissions due to malaria within 28 days (Incidence rate ratio (IRR) = 3.74, 95% CI 1.41–9.90, P = 0.008) and within 6 months (IRR = 2.66, 95% CI 1.17 – 6.07, P = 0.02) post-transfusion than HIV-uninfected children. Conclusion HIV-infected children with severe malarial anaemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.
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- 2007
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14. Unexpected stomach uptake of technetium-99m-MDP.
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Spicer JA, Slaton CK, Raveill TG, Baxter KG, Preston DF, Hladik WB, Spicer, J A, Slaton, C K, Raveill, T G, Baxter, K G, Preston, D F, and Hladik, W B
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- 1999
15. Transmission of human herpesvirus 8 by blood transfusion.
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Parisi SG, Cruciani M, Palù G, Moore PS, Chang Y, Jaffe HW, Black HJ, Johnston AM, Dollard S, Pellett P, Hladik W, Blajchman MA, Vamvakas EC, Parisi, Saverio Giuseppe, Cruciani, Mario, and Palù, Giorgio
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- 2007
16. Common uses of nonradioactive drugs in nuclear medicine
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Hladik, W
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- 1984
17. Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23.
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Stevens O, Sabin K, Anderson RL, Garcia SA, Willis K, Rao A, McIntyre AF, Fearon E, Grard E, Stuart-Brown A, Cowan F, Degenhardt L, Stannah J, Zhao J, Hakim AJ, Rucinski K, Sathane I, Boothe M, Atuhaire L, Nyasulu PS, Maheu-Giroux M, Platt L, Rice B, Hladik W, Baral S, Mahy M, and Imai-Eaton JW
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- Humans, Africa South of the Sahara epidemiology, Female, Adult, Male, Prevalence, Adolescent, Young Adult, Middle Aged, Sex Workers statistics & numerical data, Population Density, Anti-Retroviral Agents therapeutic use, Transgender Persons statistics & numerical data, Bayes Theorem, Homosexuality, Male statistics & numerical data, HIV Infections drug therapy, HIV Infections epidemiology
- Abstract
Background: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa., Methods: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors., Findings: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV., Interpretation: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates., Funding: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health., Competing Interests: Declaration of interests SB has received funding from the US National Institutes of Health (NIH). FC has received funding from the Wellcome Trust, the Medical Research Council, NIH, Unitaid, and the Bill & Melinda Gates Foundation. LD has received untied educational grants for the study of new opioid medications in Australia from Indivior and Sequirus. EF has received funding from the UK Research and Innovation Medical Research Council, the Royal Society, and the Centre for Sexual Health and HIV/AIDS Research Zimbabwe. JWI-E acknowledges funding from UNAIDS, NIH, the Gates Foundation, UK Research and Innovation, and BAO Systems, and has received support to attend meetings from UNAIDS, the South African Centre for Epidemiological Modelling and Analysis, the International AIDS Society, and the Gates Foundation. KR and MM-G have received support to attend meetings from UNAIDS. JS has received funding from UNAIDS. OS has received funding from UNAIDS. 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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18. A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics.
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Karuchit S, Thiengtham P, Tanpradech S, Srinor W, Yingyong T, Naiwatanakul T, Northbrook S, and Hladik W
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Background: Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys., Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM., Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation., Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using "borrowed" phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw., Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection., (©Samart Karuchit, Panupit Thiengtham, Suvimon Tanpradech, Watcharapol Srinor, Thitipong Yingyong, Thananda Naiwatanakul, Sanny Northbrook, Wolfgang Hladik. Originally published in JMIR Formative Research (https://formative.jmir.org), 20.05.2024.)
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- 2024
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19. Sexual and nonsexual violence and mental health among male refugees from the Democratic Republic of Congo residing in Kampala, Uganda: a population-based survey.
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Hladik W, Nasirumbi Muniina P, Familiar I, Kaiser P, Ogwal M, Serwadda D, Sande E, Kiyingi H, Siya Bahinduka C, and Dolan C
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- Male, Humans, Adult, Democratic Republic of the Congo epidemiology, Mental Health, Uganda epidemiology, Violence, Refugees, Rape psychology
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We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly ( p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.
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- 2023
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20. HIV prevalence in transgender populations and cisgender men who have sex with men in sub-Saharan Africa 2010-2022: a meta-analysis.
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Stevens O, Anderson RL, Sabin K, Garcia SA, Fearon E, Manda K, Dikobe W, Crowell TA, Tally L, Mulenga L, Philip NM, Maheu-Giroux M, McIntyre A, Hladik W, Zhao J, Mahy M, and Eaton JW
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Introduction: The Global AIDS Strategy 2021-2026 calls for equitable and equal access to HIV prevention and treatment programmes for all populations to reduce HIV incidence and end HIV/AIDS as a public health threat by 2030. Transgender populations (TGP), including transmen (TGM) and transwomen (TGW) are populations that have been marginalised and are at high risk of HIV infection in sub-Saharan Africa (SSA). Limited surveillance data on HIV among TGP are available in the region to guide programmatic responses and policymaking. Surveillance data on cisgender men who have sex with men (cis-MSM) are comparatively abundant and may be used to infer TGP HIV prevalence., Methods: Data from key population surveys conducted in SSA between 2010-2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both TGP and cis-MSM populations were analysed in a random effect meta-analysis to estimate the ratio of cis-MSM:TGW HIV prevalence., Results: Eighteen studies were identified encompassing 8,052 TGW and 19,492 cis-MSM. TGW HIV prevalence ranged from 0-71.6% and cis-MSM HIV prevalence from 0.14-55.7%. HIV prevalence in TGW was 50% higher than in cis-MSM (prevalence ratio (PR) 1.50 95% CI 1.26-1.79). TGW HIV prevalence was highly correlated with year/province-matched cis-MSM HIV prevalence (R
2 = 0.62), but poorly correlated with year/province-matched total population HIV prevalence (R2 = 0.1). Five TGM HIV prevalence estimates were identified ranging from 1-24%. Insufficient TGM data were available to estimate cis-MSM:TGM HIV prevalence ratios., Conclusion: Transgender women experience a significantly greater HIV burden than cis-MSM in SSA. Bio-behavioural surveys designed and powered to measure determinants of HIV infection, treatment coverage, and risk behaviours among transgender populations, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities among TGP and support improved programmes., Competing Interests: Competing interests None- Published
- 2023
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21. The epidemiology of HIV population viral load in twelve sub-Saharan African countries.
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Hladik W, Stupp P, McCracken SD, Justman J, Ndongmo C, Shang J, Dokubo EK, Gummerson E, Koui I, Bodika S, Lobognon R, Brou H, Ryan C, Brown K, Nuwagaba-Biribonwoha H, Kingwara L, Young P, Bronson M, Chege D, Malewo O, Mengistu Y, Koen F, Jahn A, Auld A, Jonnalagadda S, Radin E, Hamunime N, Williams DB, Kayirangwa E, Mugisha V, Mdodo R, Delgado S, Kirungi W, Nelson L, West C, Biraro S, Dzekedzeke K, Barradas D, Mugurungi O, Balachandra S, Kilmarx PH, Musuka G, Patel H, Parekh B, Sleeman K, Domaoal RA, Rutherford G, Motsoane T, Bissek AZ, Farahani M, and Voetsch AC
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- Adult, Humans, Male, Female, Viremia drug therapy, Viral Load, Seroepidemiologic Studies, Lesotho, Zimbabwe, HIV Infections drug therapy, Anti-HIV Agents therapeutic use
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Background: We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries., Methods: We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d'Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (<1,000 HIV-1 RNA copies/mL) and with unsuppressed viral load (viremic), the prevalence of unsuppressed HIV (population viremia), sex-specific HIV transmission ratios (number female incident HIV-1 infections/number unsuppressed male PLHIV per 100 persons-years [PY] and vice versa) and examined correlations between a variety of VL metrics and incident HIV. Country sample sizes ranged from 10,016 (Eswatini) to 30,637 (Rwanda); estimates were weighted and restricted to participants 15 years and older., Results: The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries' total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3-28.3/100 PY) than for female-to-male transmission (range: 1.5-10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92)., Conclusions: Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries' total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
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- 2023
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22. Improving Biomarker-based HIV Incidence Estimation in the Treatment Era.
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Fellows IE, Hladik W, Eaton JW, Voetsch AC, Parekh BS, and Shiraishi RW
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- Incidence, Algorithms, Cross-Sectional Studies, Humans, Male, Female, Biomarkers analysis, HIV Infections diagnosis, HIV Infections metabolism, HIV Infections therapy
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Background: Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty about what input parameters to use for false recency rate (FRR) and mean duration of recent infection (MDRI) after applying a recent infection testing algorithm (RITA)., Methods: This article shows how testing and diagnosis reduce both FRR and mean duration of recent infection compared to a treatment-naive population. A new method is proposed for calculating appropriate context-specific estimates of FRR and mean duration of recent infection. The result of this is a new formula for incidence that depends only on reference FRR and mean duration of recent infection parameters derived in an undiagnosed, treatment-naive, nonelite controller, non-AIDS-progressed population., Results: Applying the methodology to eleven cross-sectional surveys in Africa results in good agreement with previous incidence estimates, except in 2 countries with very high reported testing rates., Conclusions: Incidence estimation equations can be adapted to account for the dynamics of treatment and recent infection testing algorithms. This provides a rigorous mathematical foundation for the application of HIV recency assays in cross-sectional surveys., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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23. Partnership Between a Federal Agency and 4 Tribal Nations to Improve COVID-19 Response Capacities.
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Kaur H, Welch S, Bhairavabhotla R, Weidle PJ, Santibanez S, Haberling DL, Smith EM, Ferris-George W, Hayashi K, Hostler A, Ao T, Dieke A, Boyer D, King E, Teton R, Williams-Singleton N, Flying EM, Hladik W, Marshall KJ, Pourier D, Ruiz Z, Yatabe G, Abe K, Parise M, Anderson M, Evans ME, Hunt H, and Balajee SA
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- Centers for Disease Control and Prevention, U.S., Humans, Pandemics prevention & control, United States epidemiology, COVID-19 epidemiology, COVID-19 prevention & control, Civil Defense
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Upon request from tribal nations, and as part of the Centers for Disease Control and Prevention's (CDC's) emergency response, CDC staff provided both remote and on-site assistance to tribes to plan, prepare, and respond to the COVID-19 pandemic. From April 2, 2020, through June 11, 2021, CDC deployed a total of 275 staff to assist 29 tribal nations. CDC staff typically collaborated in multiple work areas including epidemiology and surveillance (86%), contact tracing (76%), infection prevention control (72%), community mitigation (72%), health communication (66%), incident command structure (55%), emergency preparedness (38%), and worker safety (31%). We describe the activities of CDC staff in collaboration with 4 tribal nations, Northern Cheyenne, Hoopa Valley, Shoshone-Bannock, and Oglala Sioux Tribe, to combat COVID-19 and lessons learned from the engagement.
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- 2022
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24. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda.
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, and Hladik W
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- Adolescent, Adult, Child, Family Planning Services, Female, Humans, Male, Pregnancy, Reproductive Health, Uganda epidemiology, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control, Sex Workers, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control
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Background: Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues., Methods: We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS., Results: We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1-2.4), giving birth to 2-3 children (aOR: 2.5, 95% CI: 1.4-4.8) or 4-5 children (aOR: 2.9, 95% CI: 1.4-5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5-1.0)., Conclusions: The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision., (© 2022. The Author(s).)
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- 2022
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25. Using geographical data and rolling statistics for diagnostics of respondent-driven sampling.
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Kim B, Ogwal M, Sande E, Kiyingi H, Serwadda D, and Hladik W
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Respondent-driven sampling (RDS) is commonly used to sample from key populations without a sampling frame since traditional methods are unable to efficiently survey them. Surveying these populations is often desirable to inform service delivery, assess effectiveness of programs, and determine prevalence of diseases. However, there are concerns about how RDS works in practice due to its many assumptions. To assess some of these assumptions, we develop diagnostics using geographical data and demonstrate their utility by identifying lack of convergence and characterizing RDS reach in surveys conducted among female sex workers and men who have sex with men in Kampala, Uganda.
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- 2022
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26. Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface.
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McIntyre AF, Fellows IE, Gutreuter S, and Hladik W
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- Bayes Theorem, Female, Homosexuality, Male, Humans, Internet, Male, Population Density, HIV Infections epidemiology, Sex Workers, Sexual and Gender Minorities
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Background: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis., Objective: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE., Methods: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine., Results: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided., Conclusions: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa., (©Anne F McIntyre, Ian E Fellows, Steve Gutreuter, Wolfgang Hladik. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 26.04.2022.)
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- 2022
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27. Positive Influences and Challenges for the Deaf Community Navigating Access to HIV Information, Testing, and Treatment in Kampala, Uganda: A Qualitative Study.
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Rolle IV, Moyer A, Ogwal M, Logan N, Rogers J, Sande E, Kibalama R, Aluzimbi G, Nyende J, Awoii P, Julliet D, Serwada D, and Hladik W
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- Focus Groups, Humans, Qualitative Research, Social Stigma, Uganda epidemiology, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
Although sub-Saharan Africa has the highest HIV burden globally, few studies have investigated disabilities and HIV in this region. We conducted a secondary analysis of text data from in-depth interviews (2014-2015) to describe HIV perceptions among a subsample of 73 deaf individuals participating in the Crane survey, Kampala, Uganda. Being deaf was defined as being profoundly or functionally deaf, having deafness onset 5 + years ago, and preferring sign language to communicate. Among participants ever tested for HIV (47%), most (88%) had a negative test. Thematic analysis revealed overcoming challenges/barriers followed by socioeconomic status, support systems, HIV, stigma, abuse, and health conditions as major themes. An unanticipated finding was the role of sex work to support basic living needs. The data showed related themes among participants, suggesting a complex context in which deaf participants experience HIV prevention and treatment. It is important to tailor HIV interventions for deaf and disabled persons., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
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- 2022
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28. HIV Surveillance and Research for Migrant Populations: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia.
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Wirtz AL, Page KR, Stevenson M, Guillén JR, Ortíz J, López JJ, Ramírez JF, Quijano C, Vela A, Moreno Y, Rigual F, Case J, Hakim AJ, Hladik W, and Spiegel PB
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Background: Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming., Objective: We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia., Methods: Respondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia., Results: Data collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022., Conclusions: Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming., International Registered Report Identifier (irrid): DERR1-10.2196/36026., (©Andrea L Wirtz, Kathleen R Page, Megan Stevenson, José Rafael Guillén, Jennifer Ortíz, Jhon Jairo López, Jhon Fredy Ramírez, Cindy Quijano, Alejandra Vela, Yessenia Moreno, Francisco Rigual, James Case, Avi J Hakim, Wolfgang Hladik, Paul B Spiegel. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.03.2022.)
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- 2022
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29. Population Viral Load, Viremia, and Recent HIV-1 Infections: Findings From Population-Based HIV Impact Assessments (PHIAs) in Zimbabwe, Malawi, and Zambia.
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Farahani M, Radin E, Saito S, Sachathep KK, Hladik W, Voetsch AC, Auld AF, Balachandra S, Tippett Barr BA, Low A, Smart TF, Musuka G, Jonnalagadda S, Hakim AJ, Wadonda-Kabondo NW, Jahn A, Mugurungi O, Williams DB, Barradas DT, Payne D, Parekh B, Patel H, Wiesner L, Hoos D, and Justman JE
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- Epidemiological Monitoring, HIV Infections virology, Health Surveys, Humans, Malawi epidemiology, Zambia epidemiology, Zimbabwe epidemiology, HIV Infections epidemiology, HIV-1, Viral Load, Viremia
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Background: HIV population viral load (PVL) can reflect antiretroviral therapy program effectiveness and transmission potential in a community. Using nationally representative data from household surveys conducted in Zimbabwe, Malawi, and Zambia in 2015-16, we examined the association between various VL measures and the probability of at least one recent HIV-1 infection in the community., Methods: We used limiting-antigen avidity enzyme immunoassay, viral load suppression (VLS) (HIV RNA <1000 copies/mL), and antiretrovirals in the blood to identify recent HIV-1 cases., Results: Among 1510 enumeration areas (EAs) across the 3 surveys, 52,036 adults aged 15-59 years resided in 1363 (90.3%) EAs with at least one HIV-positive adult consenting to interview and blood draw and whose VL was tested. Mean HIV prevalence across these EAs was 13.1% [95% confidence intervals (CI) 12.7 to 13.5]. Mean VLS prevalence across these EAs was 58.7% (95% CI: 57.3 to 60.0). In multivariable analysis, PVL was associated with a recent HIV-1 case in that EA (adjusted odds ratio: 1.4, 95% CI: 1.2 to 1.6, P = 0.001). VLS prevalence was inversely correlated with recent infections (adjusted odds ratio: 0.3, 95% CI: 0.1 to 0.6, P = 0.004). The 90-90-90 indicators, namely, the prevalence of HIV diagnosis, antiretroviral therapy coverage, and VLS at the EA level, were inversely correlated with HIV recency at the EA level., Conclusions: We found a strong association between PVL and VLS prevalence and recent HIV-1 infection at the EA level across 3 southern African countries with generalized HIV epidemics. These results suggest that population-based measures of VLS in communities may serve as a proxy for epidemic control., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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30. Population-Based HIV Impact Assessments Survey Methods, Response, and Quality in Zimbabwe, Malawi, and Zambia.
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Sachathep K, Radin E, Hladik W, Hakim A, Saito S, Burnett J, Brown K, Phillip N, Jonnalagadda S, Low A, Williams D, Patel H, Herman-Roloff A, Musuka G, Barr B, Wadondo-Kabonda N, Chipungu G, Duong Y, Delgado S, Kamocha S, Kinchen S, Kalton G, Schwartz L, Bello G, Mugurungi O, Mulenga L, Parekh B, Porter L, Hoos D, Voetsch AC, and Justman J
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- Adolescent, Adult, Anti-HIV Agents therapeutic use, Biomarkers blood, Child, Child, Preschool, Female, HIV Infections blood, HIV Infections drug therapy, Humans, Incidence, Infant, Malawi epidemiology, Male, Middle Aged, Surveys and Questionnaires, Young Adult, Zambia epidemiology, Zimbabwe epidemiology, Epidemiological Monitoring, HIV Infections epidemiology, HIV-1, Health Surveys
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Background: The population-based HIV impact assessment (population-based HIV impact assessments) surveys are among the first to estimate national adult HIV incidence, subnational prevalence of viral load suppression, and pediatric HIV prevalence. We summarize the survey methods implemented in Zimbabwe, Malawi, and Zambia, as well as response rates and quality metrics., Methods: Each cross-sectional, household-based survey used a 2-stage cluster design. Survey preparations included sample design, questionnaire development, tablet programming for informed consent and data collection, community mobilization, establishing a network of satellite laboratories, and fieldworker training. Interviewers collected demographic, behavioral, and clinical information using tablets. Blood was collected for home-based HIV testing and counseling (HBTC) and point-of-care CD4+ T-cell enumeration with results immediately returned. HIV-positive blood samples underwent laboratory-based confirmatory testing, HIV incidence testing, RNA polymerase chain reaction (viral load), DNA polymerase chain reaction (early infant diagnosis), and serum antiretroviral drug detection. Data were weighted for survey design, and chi square automatic interaction detection-based methods were used to adjust for nonresponse., Results: Each survey recruited a nationally representative, household-based sample of children and adults over a 6-10-month period in 2015 and 2016. Most (84%-90%) of the 12,000-14,000 eligible households in each country participated in the survey, with 77%-81% of eligible adults completing an interview and providing blood for HIV testing. Among eligible children, 59%-73% completed HIV testing. Across the 3 surveys, 97.8% of interview data were complete and had no errors., Conclusion: Conducting a national population-based HIV impact assessment with immediate return of HIV and other point-of-care test results was feasible, and data quality was high., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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31. Coronavirus Disease 2019 (COVID-19) Mitigation Efforts and Testing During an In-Person Training Event-Uganda, 12-29 October 2020.
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Laws RL, Biraro S, Kirungi W, Gianetti B, Aibo D, Awor AC, West C, Sachathep KK, Kiyingi H, Ward J, Mwangi C, Nkurunziza P, Okimait D, Currie D, Ajiboye A, Moore CS, Patel H, Sendagala S, Naluguza M, Mugisha V, Low A, Delgado S, Hoos D, Brown K, Galbraith JS, Hladik W, Nelson L, El-Sadr W, Musinguzi J, and Voetsch AC
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- COVID-19 Testing, COVID-19 Vaccines, Humans, SARS-CoV-2, Uganda, COVID-19
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Large public-health training events may result in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Universal SARS-CoV-2 testing during trainings for the Uganda Population-based HIV Impact Assessment identified 28 of 475 (5.9%) individuals with coronavirus disease 2019 (COVID-19) among attendees; most (89.3%) were asymptomatic. Until COVID-19 vaccine is readily available for staff and participants, effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are recommended for in-person trainings, particularly when trainees will have subsequent contact with survey participants., (Published by Oxford University Press for the Infectious Diseases Society of America 2021.)
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- 2021
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32. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey.
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Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, and Hladik W
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Background: Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda., Methods: Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence., Results: Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01)., Conclusions: Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
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- 2021
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33. Population Size Estimation Methods: Searching for the Holy Grail.
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Neal JJ, Prybylski D, Sanchez T, and Hladik W
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- Humans, Population Groups ethnology, Population Groups statistics & numerical data, Computing Methodologies, Population Density
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Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title "Key Population Size Estimations." We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information., (©Joyce J Neal, Dimitri Prybylski, Travis Sanchez, Wolfgang Hladik. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 03.12.2020.)
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- 2020
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34. Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study.
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, and Hladik W
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[This corrects the article DOI: 10.2196/12118.]., (©Reena H Doshi, Kevin Apodaca, Moses Ogwal, Rommel Bain, Ermias Amene, Herbert Kiyingi, George Aluzimbi, Geofrey Musinguzi, David Serwadda, Anne F McIntyre, Wolfgang Hladik. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 12.05.2020.)
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- 2020
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35. Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study.
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, and Hladik W
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Background: Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts., Objective: The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture., Methods: Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW)., Results: We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470)., Conclusions: Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation., (©Reena H Doshi, Kevin Apodaca, Moses Ogwal, Rommel Bain, Ermias Amene, Herbert Kiyingi, George Aluzimbi, Geofrey Musinguzi, David Serwadda, Anne F McIntyre, Wolfgang Hladik. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 12.08.2019.)
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- 2019
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36. HIV and transgender women in Kampala, Uganda - Double Jeopardy.
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King R, Nanteza J, Sebyala Z, Bbaale J, Sande E, Poteat T, Kiyingi H, and Hladik W
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- Adult, Cross-Sectional Studies, Female, Humans, Interviews as Topic, Male, Sexual Partners, Transgender Persons legislation & jurisprudence, Uganda epidemiology, Young Adult, HIV Infections epidemiology, Health Services Accessibility, Sex Workers, Social Stigma, Transgender Persons psychology
- Abstract
Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.
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- 2019
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37. National health information systems for achieving the Sustainable Development Goals.
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Suthar AB, Khalifa A, Joos O, Manders EJ, Abdul-Quader A, Amoyaw F, Aoua C, Aynalem G, Barradas D, Bello G, Bonilla L, Cheyip M, Dalhatu IT, De Klerk M, Dee J, Hedje J, Jahun I, Jantaramanee S, Kamocha S, Lerebours L, Lobognon LR, Lote N, Lubala L, Magazani A, Mdodo R, Mgomella GS, Monique LA, Mudenda M, Mushi J, Mutenda N, Nicoue A, Ngalamulume RG, Ndjakani Y, Nguyen TA, Nzelu CE, Ofosu AA, Pinini Z, Ramírez E, Sebastian V, Simanovong B, Son HT, Son VH, Swaminathan M, Sivile S, Teeraratkul A, Temu P, West C, Xaymounvong D, Yamba A, Yoka D, Zhu H, Ransom RL, Nichols E, Murrill CS, Rosen D, and Hladik W
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- Developing Countries, Goals, Health Information Systems legislation & jurisprudence, Humans, Public Health, Health Information Systems organization & administration, Sustainable Development
- Abstract
Objectives: Achieving the Sustainable Development Goals will require data-driven public health action. There are limited publications on national health information systems that continuously generate health data. Given the need to develop these systems, we summarised their current status in low-income and middle-income countries., Setting: The survey team jointly developed a questionnaire covering policy, planning, legislation and organisation of case reporting, patient monitoring and civil registration and vital statistics (CRVS) systems. From January until May 2017, we administered the questionnaire to key informants in 51 Centers for Disease Control country offices. Countries were aggregated for descriptive analyses in Microsoft Excel., Results: Key informants in 15 countries responded to the questionnaire. Several key informants did not answer all questions, leading to different denominators across questions. The Ministry of Health coordinated case reporting, patient monitoring and CRVS systems in 93% (14/15), 93% (13/14) and 53% (8/15) of responding countries, respectively. Domestic financing supported case reporting, patient monitoring and CRVS systems in 86% (12/14), 75% (9/12) and 92% (11/12) of responding countries, respectively. The most common uses for system-generated data were to guide programme response in 100% (15/15) of countries for case reporting, to calculate service coverage in 92% (12/13) of countries for patient monitoring and to estimate the national burden of disease in 83% (10/12) of countries for CRVS. Systems with an electronic component were being used for case reporting, patient monitoring, birth registration and death registration in 87% (13/15), 92% (11/12), 77% (10/13) and 64% (7/11) of responding countries, respectively., Conclusions: Most responding countries have a solid foundation for policy, planning, legislation and organisation of health information systems. Further evaluation is needed to assess the quality of data generated from systems. Periodic evaluations may be useful in monitoring progress in strengthening and harmonising these systems over time., Competing Interests: Competing interests: None declared, (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2019
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38. Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda.
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Apodaca K, Doshi RH, Ogwal M, Kiyingi H, Aluzimbi G, Musinguzi G, Lutalo I, Akello E, and Hladik W
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Background: Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda's urban centers., Objective: The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda., Methods: We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis., Results: We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono., Conclusions: The CRC activity was one of the first to be carried out in Uganda to obtain small town-level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias., (©Kevin Apodaca, Reena Hemendra Doshi, Moses Ogwal, Herbert Kiyingi, George Aluzimbi, Geofrey Musinguzi, Ibrahim Lutalo, Evelyn Akello, Wolfgang Hladik. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 03.04.2019.)
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- 2019
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39. Correlates of Undiagnosed HIV Infection and Retesting Among Voluntary HIV Testing Clients at Mildmay Clinic, Uganda.
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Hakim AJ, Mukasa B, Hundley L, Odiit M, Ogwal M, Sendagala S, Karamagi Y, Sande E, and Hladik W
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- Adolescent, Adult, Ambulatory Care Facilities, Counseling, Cross-Sectional Studies, Female, HIV Infections epidemiology, Humans, Male, Prevalence, Serologic Tests, Surveys and Questionnaires, Uganda epidemiology, HIV Infections diagnosis, Mass Screening statistics & numerical data
- Abstract
Increasing HIV diagnosis is important for combatting HIV. We invited individuals aged ≥ 13 years seeking voluntary HIV testing at Mildmay Clinic in Uganda to undertake a computer or audio-computer-assisted self-interview to facilitate post-test counseling. We evaluated first-visit data from 12,233 consenting individuals between January 2011 and October 2013. HIV prevalence was 39.0%. Of those with HIV, 37.2% already knew they were infected. Undiagnosed infection was associated with not being single, screening positive for depression (aOR 1.16, 95% CI 1.04-1.28), and screening for harmful drinking behavior (aOR 1.23, 95% CI 1.10-1.39). The odds of retesting subsequent to HIV diagnosis were lower for males (aOR 0.80, 95% CI 0.70-0.92) and those screening positive for harmful drinking behavior (aOR 0.77, 95% CI 0.66-0.88). Retesting was also associated with higher education and perceived social status below 'better off'. Our findings reiterate the value of population-based HIV surveys to provide estimates of testing coverage.
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- 2019
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40. Estimating recent HIV incidence among young men who have sex with men: Reinvigorating, validating and implementing Osmond's algorithm for behavioral imputation.
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van Griensven F, Mock PA, Benjarattanaporn P, Premsri N, Thienkrua W, Sabin K, Varangrat A, Zhao J, Chitwarakorn A, and Hladik W
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- Adolescent, Adult, Algorithms, Cohort Studies, Humans, Incidence, Male, Reproducibility of Results, Young Adult, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Sexual Behavior statistics & numerical data, Sexual and Gender Minorities statistics & numerical data
- Abstract
HIV incidence information is essential for epidemic monitoring and evaluating preventive interventions. However, reliable HIV incidence data is difficult to obtain, especially among marginalized populations, such as young men who have sex with men (YMSM). Here we evaluate the reliability of an alternative HIV incidence assessment method, behavioral imputation, as compared to serologically estimated HIV incidence. Recent HIV incidence among YMSM (aged 18 to 21 and 18 to 24 years) enrolled in a cohort study in Bangkok from 2006 to 2014 was estimated using two mid-point methods for seroconversion: 1) between age of first anal intercourse and first HIV-positive test (without previous HIV-negative test) (behavioral imputation) and 2) between the date of last negative and first positive HIV test (serological estimation). Serologically estimated HIV incidence was taken as the "gold standard" to evaluate between-method agreement. At baseline, 314 YMSM age 18 to 21 years accumulated 674 person-years (PY) of follow-up since first anal intercourse. Considering that 50 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.4 per 100 PY. Of the remaining 264 HIV-negative men, 54 seroconverted for HIV infection during the study, accumulating 724 PY of follow-up and a serologically estimated HIV incidence of 7.5 per 100 PY. At baseline, 712 YMSM age 18 to 24 years (including 18 to 21-year-old men analyzed above) accumulated 2143 PY of follow-up since first anal intercourse. Considering that 151 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.0 per 100 PY. Of the remaining 561 HIV-negative men, 125 seroconverted for HIV infection during the study, accumulating 1700 PY of follow-up and a serologically estimated HIV incidence of 7.4 per 100 PY. Behavioral imputation and serological estimation are in good agreement when estimating recent HIV incidence in YMSM., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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41. Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda.
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Doshi RH, Sande E, Ogwal M, Kiyingi H, McIntyre A, Kusiima J, Musinguzi G, Serwadda D, and Hladik W
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- Adolescent, Adult, Anti-Retroviral Agents therapeutic use, Female, HIV Infections blood, HIV Infections drug therapy, HIV Seroprevalence, Health Surveys methods, Humans, Middle Aged, Prevalence, Uganda epidemiology, Young Adult, HIV Infections epidemiology, Health Surveys statistics & numerical data, Sex Workers statistics & numerical data, Viral Load statistics & numerical data
- Abstract
Background: We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV., Methods: Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates., Results: The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%)., Conclusions: HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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42. Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response.
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Hakim AJ, MacDonald V, Hladik W, Zhao J, Burnett J, Sabin K, Prybylski D, and Garcia Calleja JM
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- Disease Eradication, Epidemics, Female, HIV Infections epidemiology, Humans, Male, Prevalence, Sexual Partners, Surveys and Questionnaires, Viral Load, Continuity of Patient Care, HIV Infections therapy, Homosexuality, Male, Prisoners, Sex Workers, Sexual and Gender Minorities, Transgender Persons
- Abstract
Introduction: The UNAIDS 90-90-90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)- sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners- and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response., Discussion: The emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population-based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high-quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real-time., Conclusions: Data are more important than ever for guiding the HIV response toward reaching 90-90-90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high-quality BBS data can be triangulated with high-quality programme data to provide a comprehensive picture of the epidemic response for KP., (© 2018 World Health Organization; licensee IAS.)
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- 2018
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43. Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15-24 Years - Seven African Countries, 2015-2017.
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Brown K, Williams DB, Kinchen S, Saito S, Radin E, Patel H, Low A, Delgado S, Mugurungi O, Musuka G, Tippett Barr BA, Nwankwo-Igomu EA, Ruangtragool L, Hakim AJ, Kalua T, Nyirenda R, Chipungu G, Auld A, Kim E, Payne D, Wadonda-Kabondo N, West C, Brennan E, Deutsch B, Worku A, Jonnalagadda S, Mulenga LB, Dzekedzeke K, Barradas DT, Cai H, Gupta S, Kamocha S, Riggs MA, Sachathep K, Kirungi W, Musinguzi J, Opio A, Biraro S, Bancroft E, Galbraith J, Kiyingi H, Farahani M, Hladik W, Nyangoma E, Ginindza C, Masangane Z, Mhlanga F, Mnisi Z, Munyaradzi P, Zwane A, Burke S, Kayigamba FB, Nuwagaba-Biribonwoha H, Sahabo R, Ao TT, Draghi C, Ryan C, Philip NM, Mosha F, Mulokozi A, Ntigiti P, Ramadhani AA, Somi GR, Makafu C, Mugisha V, Zelothe J, Lavilla K, Lowrance DW, Mdodo R, Gummerson E, Stupp P, Thin K, Frederix K, Davia S, Schwitters AM, McCracken SD, Duong YT, Hoos D, Parekh B, Justman JE, and Voetsch AC
- Subjects
- Adolescent, Africa epidemiology, Anti-HIV Agents therapeutic use, Female, HIV Infections epidemiology, Health Knowledge, Attitudes, Practice, Humans, Prevalence, Program Evaluation, Viral Load statistics & numerical data, Young Adult, Epidemics prevention & control, HIV Infections prevention & control
- Abstract
In 2016, an estimated 1.5 million females aged 15-24 years were living with human immunodeficiency virus (HIV) infection in Eastern and Southern Africa, where the prevalence of HIV infection among adolescent girls and young women (3.4%) is more than double that for males in the same age range (1.6%) (1). Progress was assessed toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2020 targets for adolescent girls and young women in sub-Saharan Africa (90% of those with HIV infection aware of their status, 90% of HIV-infected persons aware of their status on antiretroviral treatment [ART], and 90% of those on treatment virally suppressed [HIV viral load <1,000 HIV RNA copies/mL]) (2) using data from recent Population-based HIV Impact Assessment (PHIA) surveys in seven countries. The national prevalence of HIV infection in adolescent girls and young women aged 15-24 years, the percentage who were aware of their status, and among those persons who were aware, the percentage who had achieved viral suppression were calculated. The target for viral suppression among all persons with HIV infection is 73% (the product of 90% x 90% x 90%). Among all seven countries, the prevalence of HIV infection among adolescent girls and young women was 3.6%; among those in this group, 46.3% reported being aware of their HIV-positive status, and 45.0% were virally suppressed. Sustained efforts by national HIV and public health programs to diagnose HIV infection in adolescent girls and young women as early as possible to ensure rapid initiation of ART should help achieve epidemic control among adolescent girls and young women., Competing Interests: Bharat Parekh reports receipt of royalties from CDC from the sale of LAg-Avidity Enzyme Immunoassay during conduct of the study. No other conflicts of interest were reported.
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- 2018
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44. HIV Testing and Risk Perceptions: A Qualitative Analysis of Secondary School Students in Kampala, Uganda.
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Aluzimbi G, Lubwama G, Muyonga M, and Hladik W
- Abstract
The purpose of this paper is to explore the perceptions of self-reported HIV testing and risk behavior among sexually active adolescents and youth in secondary schools in Kampala Uganda. This was a cross-sectional survey conducted between June and October 2010 among secondary school students in Kampala, Uganda. Forty eight (48) students across the 54 schools were purposively selected for the qualitative sub-study based on their responses to particular questions. We thematically analyzed 28 interviews for our qualitative study using Nvivo software. Drug and alcohol use coupled with peers pressure impaired students' perceptions towards HIV risk and therefore increased their susceptibility to HIV risk behaviors. Of the 28 scripts analyzed, 82% (23/28) had ever had sexual partners, 79% (22/28) were currently sexually active, and 57% (16/28) had ever been tested for HIV. In conclusion, most adolescents interviewed did not perceive HIV testing to be important to HIV prevention and reported low perception of susceptibility to HIV infection. Development of an adolescent HIV prevention model is important in improving uptake of HIV services.
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- 2017
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45. Burden and characteristics of HIV infection among female sex workers in Kampala, Uganda - a respondent-driven sampling survey.
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Hladik W, Baughman AL, Serwadda D, Tappero JW, Kwezi R, Nakato ND, and Barker J
- Subjects
- Adolescent, Adult, Condoms statistics & numerical data, Female, Humans, Pre-Exposure Prophylaxis, Prevalence, Risk Factors, Sexually Transmitted Diseases epidemiology, Socioeconomic Factors, Uganda epidemiology, Violence statistics & numerical data, Young Adult, HIV Infections epidemiology, Sex Workers statistics & numerical data
- Abstract
Background: Sex workers in Uganda are at significant risk for HIV infection. We characterized the HIV epidemic among Kampala female sex workers (FSW)., Methods: We used respondent-driven sampling to sample FSW aged 15+ years who reported having sold sex to men in the preceding 30 days; collected data through audio-computer assisted self-interviews, and tested blood, vaginal and rectal swabs for HIV, syphilis, neisseria gonorrhea, chlamydia trachomatis, and trichomonas vaginalis., Results: A total of 942 FSW were enrolled from June 2008 through April 2009. The overall estimated HIV prevalence was 33% (95% confidence intervals [CI] 30%-37%) and among FSW 25 years or older was 44%. HIV infection is associated with low levels of schooling, having no other work, never having tested for HIV, self-reported genital ulcers or sores, and testing positive for neisseria gonorrhea or any sexually transmitted infections (STI). Two thirds (65%) of commercial sex acts reportedly were protected by condoms; one in five (19%) FSW reported having had anal sex. Gender-based violence was frequent; 34% reported having been raped and 24% reported having been beaten by clients in the preceding 30 days., Conclusions: One in three FSW in Kampala is HIV-infected, suggesting a severe HIV epidemic in this population. Intensified interventions are warranted to increase condom use, HIV testing, STI screening, as well as antiretroviral treatment and pre-exposure prophylaxis along with measures to overcome gender-based violence.
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- 2017
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46. Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey.
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Hladik W, Sande E, Berry M, Ganafa S, Kiyingi H, Kusiima J, and Hakim A
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- Adolescent, Adult, HIV Infections diagnosis, HIV Infections ethnology, Health Surveys, Homosexuality, Male psychology, Humans, Male, Middle Aged, Prevalence, Social Stigma, Substance Abuse, Intravenous epidemiology, Uganda epidemiology, Young Adult, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Risk-Taking, Sexual Partners, Unsafe Sex statistics & numerical data
- Abstract
We report on the results of a respondent-driven sampling survey among men who have sex with men (MSM) in Kampala, Uganda, where same-sex behavior is criminalized and highly stigmatized. We enrolled 608 MSM aged 18 + years and residing in greater Kampala from June 2012-November 2013. Anonymous data were collected through audio-computer assisted self-interviews; blood was tested for HIV-1 antibodies, CD4 + T cell counts, and viral load. Estimated HIV prevalence was 12.2 % (95 % confidence interval [CI] 8.0-16.1), increasing with age. One in five (19.6 %) stated knowing their HIV-positive status and a similar proportion of HIV-infected MSM were virally suppressed (19.3 %; 95 % CI 3.3-33.1). HIV-related risk behaviors included unprotected anal sex (35.8 % at last sex act), selling sex (38.5 %), having multiple steady (54.3 %) or casual (63.6 %) partners, and ever injecting drugs (31.6 %). Forty percent experienced homophobic abuse; 44.5 % ever experienced suicide ideation. HIV prevalence among MSM remains high whereas knowledge of seropositive status and suppression of viral load remains low. MSM report a wide range of high risk behaviors, frequent homophobic abuse, poor mental health, as well as low levels of testing and treatment. Better access to tailored prevention and treatment services to improve population-level viral load suppression are warranted.
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- 2017
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47. Hidden and Mobile: A Web-based Study of Migration Patterns of Men Who Have Sex With Men in China.
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Mi G, Ma B, Kleinman N, Li Z, Fuller S, Bulterys M, Hladik W, and Wu Z
- Subjects
- Adolescent, Adult, China epidemiology, Cross-Sectional Studies, HIV Infections epidemiology, HIV Infections prevention & control, Human Migration statistics & numerical data, Humans, Male, Middle Aged, Young Adult, Homosexuality, Male statistics & numerical data, Internet, Social Media statistics & numerical data, Transients and Migrants statistics & numerical data
- Abstract
Background: Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and more likely to migrate due to widespread stigma and discrimination in China. Their mobility complicates estimation of local MSM population sizes and the provision of HIV services, and may also contribute to the spread of HIV., Methods: Between 1 January 2008 and 31 December 2012, the visits of all individuals to the largest Chinese MSM dating website were recorded. After a predesigned de-identification procedure by the website, we analyzed Internet Protocol addresses for migration patterns. Migrants were defined as individuals who were away from their registered residence for >6 months in the last 12 months., Results: The website contained data on 794 912 MSM eligible for the study, of which 34.5% were migrants. The median age was 26 years (range, 18-61 years), and 85.5% were unmarried. Compared with nonmigrant MSM, migrants were less likely to be married to a woman (8.6% vs 13.5%; P < .001). The 5 provinces with the highest migrant inflow ratios were Guangdong, Shanghai, Beijing, Tianjin, and Zhejiang. Eastern coastal cities were the primary destination of MSM from southwestern China., Conclusions: Preferential MSM migration may influence MSM population sizes in both originating and destination provinces, particularly for provinces with uneven inflow and outflow. MSM migration from southwestern China, which has the highest HIV prevalence in this population, to coastal cities with lower prevalence may have implications for the spread of the HIV epidemic as well as HIV care services., (© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.)
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- 2016
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48. Sexually transmitted infections associated with alcohol use and HIV infection among men who have sex with men in Kampala, Uganda.
- Author
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Kim EJ, Hladik W, Barker J, Lubwama G, Sendagala S, Ssenkusu JM, Opio A, and Serwadda D
- Subjects
- Adolescent, Adult, Age Factors, Chlamydia Infections diagnosis, Chlamydia Infections epidemiology, Chlamydia Infections etiology, Cross-Sectional Studies, Gonorrhea diagnosis, Gonorrhea epidemiology, Gonorrhea etiology, HIV Infections complications, Humans, Male, Prevalence, Risk Factors, Sexual Partners classification, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases etiology, Surveys and Questionnaires, Syphilis diagnosis, Syphilis epidemiology, Syphilis etiology, Uganda epidemiology, Young Adult, Alcohol Drinking epidemiology, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Sexually Transmitted Diseases epidemiology
- Abstract
Objectives: Few studies have been conducted in Africa to assess prevalence of sexually transmitted infections (STIs) and risk factors among men who have sex with men (MSM). We report findings from the first behavioural survey to include STI testing among MSM in Kampala, Uganda., Methods: Respondent-driven sampling (RDS) was used to recruit MSM for a biobehavioural survey. Eligible participants were men who reported anal sex with another man in the previous 3 months, were 18 years or older, and resided in Kampala. Information was collected on demographics, sexual behaviour, alcohol and drug use, and STI symptoms. Blood, urine and rectal specimens were tested for syphilis, HIV, rectal and urethral gonorrhoea, and chlamydia. Analyses weighted for RDS were conducted to assess associations with STI diagnosis., Results: A total of 295 MSM participated in the survey. Almost half (weighted percentage: 47.3%) reported STI symptoms in the last 6 months and 12.9% tested HIV-positive. Prevalence of non-HIV STI was 13.5%; syphilis prevalence was 9.0%. Adjusting for age and education, STI was associated with HIV (adjusted OR (AOR)=3.46, 95% CI 1.03 to 11.64), alcohol use before sex (AOR=4.99, 95% CI 1.86 to 13.38) and having sold sex in the last 3 months (AOR=3.17, 95% CI 1.25 to 8.07), and inversely associated with having anonymous sex partners (AOR=0.20, 95% CI 0.07 to 0.61)., Conclusions: We observed high levels of self-reported STI symptoms and STI prevalence associated with alcohol use and HIV among MSM in Kampala. Public health interventions supporting MSM are needed to address STI risk and facilitate access to diagnosis and treatment services., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
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- 2016
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49. Quantity Versus Quality: A Survey Experiment to Improve the Network Scale-up Method.
- Author
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Feehan DM, Umubyeyi A, Mahy M, Hladik W, and Salganik MJ
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- Epidemiologic Methods, Female, HIV Infections etiology, Humans, Male, Risk Assessment methods, Rwanda epidemiology, Substance Abuse, Intravenous complications, Surveys and Questionnaires, Drug Users statistics & numerical data, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Sex Workers statistics & numerical data, Social Environment, Social Networking, Substance Abuse, Intravenous epidemiology
- Abstract
The network scale-up method is a promising technique that uses sampled social network data to estimate the sizes of epidemiologically important hidden populations, such as sex workers and people who inject illicit drugs. Although previous scale-up research has focused exclusively on networks of acquaintances, we show that the type of personal network about which survey respondents are asked to report is a potentially crucial parameter that researchers are free to vary. This generalization leads to a method that is more flexible and potentially more accurate. In 2011, we conducted a large, nationally representative survey experiment in Rwanda that randomized respondents to report about one of 2 different personal networks. Our results showed that asking respondents for less information can, somewhat surprisingly, produce more accurate size estimates. We also estimated the sizes of 4 key populations at risk for human immunodeficiency virus infection in Rwanda. Our estimates were higher than earlier estimates from Rwanda but lower than international benchmarks. Finally, in this article we develop a new sensitivity analysis framework and use it to assess the possible biases in our estimates. Our design can be customized and extended for other settings, enabling researchers to continue to improve the network scale-up method., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)
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- 2016
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50. The utility of population-based surveys to describe the continuum of HIV services for key and general populations.
- Author
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Hladik W, Benech I, Bateganya M, and Hakim AJ
- Subjects
- CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Humans, Surveys and Questionnaires, Viral Load, Anti-Retroviral Agents therapeutic use, Continuity of Patient Care, HIV Infections drug therapy
- Abstract
Monitoring the cascade or continuum of HIV services - ranging from outreach services to anti-retroviral treatment - has become increasingly important as the focus in prevention moves toward biomedical interventions, in particular, 'Treatment as Prevention.' The HIV continuum typically utilises clinic-based care and treatment monitoring data and helps identify gaps and inform programme improvements. This paper discusses the merits of a population-based survey-informed continuum of services. Surveys provide individual-level, population-based data by sampling persons both in and outside the continuum, which facilitate the estimation of population fractions, such as the proportion of people living with HIV in care, as well as the examination of determinants for being in or outside the continuum. Survey-informed cascades of services may especially benefit key populations at increased risk for HIV infection for who social marginalisation, criminalisation, and stigma result in barriers to access and retention in services, a low social visibility, mobility, and outreach-based services can compromise clinic-based monitoring. Adding CD4+ T-cell count and viral load measurements to such surveys may provide population-level information on viral load suppression, stage of disease, treatment needs, and population-level transmission potential. While routine clinic-based reporting will remain the mainstay of monitoring, a survey-informed service cascade can address some of its limitations and offer additional insights., (© The Author(s) 2015.)
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- 2016
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