46 results on '"Nakiyingi-Miiro, Jessica"'
Search Results
2. Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa
- Author
-
Francis, Suzanna C., Miiro, George, Nakuya, Kevin, Rutakumwa, Rwamahe, Nakiyingi-Miiro, Jessica, Nabaggala, Grace, Musoke, Saidat, Namakula, Juliet, Tanton, Clare, Torondel, Belen, Ross, David A., and Weiss, Helen A.
- Published
- 2019
- Full Text
- View/download PDF
3. The effects of HIV on fertility by infection duration: evidence from African population cohorts before antiretroviral treatment availability
- Author
-
Marston, Milly, Nakiyingi-Miiro, Jessica, Kusemererwa, Sylvia, Urassa, Mark, Michael, Denna, Nyamukapa, Constance, Gregson, Simon, Zaba, Basia, and Eaton, Jeffrey W.
- Published
- 2017
- Full Text
- View/download PDF
4. A comparative analysis of national HIV policies in six African countries with generalized epidemics/Analyse comparative des politiques nationals de lutte contre le VIH dans six pays africains ou l'epidemie est generalisee/Un analyses comparativo de las politicas sobre el VIH en seis paises africanos con epidemias generalizadas
- Author
-
Church, Kathryn, Kiweewa, Francis, Dasgupta, Aisha, Mwangome, Mary, Mpandaguta, Edith, Gomez-Olive, Francesc Xavier, Oti, Samuel, Todd, Jim, Wringe, Alison, Geubbels, Eveline, Crampin, Amelia, Nakiyingi-Miiro, Jessica, Hayashi, Chika, Njage, Muthoni, Wagner, Ryan G., Ario, Alex Riolexus, Makombe, Simon D., Mugurungi, Owen, and Zaba, Basia
- Subjects
HIV (Viruses) ,HIV testing ,Mortality ,Antiviral agents ,Highly active antiretroviral therapy ,Health ,World Health Organization -- Health policy - Abstract
Objective To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries. Methods We reviewed HIV policies as part of a multi-country study on adult mortality In sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance. Findings There was wide variation in policies between countries; each country was progressive in some areas and not In others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance In certain areas and key informants reported that practice often surpassed policy. Conclusion Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV Is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy Implementation and link these findings with HIV outcomes. Objectif Comparer les politiques nationales de lutte contre le virus de Hmmunodefidence humaine (VIH) qui Influenced l'acces aux services de depistage et de traitement du VIH dans six pays d'Afrique subsaharienne. Methodes Nous avons examine les politiques de lutte contre le VIH dans le cadre d'une etude multi-pays sur la mortalite des adultes en Afrique subsaharienne. Un outil d'extraction de donnees a ete mis au point et utllise afin d'examlner les documents et les directives des politiques nationales de lutte contre le VIH publles en Afrique du Sud, au Kenya, au Malawi, en Ouganda, en Republique-Unie deTanzanie et au Zimbabwe entre 2003 et 2013. Des entretiens avec des informateurs cles ont permis de combler les carences de ces resultats. Les politiques nationales ont ete classees suivant leur degre de correspondance, explicite ou implicite, avec 54 indicateurs relatlfs aux politiques, determines d'apres des analyses documentales et des examens d'experts. Nous avons egalement compare les politiques nationales avec les recommandations de l'Organisation mondlale de la Sante (QMS). Resultats Nous avons observe de grandes differences entre les politiques de ces pays; chaque pays etait avance dans certains domaines et pas dans d'autres. Le Malawi l'etait particulierement en matiere de promotion du demarrage rapidedu traitement antiretroviral. Cependant, aucun pays n'avalt un contexte politique pouvant systematiquement permettre d'augmenter l'acces aux soins et d'eviter l'arret du traitement. Dans certains domaines, les pays allaient plus loin que les recommandations de l'OMS et les Informateurs ont Indique que la pratique depassait souvent le cadre des politiques. Conclusion Evaluer l'impact des differentes politiques sur l'acces aux soins et les resultats en termes de sante des personnes qul vivent avec le VIH n'est pas chose simple. Certaines politiques exercent une influence plus forte que d'autres et les politiques officielles ne sont pas toujours mises en oeuvre. Des recherches ulterleures devraient evaluer le degre de mise en oeuvre des politiques et mettre en lien leurs conclusions avec les resultats de la lutte contre le VIH. Objetivo Comparar las politicas nacionales relativas al virus de la inmunodeficiencia humana (VIH) que influencian el acceso a las pruebas del VIH y a los tratamientos en seis paises sub-saharianos. Metodos Se revisaron las politicas relativas al VIH como parte de un estudio multinacional sobre la mortalidad de adultos en Africa Subsahanana. Se desarrollo una herramienta de extraccion de politicas y se utilizo para revisar los documentos y guias de las politicas nacionales relativas al VIH publicadas en Kenla, Malawi, Republica Unida de Tanzanla, Sudafrica, Uganda y Zlmbabue entre 2003 y 2013. Se hicieron entrevistas a Informantes claves que ayudaron a llenar los vacios en los resultados. Las politicas nacionales se clasificaron segun si se adhirieron explicita o implicitamente a 54 Indicadores de politicas, Identificados mediante bibliografia y opiniones de expertos. Asimismo, se compararon las politicas nacionales con las directrices de la Organizacion Mundial de la Salud (OMS). Resultados Se descubrio que habia una amplia variedad entre las politicas de los paises. Cada pais estaba mas avanzado en algunas areas que en otras. Malawi estaba especialmente avanzado en'la promocion de empezar rapidamente la terapia antirretroviral. Sin embargo, ningun pais tenia un contexto de Introduccion de politicas consistente que Incrementara el acceso a la atencion primaria y evitara la desercion. Algunos paises Iban mas alla de las orientaciones de la OMS en algunas areas e informantes clave Informaron de que la practica a menudo superaba la politica. Conclusion Evaluar el impacto de las diferencias en las politicas relativas en el acceso a la atencion primaria y los resultados en la salud entre aquellas personas con VIH es un reto. Algunas politicas ejerceran mas Influencia que otras y las politicas oficiales no siempre se aplican. Las Investigaciones futuras deberian evaluar el grado de aplicacion de las politicas y vincular estos resultados con los resultados del VIH., Introduction By the end of 2012, more than 7.5 million of the estimated 23.5 million people living with human immunodeficiency virus (HIV) in Africa were receiving treatment, compared to only [...]
- Published
- 2015
- Full Text
- View/download PDF
5. High HIV Incidence and Socio-Behavioral Risk Patterns in Fishing Communities on the Shores of Lake Victoria, Uganda
- Author
-
Seeley, Janet, Nakiyingi-Miiro, Jessica, Kamali, Anatoli, Mpendo, Juliet, Asiki, Gershim, Abaasa, Andrew, De Bont, Jan, Nielsen, Leslie, and Kaleebu, Pontiano
- Published
- 2012
6. Malaria health seeking practices for children, and intermittent preventive treatment in pregnancy in Wakiso District, Uganda
- Author
-
Musoke, David, primary, Ndejjo, Rawlance, additional, Tsebeni Wafula, Solomon, additional, Kasasa, Simon, additional, Nakiyingi-Miiro, Jessica, additional, and Boses Musoke, Miph, additional
- Published
- 2021
- Full Text
- View/download PDF
7. Adult life expectancy trends in the era of antiretroviral treatment in rural Uganda (1991–2012)
- Author
-
Asiki, Gershim, Reniers, Georges, Newton, Robert, Baisley, Kathy, Nakiyingi-Miiro, Jessica, Slaymaker, Emma, Kasamba, Ivan, Seeley, Janet, Todd, Jim, Kaleebu, Pontiano, and Kamali, Anatoli
- Published
- 2016
- Full Text
- View/download PDF
8. Schistosoma mansoni and HIV acquisition in fishing communities of Lake Victoria, Uganda: a nested case–control study
- Author
-
Ssetaala, Ali, Nakiyingi-Miiro, Jessica, Asiki, Gershim, Kyakuwa, Nassim, Mpendo, Juliet, Van Dam, Govert J., Corstjens, Paul L., Pala, Pietro, Nielsen, Leslie, De Bont, Jan, Pantaleo, Giuseppe, Kiwanuka, Noah, Kaleebu, Pontiano, Kamali, Anatoli, and Elliott, Alison M.
- Published
- 2015
- Full Text
- View/download PDF
9. Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)
- Author
-
Reniers, Georges, Slaymaker, Emma, Nakiyingi-Miiro, Jessica, Nyamukapa, Constance, Crampin, Amelia Catharine, Herbst, Kobus, Urassa, Mark, Otieno, Fred, Gregson, Simon, Sewe, Maquins, Michael, Denna, Lutalo, Tom, Hosegood, Victoria, Kasamba, Ivan, Price, Alison, Nabukalu, Dorean, Mclean, Estelle, and Zaba, Basia
- Published
- 2014
- Full Text
- View/download PDF
10. Updates to the Spectrum model to estimate key HIV indicators for adults and children
- Author
-
Stover, John, Andreev, Kirill, Slaymaker, Emma, Gopalappa, Chaitra, Sabin, Keith, Velasquez, Claudia, Nakiyingi-Miiro, Jessica, Crampin, Amelia, Lutalo, Tom, Herbst, Kobus, Gregson, Simon, and Urassa, Mark
- Published
- 2014
- Full Text
- View/download PDF
11. Sociodemographic distribution of non-communicable disease risk factors in rural Uganda: a cross-sectional study
- Author
-
Murphy, Georgina AV, Asiki, Gershim, Ekoru, Kenneth, Nsubuga, Rebecca N, Nakiyingi-Miiro, Jessica, Young, Elizabeth H, Seeley, Janet, Sandhu, Manjinder S, and Kamali, Anatoli
- Published
- 2013
- Full Text
- View/download PDF
12. Identifying gaps in HIV service delivery across the diagnosis-to-treatment cascade: findings from health facility surveys in six sub-Saharan countries
- Author
-
Church, Kathryn, Machiyama, Kazuyo, Todd, Jim, Njamwea, Brian, Mwangome, Mary, Hosegood, Vicky, Michel, Janet, Oti, Samuel, Nyamukapa, Constance, Crampin, Amelia, Amek, Nyaguara, Nakigozi, Gertrude, Michael, Denna, Gomez-Olive, F.Xavier, Nakiyingi-Miiro, Jessica, Zaba, Basia, and Wringe, Alison
- Subjects
HIV infections -- Care and treatment -- Patient outcomes ,HIV tests -- Usage -- Health aspects -- Surveys ,Medical care -- Management -- Sub-Saharan Africa ,Antiretroviral agents -- Health aspects -- Surveys -- Dosage and administration ,Company business management ,Health - Abstract
Introduction: Despite the rollout of antiretroviral therapy (ART), challenges remain in ensuring timely access to care and treatment for people living with HIV. As part of a multi-country study to investigate HIV mortality, we conducted health facility surveys within 10 health and demographic surveillance system sites across six countries in Eastern and Southern Africa to investigate clinic-level factors influencing (i) use of HIV testing services, (ii) use of HIV care and treatment and (iii) patient retention on ART. Methods: Health facilities (n = 156) were sampled within 10 surveillance sites: Nairobi and Kisumu (Kenya), Karonga (Malawi), Agincourt and uMkhanyakude (South Africa), Ifakara and Kisesa (Tanzania), Kyamulibwa and Rakai (Uganda) and Manicaland (Zimbabwe). Structured questionnaires were administered to in-charge staff members of HIV testing, prevention of mother-to-child transmission (PMTCT) and ART units within the facilities. Forty-one indicators influencing uptake and patient retention along the continuum of HIV care were compared across sites using descriptive statistics. Results: The number of facilities surveyed ranged from six in Malawi to 36 in Zimbabwe. Eighty percent were governmentrun; 73% were lower-level facilities and 17% were district/referral hospitals. Client load varied widely, from less than one up to 65 HIV testing clients per provider per week. Most facilities (>80%) delivered services or interventions that would support patient retention in care such as delivering free services, offering PMTCT within antenatal care, pre-ART monitoring and adherence counselling. Many facilities under-delivered in several areas, however, such as targeted testing for high- risk groups (21%) and mobile testing (36%). There were also intra-site and inter-site differences, including in the delivery of Option B+ (ranging from 6% in Kisumu to 93% in Kyamulibwa), and nurse-led ART initiation (ranging from 50% in Kisesa to 100% in Karonga and Agincourt). Only facilities in Malawi did not require additional lab tests for ART initiation. Stock-outs of HIV test kits and antiretroviral drugs were particularly common in Tanzania. Conclusions: We identified a high standard of health facility performance in delivering strategies that may support progression through the continuum of HIV care. HIV testing policy and practice was particularly weak. Inter- and intracountry differences in quality and coverage represent opportunities to improve the delivery of comprehensive services to people living with HIV. Keywords: HIV; ART; PMTCT; retention; health services; facility surveys; multi-country; continuum, Introduction In 2015 in Eastern and Southern Africa, 10.3 million people were accessing antiretroviral therapy (ART), representing an estimated 54% [50-58%] of all people living with HIV (PLHIV) in the [...]
- Published
- 2017
13. Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda
- Author
-
Watera, Christine, &odd, Jim, Muwonge, Richard, Whitworth, James, Nakiyingi-Miiro, Jessica, Brink, Anne, Miiro, George, Antvelink, Lucy, Kamali, Anatoli, French, Neil, and Mermin, Jonathan
- Subjects
HIV infection -- Prevention ,HIV patients -- Health aspects ,Health - Abstract
The feasibility and effectiveness of daily cotrimoxazole prophylaxis is examined in a well-established cohort of HIV-infected adults attending clinics in Entebbe, Uganda. The results reinforce the need for large-scale provision of cotrimoxazole prophylaxis for all HIV-positive patients in developing countries.
- Published
- 2006
14. The general population cohort in rural south-western Uganda: a platform for communicable and non-communicable disease studies
- Author
-
Asiki, Gershim, Murphy, Georgina, Nakiyingi-Miiro, Jessica, Seeley, Janet, Nsubuga, Rebecca N, Karabarinde, Alex, Waswa, Laban, Biraro, Sam, Kasamba, Ivan, Pomilla, Cristina, Maher, Dermot, Young, Elizabeth H, Kamali, Anatoli, and Sandhu, Manjinder S
- Published
- 2013
- Full Text
- View/download PDF
15. HIV prevalence and incidence are no longer falling in southwest Uganda: evidence from a rural population cohort 1989–2005
- Author
-
Shafer, Leigh Anne, Biraro, Samuel, Nakiyingi-Miiro, Jessica, Kamali, Anatoli, Ssematimba, Duncan, Ouma, Joseph, Ojwiya, Amato, Hughes, Peter, Van der Paal, Lieve, Whitworth, Jimmy, Opio, Alex, and Grosskurth, Heiner
- Published
- 2008
- Full Text
- View/download PDF
16. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda
- Author
-
de Walque, Damien, Nakiyingi-Miiro, Jessica S., Busingye, June, and Whitworth, Jimmy A.
- Published
- 2005
17. The impact of attending a behavioural intervention on HIV incidence in Masaka, Uganda
- Author
-
Quigley, Maria A, Kamali, Anatoli, Kinsman, John, Kamulegeya, Ignatius, Nakiyingi-Miiro, Jessica, Kiwuwa, Sylvia, Kengeya-Kayondo, Jane F, Carpenter, Lucy M, and Whitworth, James AG
- Published
- 2004
18. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA): Data on mortality, by HIV status and stage on the HIV care continuum, among the general population in seven longitudinal studies between 1989 and 2014
- Author
-
Slaymaker, Emma, McLean, Estelle, Wringe, Alison, Calvert, Clara, Marston, Milly, Reniers, Georges, Kabudula, Chodziwadziwa Whiteson, Crampin, Amelia, Price, Alison, Michael, Denna, Urassa, Mark, Kwaro, Daniel, Sewe, Maquins, Eaton, Jeffrey W, Rhead, Rebecca, Nakiyingi-Miiro, Jessica, Lutalo, Tom, Nabukalu, Dorean, Herbst, Kobus, Hosegood, Victoria, and Zaba, Basia
- Abstract
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum. This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART.
- Published
- 2017
19. Malaria prevention practices and associated environmental risk factors in a rural community in Wakiso district, Uganda
- Author
-
Musoke, David, primary, Miiro, George, additional, Ndejjo, Rawlance, additional, Karani, George, additional, Morris, Keith, additional, Kasasa, Simon, additional, Nakiyingi-Miiro, Jessica, additional, Guwatudde, David, additional, and Musoke, Miph Boses, additional
- Published
- 2018
- Full Text
- View/download PDF
20. From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries
- Author
-
Ambia, Julie, Renju, Jenny, Wringe, Alison, Todd, Jim, Geubbels, Eveline, Nakiyingi-Miiro, Jessica, Urassa, Mark, Lutalo, Tom, Crampin, Amelia C., Kwaro, Daniel, Kyobutungi, Catherine, Chimbindi, Natsayi, Gomez-Olive, F. Xavier, Tlhajoane, Malebogo, Njamwea, Brian, Zaba, Basia, and Mee, Paul
- Subjects
Adult ,Male ,WHO guidelines ,HIV Infections ,0807 Library And Information Studies ,Surveys and Questionnaires ,Ambulatory Care ,Health facility survey ,Humans ,Africa South of the Sahara ,lcsh:Public aspects of medicine ,Health Policy ,HIV ,lcsh:RA1-1270 ,Access ,CD4 Lymphocyte Count ,Treatment ,Policy review ,AIDS ,Cross-Sectional Studies ,1117 Public Health And Health Services ,Anti-Retroviral Agents ,Retention ,Practice Guidelines as Topic ,Africa ,Health Policy & Services ,Female ,Guideline Adherence ,Health Facilities ,ART ,Research Article - Abstract
Background Understanding the implementation of 2013 World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. Methods A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12) and retention (n = 8). Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1) and 2015/2016 (round 2) from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. Results Although, expansion of ART access was explicitly stated in all countries’ policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/μL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11%) nor in the provision of three-month supply of ART (43 to 38%). None of the facilities provided community-based ART delivery. Conclusion The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required to further minimise ART stock-outs and allow lay cadres to dispense ART in the community. Increased efforts are needed to offer longer durations between clinic visits, a strategy purported to improve retention. These changes will be important as countries move to implement the revised 2015 WHO guidelines to initiate all HIV positive people onto ART regardless of their immune status. Electronic supplementary material The online version of this article (10.1186/s12913-017-2678-1) contains supplementary material, which is available to authorized users.
- Published
- 2017
21. Additional file 1: of From policy to practice: exploring the implementation of antiretroviral therapy access and retention policies between 2013 and 2016 in six sub-Saharan African countries
- Author
-
Ambia, Julie, Renju, Jenny, Wringe, Alison, Todd, Jim, Geubbels, Eveline, Nakiyingi-Miiro, Jessica, Urassa, Mark, Lutalo, Tom, Crampin, Amelia, Kwaro, Daniel, Kyobutungi, Catherine, Natsayi Chimbindi, F. Gomez-Olive, Malebogo Tlhajoane, Njamwea, Brian, Basia Zaba, and Mee, Paul
- Abstract
A description of policies for increasing ART access and improving retention in care by country and date of adoption. (DOCX 28 kb)
- Published
- 2017
- Full Text
- View/download PDF
22. Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study
- Author
-
Miiro, George, primary, Rutakumwa, Rwamahe, additional, Nakiyingi-Miiro, Jessica, additional, Nakuya, Kevin, additional, Musoke, Saidat, additional, Namakula, Juliet, additional, Francis, Suzanna, additional, Torondel, Belen, additional, Gibson, Lorna J., additional, Ross, David A., additional, and Weiss, Helen A., additional
- Published
- 2018
- Full Text
- View/download PDF
23. Measuring the impact of antiretroviral therapy roll-out on population level fertility in three African countries
- Author
-
Marston, Milly, Nakiyingi-Miiro, Jessica, Hosegood, Victoria, Lutalo, Tom, Mtenga, Baltazar, and Zaba, Basia
- Subjects
RNA viruses ,Adult ,Adolescent ,Maternal Health ,Immunology ,Antiretroviral Therapy ,HIV Infections ,Pathology and Laboratory Medicine ,Assisted Reproductive Technology ,Microbiology ,Tanzania ,Geographical Locations ,South Africa ,Immunodeficiency Viruses ,Antiviral Therapy ,Population Metrics ,Antenatal Care ,Retroviruses ,Medicine and Health Sciences ,Humans ,Public and Occupational Health ,Uganda ,Fertility Rates ,Microbial Pathogens ,Demography ,Population Biology ,Lentivirus ,Organisms ,Obstetrics and Gynecology ,Biology and Life Sciences ,HIV ,Birth Rates ,Vaccination and Immunization ,Fertility ,Anti-Retroviral Agents ,Medical Microbiology ,Viral Pathogens ,Viruses ,People and Places ,Africa ,Women's Health ,Female ,Preventive Medicine ,Pathogens ,Research Article - Abstract
BackgroundUNAIDS official estimates of national HIV prevalence are based on trends observed in antenatal clinic surveillance, after adjustment for the reduced fertility of HIV positive women. Uptake of ART may impact on the fertility of HIV positive women, implying a need to re-estimate the adjustment factors used in these calculations. We analyse the effect of antiretroviral therapy (ART) provision on population-level fertility in Southern and East Africa, comparing trends in HIV infected women against the secular trends observed in uninfected women.MethodsWe used fertility data from four community-based demographic and HIV surveillance sites: Kisesa (Tanzania), Masaka and Rakai (Uganda) and uMkhanyakude (South Africa). All births to women aged 15–44 years old were included in the analysis, classified by mother’s age and HIV status at time of birth, and ART availability in the community. Calendar time period of data availability relative to ART Introduction varied across the sites, from 5 years prior to ART roll-out, to 9 years after. Calendar time was classified according to ART availability, grouped into pre ART, ART introduction (available in at least one health facility serving study site) and ART available (available in all designated health facilities serving study site). We used Poisson regression to calculate age adjusted fertility rate ratios over time by HIV status, and investigated the interaction between ART period and HIV status to ascertain whether trends over time were different for HIV positive and negative women.ResultsAge-adjusted fertility rates declined significantly over time for HIV negative women in all four studies. However HIV positives either had no change in fertility (Masaka, Rakai) or experienced a significant increase over the same period (Kisesa, uMkhanyakude). HIV positive fertility was significantly lower than negative in both the pre ART period (age adjusted fertility rate ratio (FRR) range 0.51 95%CI 0.42–0.61 to 0.73 95%CI 0.64–0.83) and when ART was widely available (FRR range 0.57 95%CI 0.52–0.62 to 0.83 95%CI 0.78–0.87), but the difference has narrowed. The interaction terms describing the difference in trends between HIV positives and negatives are generally significant.ConclusionsDifferences in fertility between HIV positive and HIV negative women are narrowing over time as ART becomes more widely available in these communities. Routine adjustment of ANC data for estimating national HIV prevalence will need to allow for the impact of treatment.
- Published
- 2016
24. Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda
- Author
-
Miiro, George, DeCelles, Jeff, Rutakumwa, Rwamahe, Nakiyingi-Miiro, Jessica, Muzira, Philip, Ssembajjwe, Wilber, Musoke, Saidat, Gibson, Lorna J, Hershow, Rebecca B, Francis, Suzanna, Torondel, Belen, Ross, David A, Weiss, Helen A, and MENISCUS project
- Subjects
Male ,Parents ,RNA viruses ,0301 basic medicine ,Social Sciences ,HIV Infections ,Peer support ,Pathology and Laboratory Medicine ,Adolescents ,Cultural Anthropology ,Families ,0302 clinical medicine ,Promotion (rank) ,Sociology ,Immunodeficiency Viruses ,Circumcision ,Medicine and Health Sciences ,Medicine ,Uganda ,030212 general & internal medicine ,Reproductive System Procedures ,Young adult ,Children ,media_common ,education.field_of_study ,Schools ,Alcohol Consumption ,Multidisciplinary ,3. Good health ,Religion ,Medical Microbiology ,Viral Pathogens ,Scale (social sciences) ,Viruses ,Infectious diseases ,Pathogens ,Research Article ,medicine.medical_specialty ,Adolescent ,Alcohol Drinking ,Science ,media_common.quotation_subject ,HIV prevention ,education ,Population ,MEDLINE ,Surgical and Invasive Medical Procedures ,Viral diseases ,Microbiology ,Education ,Young Adult ,03 medical and health sciences ,Intervention (counseling) ,Soccer ,Retroviruses ,Humans ,Microbial Pathogens ,Nutrition ,Preventive medicine ,Government ,business.industry ,Lentivirus ,Organisms ,HIV ,Biology and Life Sciences ,030112 virology ,Diet ,Public and occupational health ,Circumcision, Male ,Age Groups ,Anthropology ,Family medicine ,People and Places ,Physical therapy ,Population Groupings ,business - Abstract
The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention (“Make The Cut”) among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised “coaches” who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches’ circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale.
- Published
- 2017
25. HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews
- Author
-
McRobie, Ellen, primary, Wringe, Alison, additional, Nakiyingi-Miiro, Jessica, additional, Kiweewa, Francis, additional, Lutalo, Tom, additional, Nakigozi, Gertrude, additional, Todd, Jim, additional, Eaton, Jeffrey William, additional, Zaba, Basia, additional, and Church, Kathryn, additional
- Published
- 2017
- Full Text
- View/download PDF
26. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa
- Author
-
Slaymaker, Emma, Todd, Jim, Marston, Milly, Calvert, Clara, Michael, Denna, Nakiyingi-Miiro, Jessica, Crampin, Amelia, Lutalo, Tom, Herbst, Kobus, Zaba, Basia, and Wellcome Trust
- Subjects
Adult ,Male ,sub-Saharan Africa ,Malawi ,Adolescent ,Anti-HIV Agents ,antiretroviral therapy ,HIV Infections ,Tanzania ,South Africa ,Young Adult ,Humans ,Measuring HIV Associated Mortality in Africa ,Uganda ,Longitudinal Studies ,Proportional Hazards Models ,ALPHA network ,lcsh:Public aspects of medicine ,Age Factors ,HIV ,lcsh:RA1-1270 ,mortality ,Middle Aged ,RA643-645 Disease (Communicable and noninfectious) and public health ,Epidemiology ,demography ,public health ,Population Surveillance ,Female ,Sex - Abstract
Background: Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA).Methods: Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites.Results: 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14–46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32–0.58), compared to the period before ART was available, in mortality at ages 15–54 across all five sites.Discussion: Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further.Keywords: HIV; sub-Saharan Africa; mortality; ALPHA network; antiretroviral therapy(Published: 22 April 2014)Citation: Glob Health Action 2014, 7: 22789 - http://dx.doi.org/10.3402/gha.v7.22789SPECIAL ISSUEThis paper is part of the Special Issue Measuring HIV Associated Mortality in Africa. More papers from this issue can be found here and here.
- Published
- 2014
27. Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)
- Author
-
Reniers, Georges, primary, Wamukoya, Marylene, additional, Urassa, Mark, additional, Nyaguara, Amek, additional, Nakiyingi-Miiro, Jessica, additional, Lutalo, Tom, additional, Hosegood, Vicky, additional, Gregson, Simon, additional, Gómez-Olivé, Xavier, additional, Geubbels, Eveline, additional, Crampin, Amelia C, additional, Wringe, Alison, additional, Waswa, Laban, additional, Tollman, Stephen, additional, Todd, Jim, additional, Slaymaker, Emma, additional, Serwadda, David, additional, Price, Alison, additional, Oti, Samuel, additional, Nyirenda, Moffat J, additional, Nabukalu, Dorean, additional, Nyamukapa, Constance, additional, Nalugoda, Fred, additional, Mugurungi, Owen, additional, Mtenga, Baltazar, additional, Mills, Lisa, additional, Michael, Denna, additional, McLean, Estelle, additional, McGrath, Nuala, additional, Martin, Emmanuel, additional, Marston, Milly, additional, Maquins, Sewe, additional, Levira, Francis, additional, Kyobutungi, Catherine, additional, Kwaro, Daniel, additional, Kasamba, Ivan, additional, Kanjala, Chifundo, additional, Kahn, Kathleen, additional, Kabudula, Chodziwadziwa, additional, Herbst, Kobus, additional, Gareta, Dickman, additional, Eaton, Jeffrey W, additional, Clark, Samuel J, additional, Church, Kathryn, additional, Chihana, Menard, additional, Calvert, Clara, additional, Beguy, Donatien, additional, Asiki, Gershim, additional, Amri, Shamte, additional, Abdul, Ramadhani, additional, and Zaba, Basia, additional
- Published
- 2016
- Full Text
- View/download PDF
28. Adult life expectancy trends in the era of antiretroviral treatment in rural Uganda (1991–2012)
- Author
-
Asiki, Gershim, primary, Reniers, Georges, additional, Newton, Robert, additional, Baisley, Kathy, additional, Nakiyingi-Miiro, Jessica, additional, Slaymaker, Emma, additional, Kasamba, Ivan, additional, Seeley, Janet, additional, Todd, Jim, additional, Kaleebu, Pontiano, additional, and Kamali, Anatoli, additional
- Published
- 2015
- Full Text
- View/download PDF
29. Short communication: HIV type 1 transmitted drug resistance and evidence of transmission clusters among recently infected antiretroviral-naive individuals from Ugandan fishing communities of Lake Victoria
- Author
-
Nazziwa, Jamirah, Njai, Harr Freeya, Ndembi, Nicaise, Birungi, Josephine, Lyagoba, Fred, Gershim, Asiki, Nakiyingi-Miiro, Jessica, Nielsen, Leslie, Mpendo, Juliet, Nanvubya, Annet, Debont, Jan, Grosskurth, Heiner, Kamali, Anatoli, Seeley, Janet, Kaleebu, Pontiano, and Chivtum Study Team
- Subjects
virus diseases - Abstract
Human immunodeficiency virus type 1 (HIV-1) prevalence and incidence in the fishing communities on Lake Victoria in Uganda are high. This population may play a role in driving the HIV epidemic in Uganda including the spread of transmitted drug resistance (TDR). We report data on TDR in this population among antiretroviral (ARV)-naive, recently infected individuals about 5 years after ARV scaling-up in Uganda. We identified phylogenetic transmission clusters and combined these with volunteer life histories in order to understand the sexual networks within this population. From a prospective cohort of 1,000 HIV-negative individuals recruited from five communities, 51 seroconverters were identified over a period of 2 years. From these, whole blood was collected and population sequencing of the HIV-1 pol gene (protease/reverse transcriptase) was performed from plasma. Drug resistance mutations (DRMs) were scored using the 2009 WHO list for surveillance of TDR. TDR prevalence categories were estimated using the WHO recommended truncated sampling technique for the surveillance of TDR for use in resource-limited settings (RLS). Of the samples 92% (47/51) were successfully genotyped. HIV-1 subtype frequencies were 15/47 (32%) A1, 20/47 (43%) D, 1/47 (2%) C, 1/47 (2%) G, and 10/47 (21%) unique recombinant forms. Nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutation K103N was identified in two individuals and V106A in one (6%) suggesting that the level of TDR was moderate in this population. No nucleoside/tide reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) DRMs were detected. In this study, we identified five transmission clusters supported by high bootstrap values and low genetic distances. Of these, one pair included the two individuals with K103N. Two of the genotypic clusters corresponded with reported sexual partnerships as detected through prior in-depth interviews. The level of TDR to NNRTIs in these ARV-naive individuals was moderate by WHO threshold survey categorization. The transmission clusters suggest a high degree of sexual partner mixing between members of these communities.
- Published
- 2013
30. Is the risk of HIV acquisition increased during and immediately after pregnancy? A secondary analysis of pooled HIV community-based studies from the ALPHA network
- Author
-
Marston, Milly, Newell, Marie Louise, Crampin, Amelia, Lutalo, Tom, Musoke, Richard, Gregson, Simon, Nyamukapa, Constance, Nakiyingi-Miiro, Jessica, Urassa, Mark, Isingo, Raphael, and Zaba, Basia
- Subjects
Adult ,Malawi ,Adolescent ,Postpartum Period ,lcsh:R ,virus diseases ,lcsh:Medicine ,HIV Infections ,Middle Aged ,Tanzania ,Cohort Studies ,Pregnancy ,Risk Factors ,Epidemiological Monitoring ,Animals ,Humans ,Female ,Uganda ,lcsh:Q ,Disease Susceptibility ,Pregnancy Complications, Infectious ,lcsh:Science ,PMTCT (prevention of mother-to-child transmission) ,Research Article - Abstract
BackgroundPrevious studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studies are unable to tell us what the overall impact of pregnancy is on HIV acquisition in the general population.MethodsData from six community-based HIV cohorts were pooled to give 2,628 sero-conversions and a total of 178,000 person years of observation. Multiple imputation was used to allow for the uncertainty of exact sero-conversion date in surveillance intervals greater than the length of a pregnancy. Results were combined using Rubin’s rules to give appropriate error bounds. The analysis was stratified into two periods: pre- and post- widespread availability of prevention of mother-to-child HIV transmission services. This allows us to assess whether there is reporting bias relating to a person’s knowledge of their own HIV status which would become more widespread in the latter time period.ResultsResults suggest that women while pregnant have a lower risk of acquiring HIV infection over all periods (HRR 0.79, 95%CI 0.70-0.89) than women who were not pregnant. There is no evidence for a difference in the rate of HIV acquisition between postpartum and non-pregnant women (HRR 0.92 95%CI 0.84-1.03).DiscussionAlthough there may be immunological reasons for increased risk of HIV acquisition during pregnancy, at a population level this study indicates a lower risk of HIV acquisition for pregnant women. Pregnant women may be more likely to be concordant with their current sexual partner than non-pregnant women, i.e. either already HIV positive prior to the pregnancy or if negative at the time of becoming pregnant more likely to have a negative partner.
- Published
- 2013
31. Is the risk of HIV acquisition increased during and immediately after pregnancy? A secondary analysis of pooled HIV community-based studies from the ALPHA network
- Author
-
Paraskevis, Dimitrios, Marston, Milly, Newell, Marie Louise, Crampin, Amelia, Lutalo, Tom, Musoke, Richard, Gregson, Simon, Nyamukapa, Constance, Nakiyingi-Miiro, Jessica, Urassa, Mark, Isingo, Raphael, and Zaba, Basia
- Subjects
virus diseases - Abstract
Background:\ud \ud Previous studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studies are unable to tell us what the overall impact of pregnancy is on HIV acquisition in the general population.\ud Methods:\ud \ud Data from six community-based HIV cohorts were pooled to give 2,628 sero-conversions and a total of 178,000 person years of observation. Multiple imputation was used to allow for the uncertainty of exact sero-conversion date in surveillance intervals greater than the length of a pregnancy. Results were combined using Rubin’s rules to give appropriate error bounds. The analysis was stratified into two periods: pre- and post- widespread availability of prevention of mother-to-child HIV transmission services. This allows us to assess whether there is reporting bias relating to a person’s knowledge of their own HIV status which would become more widespread in the latter time period.\ud Results:\ud \ud Results suggest that women while pregnant have a lower risk of acquiring HIV infection over all periods (HRR 0.79, 95%CI 0.70-0.89) than women who were not pregnant. There is no evidence for a difference in the rate of HIV acquisition between postpartum and non-pregnant women (HRR 0.92 95%CI 0.84-1.03).\ud Discussion:\ud \ud Although there may be immunological reasons for increased risk of HIV acquisition during pregnancy, at a population level this study indicates a lower risk of HIV acquisition for pregnant women. Pregnant women may be more likely to be concordant with their current sexual partner than non-pregnant women, i.e. either already HIV positive prior to the pregnancy or if negative at the time of becoming pregnant more likely to have a negative partner.
- Published
- 2013
32. Promising Perceptions, Divergent Practices and Barriers to Integrated Malaria Prevention in Wakiso District, Uganda: A Mixed Methods Study
- Author
-
Musoke, David, primary, Miiro, George, additional, Karani, George, additional, Morris, Keith, additional, Kasasa, Simon, additional, Ndejjo, Rawlance, additional, Nakiyingi-Miiro, Jessica, additional, Guwatudde, David, additional, and Musoke, Miph Boses, additional
- Published
- 2015
- Full Text
- View/download PDF
33. Recruitment and retention of women in fishing communities in HIV prevention research
- Author
-
Ssetaala, Ali, primary, Nakiyingi-Miiro, Jessica, additional, Asiimwe, Stephen, additional, Nanvubya, Annet, additional, Mpendo, Juliet, additional, Asiki, Gershim, additional, Nielsen, Leslie, additional, Kiwanuka, Noah, additional, Seeley, Janet, additional, Kamali, Anatoli, additional, and Kaleebu, Pontiano, additional
- Published
- 2015
- Full Text
- View/download PDF
34. Correction: Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy
- Author
-
Kerkhoff, Andrew D., primary, Kranzer, Katharina, additional, Samandari, Taraz, additional, Nakiyingi-Miiro, Jessica, additional, Whalen, Christopher C., additional, Harries, Anthony D., additional, and Lawn, Stephen D., additional
- Published
- 2013
- Full Text
- View/download PDF
35. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)
- Author
-
Zaba, Basia, primary, Calvert, Clara, additional, Marston, Milly, additional, Isingo, Raphael, additional, Nakiyingi-Miiro, Jessica, additional, Lutalo, Tom, additional, Crampin, Amelia, additional, Robertson, Laura, additional, Herbst, Kobus, additional, Newell, Marie-Louise, additional, Todd, Jim, additional, Byass, Peter, additional, Boerma, Ties, additional, and Ronsmans, Carine, additional
- Published
- 2013
- Full Text
- View/download PDF
36. Systematic Review of TST Responses in People Living with HIV in Under-Resourced Settings: Implications for Isoniazid Preventive Therapy
- Author
-
Kerkhoff, Andrew D., primary, Kranzer, Katharina, additional, Samandari, Taraz, additional, Nakiyingi-Miiro, Jessica, additional, Whalen, Christopher C., additional, Harries, Anthony D., additional, and Lawn, Stephen D., additional
- Published
- 2012
- Full Text
- View/download PDF
37. Effects of Cotrimoxazole on Hematologic Parameters in HIV-Infected Adults in a Community-Based Clinic in Entebbe, Uganda
- Author
-
Watera, Christine, primary, Todd, Jim, additional, Mutonyi, Gertrude, additional, Miiro, George, additional, Mpendo, Juliet, additional, Hughes, Peter, additional, Nakiyingi-Miiro, Jessica, additional, Whitworth, Jimmy, additional, and Grosskurth, Heiner, additional
- Published
- 2007
- Full Text
- View/download PDF
38. The Role of Vertical Transmission and Health Care-Related Factors in HIV Infection of Children
- Author
-
Biraro, Samuel, primary, Morison, Linda A, additional, Nakiyingi-Miiro, Jessica, additional, Whitworth, James A G, additional, and Grosskurth, Heiner, additional
- Published
- 2007
- Full Text
- View/download PDF
39. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa.
- Author
-
Marston, Milly, Slaymaker, Emma, Zaba, Basia, Todd, Jim, Crampin, Amelia, Michael, Denna, Calvert, Clara, Nakiyingi-Miiro, Jessica, Lutalo, Tom, and Herbst, Kobus
- Subjects
ANTIRETROVIRAL agents ,CONFIDENCE intervals ,HIV infections ,PUBLIC health surveillance ,REGRESSION analysis ,DEVELOPED countries - Abstract
Background: Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries.We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Methods: Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. Results: 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14-46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR-0.43, 95% CI: 0.32-0.58), compared to the period before ART was available, in mortality at ages 15-54 across all five sites. Discussion: Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
40. Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda.
- Author
-
Walque, Damien, Nakiyingi-Miiro, Jessica S., Busingye, June, and Whitworth, Jimmy A.
- Subjects
- *
HIV infections , *AIDS , *SOCIAL status , *RURAL population , *CONDOM use , *MALE contraception - Abstract
Background Previous studies have found that in Africa, a greater risk of HIV infection is often found in groups with higher educational attainment. However, some serial cross-sectional studies have found greater reductions in HIV prevalence among more educated groups, especially in cohorts of young adults. More recent studies have found some instances where higher schooling levels are associated with lower HIV prevalence. Methods We describe changes in the association between schooling levels, HIV prevalence and condom use in a rural population-based cohort between 1989/1990 and 1999/2000, in Masaka District, Uganda. Results In 1989–1990, higher educational attainment was associated with higher risk of HIV-1 infection, especially among males, but once odds ratios are adjusted for age, no significant relation between schooling and HIV infection remains. In 1999–2000, there is, for females aged 18–29 years, a significant relationship between higher educational attainment and lower HIV prevalence, even after adjustment for age, gender, marital status and wealth ( P for trend 0.01). Tests for interaction, significant for males and both genders combined, show that more schooling has been shifting towards an association with less HIV infection between 1989–1990 and 1999–2000, especially for young individuals. Condom use increased during the study period and this increase has been concentrated among more educated individuals. Conclusions These findings suggest that over a decade more educated young adults, especially females, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
41. Afri-Can Forum 2
- Author
-
Mukudu, Hillary, Martinson, Neil, Sartorius, Benn, Coetzee, Jenny, Dietrich, Janan, Mokgatswana, Kgaugelo, Jewkes, Rachel, Gray, Glenda E, Dugas, Marylène, Béhanzin, Luc, Guédou, Fernand A, Gagnon, Marie-Pierre, Alary, Michel, Rutakumwa, Rwamahe, Mbonye, Martin, Kiwanuka, Thadeus, Nakamanya, Sarah, Muhumuza, Richard, Nalukenge, Winfred, Seeley, Janet, Atujuna, Millicent, Wallace, Melissa, Brown, Ben, Bekker, Linda G, Newman, Peter A, Harryparsad, Rushil, Olivier, Abraham J, Jaspan, Heather B, Wilson, Douglas, Mkhize, Nonhlanhla, Morris, Lynn, Cianci, Gianguido, Dinh, Minh, Hope, Thomas, Passmore, Jo-Ann S, Gray, Clive M, Henrick, Bethany M, Yao, Xiao-Dan, Rosenthal, Kenneth L, Drannik, Anna G, Abimiku, Alash’le, Chanzu, Nadia, Mwanda, Walter, Oyugi, Julius, Anzala, Omu, Mbow, Moustapha, Jallow, Sabelle, Thiam, Moussa, Davis, Alberta, Diouf, Assane, Ndour, Cheikh T, Seydi, Moussa, Dieye, Tandakha N, Mboup, Souleymane, Goodier, Martin, Rilley, Eleanor, Jaye, Assan, Omange, RW., Lester, Richard T, Kimani, Joshua, Ball, T. B, Plummer, Francis A, Geraldo, Nassirou, Mastétsé, Ella G, Sossa, Jerôme C, Zannou, Marcel D, Osawe, Sophia, Okpokoro, Evaezi, Okolo, Felicia, Umaru, Stephen, Abimiku, Rebecca, Audu, Sam, Datong, Pam, Nyange, Jacquelyn, Olenja, Joyce, Mutua, Gaudensia, Jaoko, Walter, Omosa-Manyonyi, Gloria, Farah, Bashir, Khaniri, Maureen, Cockcroft, Anne, Tonkin, Kendra, Girish, Indu, Mhati, Puna, Cunningham, Ashley, Andersson, Neil, Indangasi, Jackton, Diphoko, Thabo, Gaseitsiwe, Simani, Maiswe, Victoria, Iketleng, Thato, Maruapula, Dorcas, Bedi, Keabetswe, Moyo, Sikhulile, Musonda, Rosemary, Wainberg, Mark, Makhema, Joseph, Novitsky, Vladimir, Marlink, Richard, Essex, Max, Okoboi, Stephen, Ssali, Livingstone, Kalibala, Sam, Birungi, Josephine, Egessa, Aggrey, Wangisi, Jonathan, Okullu, Lyavala J, Bakanda, Celestin, Obare, Francis, Boer, I. M S, Semvua, Hadija H, Van Den Boogaard, Jossy, Kiwango, Krisanta W, Ngowi, Kennedy M, Nieuwkerk, Pythia T, Aarnoutse, Rob E, Kiwelu, Ireen, Muro, Eva, Kibiki, Gibson S, Datiri, Ruth, Choji, Grace, Audu, Samuel, Fomsgaard, A., Karlsson, I., Jensen, K. J, Jensen, S. S, Leo-Hansen, C., Jespersen, S., Da Silva Té, D., Rodrigues, C. M, Da Silva, Z. J, Janitzek, C. M, Gerstoft, J., Kronborg, G., Daitiri, Ruth, Emily, Nyariki, Joyce, Olenja, Robert, Lorway R, Anzala, Anzala, Viljoen, Katie, Wendoh, Jerome, Kidzeru, Elvis, Karaoz, Ulas, Brodie, Eoin, Botha, Gerrit, Mulder, Nicola, Gray, Clive, Cameron, William, Stintzi, Alain, Jaspan, Heather, Levett, Paul N, Alexander, David, Gulzar, Naveed, Grewal, Prabvir S, Poon, Art F Y, Brumme, Zabrina, Harrigan, P. R, Brooks, James I, Sandstrom, Paul A, Calvez, Stryker, Sanche, Stephen E, Scott, Jamie K, Swartz, Leslie, Kagee, Ashraf, Lesch, Anthea, Kafaar, Zuhayr, De Wet, Anneliese, Smith, Tricia, Cotton, Laura, Hornschuh, Stefanie, Van Der Watt, Martin, Miller, Cari L, Gray, Glenda, Smit, Jenni, Jaggernath, Manjeetha, Ndung’u, Thumbi, Brockman, Mark, Kaida, Angela, Akolo, Maureen, Gelmon, Larry, Chitwa, Michael, Osero, Justus, Marokoane, Nobantu, Kgakole, Leagajang, Maswabi, Boikhutso, Mpofu, Neo, Ansari, Umaira, Nakinobe, Elizabeth, Miiro, George M, Zalwango, Flavia, Nakiyingi-Miiro, Jessica, Kaleebu, Potiano, Semwanga, John R, Nyanzi, Emily, Musoke, Saidat N, Miiro, George, Mbidde, Edward K, Lutalo, Tom, Kaleebu, Pontiano, Handema, Ray, Chianzu, Graham P, Diagne-Gueye, Diabou, Ndiaye, Mame K, Ndiaye, Birahim P, Traore, Ibrahima, Dia, Mamadou C, Thomas, Gilleh, Tour-Kane, Coumba, Mpendo, Juliet, Muyindike, Winnie, Kambugu, Andrew, Sebastian, Hachizovu, Ray, Handema, Mike, Chaponda, Bertin, Kabuya J, Modest, Mulenga, Janha, Omar, Amambua-Ngwa, Alfred, Nwakanma, Davis C, Jespersen, Sanne, Hønge, Bo L, Esbjörnsson, Joakim, Medina, Candida, Da Silva TÉ, David, Correira, Faustino G, Laursen, Alex L, Østergaard, Lars, Andersen, Andreas, Aaby, Peter, Erikstrup, Christian, Wejse, Christian, Dieye, Siry, Sarr, Moussa, Sy, Haby, Mbodj, Helene D, Ndiaye, Marianne, Ndiaye, Amy, Moussa, Seydi, Nyombi, Balthazar M, Shao, Elichilia R, Chilumba, Innocent B, Inyang, Bucky, Izang, Abel, Cole, Chundung, Cameron, Bill, Rosenthal, Kenneth, Seraise, Boitumelo, and Andrea-Marobela, Kerstin
- Subjects
Infectious Diseases - Abstract
Table of contents A1 Introduction to the 2nd synchronicity forum of GHRI/CHVI-funded Canadian and African HIV prevention and vaccine teams O1 Voluntary medical male circumcision for prevention of heterosexual transmission of HIV in adult males in Soweto: What do indicators and incidence rate show? Hillary Mukudu, Neil Martinson, Benn Sartorius O2 Developing a peer-led community mobilization program for sex workers in Soweto: HIV risk and demographics Jenny Coetzee, Janan Dietrich, Kgaugelo Mokgatswana, Rachel Jewkes, Glenda E. Gray O3 Salient beliefs about adherence: A qualitative survey conducted as part of the demonstration study on "treatment as prevention" (TasP) and "pre-exposure prophylaxis" (PrEP) among female sex workers (FSWS) in Cotonou, Benin Marylène Dugas, Luc Béhanzin, Fernand A. Guédou, Marie-Pierre Gagnon, Michel Alary O4 Relative perception of risk as a driver of unsafe sexual practices among key populations: Cases of fisherfolk and women and their partners involved in multiple sexual partnerships in Uganda Rwamahe Rutakumwa, Martin Mbonye, Thadeus Kiwanuka, Sarah Nakamanya, Richard Muhumuza, Winfred Nalukenge, Janet Seeley O5 Exploring the acceptability of new biomedical HIV prevention technologies among MSM, adolescents and heterosexual adults in South Africa Millicent Atujuna, Melissa Wallace, Ben Brown, Linda Gail Bekker, Peter A. Newman O6 HIV-susceptible target cells in foreskins after voluntary medical male circumcision in South Africa Rushil Harryparsad, Abraham J. Olivier, Heather B. Jaspan, Douglas Wilson, Janan Dietrich, Neil Martinson, Hillary Mukudu, Nonhlanhla Mkhize, Lynn Morris, Gianguido Cianci, Minh Dinh, Thomas Hope, Jo-Ann S. Passmore, Clive M. Gray O7 HIV-1 proteins activate innate immune responses via TLR2 heterodimers Bethany M. Henrick, Xiao-Dan Yao, Kenneth L. Rosenthal, the INFANT Study Team O8 Characterization of an innate factor in human milk and mechanisms of action against HIV-1 Bethany M. Henrick, Xiao-Dan Yao, Anna G. Drannik, Alash’le Abimiku, Kenneth L. Rosenthal, the INFANT Study Team O9 Secretor status and susceptibility to HIV infections among female sex workers in Nairobi, Kenya Nadia Chanzu, Walter Mwanda, Julius Oyugi, Omu Anzala O10 Natural Killer cell recall responsiveness to Gag-HIV-1 peptides of HIV-1 exposed but uninfected subjects are associated with peripheral CXCR6+ NK cell subsets Moustapha Mbow, Sabelle Jallow, Moussa Thiam, Alberta Davis, Assane Diouf, Cheikh T. Ndour, Moussa Seydi, Tandakha N. Dieye, Souleymane Mboup, Martin Goodier, Eleanor Rilley, Assan Jaye O11 Profiles of resistance: Local innate mucosal immunity to HIV-1 in commercial sex workers Xiao-Dan Yao, RW. Omange, Bethany M. Henrick, Richard T. Lester, Joshua Kimani, T. Blake Ball, Francis A. Plummer, Kenneth L. Rosenthal O12 Early antiretroviral therapy and pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: A demonstration project Luc Béhanzin, Fernand A. Guédou, Nassirou Geraldo, Ella Goma Mastétsé, Jerôme Charles Sossa, Marcel Djimon Zannou, Michel Alary O13 Building capacity for HIV prevention trials: Preliminary data from a Nigerian cohort of HIV exposed sero-negatives (HESN) Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Sam Audu, Pam Datong, Alash’le Abimiku O14 Equipping healthcare professionals with skills required for the conduct of clinical trials in an effort to build capacity. Lessons learned Jacquelyn Nyange, Joyce Olenja, Gaudensia Mutua, Walter Jaoko, Gloria Omosa-Manyonyi, Bashir Farah, Maureen Khaniri, Omu Anzala O15 Educational technology to support active learning for HIV researchers and planners Anne Cockcroft, Kendra Tonkin, Indu Girish, Puna Mhati, Ashley Cunningham, Neil Andersson O16 From Lake Kivu (Rwanda) and Lake Malawi (Tanzania) to the shores of Lake Victoria (Uganda): Strengthening laboratory capacity through Good Clinical Laboratory Practice training Bashir Farah, Jackton Indangasi, Walter Jaoko, Gaudensia Mutua, Maureen Khaniri, Jacquelyn Nyange, Omu Anzala O17 Rilpivirine and etravirine resistance mutations in HIV-1 subtype C infected patients on a non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy in Botswana Thabo Diphoko, Simani Gaseitsiwe, Victoria Maiswe, Thato Iketleng, Dorcas Maruapula, Keabetswe Bedi, Sikhulile Moyo, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Vladimir Novitsky, Richard Marlink, Max Essex O18 From home-based HIV testing to initiation of treatment: The AIDS Support Organization (TASO) Experience with Home-based HIV Counselling and Testing (HBHCT) among Adolescents in Uganda, 2005-2011 Stephen Okoboi, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Lyavala Joanne Okullu, Celestin Bakanda, Francis Obare41 O19 Feasibility study on using real time medication monitoring among HIV infected and Tuberculosis patients in Kilimanjaro, Tanzania I. Marion Sumari-de Boer, Hadija H. Semvua, Jossy van den Boogaard, Krisanta W. Kiwango, Kennedy M. Ngowi, Pythia T. Nieuwkerk, Rob E. Aarnoutse, Ireen Kiwelu, Eva Muro, Gibson S. Kibiki O20 Deaths still among sero-discordant cohort in Nigeria despite Access to treatment Ruth Datiri, Grace Choji, Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Samuel Audu, Pam Datong, Alash’le Abimiku O21 Therapeutic HIV-1 vaccine trials in Denmark and Guinea-Bissau Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, the WAPHIR Group O22 Willingness to participate in a HIV vaccine Trial among HIV exposed sero-negative (HESN) persons in Jos, Nigeria Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku O23 Clinical research volunteers’ perceptions and experiences of screening for enrolment at KAVI-Institute of Clinical Research, Kenya Nyariki Emily, Olenja Joyce, Lorway R. Robert, Anzala Anzala O24 Gut microbiome, HIV-exposure, and vaccine responses in South African infants Katie Viljoen, Jerome Wendoh, Elvis Kidzeru, Ulas Karaoz, Eoin Brodie, Gerrit Botha, Nicola Mulder, Clive Gray, William Cameron, Alain Stintzi, Heather Jaspan, for the INFANT study team O25 Analysis of HIV pol diversity in the concentrated HIV epidemic in Saskatchewan Paul N. Levett, David Alexander, Naveed Gulzar, Prabvir S. Grewal, Art F. Y. Poon, Zabrina Brumme, P. Richard Harrigan, James I. Brooks, Paul A. Sandstrom, Stryker Calvez, Stephen E. Sanche, Jamie K. Scott P1 Evaluating a HIV vaccine research community engagement programme at two HIV prevention research centres in the Western Cape Leslie Swartz, Ashraf Kagee, Anthea Lesch, Zuhayr Kafaar, Anneliese De Wet P2 Validating HIV acquisition risk score using a cohort HIV exposed sero-negative persons in a discordant relationship in Jos, Nigeria, West Africa Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku P3 Bridging the gap between adults and adolescents and youth adults (AYA) – Employing a youth-centred approach to investigate HIV risk among AYA in Soweto and Durban, South Africa Janan Dietrich, Tricia Smith, Laura Cotton, Stefanie Hornschuh, Martin van der Watt, Cari L. Miller, Glenda Gray, Jenni Smit, Manjeetha Jaggernath, Thumbi Ndung’u, Mark Brockman, Angela Kaida, on behalf of the AYAZAZI study teams P4 Neighbours to sex workers: A key population that has been ignored Maureen Akolo, Joshua Kimani, Prof Larry Gelmon, Michael Chitwa, Justus Osero P5 Young women’s access to structural support programmes in a district of Botswana Anne Cockcroft, Nobantu Marokoane, Leagajang Kgakole, Boikhutso Maswabi, Neo Mpofu, Umaira Ansari, Neil Andersson P6 Voices for action from peri-urban Ugandan students, teachers and parents on HIV/STI prevention: Qualitative research results Nakinobe Elizabeth, Miiro George Mukalazi, Zalwango Flavia, Nakiyingi-Miiro Jessica, Kaleebu Potiano P7 Engaging Social Media as an education tool on the fly: The use of Facebook for HIV and Ebola prevention and awareness amongst adolescents in Uganda John Ross Semwanga, Emily Nyanzi, Saidat Namuli Musoke, Elizabeth Nakinobe, George Miiro, Edward Katongole Mbidde, Tom Lutalo, Pontiano Kaleebu P8 Circulating HIV-1 subtypes among sexual minority populations in Zambia Ray Handema, Graham P. Chianzu P9 The Development of HIV Bio-bank resource management to support clinical trial and Intervention research: WAPHIR experience Moussa Thiam, Diabou Diagne-Gueye, Mame K. Ndiaye, Moustapha Mbow, Birahim P. Ndiaye, Ibrahima Traore, Mamadou C. Dia, Gilleh Thomas, Coumba Tour-Kane, Souleymane Mboup, Assan Jaye P10 Capacity building for clinical trials as a novel approach for scaling up HIV prevention research initiatives in East Africa: achievements and challenges Emily Nyanzi, Edward Katongole Mbidde, Pontiano Kaleebu, Juliet Mpendo, Joshua Kimani, Josephine Birungi, Winnie Muyindike, Andrew Kambugu P11 Community and media perspective of research; an advocacy workshop on HIV prevention research Hachizovu Sebastian, Handema Ray, Chaponda Mike, Kabuya Jean Bertin, Mulenga Modest P12 Development of a quantitative HIV-1 and HIV-2 real time PCR (qRT-PCR) viral load assay Moussa Thiam, Omar Janha, Alberta Davis, Alfred Amambua-Ngwa, Davis C. Nwakanma, Souleymane Mboup, Assan Jaye P13 Differential effects of sex in a West African Cohort of HIV-1, HIV-2 and HIV-1/2 dual infected patients: Men are worse off Sanne Jespersen, Bo Langhoff Hønge, Joakim Esbjörnsson, Candida Medina, David Da Silva TÉ, Faustino Gomes Correira, Alex Lund Laursen, Lars Østergaard, Andreas Andersen, Peter Aaby, Christian Erikstrup, Christian Wejse, for the Bissau HIV Cohort study group P14 HIV-infected adolescents in transition from pediatric to adult HIV care in Dakar, Senegal: sample characteristics and immunological and virological profiles Siry Dieye, Moussa Sarr, Haby Sy, Helene D Mbodj, Marianne Ndiaye, Amy Ndiaye, Seydi Moussa, Assan Jaye, Souleymane Mboup100 P15 Molecular characterization of vertically transmitted HIV-1 among children born to HIV-1 seropositive mothers in Northern Tanzania Balthazar M. Nyombi, Elichilia R. Shao, Innocent B. Chilumba, Sikhulile Moyo, Simani Gaseitsiwe, Rosemary Musonda P16 Breast-fed HIV-1 exposed infants play catch up. A preliminary report Pam Datong, Bucky Inyang, Sophia Osawe, Abel Izang, Chundung Cole, Felicia Okolo, Bill Cameron, Kenneth Rosenthal, Clive Gray, Heather Jaspan, Alash’le Abimiku, the INFANT study team P17 The frequency of N348I mutation in patient failing combination antiretroviral treatment In Botswana Boitumelo Seraise, Kerstin Andrea-Marobela, Sikhulile Moyo, Rosemary Musonda, Joseph Makhema, Max Essex, Simani Gaseitsiwe
- Full Text
- View/download PDF
42. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA): Data on mortality, by HIV status and stage on the HIV care continuum, among the general population in seven longitudinal studies between 1989 and 2014.
- Author
-
Slaymaker E, McLean E, Wringe A, Calvert C, Marston M, Reniers G, Kabudula CW, Crampin A, Price A, Michael D, Urassa M, Kwaro D, Sewe M, Eaton JW, Rhead R, Nakiyingi-Miiro J, Lutalo T, Nabukalu D, Herbst K, Hosegood V, and Zaba B
- Abstract
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum. This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART., Competing Interests: Competing interests: No competing interests were disclosed.
- Published
- 2017
- Full Text
- View/download PDF
43. Measuring the Impact of Antiretroviral Therapy Roll-Out on Population Level Fertility in Three African Countries.
- Author
-
Marston M, Nakiyingi-Miiro J, Hosegood V, Lutalo T, Mtenga B, and Zaba B
- Subjects
- Adolescent, Adult, Female, HIV pathogenicity, HIV Infections complications, HIV Infections virology, Humans, South Africa, Tanzania, Uganda, Anti-Retroviral Agents therapeutic use, Fertility drug effects, HIV Infections drug therapy, HIV Infections epidemiology
- Abstract
Background: UNAIDS official estimates of national HIV prevalence are based on trends observed in antenatal clinic surveillance, after adjustment for the reduced fertility of HIV positive women. Uptake of ART may impact on the fertility of HIV positive women, implying a need to re-estimate the adjustment factors used in these calculations. We analyse the effect of antiretroviral therapy (ART) provision on population-level fertility in Southern and East Africa, comparing trends in HIV infected women against the secular trends observed in uninfected women., Methods: We used fertility data from four community-based demographic and HIV surveillance sites: Kisesa (Tanzania), Masaka and Rakai (Uganda) and uMkhanyakude (South Africa). All births to women aged 15-44 years old were included in the analysis, classified by mother's age and HIV status at time of birth, and ART availability in the community. Calendar time period of data availability relative to ART Introduction varied across the sites, from 5 years prior to ART roll-out, to 9 years after. Calendar time was classified according to ART availability, grouped into pre ART, ART introduction (available in at least one health facility serving study site) and ART available (available in all designated health facilities serving study site). We used Poisson regression to calculate age adjusted fertility rate ratios over time by HIV status, and investigated the interaction between ART period and HIV status to ascertain whether trends over time were different for HIV positive and negative women., Results: Age-adjusted fertility rates declined significantly over time for HIV negative women in all four studies. However HIV positives either had no change in fertility (Masaka, Rakai) or experienced a significant increase over the same period (Kisesa, uMkhanyakude). HIV positive fertility was significantly lower than negative in both the pre ART period (age adjusted fertility rate ratio (FRR) range 0.51 95%CI 0.42-0.61 to 0.73 95%CI 0.64-0.83) and when ART was widely available (FRR range 0.57 95%CI 0.52-0.62 to 0.83 95%CI 0.78-0.87), but the difference has narrowed. The interaction terms describing the difference in trends between HIV positives and negatives are generally significant., Conclusions: Differences in fertility between HIV positive and HIV negative women are narrowing over time as ART becomes more widely available in these communities. Routine adjustment of ANC data for estimating national HIV prevalence will need to allow for the impact of treatment.
- Published
- 2016
- Full Text
- View/download PDF
44. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa.
- Author
-
Slaymaker E, Todd J, Marston M, Calvert C, Michael D, Nakiyingi-Miiro J, Crampin A, Lutalo T, Herbst K, and Zaba B
- Subjects
- Adolescent, Adult, Age Factors, Female, HIV Infections drug therapy, Humans, Longitudinal Studies, Malawi epidemiology, Male, Middle Aged, Population Surveillance, Proportional Hazards Models, Sex, South Africa epidemiology, Tanzania epidemiology, Uganda epidemiology, Young Adult, Anti-HIV Agents therapeutic use, HIV Infections mortality
- Abstract
Background: Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries. We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)., Methods: Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites., Results: 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14-46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR =0.43, 95% CI: 0.32-0.58), compared to the period before ART was available, in mortality at ages 15-54 across all five sites., Discussion: Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further.
- Published
- 2014
- Full Text
- View/download PDF
45. Short communication: HIV type 1 transmitted drug resistance and evidence of transmission clusters among recently infected antiretroviral-naive individuals from Ugandan fishing communities of Lake Victoria.
- Author
-
Nazziwa J, Njai HF, Ndembi N, Birungi J, Lyagoba F, Gershim A, Nakiyingi-Miiro J, Nielsen L, Mpendo J, Nanvubya A, Debont J, Grosskurth H, Kamali A, Seeley J, and Kaleebu P
- Subjects
- Adult, Drug Resistance, Viral genetics, Genotype, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections virology, HIV-1 genetics, Humans, Male, Molecular Sequence Data, Phylogeny, Prevalence, Uganda epidemiology, Young Adult, HIV Infections transmission, HIV-1 drug effects
- Abstract
Human immunodeficiency virus type 1 (HIV-1) prevalence and incidence in the fishing communities on Lake Victoria in Uganda are high. This population may play a role in driving the HIV epidemic in Uganda including the spread of transmitted drug resistance (TDR). We report data on TDR in this population among antiretroviral (ARV)-naive, recently infected individuals about 5 years after ARV scaling-up in Uganda. We identified phylogenetic transmission clusters and combined these with volunteer life histories in order to understand the sexual networks within this population. From a prospective cohort of 1,000 HIV-negative individuals recruited from five communities, 51 seroconverters were identified over a period of 2 years. From these, whole blood was collected and population sequencing of the HIV-1 pol gene (protease/reverse transcriptase) was performed from plasma. Drug resistance mutations (DRMs) were scored using the 2009 WHO list for surveillance of TDR. TDR prevalence categories were estimated using the WHO recommended truncated sampling technique for the surveillance of TDR for use in resource-limited settings (RLS). Of the samples 92% (47/51) were successfully genotyped. HIV-1 subtype frequencies were 15/47 (32%) A1, 20/47 (43%) D, 1/47 (2%) C, 1/47 (2%) G, and 10/47 (21%) unique recombinant forms. Nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutation K103N was identified in two individuals and V106A in one (6%) suggesting that the level of TDR was moderate in this population. No nucleoside/tide reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) DRMs were detected. In this study, we identified five transmission clusters supported by high bootstrap values and low genetic distances. Of these, one pair included the two individuals with K103N. Two of the genotypic clusters corresponded with reported sexual partnerships as detected through prior in-depth interviews. The level of TDR to NNRTIs in these ARV-naive individuals was moderate by WHO threshold survey categorization. The transmission clusters suggest a high degree of sexual partner mixing between members of these communities.
- Published
- 2013
- Full Text
- View/download PDF
46. The role of vertical transmission and health care-related factors in HIV infection of children: a community study in rural Uganda.
- Author
-
Biraro S, Morison LA, Nakiyingi-Miiro J, Whitworth JA, and Grosskurth H
- Subjects
- Blood Transfusion statistics & numerical data, Child, Child, Preschool, Cross Infection epidemiology, Female, Humans, Iatrogenic Disease epidemiology, Infant, Injections statistics & numerical data, Male, Prevalence, Statistics as Topic, Surveys and Questionnaires, Uganda epidemiology, Delivery of Health Care, HIV Infections epidemiology, HIV Infections transmission, Infectious Disease Transmission, Vertical statistics & numerical data, Rural Health
- Abstract
Objectives: To determine the probable route of transmission of HIV to children aged 12 years or younger in a rural area of Uganda from 1999 through 2000 and to examine associations between HIV infection and health care-related variables., Methods: The HIV infections status for 6991 children was determined from 1 round of an ongoing population surveillance system, and the reported numbers of injections in the past year and blood transfusions were determined for 5922 of these children based on a medical questionnaire. Data from the surveillance system and from an additional survey were used to assess the potential for vertical infection from a mother to her child., Results: The HIV prevalence among children was 0.4%. Of 23 definite and 4 probable cases of HIV infection in children, vertical transmission was not possible for 1 case, not likely for another case, and possibly not vertical for another case. The population-attributable fraction for vertical transmission was between 90% and 94%. Large numbers of injections in the past year and ever having a blood transfusion were only associated with HIV infection in children exposed to vertical transmission., Conclusions: Up to 10% of HIV infections in children in the study area were not attributable to vertical transmission, and thus were possibly attributable to iatrogenic transmission. Associations seen between health care-related variables and HIV were likely to be attributable to treatment for AIDS-related illness in children infected vertically.
- Published
- 2007
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.