Family Health International 360

Addis Ababa, Ethiopia

Family Health International 360

Addis Ababa, Ethiopia

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PubMed | Family Health International 360, Mahidol University, Erasmus University Rotterdam and National Center for Parasitology
Type: | Journal: Malaria journal | Year: 2016

Treatment of the sub-clinical reservoir of malaria, which may maintain transmission, could be an important component of elimination strategies. The reliable detection of asymptomatic infections with low levels of parasitaemia requires high-volume quantitative polymerase chain reaction (uPCR), which is impractical to conduct on a large scale. It is unknown to what extent sub-clinical parasitaemias originate from recent or older clinical episodes. This study explored the association between clinical history of malaria and subsequent sub-clinical parasitaemia.In June 2013 a cross-sectional survey was conducted in three villages in Pailin, western Cambodia. Demographic and epidemiological data and blood samples were collected. Blood was tested for malaria by high-volume qPCR. Positive samples were analysed by nested PCR to determine the Plasmodium species. To identify previous episodes of malaria, case records were collected from village malaria workers and local health facilities and linked to study participants.Among 1343 participants, 40/122 (32.8%) with a history of clinical malaria were parasitaemic during the cross-sectional survey, compared to 172/1221 (14.1%) without this history (p<0.001). Among the 212 parasitaemic participants in the survey, 40 (18.9%) had a history of clinical malaria, compared to 87 out of 1131 (7.7%) parasite-negative participants; p<0.001, adjusted OR 3.3 (95% CI; 2.1-5.1). A history of Plasmodium vivax was associated with sub-clinical P. vivax parasitaemia in the survey (p<0.001), but this association was not seen with Plasmodium falciparum (p=0.253); only three participants had both P. falciparum parasites in the survey and a clinical history of P. falciparum.A clinical episode of vivax malaria was associated with subsequent sub-clinical parasitaemia. Treatment of P. vivax with artemisinin-based combination therapy without primaquine often resulted in recurrent episodes. Targeting individuals with a history of clinical malaria will be insufficient to eliminate the sub-clinical reservoir as they constitute a minority of parasitaemias.


Vuylsteke B.,Institute of Tropical Medicine | Semde G.,Family Health International 360 | Auld A.F.,Centers for Disease Control and Prevention | Sabatier J.,Centers for Disease Control and Prevention | And 3 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: Antiretroviral therapy (ART) for HIV-infected sex workers is an important HIV prevention strategy. However, sex workers may have additional challenges for retention in ART care. The objectives of this study were to assess retention of sex workers on ART in a routine setting in Ivory Coast and identify risk factors for loss to follow-up (LTFU). Methods: The design was a retrospective cohort study. An analysis of clinic files was conducted in 2 sites providing ART services to sex workers in Ivory Coast. Demographic, behavior, and clinical data of female and male sex workers on ART were abstracted onto a standardized anonymous data collection form. Data collection took place between May 11 and 28, 2010. Results: A total of 376 female and 38 male sex workers were included in the analysis. The retention probability was 75% at 6 months, 68% at 12 months, 55% at 24 months, and 47% at 36 months. Attrition was mainly because of LTFU. Factors significantly associated with LTFU in bivariate analysis were lower schooling level, later calendar year of starting ART, and not receiving initial adherence counseling. Later year of starting ART and not receiving adherence counseling at ART initiation remained significantly associated with LTFU in a multivariate Cox regression model. Conclusions: To improve the retention of sex workers on ART, there is a need for more in-depth investigation of the role of pre-ART counseling and the increasing rates of LTFU with each calendar year. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Aho J.,Institute of Tropical Medicine | Hakim A.,Centers for Disease Control and Prevention | Vuylsteke B.,Institute of Tropical Medicine | Semde G.,Family Health International 360 | And 4 more authors.
PLoS ONE | Year: 2014

Men who have sex with men (MSM) are at high risk of HIV. Few data are available on MSM and HIV-related risk behaviors in West Africa. We aimed to describe risk behaviors and vulnerability among MSM in Abidjan, Cote d'Ivoire. We conducted a cross-sectional respondent-driven sampling survey with 601 MSM in 2011-2012. Sociodemographic and behavioural data as well as data related to emotional state and stigma were collected. Population estimates with 95% confidence intervals were produced. Survey weighted logistic regression was used to assess factors associated with inconsistent condom use in the prior 12 months. Most MSM were 24 years of age or younger (63.9%) and had attained at least primary education (84.4%). HIV risk behaviors such as low condom and water-based lubricant use, high numbers of male and female sex partners, and sex work were frequently reported as well as verbal, physical and sexual abuse. Inconsistent condom use during anal sex with a male partner in the prior 12 months was reported by 66.0% of the MSM and was positively associated with history of forced sex, alcohol consumption, having a regular partner and a casual partner, having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit multiple and frequent HIV-related risk behaviors. To address those behaviours, a combination of individual but also structural interventions will be needed given the context of stigma, homophobia and violence. © 2014 Aho et al.


Mine M.,Botswana Harvard Reference Laboratory | Chishala S.,Botswana Harvard Reference Laboratory | Makhaola K.,Botswana Harvard Reference Laboratory | Tafuma T.A.,Care Ministry of Health | And 2 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

The study assessed the performance of rapid HIV testing with whole blood using Kehua Bio-engineering HIV (1 + 2) and Uni-Gold HIV test kits by trained and certified lay counselors, offered to female sex workers and men who have sex with men during the 2012 survey fieldwork. The results of rapid HIV testing were compared with enzyme-linked immunosorbent assay testing performed in a parallel algorithm at the HIV Reference Laboratory. The sensitivity and the specificity of rapid HIV testing were high for men who have sex with men and female sex workers, with 98.1% and 100%, and 98.2% and 98.5%, respectively. Misclassifications occurred with rapid testing. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Fred Hutchinson Cancer Research Center, Family Health International 360, Johns Hopkins University, National Institute of Allergy and Infectious Diseases and 3 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016

Tenofovir (TFV) gel partially protected against human immunodeficiency virus (HIV) in one but not subsequent trials. The disappointing results were attributed largely to poor adherence. However, timing of gel application relative to sex may impact pharmacokinetics and contribute to outcomes. Thus, we conducted a single-dose pharmacokinetic study of TFV gel applied 1 or 24 hours before or 1 hour before and 1 hour after (BAT) sex and compared results with dosing without sex.Twenty-four couples were enrolled; cervicovaginal lavage (CVL) and tissue were collected 2 hours after sex with matching timed collections at no sex visits and assayed for drug concentrations and CVL anti-HIV activity.Compared with dosing without sex, median TFV concentrations after sex decreased 72% and 78% (P < .001) in CVL, 75% and 71% (P < .001) in vaginal tissue, and 75% (P = .06) and 55% (P < .001) in cervical tissue with -1 hour and -24 hour dosing, respectively. Median concentration of TFV-diphosphate also decreased significantly in cervical tissue with -1 hour, dosing. BAT dosing resulted in drug levels at least as great as those in the absence of sex. Percent inhibition of HIV infection by post-coital CVL increased significantly from median (interquartile range) of 55% (54%) in the absence of gel to 99% (7%), 77% (57%), and 100% (0.4%) with -1 hour, -24 hour, or BAT dosing, respectively, and correlated significantly with drug concentration.Timing of TFV gel application relative to sex significantly impacts drug levels. BAT dosing or sustained delivery may be optimal for preexposure prophylaxis.


PubMed | University of Western Ontario, Family Health International 360, Makerere University, University of Alabama at Birmingham and 3 more.
Type: | Journal: EBioMedicine | Year: 2016

Long-term natural history cohorts of HIV-1 in the absence of treatment provide the best measure of virulence by different viral subtypes.Newly HIV infected Ugandan and Zimbabwean women (N=303) were recruited and monitored for clinical, social, behavioral, immunological and viral parameters for 3 to 9.5years.Ugandan and Zimbabwean women infected with HIV-1 subtype C had 2.5-fold slower rates of CD4 T-cell declines and higher frequencies of long-term non-progression than those infected with subtype A or D (GEE model, P<0.001), a difference not associated with any other clinical parameters. Relative replicative fitness and entry efficiency of HIV-1 variants directly correlated with virulence in the patients, subtype D>A>C (P<0.001, ANOVA).HIV-1 subtype C was less virulent than either A or D in humans; the latter being the most virulent. Longer periods of asymptomatic HIV-1 subtype C could explain the continued expansion and dominance of subtype C in the global epidemic.


Nguyen H.T.,National Institute of Hygiene and Epidemiology | Tran A.V.,Hanoi Medical University | Nguyen N.B.,National Institute of Hygiene and Epidemiology | Nguyen S.H.,Hanoi Medical University | And 4 more authors.
American Journal of Public Health | Year: 2015

Objectives: We implemented an intervention to reduce drug use in an urban commune in northern Vietnam. Methods: We encouraged the intervention commune to accept responsibility for developing their own intervention strategies based on a community mobilization model used in southern, rural China. We selected a comparison commune, which had demographic characteristics and a drug history similar to the intervention commune. The 2-year incidence of new drug users was estimated retrospectively in the intervention and comparison communes between baseline (2003) and follow-up (2009). Results: Increased incidence of new (noninjecting) drug users between 2003 and 2009 in the intervention commune was lower than that in the comparison commune, and these participants expressed more positive attitudes toward local authority and people with drug use and HIV/AIDS. Increased condom use during last intercourse with female sex workers and with female casual partners was observed in the intervention commune. HIV prevalence and positive opioid tests decreased more in the intervention commune. Conclusions: Our results suggested that the community mobilization had a positive influence in the intervention commune.


Crede S.,University of Cape Town | Hoke T.,Family Health International 360 | Constant D.,University of Cape Town | Green M.S.,Family Health International 360 | And 2 more authors.
BMC Public Health | Year: 2012

Background. The prevention of unintended pregnancies among HIV positive women is a neglected strategy in the fight against HIV/AIDS. Women who want to avoid unintended pregnancies can do this by using a modern contraceptive method. Contraceptive choice, in particular the use of long acting and permanent methods (LAPMs), is poorly understood among HIV-positive women. This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the IUD and female sterilization by HIV-status in a high HIV prevalence setting, Cape Town, South Africa. Methods. A quantitative cross-sectional survey was conducted using an interviewer- administered questionnaire amongst 265 HIV positive and 273 HIV-negative postpartum women in Cape Town. Contraceptive use, reproductive history and the future fertility intentions of postpartum women were compared using chi-squared tests, Wilcoxon rank-sum and Fisher's exact tests where appropriate. Women's knowledge and attitudes towards long acting and permanent methods as well as factors that influence women's choice in contraception were examined. Results. The majority of women reported that their most recent pregnancy was unplanned (61.6% HIV positive and 63.2% HIV negative). Current use of contraception was high with no difference by HIV status (89.8% HIV positive and 89% HIV negative). Most women were using short acting methods, primarily the 3-monthly injectable (Depo Provera). Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using long acting and permanent methods, all of whom were using sterilization; however, it was found that poor knowledge regarding LAPMs is likely to be contributing to the poor uptake of these methods. Conclusions. Improving contraceptive counselling to include LAPM and strengthening services for these methods are warranted in this setting for all women regardless of HIV status. These study results confirm that strategies focusing on increasing users' knowledge about LAPM are needed to encourage uptake of these methods and to meet women's needs for an expanded range of contraceptives which will aid in preventing unintended pregnancies. Given that HIV positive women were found to be more favourable to future use of the IUD it is possible that there may be more uptake of the IUD amongst these women. © 2012 Credé et al; licensee BioMed Central Ltd.


Mauck C.K.,CONRAD | Weiner D.H.,Family Health International 360 | Lai J.J.,Family Health International 360 | Schwartz J.L.,CONRAD
Sexually Transmitted Diseases | Year: 2012

Background: Colposcopy is used to evaluate vaginal microbicides, but its link to risk of HIV is unknown. This reanalysis of 9 safety studies determined the impact of omitting colposcopy on the number of findings detected and assessed whether colposcopy was useful in identifying nonoxynol-9 (N-9) as an unsafe product in one study. Methods: Product-related findings seen with naked eye and colposcopy or by colposcopy alone were evaluated. Using data from one study, the ratio of findings in N-9 users to those in hydroxyethylcellulose (HEC) users was compared for findings seen by naked eye and colposcopy versus findings detected only by colposcopy. Results: Of the 403 finding observations in the 9 studies, 173 (43%) would have been missed without colposcopy. Data from the N-9/HEC study showed that without colposcopy, there would have been 7 times as many observations in the N-9 group as in the HEC group (63 vs. 9). With colposcopy, the N-9/HEC ratio was 13:9 or 1.4. Considering epithelial integrity, finding type, and size showed similar patterns, except that among the smallest findings (<5 mm), the N-9/HEC ratio was 1.2 by naked eye and nearly the same at 1.4 by colposcopy. Conclusion: Colposcopy was not helpful in identifying an unsafe product: the conclusions reached using naked eye examination alone were more alarming regarding the safety of N-9 than reached by including colposcopy. Recommendations include: (1) naked eye examinations should be continued in microbicide studies; (2) colposcopy may be considered for early studies, such as first-in-human studies, but has no place in large studies; and (3) colposcopy should be replaced as soon as possible with a more objective validated biomarker of HIV risk. © 2012 American Sexually Transmitted Diseases Association All rights reserved.


PubMed | Family Health International 360 and Mahakali Zonal Hospital
Type: Journal Article | Journal: Kathmandu University medical journal (KUMJ) | Year: 2016

Background Being the most backward region, The Far Western Development Region has high illiteracy rate, low socioeconomic status and high migration rate contributing the progression of epidemiological status of Human Immunodeficiency Virus (HIV) towards generalized form. Objective To study the demographic profile of the HIV positive patients, along with their CD4 status and tuberculosis during diagnosis. Method A retrospective descriptive study carried out from May 2006 to July 2012 in 271 HIV patients registered in HIV clinic of Mahakali Zonal Hospital, Mahendranagar. Result Among 271 patients enrolled, 48.30% (131) were male and 51.7% (140) were females. Thirty seven (13.7%) were less than 15 years and 76.3% (207) were of age 16-45 years. 38.7% were household workers by occupation and 34.50% were involved in agriculture and 3.70%were migrant labour. At the time of presentation, 22.4% (60) were stage I according to WHO staging and 18.5% (50), 58.5 (158) and 0.7% (2) were of stage II, III and IV respectively. Similarly, 33.0% (89) had more than 350 CD4 count at the time of presentation. 20.8% (56) of patients were infected with tuberculosis. Among 236 families, 2 or more members were found to be affected in 24 families. In most of the cases, female were diagnosed first followed by male in the families, where both the couple were infected. Conclusion Most of the HIV infected patients were of productive age group. Majority of patients were uneducated and Tuberculosis was found to be common opportunistic infections associated with HIV infection.

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