Vuong T.,Family Health International FHI |
Ali R.,University of Adelaide |
Baldwin S.,Family Health International FHI |
Mills S.,Family Health International FHI
International Journal of Drug Policy | Year: 2012
Background: Driven by the rapid spread of HIV, Vietnam's response to drug use has undergone significant transformation in the past decade. This paper seeks to identify and analyse factors that prompted these changes and to investigate their impact on the lives of people who use drugs. Method: This policy analysis is based on a review of Vietnamese Government documents, peer-reviewed publications and the authors' knowledge of and involvement in drug policy in Vietnam. Results: The last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions. However, HIV prevalence among drug users at 31.5% remains high due to limited access to effective interventions and impediments caused by the compulsory treatment centre system. Conclusions: The twin epidemics of HIV and illicit drug use have commanded high-level political attention in Vietnam. Significant policy changes have allowed the implementation of HIV prevention and drug dependence treatment services. Nevertheless, inconsistencies between policies and a continued commitment to compulsory treatment centres remain as major impediments to the provision of effective services to drug users. It is critical that Vietnamese government agencies recognise the social and health consequences of policy conflicts and acknowledge the relative ineffectiveness of centre-based compulsory treatment. In order to facilitate practical changes, the roles of the three ministries directly charged with HIV and illicit drug use need to be harmonised to ensure common goals. The participation of civil society in the policymaking process should also be encouraged. Finally, stronger links between local evidence, policy and practice would increase the impact on HIV prevention and drug addiction treatment programming. © 2011 Elsevier B.V.
Schwartz J.L.,Eastern Virginia Medical School |
Rountree W.,Family Health International FHI |
Rountree W.,Duke Human Vaccine Institute |
Kashuba A.D.M.,University of North Carolina at Chapel Hill |
And 5 more authors.
PLoS ONE | Year: 2011
Background: Tenofovir (TFV) gel is being evaluated as a microbicide with pericoital and daily regimens. To inhibit viral replication locally, an adequate concentration in the genital tract is critical. Methods and Findings: Forty-nine participants entered a two-phase study: single-dose (SD) and multi-dose (MD), were randomized to collection of genital tract samples (endocervical cells [ECC], cervicovaginal aspirate and vaginal biopsies) at one of seven time points [0.5, 1, 2, 4, 6, 8, or 24 hr(s)] post-dose following SD exposure of 4 mL 1% TFV gel and received a single dose. Forty-seven were randomized to once (QD) or twice daily (BID) dosing for 2 weeks and to collection of genital tract samples at 4, 8 or 24 hrs after the final dose, but two discontinued prior to gel application. Blood was collected during both phases at the seven times post-dose. TFV exposure was low in blood plasma for SD and MD; median C max was 4.0 and 3.4 ng/mL, respectively (C≤29 ng/mL). TFV concentrations were high in aspirates and tissue after SD and MD, ranging from 1.2×10 4 to 9.9×10 6 ng/mL and 2.1×10 2 to 1.4×10 6 ng/mL, respectively, and did not noticeably differ between proximal and distal tissue. TFV diphosphate (TFV-DP), the intracellular active metabolite, was high in ECC, ranging from 7.1×10 3 to 8.8×10 6 ng/mL. TFV-DP was detectable in approximately 40% of the tissue samples, ranging from 1.8×10 2 to 3.5×10 4 ng/mL. AUC for tissue TFV-DP was two logs higher after MD compared to SD, with no noticeable differences when comparing QD and BID. Conclusions: Single-dose and multiple-dose TFV gel exposure resulted in high genital tract concentrations for at least 24 hours post-dose with minimal systemic absorption. These results support further study of TFV gel for HIV prevention. Trial registration: ClinicalTrials.gov NCT00561496. © 2011 Schwartz et al.
von Mollendorf C.E.,University of Witwatersrand |
Van Damme Lut.,Family Health International FHI |
Moyes J.A.,University of Witwatersrand |
Rees V.H.,University of Witwatersrand |
And 5 more authors.
Contraception | Year: 2010
Background: New strategies are needed for preventing HIV infection in women. One potential approach is female-initiated use of an effective topical microbicidal gel in combination with a cervical barrier such as the diaphragm. Study design: Randomized, placebo-controlled safety and feasibility trial of diaphragm with vaginal gel during 6 months of use among 120 HIV-negative sexually active women in Johannesburg, South Africa. Results: Pelvic event rates were 338.3 and 247.1 per 100 women-years in the ACIDFORM gel (plus diaphragm) and K-Y® Jelly (plus diaphragm) groups, respectively, with a rate ratio of 1.37 (95% CI: 0.89-2.11). Most women found diaphragm with gel use acceptable. Conclusion: There was a trend towards more safety events in the ACIDFORM plus diaphragm group, although no primary comparisons achieved statistical significance. Adding an effective microbicidal gel to a mechanical barrier may still prove to be an important and acceptable combination method to help prevent pregnancy and HIV/sexually transmitted infection transmission. © 2010 Elsevier Inc. All rights reserved.
Joanis C.,Family Health International FHI |
Beksinska M.,University of Witwatersrand |
Hart C.,Family Health International FHI |
Tweedy K.,Family Health International FHI |
And 2 more authors.
Contraception | Year: 2011
Background: The widespread distribution of female condoms (FCs) in developing countries has been hindered by high unit cost, making new less expensive devices a priority for donor agencies. Study Design: Randomized, crossover study assessing product preference, safety, acceptability and function of three new FCs (PATH Woman's Condom, FC2 and V-Amour) among 170 women in Durban, South Africa. A subsequent "simulated market" study provided participants with free choice of FCs and assessed condom uptake over 3 months. Results: Of the 160 women who used at least one FC of each type, 47.5% preferred the PATH Woman's Condom (WC), 35.6% preferred FC2 and 16.3% preferred V-Amour (p<.001). Women rated the WC better than FC2 and V-Amour for appearance, ease of use and overall fit and better than V-Amour for feel. WC was rated worse than FC2 and V-Amour for lubrication volume. The simulated market demonstrated similar preferences. Total clinical failure rates (i.e., the types of failures that could result in pregnancy or STI) were low (<4%), regardless of condom type. Conclusions: Three new FC types functioned similarly and were generally acceptable. Most participants preferred WC and FC2 over V-Amour, and WC was preferred over FC2 in several acceptability measures. © 2011 Published by Elsevier Inc.
Tuan N.T.,Johns Hopkins Global Center on Childhood Obesity |
Tuan N.T.,Family Health International FHI |
Wang Y.,Johns Hopkins Global Center on Childhood Obesity |
Wang Y.,State University of New York at Buffalo
Obesity | Year: 2014
Objectives To evaluate performance of anthropometric measures relative to percentage body fat (%BF) measured by dual-energy X-ray absorptiometry in children. Methods Data from 8 to 19-year-old U.S. children enrolled in a nationally representative cross-sectional survey in 2001-2004 (n=5,355) with measured %BF, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and triceps skinfold thickness (TSF) were used. Agreement and prediction were evaluated based on standardized regression coefficients (β), kappa, and the area under the receiver-operating characteristic curves (AUC). Results The association between Z-scores for %BF and anthropometric measures was strong (β of ∼0.75-0.90, kappa of ∼0.60-0.75, and AUC of ∼0.87-0.98; P < 0.001 for all), with only some variations by race-ethnicity, mostly in girls. In boys, TSF and WHtR Z-scores had stronger agreement with %BF than BMI (β of 0.91 and 0.86 vs. 0.79, kappa of 0.75 and 0.71 vs. 0.59, and AUC of 0.97 and 0.97 vs. 0.91; P < 0.05 for all). In boys with BMI
Karim Q.A.,Center for the Program of Research in South Africa |
Karim Q.A.,Columbia University |
Karim S.S.A.,Center for the Program of Research in South Africa |
Karim S.S.A.,Columbia University |
And 15 more authors.
Science | Year: 2010
The Centre for the AIDS Program of Research in South Africa (CAPRISA) 004 trial assessed the effectiveness and safety of a 1% vaginal gel formulation of tenofovir, a nucleotide reverse transcriptase inhibitor, for the prevention of HIV acquisition in women. A double-blind, randomized controlled trial was conducted comparing tenofovir gel (n = 445 women) with placebo gel (n = 444 women) in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural KwaZulu-Natal, South Africa. HIV serostatus, safety, sexual behavior, and gel and condom use were assessed at monthly follow-up visits for 30 months. HIV incidence in the tenofovir gel arm was 5.6 per 100 women-years (person time of study observation) (38 out of 680.6 women-years) compared with 9.1 per 100 women-years (60 out of 660.7 women-years) in the placebo gel arm (incidence rate ratio = 0.61; P = 0.017). In high adherers (gel adherence > 80%), HIV incidence was 54% lower (P = 0.025) in the tenofovir gel arm. In intermediate adherers (gel adherence 50 to 80%) and low adherers (gel adherence < 50%), the HIV incidence reduction was 38 and 28%, respectively. Tenofovir gel reduced HIV acquisition by an estimated 39% overall, and by 54% in women with high gel adherence. No increase in the overall adverse event rates was observed. There were no changes in viral load and no tenofovir resistance in HIV seroconverters. Tenofovir gel could potentially fill an important HIV prevention gap, especially for women unable to successfully negotiate mutual monogamy or condom use.
Barua P.,Regional Medical Research Center |
Mahanta J.,Regional Medical Research Center |
Medhi G.K.,Regional Medical Research Center |
Dale J.,National AIDS Research Institute NARI |
And 2 more authors.
Indian Journal of Medical Research, Supplement | Year: 2012
Background & objectives: Female sex workers (FSWs) of north-east India form a unique group as they are exposed to an enormous injecting drug user (IDU) clientele. This association makes them more vulnerable to blood borne viral infections. Over and above some of them also indulge in drug injecting practices along with their partners. The present study was carried out on FSWs to assess the prevalence of hepatitis C virus (HCV) infection and possibility of sexual transmission of HCV and associated risk factors among them. Methods: A sample of 426 FSWs was recruited cross-sectionally using respondent driven sampling methods. Univariate and multivariate logistic regression analysis was carried out to determine the factors associated with HCV infection. Results: The seroprevalence of HCV among 426 FSWs was 9.6 per cent, antibody to HIV was present in 13.4 per cent, 4.9 per cent were co-infected with HIV and HCV. Seroprevalence of HCV among participants without history of injecting drugs use, tattooing or blood transfusion was 7.5 per cent. An increased risk of HCV seropositivity was associated with history of injecting drug use (OR 10.41, CI 4.30-25.22), use of oral drugs (OR 4.7, CI 2.4-9.08), having sexual partners who were injecting drug users (OR 2.9, CI 1.5-5.6), having live-in relationship (OR 7.1, CI 1.59-31.52), HIV seropositivity (OR 10.18, CI 5.05-20.54) and HSV-2 seropositivity (OR 2.86, CI 1.45-5.43) in univariate analysis. In the multivariate analysis, history of injecting drug use, HIV and HSV-2 seropositivity were found to be significantly associated with HCV seropositivity. Interpretation & conclusion: Although acquisition of HCV by sexual route may not be as efficient as parenteral route, yet sexual transmissibility of HCV among FSWs poses high risk to the community.
Kouanda S.,Institute Of Recherche En Science Of La Sante |
Meda I.B.,Institute Of Recherche En Science Of La Sante |
Nikiema L.,Institute Of Recherche En Science Of La Sante |
Tiendrebeogo S.,Institute Of Recherche En Science Of La Sante |
And 7 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2012
In this study, we investigated the causes of death and the factors associated with mortality in a cohort of patients receiving highly active antiretroviral therapy (HAART) in Burkina Faso, an African country with limited resources. This retrospective cohort study included patients aged 15 years and older who started HAART for the first time between January 2003 and December 2008 in 14 health districts. We used survival analyses, including the Kaplan-Meier method, to examine potential predictors of death and two Cox proportional hazard models to estimate hazard ratios for death, first from baseline covariates and then from time-dependent covariates. A total of 6641 patients initiated HAART during this period; of these, 5608 were included in the analysis. By the end of the study period, 4310 of those patients were still receiving HAART, 690 had died, 207 had been transferred and 401 were lost to follow-up. The median duration of follow-up was 23.2 months [interquartile range (IQR): 12.4-36.9], and the overall incidence of mortality was 6 per 100 person-years. The clinical stage, CD4 count, body mass index (BMI), haemoglobin level, HAART regimen, gender, age, profession and year of initiation were the primary risk factors associated with death. In the multivariate analysis, BMI, clinical stage, treatment regimen and CD4 count remained significantly associated with death. The most frequent causes of death were wasting syndrome, tuberculosis and anaemia. This result highlights the already advanced stage of immunodeficiency among patients in Burkina Faso when they start HAART. Testing patients for HIV and starting antiretroviral therapy earlier are necessary to further reduce the mortality of patients living with HIV. This study provides a solid evidence base with which future evaluations of HAART in Burkina Faso can be compared. © 2012 Copyright Taylor and Francis Group, LLC.
Medhi G.K.,Regional Medical Research Center |
Mahanta J.,Regional Medical Research Center |
Adhikary R.,Family Health International FHI |
Akoijam B.S.,Regional Institute of Medical Science |
And 4 more authors.
BMC Public Health | Year: 2011
Background: Injecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. We have assessed the spatial distribution of locations where injecting drug users (IDU) congregate, as well as the risk behaviour and key characteristics of IDUs to develop new strategies strengthening intervention measures for HIV prevention in this region. Methods. Locations of IDUs congregation for buying and injecting drugs were identified through Key Informants (KI). Verification of the location and its characteristics were confirmed through field visits. We also conducted semi-structured and structured interviews with IDUs to learn more about their injecting behaviour and other characteristics. Results: Altogether, 2462 IDU locations were identified in 5 states. The number of IDU locations was found to be greater in the states bordering Myanmar. Private houses, parks, abandoned buildings, pharmacies, graveyards, and isolated places were the most frequently chosen place for injecting drugs. Many injecting locations were visited by IDUs of varying ages, of which about 10-20% of locations were for females. In some locations, female IDUs were also involved in sex work. Sharing of needle and syringes was reported in all the states by large proportion of IDUs, mainly with close friends. However, even sharing with strangers was not uncommon. Needle and syringes were mainly procured from pharmacies, drug peddlers and friends. Lack of access to free sterile needles and syringes, and inconsistent supplies from intervention programs, were often given as the cause of sharing or re-use of needles and syringes by IDUs. Most of the IDUs described a negative attitude of the community towards them. Conclusion: We highlight the injection of drugs as a problem in 5 Northeastern India states where this is the major driving force of an HIV epidemic. Also highlighted are the large numbers of females that are unrecognized as IDUs and the association between drug use and sex work. Understanding of risk behaviours and other key charecteristics of IDUs in the region will help in strengthening harm reduction efforts that can prevent HIV transmission. © 2011 Medhi et al; licensee BioMed Central Ltd.
Okello F.O.,Family Health International FHI |
Kidane A.,Family Health International FHI |
Wube M.,Family Health International FHI
Health Policy and Planning | Year: 2013
Poverty and limited availability of health facilities are major barriers to health care in resource-poor countries. For people living with HIV (PLHIV), these factors are compounded by social stigma and decreased mobility, making delivery of public health services a greater challenge. In 2003, the international development organization FHI (formerly known as Family Health International and now known as FHI 360) collaborated with the Ethiopian government, local non-governmental organizations and traditional burial societies (Idirs) to implement community and home-based care interventions for PLHIV in Addis Ababa and 13 other major cities. Programme activities included capacity building, care and support, stigma reduction, resource mobilization, support of orphans and vulnerable children, and income generation through community savings and loans groups. Programme results from 2003 to 2010 were evaluated using a quasi-experimental design with an intervention group (PLHIV who received community and home-based care programme services) and a control group (PLHIV who did not receive programme interventions). Propensity score matching was used to select matched intervention and control pairs for analysis. McNemar and Wilcoxon signed-ranks tests were used to determine outcomes and impact. Findings from routine monitoring data and a population survey showed that individuals who received the integrated community and home-based care services from Idirs reported significantly more savings, better social relations, more independence and better environments for PLHIV. Programme clients were also shown to have known their HIV status longer than the control respondents. However, a higher percentage of control respondents reported not having had an opportunistic infection in the past 6 months. We conclude that volunteer-based community organizations can be empowered to deliver and sustain health interventions for PLHIV. We also conclude that targeting the multiple needs of PLHIV enables holistic improvements in the quality of life and socio-economic conditions of PLHIV. © The Author 2012; all rights reserved.