Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
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| PARTNER COMMUNICATION | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | SURVEYS | SAMPLING STUDIES | FAMILY PLANNING SURVEYS | FAMILY PLANNING | PUERPERIUM | REPRODUCTION | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | CONTRACEPTION | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE AGENTS | CONTRACEPTIVE METHODS | INTERPERSONAL RELATIONS | BEHAVIOR
Document Number: 310729 Polymorphisms in IRF-1 associated with resistance to HIV-1 infection in highly exposed uninfected Kenyan sex workers. Author: Ball TB; Ji H; Kimani J; McLaren P; Marlin C Source: AIDS. 2007 May 31;21(9):1091-1101. Abstract: The objective was to determine the correlation between polymorphisms in the IL-4 gene cluster and resistance to HIV-1 infection. A cross-sectional genetic analysis of polymorphisms within the IL-4 gene cluster was conducted in a well-described female sex worker cohort from Nairobi, Kenya, known to exhibit differential susceptibility to HIV-1 infection. Microsatellite genotyping was used to screen six microsatellite markers in the IL-4 gene cluster for associations with HIV-1 resistance. Further analysis of the interferon regulatory factor 1 (IRF-1) gene was conducted by genomic sequencing. Associations between IRF-1 gene polymorphisms and the HIV-1 resistance phenotype were determined using the chi-square test and Kaplan-Meier survival analysis. The functional consequence of IRF-1 polymorphism was conducted by quantitative Western blot. Three polymorphisms in IRF-1, located at 619, the microsatellite region and 6516 of the gene, showed associations with resistance to HIV-1 infection. The 619A, 179at IRF-1 microsatellite and 6516G alleles were associated with the HIV-1-resistant phenotype and a reduced likelihood of seroconversion. Peripheral blood mononuclear cells from patients with protective IRF-1 genotypes exhibited significantly lower basal IRF-1 expression and reduced responsiveness to exogenous IFN-t stimulation. Polymorphisms in the IRF-1 gene are associated with resistance to infection by HIV-1 and a lowered level of IRF-1 protein expression. This study adds IRF-1, a transcriptional immunoregulatory gene, to the list of genetic correlates of altered susceptibility to HIV-1. This is the first report suggesting that a viral transcriptional regulator might contribute to resistance to HIV-1. Further functional analysis on the role of IRF-1 polymorphisms and HIV-1 resistance is underway. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX WORKERS | WOMEN | HIV INFECTIONS | GENETICS | LABORATORY PROCEDURES | IMMUNITY | HIV PREVENTION | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | VIRAL DISEASES | DISEASES | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | IMMUNE SYSTEM | PHYSIOLOGY Document Number: 313499 Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Author: Balley RC; Moses S; Parker CB; Agot K; Maclean I Source: Lancet. 2007 Feb 24;369(9562):643-656. Abstract: Male circumcision could provide substantial protection against acquisition of HIV-1 infection. Our aim was to determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention. We did a randomised controlled trial of 2784 men aged 18-24 years in Kisumu, Kenya. Men were randomly assigned to an intervention group (circumcision; n = 1391) or a control group (delayed circumcision, 1393), and assessed by HIV testing, medical examinations, and behavioural interviews during follow-ups at 1, 3, 6, 12, 18, and 24 months. HIV seroincidence was estimated in an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, with the number NCT00059371. The trial was stopped early on December 12, 2006, after a third interim analysis reviewed by the data and safety monitoring board. The median length of follow-up was 24 months. Follow-up for HIV status was incomplete for 240 (8.6%) participants. 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p = 0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72). Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrolment, the protective effect of circumcision was 60% (32-77). Adverse events related to the intervention (21 events in 1.5% of those circumcised) resolved quickly. No behavioural risk compensation after circumcision was observed. Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | CONTROL GROUPS | INCIDENCE | MEN | HIV TESTING | MALE CIRCUMCISION | EXAMINATIONS AND DIAGNOSES | HIV PREVENTION | PROGRAM EFFECTIVENESS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | CLINICAL RESEARCH | RESEARCH METHODOLOGY | MEASUREMENT | DEMOGRAPHIC FACTORS | POPULATION | LABORATORY EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HIV INFECTIONS | VIRAL DISEASES | DISEASES | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION Document Number: 312757 Self-reported adherence to single dose nevirapine in the prevention of mother to child transmission of HIV at Kitale District Hospital. Author: Bii SC; Otieno-Nyunya B; Siika A; Rotich JK Source: East African Medical Journal. 2007 Dec;84(12):571-576. Abstract: Objectives: To evaluate the uptake and adherence to single dose nevirapine among HIV positive mothers. Design: Descriptive cross-sectional study. Setting: The maternal and child health and family planning (MCH-FP) clinics in Kitale district hospital, Western Kenya. Subjects: HIV positive postnatal women attending MCH-FP clinic who had gone through the PMTCT programme. Results: A total of 146 respondents were recruited for this study. Most (90%) of them reported swallowing their nevirapine tablets, however only 55 swallowed their tablets within 4-12 hours before delivery. The most important factor affecting nevirapine adherence was place or delivery (p<0.05). Most (71%) of mothers who did not swallow their nevirapine delivered at home. Women attending ANC for two times or less young women under 20 years of age and single women were also less likely to swallow their nevirapine (p < 0.05). Most (91%) of the babies received their nevirapine syrup with 98% of them getting it within 72 hours of delivery. Eighty eight percent of babies who did not take their nevirapine were delivered at home. Babies whose mothers did not take their nevirapine were also more likely to miss it. Conclusions: Self reported adherence to take home nevirapine is high. However mothers who deliver in a health facility were more likely to access nevirapine both for themselves and their babies than those delivering at home. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | INFANT | ANTIRETROVIRAL DRUGS | USER COMPLIANCE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | ANTENATAL CARE | AGE FACTORS | CHILDBIRTH | TIME FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | YOUTH | TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | BEHAVIOR | DISEASE TRANSMISSION CONTROL | PREVENTION AND CONTROL | MATERNAL HEALTH SERVICES | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE | PREGNANCY OUTCOMES | PREGNANCY | REPRODUCTION | POPULATION DYNAMICS Document Number: 325870 Correlation of CD4 counts and CD4 / CD8 ratio with HIV-infection associated oral manifestations. Author: Butt FM; Vaghela VP; Chindia ML Source: East African Medical Journal. 2007 Aug;84(8):383-388. Abstract: Background: The relationship between oral lesions arising from HIV infection and CD4/CD8 cell ratios is of relevance in clinical assessment of immune suppression. Objective: To correlate the prevalence of oral manifestations arising from HIV infection and the levels of CD4/CD8 cell ratios. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi, Kenya. Subjects: Two hundred and seven HIV-infected patients in medical wards were recruited in the study. Results: Seventy eight (37.7%) were male and 129 (62.3%) female, with an age range of 18-73 years (mean = 34.81 years). Oral manifestations encountered with highest prevalence in the oral cavity included: hyperplastic candidosis (labial mucosa) 15%, erythematous candidosis (gingival) 5%, angular cheilitis 32.4%, herpes simplex(corner of the mouth) 0.5%, persistent oral ulceration (labial mucosa) 0.5%, Parotid enlargement 2% and Kaposi's sarcoma (hard/soft palate) 2.9%. Conclusion: The prevalence of oral manifestations was higher with low CD4 count <200 cell/mm3 and mean CD4/CD8<0.39(95%CI 0.32-0.48). (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | CLIENTS | HIV POSITIVE PERSONS | ORAL EFFECTS | BACTERIAL AND FUNGAL DISEASES | HIV INFECTIONS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS | | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | Document Number: 308881 Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections. Author: Chersich MF; Luchters SM; Malonza IM; Mwarogo P; King’ola N Source: International Journal of STD and AIDS. 2007 Nov;18(11):764-769. Abstract: This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (>/= 5 alcoholic drinks on >/= 1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR) = 1.59, 95% confidence interval [CI] = 1.00-2.53; P = 0.047) and sexual violence (AOR = 1.85, 95% CI = 1.27-2.71; P = 0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR = 1.56, 95% CI = 1.00-2.41; P = 0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%; P < 0.001), but was not associated with drinking patterns. Interventions are needed to assist female sex workers adopt safer drinking patterns. Investigation is needed for the effectiveness of such interventions in reducing unprotected sex, sexual violence and sexually transmitted infections. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SEX WORKERS | WOMEN | ALCOHOL USE AND ABUSE | SOCIOECONOMIC FACTORS | SEX BEHAVIOR | RISK BEHAVIOR | VIOLENCE | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | ECONOMIC FACTORS | VIRAL DISEASES | DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS Document Number: 321629 Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya. Author: Cohen CR; Nosek M; Meier A; Astete SG; Iverson-Cabral S Source: Sexually Transmitted Diseases. 2007 May;34(5):274-279. Abstract: The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya. Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction. At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5- 4.0), GC (HR = 2.0; 95% CI =1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and greater than or equal to 7 months, respectively. The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | SEX WORKERS | WOMEN | SEXUALLY TRANSMITTED DISEASES | UROGENITAL EFFECTS | PREVALENCE | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | DISEASES | UROGENITAL SYSTEM | PHYSIOLOGY | BIOLOGY | MEASUREMENT Document Number: 313478 Infectious correlates of HIV-1 shedding in the female upper and lower genital tracts. Author: Coleman JS; Hitti J; Bukusi EA; Mwachari C; Muliro A Source: AIDS. 2007 Mar 30;21(6):755-759. Abstract: The objectives were to determine the effects of vaginal, cervical, and endometrial infections on shedding of HIV-1 RNA in the female genital tract. Design: Cross-sectional. Antiretroviral-naive women from Nairobi, Kenya with CD4 cell counts >/= 350 cells/microliter had plasma and endocervical wick samples collected for HIV quantification by real-time RNA reverse transcriptase-polymerase chain reaction. Vaginal and cervical Gram stains and endometrial biopsies were obtained. Vaginal Gram stain was used to diagnose bacterial vaginosis and to quantify Lactobacillus levels. Twenty-six of 50 (52%) women had detectable endocervical HIV-1 RNA with a median endocervical viral load of 1760 copies/ml (range: undetectable to 1 030 000 copies/ml). Women with decreased Lactobacillus had 15.8-fold [95% confidenceinterval (CI), 2.0-123] greater endocervical HIV-1 RNA than women with normal Lactobacillus levels. Women with plasma cell (PC) endometritis [>/= 1 PC/ high-power field (hpf)] had a 15.8-fold (95% CI, 2.0-120) higher endocervical HIV RNA level than women without PC endometritis. Both these associations remained after controlling for plasma viral load. Cervicitis (>/= 30 polymorphonuclear leukocytes/hpf), however, was not associated with endocervical HIV-1 RNA shedding (P=0.81). In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | HIV POSITIVE PERSONS | IMMUNITY, CELLULAR | LABORATORY PROCEDURES | GENITAL EFFECTS, FEMALE | ENDOMETRITIS | VAGINOSIS | PELVIC INFLAMMATORY DISEASE | SEXUALLY TRANSMITTED DISEASES | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | GENITALIA, FEMALE | GENITALIA | UROGENITAL SYSTEM | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | VAGINAL ABNORMALITIES |