1) The study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for microbicide trials by determining HIV prevalence and incidence.
2) HIV prevalence was 24% in Madibeng and 22% in Mbekweni. Estimated HIV incidence rates were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni.
3) Pregnancy incidence rates were 4.8/100 person-years in Madibeng and 7.0/100 person-years in Mbekweni. Genital symptoms were very common.
4) The
This study evaluated the suitability of populations of sexually active women in Madibeng, North-West Province and Mbekweni, Western Cape, South Africa for microbicide trials by determining HIV prevalence and incidence.
The study found an HIV prevalence of 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months in the cohort studies were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Incidence rates estimated by cross-sectional BED testing were similar. Pregnancy incidence rates were also determined.
Nearly all participants expressed a willingness to participate
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas measured HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
This document summarizes key information from an HIV & Global Health Rounds presentation on updates from the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020). The presentation covered the global HIV epidemic, contraception and prevention, treatment as prevention, pre-exposure prophylaxis (PrEP), and HIV vaccines. Highlights included findings from the ECHO contraceptive study showing no increased HIV risk from various contraceptives, modest reductions in HIV incidence from universal test and treat trials, long-term efficacy and safety data from the DISCOVER PrEP trial, and the failure of the HVTN 702 vaccine trial to show efficacy.
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Testing for Acute HIV and Early Initiation of ARTHopkinsCFAR
This document summarizes evidence from several studies on testing for acute HIV infection and initiating antiretroviral therapy (ART) on the same day as diagnosis. It discusses the optimal window for initiating ART after infection to restore immune function based on a study showing greater probability of achieving CD4 counts over 900 if starting ART within 4 months of infection. It also summarizes results from randomized controlled trials and observational studies demonstrating that rapid/same-day ART initiation improves linkage to care, ART initiation rates, and viral suppression compared to standard of care with initiation delayed by weeks or months.
This document provides an overview of the President's Emergency Plan for AIDS Relief (PEPFAR) program, including its goals, strategies, and challenges. PEPFAR aims to control the HIV/AIDS epidemic through strategies like testing and treatment (95-95-95 goals), focusing on high-risk populations and geographic hotspots, and strengthening HIV testing services. However, PEPFAR faces ongoing challenges like ensuring accurate HIV testing and achieving viral suppression targets among youth. The document discusses ongoing efforts to address weaknesses in HIV testing practices and increase testing quality through proficiency testing, monitoring, and training.
This study evaluated the suitability of populations of sexually active women in Madibeng, North-West Province and Mbekweni, Western Cape, South Africa for microbicide trials by determining HIV prevalence and incidence.
The study found an HIV prevalence of 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months in the cohort studies were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Incidence rates estimated by cross-sectional BED testing were similar. Pregnancy incidence rates were also determined.
Nearly all participants expressed a willingness to participate
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas measured HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
This document summarizes key information from an HIV & Global Health Rounds presentation on updates from the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020). The presentation covered the global HIV epidemic, contraception and prevention, treatment as prevention, pre-exposure prophylaxis (PrEP), and HIV vaccines. Highlights included findings from the ECHO contraceptive study showing no increased HIV risk from various contraceptives, modest reductions in HIV incidence from universal test and treat trials, long-term efficacy and safety data from the DISCOVER PrEP trial, and the failure of the HVTN 702 vaccine trial to show efficacy.
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Testing for Acute HIV and Early Initiation of ARTHopkinsCFAR
This document summarizes evidence from several studies on testing for acute HIV infection and initiating antiretroviral therapy (ART) on the same day as diagnosis. It discusses the optimal window for initiating ART after infection to restore immune function based on a study showing greater probability of achieving CD4 counts over 900 if starting ART within 4 months of infection. It also summarizes results from randomized controlled trials and observational studies demonstrating that rapid/same-day ART initiation improves linkage to care, ART initiation rates, and viral suppression compared to standard of care with initiation delayed by weeks or months.
This document provides an overview of the President's Emergency Plan for AIDS Relief (PEPFAR) program, including its goals, strategies, and challenges. PEPFAR aims to control the HIV/AIDS epidemic through strategies like testing and treatment (95-95-95 goals), focusing on high-risk populations and geographic hotspots, and strengthening HIV testing services. However, PEPFAR faces ongoing challenges like ensuring accurate HIV testing and achieving viral suppression targets among youth. The document discusses ongoing efforts to address weaknesses in HIV testing practices and increase testing quality through proficiency testing, monitoring, and training.
This document summarizes a presentation on new and investigational antiretrovirals given at the UC San Diego HIV & Global Health Rounds. The presentation reviewed fostemsavir, cabotegravir/rilpivirine, leronlimab, islatravir, and lenacapavir. For each drug, the presenter discussed indications, dosing, efficacy and safety data from clinical trials, resistance profiles, and potential advantages and limitations. The goal of the HIV & Global Health Rounds is to provide clinicians and researchers with the most up-to-date information on HIV, hepatitis, tuberculosis, and other infectious diseases.
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
There are more than 1 million new cases of curable STIs every day, according to new WHO data. Across four diseases — chlamydia, gonorrhea, trichomoniasis, and syphilis — this translates to nearly 380 million cases globally every year. Researchers looked through studies between 2009 and 2016 to estimate the prevalence of these STIs in those aged 15-49 and found that of these four diseases, trichomoniasis was most common in women while chlamydia was most common in men. Trichomoniasis also accounted for the majority of the STIs worldwide, followed by chlamydia, gonorrhea, and syphilis. And compared to 2012 estimates, rates of trichomoniasis in women have increased, while chlamydia incidence has decreased. The prevalence of gonorrhea has increased in men, while the other three diseases have remained stable.
Global HIV cohort studies among IDU and future vaccine trialsThira Woratanarat
The author reviewed data on the global HIV epidemic among injecting drug users (IDUs) and identified potential cohorts of IDUs that could participate in future HIV vaccine trials. High HIV prevalence rates were observed among IDUs in many countries in Asia, Eastern Europe, Latin America, and parts of Africa and North America. Several cohort studies also showed high HIV incidence rates among IDUs in China, Thailand, Canada, and Spain. These findings emphasize the seriousness of the IDU epidemic globally and the potential for IDU cohorts to participate in HIV vaccine trials due to demonstrated high participation and retention rates in past studies.
This document discusses HIV drug resistance monitoring in Indonesia. It provides background on the HIV epidemic in Indonesia, noting the first reported case in 1980 and rapid increase between 1990-2010. It describes the scale up of antiretroviral therapy (ART) starting in 2004-2005. It also discusses the establishment of the National Working Group on HIV Drug Resistance in 2005 and their key activities of monitoring early warning indicators and conducting HIV drug resistance surveys. Results of various drug resistance monitoring activities from 2004-2014 are presented, finding levels of transmitted drug resistance below 5%. Future plans for 2016-2019 include expanding early warning indicator monitoring, conducting additional drug resistance monitoring and surveys, and achieving WHO accreditation for the national HIV drug resistance genotyping
Случаи и разногласия по ВИЧ в 2019 году: европейские перспективы / Cases and...hivlifeinfo
Learn unique perspectives across Europe on PrEP, rapid ART initiation, ART in women, and options for switching ART.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.33 MB
Released: July 10, 2019
01 Setswe~Hiv Prevention Where Is The Evidence Of Interventions That WorkNicholas Jacobs
The document summarizes evidence for HIV prevention interventions that work. It discusses biomedical interventions like male circumcision, HAART, and PMTCT that have good evidence of effectiveness ranging from 60-98% based on randomized controlled trials. It also reviews behavioral interventions like HIV counseling and testing, the Stepping Stones program, and structural interventions like microfinance combined with gender training, finding some have promising evidence of effectiveness while evidence is limited or lacking for others.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
Rotavirus vaccines in India - Whats new in 2021 Gaurav Gupta
This document provides information on Rotavirus gastroenteritis (RVGE) and rotavirus vaccines in India, with a focus on vaccine 116E. It discusses how RVGE is a major cause of childhood diarrhea and mortality in India. It summarizes clinical trial results showing the 116E vaccine is effective at preventing severe RVGE, has a good safety profile with no increased risk of intussusception compared to other vaccines, and provides broad protection against circulating rotavirus strains in India. Phase 3 and 4 trials demonstrated 116E is well-tolerated and effective in preventing severe RVGE in Indian children when administered in a 3-dose schedule.
The Role of Connected Diagnostics in Strengthening Regional, National and Con...SystemOne
Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality – and not
the lack of surveillance systems or networks – that prevented the global community from acting earlier in response to the Ebola outbreak in 2014–2016. The new field of ‘connected diagnostics’ is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response.
This article details how the intervention of ‘connected diagnostics’ could solve the primary underlying failure in existing surveillance systems – the lack of accurate and timely data – to enable
difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent
and automated data feed while still maintaining country privacy and controls.
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
A study on clinical presentation and various risk factors associated with pht...IjcmsdrJournal
Background: Tuberculosis is one of the most ancient infectious diseases caused by Mycobacterium tuberculosis. The population most affected is the young and economically productive one. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under nutrition, lack of education, and last but not the least lack of awareness of cause of illness.
Aims and Objectives:
1. To study the clinical presentation of tuberculosis in patients.
2. To study various risk factors of tuberculosis.
Material and Methods: This study was conducted at selected designated microscopic centre (DMCs) Kanpur Nagar district has a population of 45.73lakh ( Census 2011).All the patients who were registered in the selected DMCs in the last one month of the year 2016 ( between April and May) were taken into consideration for the present study. Data was collected on predesigned and pretested questionnaire using direct personal interview method of patients at DMCs on the DOTS days of the week i.e Monday, Wednesday and Friday. Informed consent of the study subjects was taken before interview. A total of 105 registered patients were interviewed personally and also the treatment card of patients was obtained from their respective DMCs.
Results: Out of 105 cases of tuberculosis which reported at DMCs maximum no. of patients belongs to age group between 21-40 yrs of age group (58%). Majority of cases were married (65.7%) cases. (62%) cases were Hindu by religion and (58%) belongs to other backward caste. In the study we found majority of patient was illiterate (34.3%). Most common clinical presentation was cough, fever and cough with expectoration, anorexia was reported in (61.9 %) of cases (77%) were cigarette/bidi smokers, 60% were tobacco chewer. Diabetes was reported in (12.4%) cases and (3.8%) cases were HIV positive.
The documents discuss HIV/AIDS issues in Pakistan. The first describes an HIV/AIDS prevention and control program in Sindh province that has made progress but still has gaps. It recommends strategies for implementation at provincial and national levels. The second discusses a study that found high needlestick injury rates and HBV/HCV infection prevalence among operating room personnel, indicating a need for improved vaccination and safety measures. The third reports HBV and HCV infection in many hepatocellular carcinoma cases in Pakistan, suggesting viral causes. It recommends screening and prevention strategies. The last outlines urbanization, migration, exploitation, and drug use as factors enabling HIV's spread in Pakistan.
This study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for participation in microbicide trials by determining HIV prevalence and incidence. The study found HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Genital symptoms were very common. The populations were found to be suitable for microbicide trials if HIV incidence remains sufficiently high over time.
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas then determined HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years, respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
Hiv &ictc seminar by Dr. Mousumi Sarkarmrikara185
India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
This document summarizes a presentation on new and investigational antiretrovirals given at the UC San Diego HIV & Global Health Rounds. The presentation reviewed fostemsavir, cabotegravir/rilpivirine, leronlimab, islatravir, and lenacapavir. For each drug, the presenter discussed indications, dosing, efficacy and safety data from clinical trials, resistance profiles, and potential advantages and limitations. The goal of the HIV & Global Health Rounds is to provide clinicians and researchers with the most up-to-date information on HIV, hepatitis, tuberculosis, and other infectious diseases.
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
There are more than 1 million new cases of curable STIs every day, according to new WHO data. Across four diseases — chlamydia, gonorrhea, trichomoniasis, and syphilis — this translates to nearly 380 million cases globally every year. Researchers looked through studies between 2009 and 2016 to estimate the prevalence of these STIs in those aged 15-49 and found that of these four diseases, trichomoniasis was most common in women while chlamydia was most common in men. Trichomoniasis also accounted for the majority of the STIs worldwide, followed by chlamydia, gonorrhea, and syphilis. And compared to 2012 estimates, rates of trichomoniasis in women have increased, while chlamydia incidence has decreased. The prevalence of gonorrhea has increased in men, while the other three diseases have remained stable.
Global HIV cohort studies among IDU and future vaccine trialsThira Woratanarat
The author reviewed data on the global HIV epidemic among injecting drug users (IDUs) and identified potential cohorts of IDUs that could participate in future HIV vaccine trials. High HIV prevalence rates were observed among IDUs in many countries in Asia, Eastern Europe, Latin America, and parts of Africa and North America. Several cohort studies also showed high HIV incidence rates among IDUs in China, Thailand, Canada, and Spain. These findings emphasize the seriousness of the IDU epidemic globally and the potential for IDU cohorts to participate in HIV vaccine trials due to demonstrated high participation and retention rates in past studies.
This document discusses HIV drug resistance monitoring in Indonesia. It provides background on the HIV epidemic in Indonesia, noting the first reported case in 1980 and rapid increase between 1990-2010. It describes the scale up of antiretroviral therapy (ART) starting in 2004-2005. It also discusses the establishment of the National Working Group on HIV Drug Resistance in 2005 and their key activities of monitoring early warning indicators and conducting HIV drug resistance surveys. Results of various drug resistance monitoring activities from 2004-2014 are presented, finding levels of transmitted drug resistance below 5%. Future plans for 2016-2019 include expanding early warning indicator monitoring, conducting additional drug resistance monitoring and surveys, and achieving WHO accreditation for the national HIV drug resistance genotyping
Случаи и разногласия по ВИЧ в 2019 году: европейские перспективы / Cases and...hivlifeinfo
Learn unique perspectives across Europe on PrEP, rapid ART initiation, ART in women, and options for switching ART.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.33 MB
Released: July 10, 2019
01 Setswe~Hiv Prevention Where Is The Evidence Of Interventions That WorkNicholas Jacobs
The document summarizes evidence for HIV prevention interventions that work. It discusses biomedical interventions like male circumcision, HAART, and PMTCT that have good evidence of effectiveness ranging from 60-98% based on randomized controlled trials. It also reviews behavioral interventions like HIV counseling and testing, the Stepping Stones program, and structural interventions like microfinance combined with gender training, finding some have promising evidence of effectiveness while evidence is limited or lacking for others.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
Rotavirus vaccines in India - Whats new in 2021 Gaurav Gupta
This document provides information on Rotavirus gastroenteritis (RVGE) and rotavirus vaccines in India, with a focus on vaccine 116E. It discusses how RVGE is a major cause of childhood diarrhea and mortality in India. It summarizes clinical trial results showing the 116E vaccine is effective at preventing severe RVGE, has a good safety profile with no increased risk of intussusception compared to other vaccines, and provides broad protection against circulating rotavirus strains in India. Phase 3 and 4 trials demonstrated 116E is well-tolerated and effective in preventing severe RVGE in Indian children when administered in a 3-dose schedule.
The Role of Connected Diagnostics in Strengthening Regional, National and Con...SystemOne
Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality – and not
the lack of surveillance systems or networks – that prevented the global community from acting earlier in response to the Ebola outbreak in 2014–2016. The new field of ‘connected diagnostics’ is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response.
This article details how the intervention of ‘connected diagnostics’ could solve the primary underlying failure in existing surveillance systems – the lack of accurate and timely data – to enable
difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent
and automated data feed while still maintaining country privacy and controls.
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
A study on clinical presentation and various risk factors associated with pht...IjcmsdrJournal
Background: Tuberculosis is one of the most ancient infectious diseases caused by Mycobacterium tuberculosis. The population most affected is the young and economically productive one. The social factors include poor quality of life, poor housing, overcrowding, population explosion, under nutrition, lack of education, and last but not the least lack of awareness of cause of illness.
Aims and Objectives:
1. To study the clinical presentation of tuberculosis in patients.
2. To study various risk factors of tuberculosis.
Material and Methods: This study was conducted at selected designated microscopic centre (DMCs) Kanpur Nagar district has a population of 45.73lakh ( Census 2011).All the patients who were registered in the selected DMCs in the last one month of the year 2016 ( between April and May) were taken into consideration for the present study. Data was collected on predesigned and pretested questionnaire using direct personal interview method of patients at DMCs on the DOTS days of the week i.e Monday, Wednesday and Friday. Informed consent of the study subjects was taken before interview. A total of 105 registered patients were interviewed personally and also the treatment card of patients was obtained from their respective DMCs.
Results: Out of 105 cases of tuberculosis which reported at DMCs maximum no. of patients belongs to age group between 21-40 yrs of age group (58%). Majority of cases were married (65.7%) cases. (62%) cases were Hindu by religion and (58%) belongs to other backward caste. In the study we found majority of patient was illiterate (34.3%). Most common clinical presentation was cough, fever and cough with expectoration, anorexia was reported in (61.9 %) of cases (77%) were cigarette/bidi smokers, 60% were tobacco chewer. Diabetes was reported in (12.4%) cases and (3.8%) cases were HIV positive.
The documents discuss HIV/AIDS issues in Pakistan. The first describes an HIV/AIDS prevention and control program in Sindh province that has made progress but still has gaps. It recommends strategies for implementation at provincial and national levels. The second discusses a study that found high needlestick injury rates and HBV/HCV infection prevalence among operating room personnel, indicating a need for improved vaccination and safety measures. The third reports HBV and HCV infection in many hepatocellular carcinoma cases in Pakistan, suggesting viral causes. It recommends screening and prevention strategies. The last outlines urbanization, migration, exploitation, and drug use as factors enabling HIV's spread in Pakistan.
This study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for participation in microbicide trials by determining HIV prevalence and incidence. The study found HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Genital symptoms were very common. The populations were found to be suitable for microbicide trials if HIV incidence remains sufficiently high over time.
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas then determined HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years, respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
Hiv &ictc seminar by Dr. Mousumi Sarkarmrikara185
India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
Factors Associated with Human Papilloma Virus Vaccine Uptake amongst Girls Ag...PUBLISHERJOURNAL
Human papillomavirus (HPV) infection is a sexually transmitted infection. HPV vaccine since its first licensure in 2006 has proven to be safe, highly immunogenic, and induces strong direct and indirect protection against HPV and its sequelae. The study was designed to determine the socio-demographic, health care, and parental factors associated with human papillomavirus vaccine uptake amongst girls aged 9-14 years. The study was a cross-sectional study employing a simple random sampling method and a total of 364 girls were interviewed following the set criteria using questionnaire data. Data were cleaned, coded, and analyzed using SPSS version 22.0. Findings were presented as frequencies, percentages, odd ratios, and p-values using univariate, bivariate, and multivariate analysis. From the study, statistically significant sociodemographic factors such as age (p=0.0000), schooling status (p=0.0000), level of education (p=0.007442), attitudes towards the HPV vaccine (p=0.005175), Receiving vaccine doses from different vaccination sites (p=0.0000), and Ethnicity (p=0.0000), healthcare factors such as outreaches in communities (p=0.0000), information received (p=0.0000), encouragement from health workers (p=0.0000), availability of vaccines (p=0.0000) and parental factors such as knowledge about HPV vaccine(p=0.001), parental hesitancy (p<0.001), level of education (p=0.0000), social economic status (p=0.001), attitudes towards HPV vaccine, (p=0.0000) and HPV vaccine awareness (p=0.0000) were found statistically associated with HPV vaccine uptake amongst girls aged 9-14 years. From the study findings, the study variables such as sociodemographic, and health-related factors were found to be statistically associated with HPV vaccine uptake amongst girls aged 9-14 years. Therefore, effort should be brought to all levels of intervention so that HPV uptake is taken into consideration if the need for good health among girls needs to be achieved.
Keywords: Human papillomavirus virus, sexually transmitted infection, Health care, HPV vaccine, Cancer.
This study analyzed data from over 18,000 pregnant women tested for HIV between 2005-2012 at a hospital in southern Odisha, India. The overall HIV prevalence was 0.66%, declining from 1.53% in 2006 to 0.34% in 2012. Most HIV-positive women were aged 25-29, married, from rural areas with low education/socioeconomic status. The declining prevalence suggests prevention campaigns promoting condom use and safe sexual behaviors are having a positive impact.
This study examined the relationship between knowledge of HIV transmission and prevention and HIV counselling and testing uptake among young people in Nigeria. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [2]. Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputing them into SPSS v21.0 for analysis [4] and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that the cognitive factors of knowledge of HIV prevention and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. It was among others recommended that stakeholders, authorities, and providers of health services in Nigeria should strive to increase the rate of HCT uptake among young people ages 15 to 24 years.
MRC/info4africa KZN Community Forum | May 2012info4africa
Dr Shay Ganesh, Clinical Manager at medical Research Council in the HIV Prevention, Treatment and Wellness Unit presented on local and global HIV prevention efforts, focusing on previous, current and future programmes. Dr Ganesh looked towards Pre-Exposure Prophylaxis as a possible future prevention programme and gave some insight into possible programmatic and public health challenges involved in rolling out new HIV prevention programmes.
Awareness, Approach and Practice of Youth towards preclusion of Sexually Tran...PUBLISHERJOURNAL
Awareness, Approach and Practice of Youth towards preclusion of Sexually Transmitted Infections at KIU-TH, Ishaka Bushenyi District
Ahura, Alex
Department of Nursing Science, Kampala International University, Uganda.
________________________________________
ABSTRACT
Sexually Transmitted Infections (STIs) remains a serious reproductive health problem globally. Despite this fact, youths recklessly involve in sexual activities which predisposes them to STIs which could rather be easily preventable. Therefore, the aim of this study was to evaluate the knowledge, attitude and practice of youths aged 19–24 towards prevention of STIs at KIU-TH in Ishaka Bushenyi district, Uganda. The study was a descriptive cross-sectional and quantitative methods were employed in data collection. Fifty respondents both male and female were selected using a convenient sampling method. Most respondents 30 (60%) were between 19 – 20 years, 30(60%) were students and 30(60%) were single. Knowledge towards prevention of STIs was good as majority 50(100%) understood the term STIs, 25(50%) knew HIV infection as an STIs, 50(100%) knew about transmission of STIs, 30(60%) had been sensitized and health educated about STIs prevention and majority knew condom use 30(60%) as one of the ways of preventing STIs. Attitudes were fair as majority 40(80%) believed that STIs can be dangerous and majority 40(80%) felt they could prevent STIs. Practice was poor as majority had 1-2 partners, 30(60%) and majority had their first partner at 15-17 years old 30(60%), majority of the respondents took alcohol 35(70%), majority 37(74%) reported teenage involvement in sexual relationship and 35(70%) reported alcohol as one of the most leading factors into sexual relationships, majority 33(66%) did not take precautions during sexual intercourse only 18(36%) used condoms. The study found out adequate knowledge towards STIs prevention and attitudes were fair but practices were poor.
Keywords: knowledge, attitude, practice, youth, sexually transmitted infections, Uganda
1. The document discusses anal cancer prevention in HIV patients, including the epidemiology of anal cancer, current screening guidelines, and treatment options.
2. Rates of anal cancer are increasing, especially among HIV-positive men who have sex with men, due to higher rates of HPV infection. Screening is recommended for high-risk groups but guidelines are based on expert opinion rather than evidence.
3. Screening involves anal cytology and visual inspection, with follow up such as high resolution anoscopy for abnormal results. Treatment options depend on the grade of anal dysplasia or cancer found. Vaccination and condoms may help reduce HPV transmission and anal cancer risk.
A study was conducted on HIV counseling and testing clients at an integrated counseling and testing center in a tertiary hospital in Odisha, India between 2009-2012. Of the 22,897 clients tested, 1732 (7.5%) tested positive for HIV. Most of the HIV-positive clients were males between 15-49 years old. Client-initiated testing identified more HIV-positive clients than provider-initiated testing. The majority of HIV transmission was found to be through heterosexual contact. There was a need found to increase HIV counseling and testing activities to diagnose more cases of HIV infection.
Genotypes and Associated Risk Levels of Human Papilloma Virus among Female Pa...IIJSRJournal
Background: Human papillomavirus is the main factor in the etiology of cervical cancer, with over 99.7% of cases being associated with high-risk human papillomavirus infection. Although the majority of HPV infections are asymptomatic and self-limiting, persistent HPV infection can result in genital warts, oropharyngeal cancer, and cervical cancer in women, in addition to various anogenital malignancies and other genital warts in both men and women.
Method: This was a cross-sectional descriptive study which employed a convenience sampling technique where both qualitative and quantitative methods were used for data collection. A total of 374 participants were enrolled in the study and a semi structured questionnaire was administered to collect socio-demographic, reproductive and sexual history data. Laboratory analysis involved detection of HPV DNA hybrids with a chemiluminescent substrate, Digene Hybrid Capture 2 technology. Descriptive and inferential (logistic regression) analyses at level of significant (α=0.05) were used to summarize the data, and results illustrated using charts and tables.
Results: The study findings reported a significant risk level of human papillomavirus among female of age group 40-49 years (AOR; 0.15, 95% CI: 0.03-0.79; p = 0.026). Furthermore, in bivariate logistic regression the circulating HPV genotypes among the respondents was significantly characterized among women of the same age group (95% CI; 0.09-0.7; p = 0.008) as well as in the multivariate regression (AOR = 0.13; 95% CI: 0.02-0.72; p = 0.019).
Conclusion: The study thus concluded that there is 23/94 (25.67%) risk of developing cervical cancer due to high risk level HPV (with the presence of low risk level HPV 71/94 (74.33%) known for causing various forms of warts. Therefore, there is need for combined efforts from the Ministry of health and stakeholders to avail and train health care workers on the usage of HPV DNA kits to ensure timely detection of low and high-risk levels HPV. This will ensure timely identification of women at increased risk for the development of cervical cancer, thereby reducing mortality rate.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...JohnJulie1
This study aimed to determine the prevalence of HPV infection in women in the Lekoumou and Niari departments of Congo Brazzaville. The researchers collected samples from 100 women aged 16-73 and tested them for HPV. They found an overall HPV prevalence of 29%. Certain demographic factors like age, education level, marital status, age of first intercourse, number of sexual partners and parity did not show statistically significant associations with HPV infection status. The study provides baseline data on HPV prevalence in the region that can inform future cervical cancer prevention efforts.
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...NainaAnon
This study aimed to determine the prevalence of HPV infection in women in the Lekoumou and Niari departments of Congo Brazzaville. The researchers collected samples from 100 women aged 16-73 and tested them for HPV. They found an overall HPV prevalence of 29%, with the highest rates (58.3%) in women over 50. No significant associations were found between HPV infection and factors like education level, age of first intercourse, number of sexual partners, or number of pregnancies. The study provides baseline data on HPV prevalence in these regions of Congo to help guide cervical cancer prevention efforts.
Clinics of Oncology | Oncology Journals | Open Access JournaEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury
Prevalence of Hpv Infection in the Lekoumou and Niari Departments (Congo Braz...daranisaha
This study aimed to determine the prevalence of HPV infection in women in the Lekoumou and Niari departments of Congo Brazzaville. The researchers collected samples from 100 women aged 16-73 and tested them for HPV. They found an overall HPV prevalence of 29%, with the highest rates (58.3%) in women over 50. No significant associations were found between HPV infection and factors like education level, age of first intercourse, number of sexual partners, or number of pregnancies. The study concludes that HPV is relatively common in this region and understanding its prevalence is important for cervical cancer prevention efforts.
This document provides an overview of various techniques used in biotechnology and molecular biology to study DNA, including X-ray crystallography, chromatography, electrophoresis, ultracentrifugation, UV spectroscopy, restriction enzymes, DNA cloning, sequencing, probes, Southern blotting, and polymerase chain reaction. These techniques have contributed to understanding the structure of DNA and sequencing the human genome, enabling research on genetic diseases.
Radiopharmacy involves the compounding and dispensing of radioactive materials for use in nuclear medicine procedures. Radiopharmaceuticals are radioactive drugs used for diagnostic or therapeutic purposes. They consist of radioactive isotopes attached to other molecules to allow for localization within the body. Radiopharmaceuticals are prepared following stringent quality control procedures to ensure safety, purity and sterility prior to administration. Effective shielding is also required to protect personnel from radiation exposure during preparation and handling.
The document provides an outline for lectures on pharmaceutical dosage form processing. It will cover general introduction to manufacturing processes, formulation assessment, analytical method development, formulation development, good manufacturing practices, and drug product stability. Key aspects of preformulation are also summarized, including characterizing organoleptic properties, purity, particle size and shape, solubilization using surfactants, and preformulation stability studies. Manufacturing processes involve transforming raw materials into finished products through various treatment, machining, and reshaping steps while ensuring quality.
Colloids have many important applications in pharmaceuticals, food, and industry. Pharmaceutical applications include using colloids for drug delivery and therapy, as well as coating tablets for protection and controlled release. Colloids are also important in food products like milk, butter, and ice cream. Industrial uses involve non-drip paints, sewage treatment, clarifying water, and in artificial kidney machines.
This document discusses polymers and their applications in drug delivery. It begins by defining polymers as large molecules composed of repeating monomer units. The document then covers different types of polymers based on their structure and properties, including thermoplastics, thermosets, and elastomers. It also addresses various polymerization methods and classifications. The document discusses mechanisms of drug release from polymers, including diffusion, degradation, and swelling. It provides examples of controlled drug delivery applications using polymers, such as transdermal patches, implants, and biodegradable systems. In closing, it emphasizes the benefits of biodegradable polymers for localized, sustained drug delivery with reduced side effects.
This document discusses different types and design considerations for sedimentation processes used in water and wastewater treatment to remove solids via gravity settling. It describes four types of settling (discrete, flocculent, zone, and compression) and compares design parameters for discrete and flocculent settling. The document outlines batch settling tests and analyses, including determining zone settling velocity and its relationship to solids concentration. It provides details on designing zone settling tanks, including mass balances and limiting flux analyses to size tanks and select operating parameters like underflow rate.
Lyophilization, also known as freeze drying, is a process used to remove water from materials while preserving their structure. It involves freezing the material and then reducing pressure to allow the frozen water to sublimate from the solid to gas phase. The process is carried out below the triple point of water to enable sublimation of ice. Freeze drying has applications in the food and pharmaceutical industries as it can preserve thermolabile compounds and materials by removing water while retaining quality.
This document provides an overview of heat transfer and related topics. It discusses the three methods of heat transfer: convection, conduction, and radiation. It also covers factors that affect heat transfer like temperature and thermal resistance. The document outlines course contents on heat transfer equipment, fired process equipment, and combustion of fuels. It provides details on topics like heat exchangers, boilers, burners, and methods of heat exchange.
Extraction theory involves removing soluble materials from insolids using liquid solvents. Liquid-liquid extraction is a useful method to separate components of a mixture based on differences in solubility between solvents. For example, sugar can be extracted from vegetable oil by shaking the mixture with water, as sugar is more soluble in water than oil. The partition coefficient K quantifies differences in solubility, with some compounds made more water-soluble by conversion to ionic salt forms using acid or base treatment. This allows separation of organic acid/base mixtures based on differing solubility properties.
This document discusses various processes by which water changes phase from liquid to gas, including evaporation, transpiration, and sublimation. It provides details on the factors that control evaporation rates, such as energy inputs, temperature, humidity, wind, and water availability. It explains the differences between potential evapotranspiration (PET) and actual evapotranspiration (AET). Transpiration from plants and how it is affected by various environmental factors is also covered. Common methods for measuring and estimating evaporation and evapotranspiration are presented.
Distillation is a process used to separate mixtures based on differences in their boiling points. It involves heating the mixture until it vaporizes, then cooling the vapors until they condense. There are several types of distillation processes. Simple distillation is used to purify liquids. Fractional distillation separates mixtures with components of different boiling points. Steam distillation is used for mixtures containing water. Vacuum distillation allows distillation of substances that decompose at their normal boiling points. Destructive distillation involves decomposition during heating.
This document provides an overview of crystallization as a separation and purification technique. It discusses key concepts such as crystallization, nucleation, crystal growth, and factors that affect crystallization. Specifically, it describes three steps of crystallization from solution: induction of supersaturation through methods like cooling, solvent evaporation, or adiabatic evaporation; nucleation through Miers' theory; and crystal growth which depends on concentration, temperature, and velocity gradients. It also discusses methods of controlling crystal size and factors that influence the crystallization process like temperature, impurities, and agitation.
This document discusses coagulation and flocculation processes. It defines key terms like coagulation and flocculation. It also poses questions to prompt a detailed explanation of the processes, examples of their applications, and potential topics for group discussion including further explaining the processes with examples and applications.
This document discusses the importance and process of mixing in pharmaceutical manufacturing. It makes several key points:
1) Mixing is required in most pharmaceutical products to ensure uniform distribution of active ingredients and proper functioning of the dosage form.
2) The type of mixing needed (positive, negative, neutral) depends on the product components and how they interact.
3) Achieving a perfectly mixed state is impossible, so the goal is a random mixture with minimal variation between doses.
4) Both the number of particles in a dose and the proportion of active ingredient impact mixing quality and uniformity. More of each improves consistency.
This document provides an overview of filtration theory and processes. It defines filtration as the removal of solids suspended in a liquid by passing the liquid through a porous medium that retains the solids. Various filter types and operating mechanisms are described, including depth filtration, cake filtration, and clarification. Key factors that affect filtration rates such as pressure, viscosity, permeability, and particle size are also discussed. Dimensionless parameters important to modeling filtration like the Reynolds number are introduced.
This document provides an overview of drying in the pharmaceutical industry. It discusses the importance of drying as the last stage of manufacturing before packaging. The key types of drying covered are convective, conductive, and radiative drying. Convective drying can be static bed or dynamic fluidized bed. Conductive drying uses vacuum ovens or tumblers. Radiative drying includes infrared and microwave radiation. Factors that influence drying like moisture content, bound vs unbound water, and equilibrium moisture content are also explained.
This document discusses size reduction and comminution. It outlines the objectives of size reduction such as improving flow properties and increasing surface area. It examines how material properties like brittleness, toughness, and hardness influence size reduction. Different size reduction methods are described, including cutting, compression, impact, attrition, and combined impact/attrition. Specific equipment like ball mills, hammer mills, and fluidized mills are discussed in terms of how they achieve size reduction through impacts and attrition. Factors that influence particle size distribution changes during milling are also covered.
Adsorption is the adhesion of atoms, ions or molecules from a gas, liquid or dissolved solid onto a surface. There are two types of adsorption - physical adsorption, which involves relatively weak van der Waals forces, and chemisorption, which involves stronger chemical bonding. Physical adsorption is rapid, reversible and allows for multilayers, while chemisorption is specific, may require activation energy, and allows only for monolayers. Factors like solute concentration, temperature, pH, and surface area affect adsorption from solutions. Pharmaceutical applications of adsorption include chromatography, removal of toxins, taste masking, and haemoperfusion. Adsorption can also cause issues like loss of pot
This document provides an overview of rheology concepts including:
1. It defines rheology as the science concerned with the deformation of matter under stress.
2. It describes Newtonian and non-Newtonian fluids, explaining that Newtonian fluids have a constant viscosity while non-Newtonian fluids have variable viscosity.
3. It discusses the different types of non-Newtonian flow - plastic, pseudoplastic, and dilatant - and provides examples of materials that exhibit each type of flow.
This document discusses polymers and their applications in drug delivery. It begins with an introduction to polymers, including their classification and molecular structure. It then covers general mechanisms of drug release from polymers, including diffusion, degradation and swelling. Applications of polymers in conventional dosage forms and controlled drug delivery are presented. The document also discusses biodegradable polymers and natural polymers. It provides details on the classification, characteristics and selection of polymers for drug delivery.
More from University of Zambia, School of Pharmacy, Lusaka, Zambia (20)
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
COLOUR CODING IN THE PERIOPERATIVE NURSING PRACTICE.SamboGlo
COLOUR CODING IN THE PERIOPERATIVE ENVIRONMENT HAS COME TO STAY ,SOME SENCE OF HUMOUR WILL BE APPRECIATED AT THE RIGHT TIME BY THE PATIENT AND OTHER SURGICAL TEAM MEMBERS.
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R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
1. HIV Prevalence and Incidence among Sexually Active
Females in Two Districts of South Africa to Determine
Microbicide Trial Feasibility
Annale´ne Nel 1, Cheryl Louw 2, Elizabeth Hellstrom 3, Sarah L. Braunstein 4, Ina Treadwell 3, Melanie
Marais3
, Martie de Villiers2
, Jannie Hugo2
, Inge Paschke 3
, Chrisna Andersen3
, Janneke van de Wijgert5
MuungoLungwani
*
1 International Partnership for Microbicides, Silver Spring, Maryland, United States of America, 2 Madibeng Centre for Research, Brits, South Africa, 3 Be Part Yoluntu
Centre, Mbekweni and Paarl, South Africa, 4 New York City Department of Health and Mental Hygiene, New York City, New York, United States of America, 5 Academic
Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
Abstract
Background: The suitability of populations of sexually active women in Madibeng (North-West Province) and Mbekweni
(Western Cape), South Africa, for a Phase III vaginal microbicide trial was evaluated.
Methods: Sexually active women 18–35 years not known to be HIV-positive or pregnant were tested cross-sectionally to
determine HIV and pregnancy prevalence (798 in Madibeng and 800 in Mbekweni). Out of these, 299 non-pregnant, HIV-
negative women were subsequently enrolled at each clinical research center in a 12-month cohort study with quarterly
study visits.
Results: HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12
months were 6.0/100 person-years (PY) (95% CI 3.0, 9.0) in Madibeng and 4.5/100 PY (95% CI 1.8, 7.1) in Mbekweni and
those estimated by cross-sectional BED testing were 7.1/100 PY (95% CI 2.8, 11.3) in Madibeng and 5.8/100 PY (95% CI 2.0,
9.6) in Mbekweni. The 12-month pregnancy incidence rates were 4.8/100 PY (95% CI 2.2, 7.5) in Madibeng and 7.0/100 PY
(95% CI 3.7, 10.3) in Mbekweni; rates decreased over time in both districts. Genital symptoms were reported very frequently,
with an incidence of 46.8/100 PY (95% CI 38.5, 55.2) in Madibeng and 21.5/100 PY (95% CI 15.8, 27.3) in Mbekweni. Almost
all (.99%) participants said that they would be willing to participate in a microbicide trial.
Conclusion: These populations might be suitable for Phase III microbicide trials provided that HIV incidence rates over time
remain sufficiently high to support endpoint-driven trials.
Citation: Nel A, Louw C, Hellstrom E, Braunstein SL, Treadwell I, et al. (2011) HIV Prevalence and Incidence among Sexually Active Females in Two Districts of
South Africa to Determine Microbicide Trial Feasibility. PLoS ONE 6(8): e21528. doi:10.1371/journal.pone.0021528
Editor: Matthew P. Fox, Boston University, United States of America
Received March 18, 2011; Accepted June 2, 2011; Published August 10, 2011
Copyright: ß 2011 Nel et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was funded by the International Partnership for Microbicides (a not-for-profit public-private partnership). The funders were involved in study
design, data collection and preparation of the manuscript.
Competing Interests: AN is employed by The International Partnership for Microbicides (IPM), a not-for-profit public-private partnership aiming to develop a
safe and effective vaginal microbicide for HIV prevention. All other authors are employed by not-for-profit organizations receiving funding from IPM to assist IPM
with achieving this goal. The study reported in this manuscript did not involve the use of any candidate vaginal microbicides governed by intellectual property
right; it was an observational cohort study to determine HIV incidence rates in preparation for future clinical trials of vaginal microbicides. The authors will adhere
to all PLoS ONE policies on sharing data and materials.
* E-mail: j.vandewijgert@amc-cpcd.org
Introduction
At the end of 2009, about 7,000 new HIV infections occurred
each day [1]. New HIV prevention tools, especially those that
women can use, are therefore desperately needed. Microbicides
are being developed for topical application inside the vagina or
rectum to prevent infection with HIV and possibly other sexually
transmitted infections (STIs) [2]. Microbicide research has been
ongoing for about 20 years. Proof-of-concept for vaginal
microbicides was obtained in 2010, when the CAPRISA 004 trial
showed a 39% reduction in HIV incidence after 30 months of
tenofovir gel use compared to placebo gel use [3]. Phase III clinical
trials of candidate microbicides are often conducted in sub-
Saharan Africa because this is where 70% of the new HIV
infections occur [1]. In preparation for such trials, estimates of
HIV incidence in target populations are needed to determine
adequate sample size and statistical power for demonstrating safety
and efficacy [4].
South Africa has hosted, and is hosting, several microbicide and
other HIV prevention intervention trials. While HIV prevalence
data are available for many districts of South Africa, they are not
available for all potential microbicide trial populations. HIV
incidence data are hard to find [5]. Madibeng and Mbekweni are
two districts of South Africa that had not yet participated in HIV
prevention intervention trials when the studies described in this
paper were conducted, and HIV prevalence and incidence where
not yet known. Madibeng is a rural district municipality in North-
West Province supported by mining (chrome, granite, and
PLoS ONE | www.plosone.org 1 August 2011 | Volume 6 | Issue 8 | e21528
2
2. platinum), manufacturing (automotive, metal, and fuel), and
agriculture. Mbekweni is a small urban township close to Paarl
in the Western Cape; many of its residents are employed in the
deciduous farming and wine-making industry. In both districts, the
community is somewhat migratory because of unstable employ-
ment.
Methods
Study design and populations
HIV prevalence and incidence in two districts of South Africa,
Madibeng and Mbekweni, were estimated in cross-sectional
studies (targeting 800 women) followed by prospective cohort
studies (targeting 300 women) to determine the suitability of the
populations for participation in Phase III microbicide trials.
Women were recruited from local family planning clinics in
Madibeng and from family planning clinics, community events,
and door-to-door visits in Mbekweni. The clinical research centers
(CRCs) used recruitment strategies that they also plan to use in
future Phase III microbicide trials and these were CRC-specific.
However, the same study procedures were followed at each CRC
from the moment women visited the CRC to be screened for study
participation. Women were eligible for the cross-sectional studies if
they were 18–35 years, not HIV-positive or pregnant by self-
report, not breastfeeding, and sexually active (defined as at least
one penetrative vaginal coital act per month for the previous three
months). At cross-sectional study visits, eligible women were tested
for HIV antibodies using a rapid testing algorithm (Figure 1) and
for pregnancy. Women who tested positive for HIV antibodies
were also tested by BED capture enzyme immunoassay (BED) to
determine the proportion of recent infections [6].
Women who tested HIV- and pregnancy-negative in the cross-
sectional cohort studies, still met the entry criteria described above,
and met additional entry criteria for the cohort studies were
subsequently offered enrollment into the cohort studies. These
additional entry criteria included using a reliable WHO-approved
contraceptive method [7], not injecting non-therapeutic drugs, not
participating in other studies, not suffering from specified chronic
Figure 1. HIV testing algorithm. Approximately 800 women at each CRC were tested for HIV infection at screening as indicated. Those confirmed
as seronegative and who met the entry criteria (299 at each CRC) were enrolled into the prospective cohort study and retested at 3, 6, 9, and 12
months after enrollment using the same algorithm. Participants who became HIV-positive while on study were referred to available sources of
psychosocial and medical care and support. HIV-positive participants could continue on study for scheduled examinations per protocol with the
exception of any further HIV testing and genital assessment, unless clinically indicated.
doi:10.1371/journal.pone.0021528.g001
HIV Epidemiology among Young Women in South Africa
PLoS ONE | www.plosone.org 2 August 2011 | Volume 6 | Issue 8 | e21528
3. diseases or allergies, refraining from anal sex and planning to stay
in the study area for the duration of the study. Follow-up visits
occurred after 3, 6, 9 and 12 months. Screening continued until
800 women were enrolled in the cross-sectional studies and 300
HIV-negative women were enrolled in the cohort studies at each
CRC.
All women in the cross-sectional and cohort studies (at all study
visits) were interviewed regarding demographics, sexual behavior,
and medical history; and received HIV risk reduction and
contraceptive counseling, condoms, and syndromic management
of sexually transmitted infections (STI) free of charge [8].
Confirmed HIV-positive women were referred for HIV care,
and pregnant women were referred for antenatal care, but HIV-
positive and pregnant women were retained in the study. The
study was approved by Pharma-Ethics in South Africa. Written
informed consent was obtained from all study participants.
Laboratory testing
Oral swabs from each participant were tested using OraQuick
ADVANCE Rapid HIV-1/2 Antibody Test (OraSure Technol-
ogies, Inc., Bethlehem, PA, USA). Blood samples from women
with positive OraQuick results were tested by Determine HIV-1/2
rapid test (Inverness Medical Professional Diagnostics, Princeton,
NJ, USA), and by enzyme-linked immunosorbant assay (ELISA) if
a tiebreaker was needed. Blood samples from women who were
confirmed HIV-positive were also tested by BED assay (Calypte
Biomedical Coorporation, Portland, OR, USA) according to the
manufacturer’s instructions. A specimen with a final normalized
optical density value of less than or equal to 0.8 was considered to
be from a patient who was infected less than 155 days ago [6].
Data Analysis and Statistics
Sample size calculations. In the cross-sectional studies, a
sample size of 800 women would allow for a precision level of the
HIV incidence estimate of 4.0/100 PY63.5, 5.0/100 PY63.7,
and 6.0/100 PY63.9 assuming an HIV prevalence of 25% and
using the McWalter and Welte formula described below [9,10]. In
the cohort studies, accumulation of 270 personyears (PY) of follow
up (300 women for one year minus 10% PY lost to follow-up)
would generate the following 95% confidence intervals around the
observed HIV incidence rates: 11 seroconversions, 4.1 (95% CI
1.7, 6.5); 14 seroconversions, 5.2 (95% CI 2.5, 7.9); 17 serocon-
versions, 6.3 (95% CI 3.3, 9.3).
Statistical analysis. Data were double entered and analyzed
using SAS version 9.2 (SAS Institute, Cary, NC). Descrip-
tive statistics were used to summarize baseline demographic,
behavioral and clinical characteristics. Categorical variables are
expressed as percentages, and continuous data as medians with
inter-quartile ranges.
HIV, pregnancy, and STI symptom incidence rates in the
cohort studies were calculated based on a Poisson distribution with
PY at risk in the denominator. A person’s time at risk began at the
enrollment visit and ended at the last study visit attended (usually
the Month 12 visit) or when HIV infection or pregnancy occurred.
HIV infection and pregnancy were assumed to have occurred at
the mid-point between the last available negative test and first
positive test. A woman who reached an HIV endpoint was no
longer considered at risk for HIV but was still considered at risk for
pregnancy, and vice versa. Incident genital symptom cases were
defined as participants ever reporting a symptom during follow-up.
HIV incidence rates and 95% confidence intervals based on
BED results in the cross-sectional studies were calculated using the
formula, and accompanying spreadsheet, provided by McWalter
and Welte [9,10]. Inputs in the formula include the total number
of HIV-positive and HIV-negative individuals in the sample, the
number of HIV-positive individuals who also tested positive on the
BED assay, the BED window period (155 days), and an estimated
BED false-recent rate of 5.2% [11]. Incidence estimates are
expressed as an incidence rate (number of new HIV infections per
100 PY).
Age-adjusted logistic regression models were used to assess
predictors of prevalent HIV infection and pregnancy, with p-values
from the Wilcoxon-Mann-Whitney test for continuous variables
and the Chi-square and Fisher’s exact tests for categorical variables.
Age-adjusted Cox proportional hazards regression models were
used to assess predictors of HIV seroconversion and incident
pregnancy.
Results
Disposition
Between April 2007 and March 2008, 798 women were enrolled
in the cross-sectional study in Madibeng and 800 in Mbekweni; 299
women at each CRC were subsequently enrolled in the cohort
studies. In the cohort studies, total PY of follow-up were 258.4 and
250.8 in Madibeng and Mbekweni, respectively. In Madibeng, 254
of 299 (85%) participants completed all scheduled visits; 17 women
withdrew early from the cohort study, 15 were lost to follow-up, 13
missed a scheduled visit, and none died. In Mbekweni, 229 of 299
(77%) participants completed all scheduled visits; 23 women
withdrew early from the cohort study, 22 were lost to follow-up,
25 missed a scheduled visit, and none died.
Demographic Characteristics
In the cross-sectional studies, the median age of study
participants at each CRC was 24 years (Table 1). Most
participants were black African, single, and had at least some
high school education. Over 85% of participants at each CRC had
one male sexual partner in the previous 3 months, and less than
half (44–45%) used a condom during their last sex act. Twice as
many participants in Mbekweni (32%) as Madibeng (16%) had a
current sexual partner that they knew was HIV-positive. Anal sex
was rarely reported at each CRC (,2%), but oral sex was more
common (9–13%). The percentage of women cleansing the vagina
before or after sex was higher in Madibeng than Mbekweni (6.5%
vs 1.4% and 13.0% vs 0.9%, respectively). At each CRC,
demographic and sexual behavior characteristics of cohort study
participants at enrollment were similar to cross-sectional partic-
ipants with one exception: in Madibeng, fewer women in the
cohort than in cross-sectional study felt that they were at high risk
for HIV (21% vs. 41%).
HIV prevalence
HIV prevalence was similar in the two districts: 24.1% (95% CI
12.1, 27.1) in Madibeng and 21.8% (95% CI 18.9, 24.7) in
Mbekweni. Factors positively associated with prevalent HIV
infection at both CRCs were: primary education as highest
educational level achieved, inconsistent condom use in the last 7
days, self-assessment of HIV risk as high, suspected positive or
unknown HIV serostatus of a current sexual partner, and presence
of STI symptoms at baseline (Table 2). Being married or living
together was negatively associated with HIV infection. Other risk
factors were significantly associated with prevalent HIV infection
at one CRC only (Table 2).
HIV incidence
HIV incidence rates based on seroconversions in the cohort
studies are shown in Figure 2. Overall incidence rates for the 12-
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4. Table 1. Baseline Characteristics of Study Participants.
Cross-Sectional Studies Cohort Studies
Madibeng Mbekweni Madibeng Mbekweni
Characteristic n (%) N = 7981
N = 800 N = 2992
N = 2993
Age in years (median) 24 24 23 23
Age in years
18–20 202 (25.3) 172 (21.5) 95 (31.8) 90 (30.1)
21–25 316 (39.6) 283 (35.4) 120 (40.1) 110 (36.8)
26–30 159 (19.9) 195 (24.4) 53 (17.7) 57 (19.1)
31–35 121 (15.2) 150 (18.8) 31 (10.4) 42 (14.1)
Race
Black African 744 (93.2) 711 (88.9) 270 (90.3) 292 (97.7)
Other 54 (6.8) 89 (11.1) 29 (9.7) 7 (2.3)
Marital status
Married/living together 210 (26.3) 274 (34.3) 61 (20.4) 76 (25.4)
Separated/divorced 3 (0.4) 4 (0.5) 0 2 (0.7)
Widowed 0 1 (0.1) 0 0
Single 590 (73.9) 521 (65.1) 238 (79.6) 221 (73.9)
Education
No school 2 (0.3) 1 (0.1) 1 (0.3) 0
Some/completed primary school 52 (6.5) 58 (7.3) 9 (3.0) 13 (4.3)
Some/completed high school 728 (91.2) 708 (88.5) 281 (94.0) 272 (91.0)
Some/completed tertiary school 16 (2.0) 33 (4.1) 8 (2.7) 14 (4.7)
Male sex partners in last 3 months
1 685 (85.8) 759 (94.9) 256 (85.6) 287 (96.0)
2 85 (10.7) 38 (4.8) 32 (10.7) 11 (3.7)
3 or more 27 (3.4) 3 (0.4) 11 (3.7) 1 (0.3)
Male sex partners in last 7 days
0 43 (5.4) 29 (3.6) 25 (8.4) 12 (4.0)
1 725 (91.4) 761 (95.1) 266 (89.6) 287 (96.0)
2 or more 25 (3.2) 10 (1.3) 6 (2.0) 0
Condom used during last sex act 355 (44.5) 348 (43.5) 138 (46.3) 153 (51.2)
Any chance that any current sex partner is HIV+
Yes 123 (15.9) 246 (32.2) 34 (11.9) 104 (37.3)
No 413 (53.3) 216 (28.3) 175 (61.0) 45 (16.1)
Don’t know 239 (30.8) 301 (39.5) 78 (27.2) 130 (46.6)
Willing to participate in microbicide trial 784 (98.6) 798 (99.9) 294 (98.3) 297 (99.7)
Ever had anal sex 15 (1.9) 12 (1.5) 6 (2.0) 4 (1.3)
Ever had oral sex 103 (12.9) 69 (8.6) 40 (13.4) 42 (14.0)
Ever vaginal cleansing before sex4
52 (6.5) 11 (1.4) 19 (6.4) 6 (2.0)
Ever vaginal cleansing after sex4
103 (13.0) 7 (0.9) 43 (14.4) 5 (1.7)
Self assessment of HIV risk
No risk 49 (6.2) 3 (0.4) 28 (9.4) 0
Low risk 259 (32.6) 252 (31.7) 139 (46.5) 88 (29.4)
Moderate risk 87 (11.0) 26 (3.3) 37 (12.4) 3 (1.0)
High risk 327 (41.2) 484 (60.9) 64 (21.4) 204 (68.2)
Don’t know 72 (9.1) 30 (3.8) 31 (10.4) 4 (1.4)
1
Two women were not eligible and excluded.
2
One woman was found to be less than 18 years of age after enrollment and was subsequently excluded.
3
One woman enrolled twice using a different name; data from her second enrollment were excluded.
4
Included disinfectants/soaps, cotton wool/wad of cloth, and traditional herbs (Mbekweni only).
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5. Table 2. Determinants of Prevalent HIV Infection in the Cross-Sectional Studies1
.
Determinant Madibeng (N = 192) Mbekweni (N = 174)
% HIV+ Age-adjusted OR (95% CI) % HIV+ Age-adjusted OR (95% CI)
Race
Black African 24.7 2.1 (1.0, 4.7) 24.3 32.5 (4.5, 235.7)2,3
Other (reference) 14.8 1.1
Marital status:
Married/living together 24.3 0.6 (0.4, 0.9)2
21.5 0.6 (0.4, 0.9)2
Single, separated or divorced (reference) 24.0 21.9
Highest level of education achieved4
:
Some/completed primary education 50.0 8.8 (1.1, 73.5)2
34.5 11.9 (1.5, 94.7)2
Some/completed high school 22.7 3.0 (0.4, 23.0) 21.5 8.0 (1.1, 59.1)2
Some/completed tertiary
education (reference)
6.3 3.0
Source of income:
Woman herself (reference) 27.6 22.9
Husband/partner 27.1 1.0 (0.6, 1.7) 20.4 0.8 (0.5, 1.2)
Family 18.1 1.1 (0.6, 2.0) 17.6 1.0 (0.7, 1.6)
Other 29.4 1.4 (0.8, 2.4) 40.3 2.9 (1.6, 5.3)2
Average monthly income5
0-R500 (reference) 24.2 37.7
R501-R1000 19.8 0.6 (0.4, 1.1) 29.2 0.7 (0.4, 1.2)
R1001-R2000 32.0 1.2 (0.8, 2.0) 22.1 0.5 (0.3, 0.9)2
.R2000 18.3 0.6 (0.3, 1.1) 12.7 0.2 (0.1, 0.5)2
Condom use in last 7 days
Always (reference) 17.2 14.6
Inconsistent 28.7 1.7 (1.0, 2.8)2
26.7 1.9 (1.1, 3.3)2
Never 25.0 1.1 (0.6, 1.8) 15.3 0.7 (0.4, 1.4)
Ever had anal sex
Yes 46.7 3.3 (1.1, 9.9)2
16.7 0.6 (0.1, 3.0)
No (reference) 23.6 21.9
Ever had oral sex
Yes 21.4 0.9 (0.5, 1.4) 7.3 0.3 (0.1, 0.7)2
No (reference) 24.5 23.1
Self assessment of HIV risk
No/low risk (reference) 9.4 11.0
Moderate risk 27.6 3.2 (1.7, 5.9)2
19.2 1.8 (0.6, 5.2)
High risk 35.8 5.1 (3.3, 8.1)2
26.5 2.7 (1.7, 4.2)2
Any chance that any
current sex partner is HIV+
Yes 50.4 5.5 (3.5, 8.8)2
26.0 2.2 (1.3, 3.5)2
No (reference) 13.2 13.9
Don’t know 28.5 2.3 (1.5, 3.4)2
22.9 1.9 (1.2, 3.1)2
Reported STI symptom at baseline
Yes 31.0 1.6 (1.2, 2.3)2
41.8 3.1 (1.9, 5.1)2
No (reference) 20.7 19.6
1
Each row represents one bivariable model including age and the predictor of interest.
2
Age-adjusted odds ratio significantly different for predictor vs. reference value (p,0.05);
3
Only 7 women had a race other than black African (they were Cape coloured).
4
Only 8 women in Madibeng and 14 women in Mbekweni had some/completed tertiary education.
5
R = rand; 1 US dollar = 7.4 South African rands.
doi:10.1371/journal.pone.0021528.t002
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6. month period were 6.0/100 PY (95% CI 3.0, 9.0) in Madibeng
and 4.5/100 PY (95% CI 1.8, 7.1) in Mbekweni. Rates in
Madibeng varied by study quarter, while rates in Mbekweni
declined steadily, but number of events per quarter were small and
confidence intervals wide (Figure 2). Positive predictors of
seroconversion in Madibeng were ever having had anal sex (HR
8.5, 95% CI 1.9, 37.9); self-assessment of HIV risk as moderate/
high versus none/low (HR 3.2, 95% CI 1.1, 9.1); and having two
or more male sexual partners versus one in the 3-month period
prior to screening (HR 7.4, 95% CI 2.7, 20.6). In Mbekweni,
having a current sexual partner who is HIV-positive (HR 3.8, 95%
CI 1.1, 13.0) was positively associated with HIV seroconversion.
HIV incidence rates estimated by cross-sectional BED testing
were 7.1/100 PY (95% CI 2.8, 11.3) in Madibeng and 5.8/100 PY
(95% CI 2.0, 9.6) in Mbekweni.
Pregnancy rates
In the cross-sectional studies, pregnancy prevalence was 2.5%
(95% CI 1.4, 3.6) in Madibeng and 2.3% (95% CI 1.2, 3.3) in
Mbekweni. In the cohort studies, overall pregnancy rates for the 12-
month period were higher in Mbekweni (7.0/100 PY [95% CI 3.7,
10.3]) than Madibeng (4.8/100 PY [95% CI 2.2, 7.5]). In both
districts, pregnancy rates decreased during the observation period
(Figure 3). In Madibeng, decreased likelihood of condom use at last
sex from baseline to follow-up was associated with incident pregnancy
(6.0 [95% CI 1.6, 22.7], p,0.01). In Mbekweni, ever having cleansed
the vagina before sex (reported at baseline) (7.7 [95% CI 1.7, 34.6],
p,0.01); ever having cleansed the vagina after sex (reported at
baseline) (12.6 [95% CI 2.7, 58.7], p,0.01); and not having used a
condom in the last 7 days (reported during follow-up) (6.2 [95% CI
1.3, 29.6], p =0.02) were predictors of incident pregnancy.
Genital symptom rates
In the cross-sectional studies, the prevalence of self-reported
genital symptoms (including genital discharge, lower abdominal
pain, vaginal pruritus, dysuria, genital odor, genital sores/ulcers,
swelling in groin area, and others) was 32.7% (95% CI 29.5, 36.0)
in Madibeng and 9.9% (95% CI 7.8, 12.0) in Mbekweni. In the
cohort studies, the incidence of self-reported genital symptoms
during the 12-month period was 46.8/100 PY (95% CI 38.5, 55.2)
in Madibeng and 21.5/100 PY (95% CI 15.8, 27.3) in Mbekweni.
Over half of participants who reported genital symptoms during
follow-up, 87 of 121 (72%) in Madibeng and 30 of 54 (56%) in
Mbekweni, also reported symptoms at enrollment. In both
districts, the percentage of participants reporting genital symptoms
at each visit decreased throughout the 12-month observation
period to 6% at Madibeng and 3.7% at Mbekweni.
Willingness to participate in a microbicide trial
Almost all participants in each district (99–100%) reported that
they are willing to participate in a microbicide trial.
Discussion
The HIV prevalence in our studies among sexually active adult
women 18–35 years of age was estimated to be 22–24% in
Madibeng and Mbekweni, which is higher than the 2009
UNAIDS estimates of 13.6% for 15–24 year-old and 17.8% for
15–49 year-old South African women [1]. We may have measured
a higher HIV prevalence because our study populations were
(semi-)urban or because women who suspected that they were at
risk for HIV were more interested in participating in our studies to
access counseling, testing, and prevention services. On the other
hand, women who already knew that they were HIV-positive were
not eligible for study participation, which would suggest an
underestimation of the true HIV prevalence in our studies.
In the cohort studies, HIV incidence based on seroconversions
over the 12-month follow-up period was 6.0/100 PY in Madibeng
and 4.5/100 PY in Mbekweni. BED-based HIV incidence
estimates from the cross-sectional studies were slightly higher:
7.1 and 5.8/100 PY in Madibeng and Mbekweni, respectively. It
Figure 2. HIV incidence in the prospective cohort studies. Women enrolled in the 12-month cohort studies visited the CRC at 3, 6, 9, and 12
months after enrollment for HIV testing according to the algorithm presented in Figure 1. HIV incidence rates were calculated based on a Poisson
distribution with PY at risk in the denominator. They are expressed as number of cases per 100 PY, with 95% confidence intervals (CI). HIV infection
was assumed to have occurred at the mid-point between the last available negative test and first positive test.
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7. should be noted, however, that the BED-based estimates were
almost identical to the seroconversion rates in the first 6 months of
the cohort studies (6.8 and 5.9/100 PY, respectively; data not
shown). Data from the first 6 months of the cohort studies may be
the most relevant for comparison with cross-sectional estimates
because study participants may change their behavior in response
to prevention messages and services received at the quarterly
follow-up visits [12]. HIV seroconversion rates in Mbekweni
indeed declined steadily during the 12 month follow-up period.
HIV incidence in both districts was high despite the fact that
more than 85% of the women reported to only have had one sex
partner in the past 3 months. This is most likely due to the high
HIV prevalence in the communities: 12% of women in Madibeng
and 37% of women in Mbekweni suspected that they had current
sex partners that were HIV-positive. This proportion was most
likely higher in Mbekweni than in Madibeng due to recent
interventions in Mbekweni that promoted HIV testing. Further-
more, in both districts, condoms were not used consistently. In
statistical models, determinants of both prevalent HIV infection at
baseline and HIV seroconversion during the 12-month cohort
studies were moderate or high perceived HIV risk, suspected
positive or unknown serostatus of a current sexual partner, and
ever having had anal sex. At entry into the cohort studies, women
were asked to refrain from anal sex, and very few women reported
anal sex throughout the studies (#2% in both districts). However,
anal sex is likely underreported in research studies due to social
desirability bias [13]. Therefore, Phase III vaginal microbicide
trial participants should be counselled on the increased HIV risk
associated with anal sex, and the fact that vaginal microbicides are
designed to protect women from vaginal acquisition of HIV only.
A few limitations of our data should be noted. The eligibility
criteria for entry into our study limit generalizability of our results.
The HIV prevalence rates in our paper apply to young, sexually
active women who were not known to be HIV-infected or
pregnant, and who agreed to be tested regularly for HIV. The
total number of seroconversions in each prospective cohort study
(15 and 11 in Madibeng and Mbekweni, respectively) were low
and the 95% confidence intervals were therefore wide. Models of
determinants of HIV prevalence and HIV seroconversion were
adjusted for age only to maximize statistical power, and residual
confounding may therefore have been present. The 95%
confidence intervals of the cross-sectional BED-based HIV
incidence estimates were also wide. Furthermore, we did not
measure local false-recent rates or window periods and could
therefore not adjust our BED estimates as recommended by WHO
[14].
The use of a reliable contraceptive method was a study
requirement because this would also be a requirement for
enrollment into a vaginal microbicide trial of a microbicide
containing a new chemical entity. Despite this, pregnancy
incidence rates were high in both districts (4.8 and 7.0/100 PY
in Madibeng and Mbekweni, respectively). The number of
pregnancies decreased throughout the studies, perhaps due to
contraceptive counseling and provision of condoms at each study
visit. However, contraceptive services at the CRCs should be
strengthened further to keep pregnancy rates as low as possible
during future microbicide trials [15].
The prevalence and incidence of self-reported genital symptoms
were high in Madibeng (33%, 46.8/100 PY) and Mbekweni (10%,
21.5/100 PY), but since laboratory testing for STIs and vaginal
infections was not done in these studies, conclusions cannot be
drawn about the prevalence and incidence of STIs or vaginal
infections in these communities. Almost all participants (over 99%)
in both Madibeng and Mbekweni expressed strong interest in
future microbicide trials.
In conclusion, the Madibeng and Mbekweni populations might
be suitable for Phase III microbicide trials provided that HIV
incidence rates over time remain sufficiently high to support
endpoint-driven trials. However, contraceptive services should be
strengthened to keep pregnancy rates as low as possible.
Figure 3. Pregnancy rates in the prospective cohort studies. Urine pregnancy tests were done at each study visit (screening, enrollment, and
3, 6, 9, and 12 months after enrollment in the cohort study). If test result was positive, the participant was to continue on study for follow-up per
protocol. Estimated date of conception and estimated due date were to be recorded. If possible, follow-up was to continue for pregnancy outcome.
Contraceptive counseling was provided and condoms were dispensed at each study visit.
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8. Acknowledgments
The authors gratefully acknowledge the study teams at the CRCs in
Madibeng and Mbekweni, and the study team at the International
Partnership for Microbicides, in particular Dr. Mercy Kamupira (Clinical
Safety Physician), Nelie¨tte van Niekerk (Medical Writer), Dr. Paulina
Kaptur (Scientific Writer) and Karen Bester (Project Manager).
Author Contributions
Conceived and designed the experiments: AN JvdW. Performed the
experiments: CL EH IT MM MdV JH IP CA. Analyzed the data: SB
JvdW. Wrote the paper: JvdW. Critically reviewed the manuscript: all
authors.
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