STD Treatment to Prevent HIV Infection: Implications of Recent Community-Level Studies

1998 ◽  
Keyword(s):  
Hiv Infection ◽  
Community Level

scholarly journals Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244761
Author(s):  
Edinah Mudimu ◽  
Kathryn Peebles ◽  
Zindoga Mukandavire ◽  
Emily Nightingale ◽  
Monisha Sharma ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Fast Track ◽  
Scale Up ◽  
Status Quo ◽  
Community Level ◽  
Voluntary Medical Male Circumcision ◽  
Western Kenya ◽  
Indirect Benefits ◽  
Over Time

Background Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical. Methods We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections prevented among non-PrEP users as a result of PrEP) benefits of PrEP, the person-years of PrEP required to prevent one HIV infection, and the community-level impact of providing PrEP to populations defined by gender and age in western Kenya and South Africa. We examined sensitivity of results to scale-up of antiretroviral therapy (ART) and voluntary medical male circumcision (VMMC) by comparing two scenarios: maintaining current coverage (“status quo”) and rapid scale-up to meet programmatic targets (“fast-track”). Results The community-level impact of PrEP was greatest among women aged 15–24 due to high incidence, while PrEP use among men aged 15–24 yielded the highest proportion of indirect infections prevented in the community. These indirect infections prevented continue to increase over time (western Kenya: 0.4–5.5 (status quo); 0.4–4.9 (fast-track); South Africa: 0.5–1.8 (status quo); 0.5–3.0 (fast-track)) relative to direct infections prevented among PrEP users. The number of person-years of PrEP needed to prevent one HIV infection was lower (59 western Kenya and 69 in South Africa in the status quo scenario; 201 western Kenya and 87 in South Africa in the fast-track scenario) when PrEP was provided only to women compared with only to men over time horizons of up to 5 years, as the indirect benefits of providing PrEP to men accrue in later years. Conclusions Providing PrEP to women aged 15–24 prevents the greatest number of HIV infections per person-year of PrEP, but PrEP provision for young men also provides indirect benefits to women and to the community overall. This finding supports existing policies that prioritize PrEP use for young women, while also illuminating the community-level benefits of PrEP availability for men when resources permit.

scholarly journals Risk scores for predicting HIV incidence among the general population in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Katherine M. Jia ◽  
Hallie Eilerts ◽  
Olanrewaju Edun ◽  
Kevin Lam ◽  
Adam Howes ◽  
...  
Keyword(s):  
General Population ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Community Level ◽  
Sub Saharan Africa ◽  
Risk Scores ◽  
Younger Age ◽  
Sub Saharan

AbstractIntroductionSeveral HIV ‘risk scores’ have been developed to identify individuals for prioritised HIV prevention in sub-Saharan Africa. We systematically reviewed HIV risk scores to: (i) identify factors that consistently predicted incident HIV infection, (ii) review inclusion of community-level HIV risk in predictive models, and (iii) examine predictive performance.MethodsWe systematically searched nine databases for studies developing and/or validating HIV risk scores among the general population in sub-Saharan Africa from database inception until February 15, 2021. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction, and critical appraisal were conducted in duplicate. We used random-effect meta-analysis to summarise hazard ratios and the area under the receiver-operating characteristic curve (AUC-ROC).ResultsFrom 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraception enrolled in randomised-controlled trials, three among adolescent girls and young women (AGYW), and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% Confidence Interval: 1.17, 2.23], compared to above-25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV-2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW only STIs were consistently associated with higher incidence, but studies were limited (n=3). Community-level HIV prevalence or unsuppressed viral load strongly predicted incidence but were only considered in three of 11 multi-site studies. The AUC-ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC-ROC 0.626 [0.588, 0.663] (I2: 64.02%).ConclusionsYounger age, non-cohabiting, and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low-to-moderate discriminatory ability and uncertain generalizability outside of the study populations. Further evidence on the relative value of specific factors and data outside high-risk populations will help inform optimal implementation of risk scoring algorithms in HIV programmes.PROSPERO NumberCRD42021236367

scholarly journals Spatial pattern and associated factors of HIV testing and counselling among youths (15–24 years) in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adugnaw Zeleke Alem ◽  
Alemneh Mekuriaw Liyew ◽  
Habtamu Alganeh Guadie
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Hot Spot ◽  
Positive Association ◽  
Community Level ◽  
Targeted Prevention ◽  
Community Factors ◽  
Care And Support ◽  
Related Stigma ◽  
Hiv Testing And Counselling

Abstract Background HIV testing and counseling (HTC) services are key for HIV prevention, treatment, care, and support. Although the prevalence of HIV infection is high among adolescents and young adults, evidence suggests the utilization of HTC service among youth is very low in Ethiopia. Identifying factors and the geographic variation of HTC uptake is important to prioritize and design targeted prevention programs to increase its utilization and reduce HIV infection in hot spot areas. Methods Data from the 2016 Ethiopian Demographic and Health Survey were used to analyze 10,781 youth aged 15–24 years. The spatial analysis was performed in ArcGIS 10.1. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of HTC uptake. A multilevel logistic regression analysis was used to identify the associated individual and community-level factors of HTC uptake and estimate between community variance. All models were fitted in Stata version 14.0 and finally, the adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) were reported. Results In this study, the spatial patterns of HTC uptake were found to be non-random (Global Moran’s I = 0.074, p value< 0.001). Forty-seven primary clusters were identified that were located in the entire Somali region with a relative likelihood of 1.50 and the Log-Likelihood Ratio of 135.57. Youth who were ever married (AOR = 4.65; 95% CI; 4.05, 5.34), those attended higher education (AOR = 3.97; 95% CI; 3.10,5.08), those from richest household (AOR = 1.86; 95% CI; 1.44, 2.39), aged 20–24 years (AOR = 2.25; 95% CI; 2.02,2.51), having compressive HIV related knowledge (AOR = 2.05; 95% CI; 1.75,2.41), and exposed to media (AOR = 1.38; 95% CI; 1.22,1.57) were positive association with HTC uptake. However, being male (AOR = 0.81; 95% CI; 0.73,0.91) and having high HIV related stigma (AOR = 0.53; 95% CI; 0.42,0.67) were negatively associated with HTC uptake. At the community-level, youth from communities with a high percentage of educated (AOR = 1.45; 95% CI; 1.17,1.80) were more likely to utilize HTC compared with those from communities with low percentages of educated. Conclusion The current study indicated differences in HTC uptake in the country. Both individual and community-level factors affected HTC uptake in Ethiopia. Multifaceted intervention approaches that consider individual and community factors are required to improve HTC uptake.

Myelodysplastic features in patients with long-term HIV infection and haemophilia

Haemophilia ◽  
2001 ◽  
Vol 7 (1) ◽  
pp. 47-52 ◽  
Author(s):  
O. Katsarou ◽  
E. Terpos ◽  
E. Patsouris ◽  
P. Peristeris ◽  
N. Viniou ◽  
...  
Keyword(s):  
Hiv Infection

Behavioural risk factors for HIV infection amongst blood donors in London

1996 ◽  
Vol 6 (1) ◽  
pp. 31-36 ◽  
Author(s):  
F. M. Cowan ◽  
A. M. Johnson ◽  
J. Wadsworth ◽  
M. Brennan
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Blood Donors ◽  
Behavioural Risk Factors

Human Immunodeficiency Virus (HIV) Infection in Children

1987 ◽  
Vol 1 (3) ◽  
pp. 381-395 ◽  
Author(s):  
Beverly Ryan ◽  
Edward Connor ◽  
Anthony Minnefor ◽  
Frank Desposito ◽  
James Oleske
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Immunodeficiency Virus
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