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Stanton AM, O'Cleirigh C, Knight L, Davey DLJ, Myer L, Joska JA, Mayer KH, Bekker L, Psaros C. The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities. J Int AIDS Soc 2022; 25:e26026. [PMID: 36251124 PMCID: PMC9575939 DOI: 10.1002/jia2.26026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA,Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA
| | - Conall O'Cleirigh
- Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Lucia Knight
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Dvora L. Joseph Davey
- School of Public HealthUniversity of Cape TownCape TownSouth Africa,Division of Infectious Diseases, Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Landon Myer
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Kenneth H. Mayer
- Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Christina Psaros
- Massachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner JD. Diagnosis and treatment of sexually transmitted infections in male partners of pregnant women in Brazil. Int J STD AIDS 2021; 32:1242-1249. [PMID: 34311604 PMCID: PMC8608751 DOI: 10.1177/09564624211032759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexually transmitted infections (STIs) can adversely affect a woman's pregnancy and the health of the developing fetus. The source of these infections may be the male sexual partner who remains under-diagnosed and un-treated due to a combination of lack of symptoms, decreased access to health care, and poor health-seeking behaviors. From September 2018 to November 2019, we offered a cohort of pregnant women (gestational age range: 4.6-41 weeks) clinic-based STI testing for HIV and syphilis (via lateral flow assay rapid tests) and for Neisseria (N.) gonorrhoeae, Chlamydia (C.) trachomatis, and Trichomonas (T.) vaginalis (via PCR-based testing) at Santa Casa Hospital and 10 affiliated prenatal clinics in Porto Alegre, Brazil. 400 women between the ages of 18 and 46 years (mean age: 27 years) enrolled and 24% were diagnosed with an STI. Each woman enrolled agreed to invite their male partners to clinic for the same panel of STI testing, and 255 men (64%) between the ages of 18 and 64 years (mean age: 29 years) attended clinic and all accepted full intervention. In these male partners, 40 (16%) were diagnosed with an STI including 22 (8.7%) testing positive for C. trachomatis, 15 (6%) for treponemal antibody (syphilis), 7 (2.8%) for T. vaginalis, 3 (1.2%) for N. gonorrhoeae, and 1 (0.4%) for HIV antibody. In our multivariate analysis, having symptoms of an STI (AOR 4.5, 95% CI 1.3-15.2) and arguing about jealousy (AOR 3.1, 95% CI 1.2-8.2) remained significantly associated with male diagnosis of an STI. Sexually transmitted infections are common in sexual partners of pregnant women in Brazil and should be addressed to prevent reinfection of pregnant women.
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Affiliation(s)
- Nava Yeganeh
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil and Federal University Of Health Sciences, Porto Alegre, Brazil
| | - Mei Leng
- Department of Medicine Biostats, UCLA, Los Angeles CA, USA
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Internal Medicine, Division of Infectious Disease, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Newman CM, Tarantal AF, Martinez ML, Simmons HA, Morgan TK, Zeng X, Rosinski JR, Bliss MI, Bohm EK, Dudley DM, Aliota MT, Friedrich TC, Miller CJ, O’Connor DH. Early Embryonic Loss Following Intravaginal Zika Virus Challenge in Rhesus Macaques. Front Immunol 2021; 12:686437. [PMID: 34079560 PMCID: PMC8165274 DOI: 10.3389/fimmu.2021.686437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/04/2021] [Indexed: 01/25/2023] Open
Abstract
Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) and is primarily transmitted by Aedes species mosquitoes; however, ZIKV can also be sexually transmitted. During the initial epidemic and in places where ZIKV is now considered endemic, it is difficult to disentangle the risks and contributions of sexual versus vector-borne transmission to adverse pregnancy outcomes. To examine the potential impact of sexual transmission of ZIKV on pregnancy outcome, we challenged three rhesus macaques (Macaca mulatta) three times intravaginally with 1 x 107 PFU of a low passage, African lineage ZIKV isolate (ZIKV-DAK) in the first trimester (~30 days gestational age). Samples were collected from all animals initially on days 3 through 10 post challenge, followed by twice, and then once weekly sample collection; ultrasound examinations were performed every 3-4 days then weekly as pregnancies progressed. All three dams had ZIKV RNA detectable in plasma on day 3 post-ZIKV challenge. At approximately 45 days gestation (17-18 days post-challenge), two of the three dams were found with nonviable embryos by ultrasound. Viral RNA was detected in recovered tissues and at the maternal-fetal interface (MFI) in both cases. The remaining viable pregnancy proceeded to near term (~155 days gestational age) and ZIKV RNA was detected at the MFI but not in fetal tissues. These results suggest that sexual transmission of ZIKV may represent an underappreciated risk of pregnancy loss during early gestation.
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Affiliation(s)
- Christina M. Newman
- Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Alice F. Tarantal
- Pediatrics, Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA, United States
- California National Primate Research Center, University of California, Davis, CA, United States
| | - Michele L. Martinez
- Pediatrics, Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, CA, United States
- California National Primate Research Center, University of California, Davis, CA, United States
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Terry K. Morgan
- Pathology, Oregon Health and Sciences University, Portland, OR, United States
| | - Xiankun Zeng
- Pathology Division, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, United States
| | - Jenna R. Rosinski
- Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Mason I. Bliss
- Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Ellie K. Bohm
- Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Dawn M. Dudley
- Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Matthew T. Aliota
- Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, United States
| | - Thomas C. Friedrich
- Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Christopher J. Miller
- California National Primate Research Center, University of California, Davis, CA, United States
- Pathology, Microbiology, and Immunology, School of Veterinary Medicine, Center for Immunology and Infectious Diseases, University of California, Davis, CA, United States
| | - David H. O’Connor
- Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
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Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner J. High Prevalence of Sexually Transmitted Infections in Pregnant Women Living in Southern Brazil. Sex Transm Dis 2021; 48:128-133. [PMID: 32976355 PMCID: PMC7817184 DOI: 10.1097/olq.0000000000001276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Porto Alegre, Brazil, has the highest rates of congenital syphilis and HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with poor pregnancy and neonatal outcomes, but are only diagnosed by syndromic algorithms. METHODS Between September 2018 and November 2019, we offered all pregnant women clinic-based STI testing for HIV antibody and treponemal antibody (via lateral flow assay rapid tests provided by the Brazilian Government) and for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis (via polymerase chain reaction-based testing provided by Gene Xpert, Sunnyvale, CA) in 10 public prenatal health clinics in Porto Alegre. Participating women answered a brief survey via audio computer-assisted survey instrument regarding demographics, partnerships, and sexual behaviors. All infected individuals received appropriate treatment and referrals. RESULTS Of 400 pregnant women recruited, 94 (24%) were diagnosed with an STI, including 2% with HIV, 11% with syphilis, 9% with chlamydia, 1% with gonorrhea, 5% with trichomoniasis, and 3% with more than 1 STI. In our multivariate analysis, younger age (adjusted odds ratio [AOR], 1.1; 95% confidence interval [CI], 1-1.2), being non-White (AOR, 1.8; 95% CI, 1.1-3.1), having less education (AOR, 2; 95% CI, 1.2-3.4), and having a relationship <1 year (AOR, 2; 95% CI, 1.1-3.6) were all independent predictors of women having an STI. Endorsing symptoms of an STI (e.g., vaginal ulcers/lesions and vaginal discharge) was not predictive of having a laboratory-diagnosed STI (OR, 1.1; 95% CI, 0.7-1.7). CONCLUSIONS Etiologic-based screening for STIs was uniformly accepted by women attending both hospital-based and primary health clinics in the south of Brazil and can result in appropriate treatment of pregnant women.
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Affiliation(s)
- Nava Yeganeh
- From the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre
| | - Mei Leng
- UCLA Department of Medicine Biostats
| | - Karin Nielsen-Saines
- From the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health at UCLA
| | - Jeffrey Klausner
- Department of Internal Medicine, David Geffen School of Medicine at UCLA
- Division of Infectious Disease, UCLA CARE Center, Los Angeles, CA
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Waltmann A, McKinnish TR, Duncan JA. Nonviral sexually transmitted infections in pregnancy: current controversies and new challenges. Curr Opin Infect Dis 2021; 34:40-49. [PMID: 33337618 PMCID: PMC8634851 DOI: 10.1097/qco.0000000000000702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections. RECENT FINDINGS Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners. SUMMARY These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tyler R McKinnish
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2020; 34:761-776. [PMID: 32167990 DOI: 10.1097/qad.0000000000002487] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES A previous meta-analysis reported high HIV incidence among pregnant and breast-feeding women in sub-Saharan Africa (SSA), but limited evidence of elevated risk of HIV acquisition during pregnancy or breast-feeding when compared with nonpregnant periods. The rapidly evolving HIV prevention and treatment landscape since publication of this review may have important implications for maternal HIV incidence. DESIGN Systematic review and meta-analysis. METHODS We searched four databases and abstracts from relevant conferences through 1 December 2018, for literature on maternal HIV incidence in SSA. We used random-effects meta-analysis to summarize incidence rates and ratios, and to estimate 95% prediction intervals. We evaluated potential sources of heterogeneity with random-effects meta-regression. RESULTS Thirty-seven publications contributed 100 758 person-years of follow-up. The estimated average HIV incidence rate among pregnant and breast-feeding women was 3.6 per 100 person-years (95% prediction interval: 1.2--11.1), while the estimated average associations between pregnancy and risk of HIV acquisition, and breast-feeding and risk of HIV acquisition, were close to the null. Wide 95% prediction intervals around summary estimates highlighted the variability of HIV incidence across populations of pregnant and breast-feeding women in SSA. Average HIV incidence appeared associated with age, partner HIV status, and calendar time. Average incidence was highest among studies conducted pre-2010 (4.1/100 person-years, 95% prediction interval: 1.1--12.2) and lowest among studies conducted post-2014 (2.1/100 person-years, 95% prediction interval: 0.7--6.5). CONCLUSION Substantial HIV incidence among pregnant and breast-feeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and breast-feeding women.
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Morhason-Bello IO, Kabakama S, Baisley K, Francis SC, Watson-Jones D. Reported oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa: a systematic review. Reprod Health 2019; 16:48. [PMID: 31060573 PMCID: PMC6501425 DOI: 10.1186/s12978-019-0722-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral and anal sexual behaviours are increasingly reported among adolescents and adults reporting heterosexual sex in peer-reviewed journals in high income countries, but less is known about these behaviours in low and middle-income countries, especially in sub-Saharan Africa. The aim of this systematic review is to describe the prevalence of, and motivations for, oral and anal sex among adolescents and adults reporting heterosexual sex in sub-Saharan Africa. METHODS A systematic review of published articles that reported oral and or anal sex in sub-Saharan Africa was conducted from seven databases up to and including 30th August 2018. RESULTS Of 13,592 articles, 103 met the inclusion criteria. The prevalence of reporting ever practising oral sex among adolescents, university students and a combined population of adolescents/adults ranged from 1.7-26.6%, 5.0-46.4% and 3.0-47.2% respectively. Similarly, prevalences of reported ever practising anal sex ranged from 6.4-12.4% among adolescents, 0.3-46.5% among university students and 4.3-37.8% amongst combined population of adolescents and adults. Higher prevalences of oral and anal sex were reported among populations at high-risk for sexually transmitted infections and HIV and university students and, in most studies, both behaviours were more commonly reported by males than females. Heterosexual oral and anal sexual acts were associated with some high-risk behaviours such as inconsistent condom use and multiple sexual partners. CONCLUSION Reported oral and anal sex between men and women are prevalent behaviours in sub-Saharan Africa. Health professionals and policy makers should be aware of these behaviours and their potential associated health risks.
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Affiliation(s)
- Imran O. Morhason-Bello
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Obstetrics and Gynaecology Department, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Severin Kabakama
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Suzanna C. Francis
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Deborah Watson-Jones
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO Box 11936, Mwanza, Tanzania
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Carlos S, López-del Burgo C, Ndarabu A, Osorio A, Rico-Campà A, Reina G, Burgueño E, de Irala J. Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort. PLoS One 2019; 14:e0210398. [PMID: 30650137 PMCID: PMC6334946 DOI: 10.1371/journal.pone.0210398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. METHODS OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15-59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. RESULTS Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting "not" having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. CONCLUSIONS Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa.
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Affiliation(s)
- Silvia Carlos
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- * E-mail:
| | - Cristina López-del Burgo
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
| | | | - Alfonso Osorio
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
- School of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Anaïs Rico-Campà
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gabriel Reina
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Microbiology Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Burgueño
- Monkole Hospital, Kinshasa, Democratic Republic of Congo
- School of Medicine, University of Mwene-Ditu, Mwene-Ditu, Democratic Republic of the Congo
| | - Jokin de Irala
- Preventive Medicine and Public Health Department, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality, University of Navarra, Pamplona, Spain
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Thomson KA, Hughes J, Baeten JM, John-Stewart G, Celum C, Cohen CR, Ngure K, Kiarie J, Mugo N, Heffron R. Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners. J Infect Dis 2018; 218:16-25. [PMID: 29514254 PMCID: PMC5989601 DOI: 10.1093/infdis/jiy113] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/27/2018] [Indexed: 01/13/2023] Open
Abstract
Background Understanding the absolute and relative risk of human immunodeficiency virus type 1 (HIV) acquisition during pregnancy and the postpartum period can inform HIV prevention strategies for women. Methods We used a complementary log-log model and data from 2751 HIV-serodiscordant couples to compare the probability of HIV acquisition among women per sex act during early pregnancy, late pregnancy, the postpartum period, and the nonpregnant period. Results At total of 686 pregnancies were identified, and 82 incident HIV infections occurred. After adjustment for condom use, age, preexposure prophylaxis (PrEP) use, and HIV viral load, the per-act probability of HIV acquisition was higher in late pregnancy (adjusted relative risk [aRR], 2.82; P = .01) and the postpartum period (aRR, 3.97; P = .01) as compared to that during nonpregnant period. For a 25-year-old woman not taking PrEP, the HIV acquisition probability per condomless sex act with an HIV-infected male partner with a viral load of 10 000 copies/mL was 0.0011 (95% confidence interval [CI] 0.005-0.0019), 0.0022 (95% CI, 0.0004-0.0093), 0.0030 (95% CI, 0.0007-0.0108), and 0.0042 (95% CI, 0.0007-0.0177) during the nonpregnant period, early pregnancy, late pregnancy, and the postpartum period, respectively. Conclusion The HIV acquisition probability per condomless sex act steadily increased during pregnancy and was highest during the postpartum period, suggesting that biological changes during pregnancy and the postpartum period increase HIV susceptibility among women.
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Affiliation(s)
- Kerry A Thomson
- Department of Epidemiology, University of Washington, Seattle
| | - James Hughes
- Department of Biostatistics, University of Washington, Seattle
| | - Jared M Baeten
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | - Craig R Cohen
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi
| | - James Kiarie
- Department of Global Health, University of Washington, Seattle
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
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10
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Teasdale CA, Abrams EJ, Chiasson MA, Justman J, Blanchard K, Jones HE. Incidence of sexually transmitted infections during pregnancy. PLoS One 2018; 13:e0197696. [PMID: 29795625 PMCID: PMC5967814 DOI: 10.1371/journal.pone.0197696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 05/07/2018] [Indexed: 11/18/2022] Open
Abstract
Prevalence of sexually transmitted infections (STI) is high among pregnant women in certain settings. We estimated STI incidence and compared STI risk in pregnant and non-pregnant women. Data came from the Methods for Improving Reproductive Health in Africa (MIRA) study conducted in South Africa and Zimbabwe 2003-2006. Women aged 18-50 years with at least one follow-up visit within 6 months of enrollment were included. Follow-up visits included laboratory testing for pregnancy, chlamydia, gonorrhea, trichomoniasis, and HIV, as well as self-report of hormonal contraceptive (HC) use, sexual behaviors and intravaginal practices. All visits were classified according to pregnancy status. Incidence of each STI was calculated using follow-up time. Cox proportional hazards models were fitted using pregnancy as a time-varying exposure and sexual behaviors and intravaginal practices as time-varying covariates. Among 4,549 women, 766 (16.8%) had a positive pregnancy test. Median follow-up time was 18 months [IQR: 12-24]. The overall incidence rate of chlamydia was 6.7 per 100 person years (py) and 9.9/100py during pregnancy; gonorrhea incidence was 2.7/100py and 4.9/100py during pregnancy; trichomoniasis incidence was 7.1/100py overall and 9.2/100py during pregnancy. Overall HIV incidence was 3.9/100py and 3.8/100py during pregnancy. In crude models, pregnancy increased risk for chlamydia (hazard ratio (HR) 1.5, 95%CI: 1.1-1.2), however there was no increased risk of any measured STI in adjusted models. STI Incidence was high during pregnancy however pregnancy did not increase STI risk after adjustment for sexual behaviors. Greater efforts are needed to help pregnant women avoid STIs.
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Affiliation(s)
- Chloe A. Teasdale
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Elaine J. Abrams
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Jessica Justman
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, MA, United States of America
| | - Heidi E. Jones
- Department of Epidemiology, City University of New York School of Public Health, New York, NY, United States of America
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Genital Tract Infections in an Isolated Community: 100 Women of the Príncipe Island. Infect Dis Obstet Gynecol 2017; 2017:3058569. [PMID: 29259388 PMCID: PMC5702945 DOI: 10.1155/2017/3058569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To characterize the vaginal microbiome and the rate of sexually transmitted infections (STIs) in the women of Príncipe (São Tomé and Príncipe). Methods Cross-sectional study of 100 consecutive women, invited for a free appointment and cervical cancer screening. A vaginal slide (wet mount microscopy) and a cervical sample (ThinPrep®) (Pap test, high risk human papillomavirus [HR-HPV], N. gonorrhea [NG], T. vaginalis [TV], and C. trachomatis [CT]) were obtained. Results TV, NG, CT, and HIV were found in 8.0%, 2.0%, 3.0%, and 2.0%, respectively, and were more prevalent in younger women. HR-HPV was positive in 36.7%; 2 were positive for HPV18, but none for HPV16. Coinfection of HPV with other STIs was 8.3%. Prevalence of abnormal vaginal flora (AVF) was 82.5%, mostly bacterial vaginosis (BV) 54.6%, and moderate/severe aerobic vaginitis (msAV) 25.8%. HR-HPV was not related to BV (p = 0.67). The association of abnormal Pap test with msAV was not significant (p = 0.08). Conclusion The prevalence of NG, CT, TV, and HR-HPV was according to expected, while that of HR-AVF was higher. The surprisingly low prevalence of HPV16 and HPV18 must be considered in the design of programs for prevention and vaccination; this setting can be useful as a model for postvaccination scenarios.
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Magalhaes T, Foy BD, Marques ETA, Ebel GD, Weger-Lucarelli J. Mosquito-borne and sexual transmission of Zika virus: Recent developments and future directions. Virus Res 2017; 254:1-9. [PMID: 28705681 DOI: 10.1016/j.virusres.2017.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/08/2017] [Accepted: 07/08/2017] [Indexed: 02/04/2023]
Abstract
Zika virus (ZIKV; Genus Flavivirus, Family Flaviviridae) has recently emerged in Asia and the Americas to cause large outbreaks of human disease. The outbreak has been characterized by high attack rates, birth defects in infants and severe neurological complications in adults. ZIKV is transmitted to humans by Aedes mosquitoes, but recent evidence implicates sexual transmission as playing an important role as well. This review highlights the transmission of ZIKV in humans, with a focus on both mosquito and sexually-transmitted routes and their outcomes. We also discuss critical directions for future research.
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Affiliation(s)
- Tereza Magalhaes
- Department of Microbiology, Immunology and Pathology, Arthropod-borne and Infectious Diseases Laboratory, Colorado State University, Fort Collins, CO, United States
| | - Brian D Foy
- Department of Microbiology, Immunology and Pathology, Arthropod-borne and Infectious Diseases Laboratory, Colorado State University, Fort Collins, CO, United States.
| | - Ernesto T A Marques
- Laboratory of Virology and Experimental Therapeutics, Centro de Pesquisas Aggeu Magalhaes, Fundacao Oswaldo Cruz, Recife, PE, Brazil; Center for Vaccine Research, Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gregory D Ebel
- Department of Microbiology, Immunology and Pathology, Arthropod-borne and Infectious Diseases Laboratory, Colorado State University, Fort Collins, CO, United States
| | - James Weger-Lucarelli
- Department of Microbiology, Immunology and Pathology, Arthropod-borne and Infectious Diseases Laboratory, Colorado State University, Fort Collins, CO, United States
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