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Rimoin AW, Hoff NA, Djoko CF, Kisalu NK, Kashamuka M, Tamoufe U, LeBreton M, Kayembe PK, Muyembe JJ, Kitchen CR, Saylors K, Fair J, Doshi R, Papworth E, Mpoudi-Ngole E, Grillo MP, Tshala F, Peeters M, Wolfe ND. HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo. Int J STD AIDS 2014; 26:187-95. [PMID: 24828556 DOI: 10.1177/0956462414533672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection.
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Affiliation(s)
- A W Rimoin
- Department of Epidemiology, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - N A Hoff
- Department of Epidemiology, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - C F Djoko
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon
| | - N K Kisalu
- Vaccine Research Center, NIAID/NIH, Bethesda, MD, USA
| | - M Kashamuka
- Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo
| | - U Tamoufe
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon
| | - M LeBreton
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon
| | - P K Kayembe
- Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo
| | - J J Muyembe
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - C R Kitchen
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - K Saylors
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon
| | - J Fair
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon
| | - R Doshi
- Department of Epidemiology, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - E Papworth
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - M P Grillo
- Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, CA, USA
| | - F Tshala
- Military Health Services, Ministry of Defense, Kinshasa, Democratic Republic of the Congo
| | - M Peeters
- Laboratoire Retrovirus, UMR 145, Institute for Research and Development (IRD) and University of Montpellier 1, Montpellier, France
| | - N D Wolfe
- Global Viral Forecasting (now known as Metabiota) San Francisco, California, USA, and Yaoundé, Cameroon Program in Human Biology, Stanford University, Stanford, CA, USA
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Lloyd J, Papworth E, Grant L, Beyrer C, Baral S. Systematic review and meta-analysis of HIV prevalence among men in militaries in low income and middle income countries. Sex Transm Infect 2014; 90:382-7. [PMID: 24711546 DOI: 10.1136/sextrans-2013-051463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether the current HIV prevalence in militaries of low-income and middle-income countries is higher, the same, or lower than the HIV prevalence in the adult male population of those countries. METHODS HIV prevalence data from low-income and middle-income countries' military men were systematically reviewed during 2000-2012 from peer reviewed journals, clearing-house databases and the internet. Standardised data abstraction forms were used to collect information on HIV prevalence, military branch and sample size. Random effects meta-analyses were completed with the Mantel-Haenszel method comparing HIV prevalence among military populations with other men in each country. RESULTS 2214 studies were retrieved, of which 18 studies representing nearly 150000 military men across 11 countries and 4 regions were included. Military male HIV prevalence across the studies ranged from 0.06% (n=22666) in India to 13.8% (n=2733) in Tanzania with a pooled prevalence of 1.1% (n=147591). HIV prevalence in male military populations in sub-Saharan Africa was significantly higher when compared with reproductive age (15-49 years) adult men (OR: 2.8, 95% CI 1.01 to 7.81). HIV prevalence in longer-serving male military populations compared with reproductive age adult men was significantly higher (OR: 2.68, 95% CI 1.65 to 4.35). CONCLUSIONS Our data reveals that across the different settings, the burden of HIV among militaries may be higher or lower than the civilian male populations. In this study, male military populations in sub-Saharan Africa, low-income countries and longer-serving men have significantly higher HIV prevalence. Given the national security implications of the increased burden of HIV, interventions targeting military personnel in these populations should be scaled up where appropriate.
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Affiliation(s)
- Jennifer Lloyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin Papworth
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay Grant
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Shalihu N, Pretorius L, van Dyk A, Vander Stoep A, Hagopian A. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence. AIDS Care 2014; 26:968-75. [PMID: 24499371 DOI: 10.1080/09540121.2014.880398] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Little is available in scholarly literature about how HIV-positive prisoners, especially in low-income countries, access antiretroviral therapy (ART) medication. We interviewed 18 prisoners at a large prison in Namibia to identify barriers to medication adherence. The lead nurse researcher was a long-standing clinic employee at the prison, which afforded her access to the population. We identified six significant barriers to adherence, including (1) the desire for privacy and anonymity in a setting where HIV is strongly stigmatized; (2) the lack of simple supports for adherence, such as availability of clocks; (3) insufficient access to food to support the toll on the body of ingesting taxing ART medications; (4) commodification of ART medication; (5) the brutality and despair in the prison setting, generally leading to discouragement and a lack of motivation to strive for optimum health; and (6) the lack of understanding about HIV, how it is transmitted, and how it is best managed. Because most prisoners eventually transition back to communitysettings when their sentences are served, investments in prison health represent important investments in public health.
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Affiliation(s)
- Nauyele Shalihu
- a Senior Superintendent and Head Nurse with Ministry of Safety and Security, Department of Correctional Service , Windhoek Correctional Facility , Windhoek , Namibia
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Kim YM, Banda J, Kanjipite W, Sarkar S, Bazant E, Hiner C, Tholandi M, Reinhardt S, Njobvu PD, Kols A, Benavides B. Improving performance of Zambia Defence Force antiretroviral therapy providers: evaluation of a standards-based approach. GLOBAL HEALTH: SCIENCE AND PRACTICE 2013; 1:213-27. [PMID: 25276534 PMCID: PMC4168581 DOI: 10.9745/ghsp-d-13-00053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
A detailed standards-based performance approach modestly improved providers' performance and facility readiness to offer antiretroviral therapy. The approach included mutually reinforcing activities: (1) training, (2) supportive supervision, (3) assessments of service quality, and (4) facility-based action plans. Background: The Zambia Defence Force (ZDF) has applied the Standards-Based Management and Recognition (SBM-R®) approach, which uses detailed performance standards, at some health facilities to improve HIV-related services offered to military personnel and surrounding civilian communities. This study examines the effectiveness of the SBM-R approach in improving facility readiness and provider performance at ZDF facilities. Methods: We collected data on facility readiness and provider performance before and after the 2010–2012 intervention at 4 intervention sites selected for their relatively poor performance and 4 comparison sites. Assessors observed whether each facility met 16 readiness standards and whether providers met 9 performance standards during consultations with 354 returning antiretroviral therapy (ART) clients. We then calculated the percentages of criteria achieved for each readiness and performance standard and conducted bivariate and multivariate analyses of provider performance data. Results: Facilities' ART readiness scores exceeded 80% before the intervention at both intervention and comparison sites. At endline, scores improved on 4 facility readiness standards in the intervention group but on only 1 standard in the comparison group. Multivariate analysis found that the overall provider performance score increased significantly in the intervention group (from 58% to 84%; P<.01) but not in the comparison group (from 62% to 70%). The before-and-after improvement in scores was significantly greater among intervention sites than among comparison sites for 2 standards—initial assessment of the client's condition and nutrition counseling. Conclusion: The standards-based approach, which involved intensive and mutually reinforcing intervention activities, showed modest improvements in some aspects of providers' performance during ART consultations. Further research is needed to determine whether improvements in provider performance affect client outcomes such as adherence to ART.
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Affiliation(s)
- Young Mi Kim
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | - Joseph Banda
- Jhpiego/Zambia, an affiliate of Johns Hopkins University , Lusaka , Zambia
| | - Webby Kanjipite
- Jhpiego/Zambia, an affiliate of Johns Hopkins University , Lusaka , Zambia
| | - Supriya Sarkar
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | - Eva Bazant
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | - Cyndi Hiner
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | - Maya Tholandi
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | | | | | - Adrienne Kols
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
| | - Bruno Benavides
- Jhpiego/USA, an affiliate of Johns Hopkins University , Baltimore, MD , USA
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Kim YM, Banda J, Hiner C, Tholandi M, Bazant E, Sarkar S, Andrade ASA, Makwala C. Assessing the quality of HIV/AIDS services at military health facilities in Zambia. Int J STD AIDS 2013; 24:365-70. [PMID: 23970703 DOI: 10.1177/0956462412472811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After rapidly scaling up HIV/AIDS-related health services, the Zambian Defence Force (ZDF) has become concerned with assuring their quality. This evaluation assesses provider performance at eight ZDF facilities based on direct observations of 191 antenatal care (ANC) consultations and 175 follow-up consultations for antiretroviral therapy (ART). In addition, 43 ZDF health providers were interviewed about the work environment and service quality. On-the-job performance varied widely: providers completed as few as 0% and as many as 100% of tasks associated with each performance standard. Overall scores averaged 66% (range: 47-93%) for ANC consultations and 60% (range: 37-100%) for ART consultations. Perceptions of the work environment were generally positive, but 57% of providers lack confidence in their clinical skills and 42% think staffing is insufficient. These findings, which point to the unique opportunities and challenges in the military setting, will be used to guide a quality improvement initiative.
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Affiliation(s)
- Y M Kim
- Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore MD 21231, USA.
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Rogier C. Soldiers and epidemics. Clin Microbiol Infect 2012; 18:721-2. [DOI: 10.1111/j.1469-0691.2012.03932.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Muhwezi WW, Kinyanda E, Mungherera M, Onyango P, Ngabirano E, Muron J, Kagugube J, Kajungu R. Vulnerability to high risk sexual behaviour (HRSB) following exposure to war trauma as seen in post-conflict communities in eastern uganda: a qualitative study. Confl Health 2011; 5:22. [PMID: 22011647 PMCID: PMC3213062 DOI: 10.1186/1752-1505-5-22] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 10/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much of the literature on the relationship between conflict-related trauma and high risk sexual behaviour (HRSB) often focuses on refugees and not mass in-country displaced people due to armed conflicts. There is paucity of research about contexts underlying HRSB and HIV/AIDS in conflict and post-conflict communities in Uganda. Understanding factors that underpin vulnerability to HRSB in post-conflict communities is vital in designing HIV/AIDS prevention interventions. We explored the socio-cultural factors, social interactions, socio-cultural practices, social norms and social network structures that underlie war trauma and vulnerability to HRSB in a post-conflict population. METHODS We did a cross-sectional qualitative study of 3 sub-counties in Katakwi district and 1 in Amuria in Uganda between March and May 2009. We collected data using 8 FGDs, 32 key informant interviews and 16 in-depth interviews. We tape-recorded and transcribed the data. We followed thematic analysis principles to manage, analyse and interpret the data. We constantly identified and compared themes and sub-themes in the dataset as we read the transcripts. We used illuminating verbatim quotations to illustrate major findings. RESULTS The commonly identified HRSB behaviours include; transactional sex, sexual predation, multiple partners, early marriages and forced marriages. Breakdown of the social structure due to conflict had resulted in economic destruction and a perceived soaring of vulnerable people whose propensity to HRSB is high. Dishonour of sexual sanctity through transactional sex and practices like incest mirrored the consequence of exposure to conflict. HRSB was associated with concentration of people in camps where idleness and unemployment were the norm. Reports of girls and women who had been victims of rape and defilement by men with guns were common. Many people were known to have started to display persistent worries, hopelessness, and suicidal ideas and to abuse alcohol. CONCLUSIONS The study demonstrated that conflicts disrupt the socio-cultural set up of communities and destroy sources of people's livelihood. Post-conflict socio-economic reconstruction needs to encompass programmes that restructure people's morals and values through counselling. HIV/AIDS prevention programming in post-conflict communities should deal with socio-cultural disruptions that emerged during conflicts. Some of the disruptions if not dealt with, could become normalized yet they are predisposing factors to HRSB. Socio-economic vulnerability as a consequence of conflict seemed to be associated with HRSB through alterations in sexual morality. To pursue safer sexual health choices, people in post-conflict communities need life skills.
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Affiliation(s)
- Wilson Winstons Muhwezi
- Makerere University College of Health Sciences, School of Medicine, Department of Psychiatry, P. O. Box 7072, Kampala, Uganda
| | - Eugene Kinyanda
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), P. O. Box 49, Entebbe, Uganda
| | - Margaret Mungherera
- Makerere University College of Health Sciences, School of Medicine, Department of Psychiatry, P. O. Box 7072, Kampala, Uganda
| | - Patrick Onyango
- Transcultural Psychosocial Organization Uganda (TPO-Uganda), Plot 3271 Kansanga off Ggaba Road, P.O. Box 21646 Kampala, Uganda
| | - Emmanuel Ngabirano
- Transcultural Psychosocial Organization Uganda (TPO-Uganda), Plot 3271 Kansanga off Ggaba Road, P.O. Box 21646 Kampala, Uganda
| | - Julius Muron
- Butabika National Referral Mental Hospital, Plot 2, Block 237-238, Butabika Road, Kampala, Uganda
| | - Johnson Kagugube
- Uganda Bureau of Statistics (UBOS), P.O. Box 7186, Kampala, Uganda
| | - Rehema Kajungu
- Transcultural Psychosocial Organization Uganda (TPO-Uganda), Plot 3271 Kansanga off Ggaba Road, P.O. Box 21646 Kampala, Uganda
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Noden BH, Pearson RJC, Gomes A. Age-specific mortality patterns in Central Mozambique during and after the end of the Civil War. Confl Health 2011; 5:8. [PMID: 21615947 PMCID: PMC3118347 DOI: 10.1186/1752-1505-5-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/26/2011] [Indexed: 11/18/2022] Open
Abstract
Background In recent years, vigorous debate has developed concerning how conflicts contribute to the spread of infectious diseases, and in particular, the role of post-conflict situations in the epidemiology of HIV/AIDS. This study details the age-specific mortality patterns among the population in the central provincial capital of Beira, Mozambique, during and after the Mozambican civil war which ended in 1992. Methods Data was collected from the death register at Beira's Central Hospital between 1985 and 2003 and descriptively analyzed. Results The data show two distinct periods: before and after the peace agreements in 1992. Before 1992 (during the civil war), the main impact of mortality was on children below 5 years of age, including still births, accounting for 58% of all deaths. After the war ended in 1992, the pattern shifted dramatically and rapidly to the 15-49 year old age group which accounted for 49% of all deaths by 2003. Conclusions As under-5 mortality rates were decreasing at the end of the conflict, rates for 24-49 year old adults began to dramatically increase due to AIDS. This study demonstrates that strategies can be implemented during conflicts to decrease mortality rates in one vulnerable population but post-conflict dynamics can bring together other factors which contribute to the rapid spread of other infectious diseases in other vulnerable populations.
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Affiliation(s)
- Bruce H Noden
- Department of Biomedical Science, School of Health and Applied Science, Polytechnic of Namibia, Windhoek, Namibia.
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Baelani I, Dünser MW. Facing medical care problems of victims of sexual violence in Goma/Eastern Democratic Republic of the Congo. Confl Health 2011; 5:2. [PMID: 21375778 PMCID: PMC3059296 DOI: 10.1186/1752-1505-5-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 03/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 1998, the Eastern Democratic Republic of the Congo has been torn by a military conflict. A particular atrocity of the war is widespread sexual violence. METHODS In this combined retrospective analysis and prospective survey, we sought to identify hospital facilities and resources available to treat victims of sexual violence in Goma, the capital city of the North Kivu province. RESULTS Of twenty-three acute care hospitals registered in the area of Goma, four (17%) regularly cared for victims of sexual violence. One hospital had all resources always available to appropriately care for victims of sexual violence. From Jan 2009 until Oct 2010, 7,048 females sought medical care because of physical or psychological sequelae from sexual violence in the four hospitals of Goma. Only half of the hospitals had physicians specialized in gynaecology or gynaecological surgery available. Similarly, anaesthetists and psychiatrists/psychologists were available in two (50%) and one (25%) hospital, respectively. Post-discharge care facilities, material resources, such as surgical and anaesthesiological equipment and drugs, were inconsistently available in the hospitals caring for sexually abused females. At one selected hospital, acyclovir and/or antibiotics were administered to 1,202 sexually abused females (89.5%), whereas post-exposure HIV prophylaxis and surgery because of vesico-vaginal fistula was provided to only 75 (5.6%) and 121 (9%) patients, respectively. CONCLUSIONS This study provides data that only few hospitals in Goma care for victims of sexual violence. In addition, these hospitals suffer from a relevant shortage of human and material resources to provide adequate care for sexually abused females. Aside from establishment of adequate protection strategies, steps must be taken to increase the availability of trained health care professionals and resources to provide adequate care for victims of sexual violence in Goma and the North Kivu province.
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Affiliation(s)
- Inipavudu Baelani
- Department of Anaesthesiology and Intensive Care Medicine, DOCS Hospital, Goma, Democratic Republic of the Congo.
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Djoko CF, Rimoin AW, Vidal N, Tamoufe U, Wolfe ND, Butel C, LeBreton M, Tshala FM, Kayembe PK, Muyembe JJ, Edidi-Basepeo S, Pike BL, Fair JN, Mbacham WF, Saylors KE, Mpoudi-Ngole E, Delaporte E, Grillo M, Peeters M. High HIV type 1 group M pol diversity and low rate of antiretroviral resistance mutations among the uniformed services in Kinshasa, Democratic Republic of the Congo. AIDS Res Hum Retroviruses 2011; 27:323-9. [PMID: 20954909 DOI: 10.1089/aid.2010.0201] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
For the first time the genetic diversity among the uniformed personnel in Kinshasa, the capital city of the Democratic Republic of Congo (DRC), a country that has experienced military conflicts since 1998 and in which the global HIV-1/M pandemic started, has now been documented. A total of 94 HIV-1-positive samples, collected in 2007 in Kinshasa garrison settings from informed consenting volunteers, were genetically characterized in the pol region (protease and RT). An extensive diversity was observed, with 51% of the strains corresponding to six pure subtypes (A 23%, C 13.8%, D, G, H, J, and untypable), 15% corresponding to nine different CRFs (01, 02, 11, 13, 25, 26, 37, 43, and 45), and 34% being unique recombinants with one-third being complex mosaic viruses involving three or more different subtypes/CRFs. Only one strain harbored a single mutation, I54V, associated with drug resistance to protease inhibitors. Due to their high mobility and potential risk behavior, HIV infections in military personnel can lead to an even more complex epidemic in the DRC and to a possible increase of subtype C.
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Affiliation(s)
- Cyrille F. Djoko
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
- Biotechnology Center and Department of Biochemistry, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nicole Vidal
- Laboratoire Retrovirus, UMR 145, Institute for Research and Development (IRD) and University of Montpellier 1, Montpellier, France
| | - Ubald Tamoufe
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
| | - Nathan D. Wolfe
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
- Stanford University, Program in Human Biology, Stanford, California
| | - Christelle Butel
- Laboratoire Retrovirus, UMR 145, Institute for Research and Development (IRD) and University of Montpellier 1, Montpellier, France
| | - Matthew LeBreton
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
| | - Felix M. Tshala
- Military Health Services, Ministry of Defence, Kinshasa, Democratic Republic of the Congo
| | - Patrick K. Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jean Jacques Muyembe
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Samuel Edidi-Basepeo
- National AIDS Control Program Laboratory, Kinshasa, Democratic Republic of the Congo
| | - Brian L. Pike
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
| | - Joseph N. Fair
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
| | - Wilfred F. Mbacham
- Biotechnology Center and Department of Biochemistry, University of Yaoundé I, Yaoundé, Cameroon
| | - Karen E. Saylors
- Global Viral Forecasting Initiative (GVF), San Francisco, California, and Yaoundé, Cameroon
| | | | - Eric Delaporte
- Laboratoire Retrovirus, UMR 145, Institute for Research and Development (IRD) and University of Montpellier 1, Montpellier, France
- Department of Infectious Diseases, CHU, Montpellier, France
| | - Michael Grillo
- Department of Defense HIV AIDS Prevention Program (DHAPP), San Diego, California
| | - Martine Peeters
- Laboratoire Retrovirus, UMR 145, Institute for Research and Development (IRD) and University of Montpellier 1, Montpellier, France
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Virginie S, Yasmin H, Sally B. Assessing the impact of mass rape on the incidence of HIV in conflict-affected countries. AIDS 2010; 24:2841-7. [PMID: 20859191 PMCID: PMC2978669 DOI: 10.1097/qad.0b013e32833fed78] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify the potential impact of mass rape on HIV incidence in seven conflict-afflicted countries (CACs), with severe HIV epidemics, in sub-Saharan Africa. DESIGN Uncertainty analysis of a risk equation model. METHODS A mathematical model was used to evaluate the potential impact of mass rape on increasing HIV incidence in women and girls in Burundi, Democratic Republic of Congo (DRC), Rwanda, Sierra Leone, Somalia, southern Sudan and Uganda. The model was parameterized with data from UNAIDS/WHO and the US Census Bureau's International Database. Incidence data from UNAIDS/WHO were used for calibration. RESULTS Mass rape could cause approximately five HIV infections per 100,000 females per year in the DRC, Sudan, Somalia and Sierra Leone, double the number in Burundi and Rwanda, and quadruple the number in Uganda. The number of females infected per year due to mass rape is likely to be relatively low in Somalia and Sierra Leone at 127 [median (interquartile range [IQR] 55-254)] and 156 [median (IQR 69-305)], respectively. Numbers could be high in the DRC and Uganda: 1120 [median (IQR 527-2360)] and 2172 [median (IQR 1031-4668)], respectively. In Burundi, Rwanda and Sudan, the numbers are likely to be intermediate. Under extreme conditions, 10,000 women and girls could be infected per year in the DRC and 20 000 women and girls could be infected per year in Uganda. Mass rape could increase annual incidence by approximately 7% [median (IQR 3-15)]. CONCLUSION Interventions and treatment targeted to rape survivors during armed conflicts could reduce HIV incidence. Support should be provided both on the basis of human rights and public health.
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Affiliation(s)
- Supervie Virginie
- Semel Institute of Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Halima Yasmin
- Global Campaign for Microbicides, Washington DC and School of International Studies, American University, Washington DC
| | - Blower Sally
- Semel Institute of Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
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Behets F, Edmonds A, Kitenge F, Crabbé F, Laga M. Heterogeneous and decreasing HIV prevalence among women seeking antenatal care in Kinshasa, Democratic Republic of Congo. Int J Epidemiol 2010; 39:1066-73. [PMID: 20453017 DOI: 10.1093/ije/dyq060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We examined HIV prevalence trends over 4.5 years among women receiving antenatal care in Kinshasa, Democratic Republic of Congo, by geographic location, clinic management and urbanicity. METHODS Quarterly proportions and 95% confidence intervals (CIs) of pregnant women with HIV positive results were determined using aggregate service provision and uptake data from 22 maternity units that provided vertical HIV prevention services from October 2004 to March 2009. Assuming linearity, proportions were assessed for trend via the Cochran-Armitage test. Multivariable binomial regression was used to describe detailed prevalence trends. RESULTS HIV testing was offered to 220,006 pregnant women; 210,348 (95.6%) agreed to be tested and 191,216 (90.9%) received their results. A total of 3999 women were found to be HIV positive, a prevalence of 1.90% (95% CI: 1.84-1.96%). The median quarterly proportion of women testing positive for HIV was 1.94% (range: 1.44-2.44%). Prevalence was heterogeneous in terms of maternity management, urbanicity and geographic location. Modeling suggested that the overall prevalence dropped from 2.04% (95% CI: 1.92-2.16%) to 1.77% (95% CI: 1.66-1.88%) over 4.5 years, a relative decrease of 13.2% (95% CI: 3.53-22.9%). Trend testing corroborated this decline (P < 0.01). CONCLUSIONS The decreasing HIV prevalence among Kinshasa antenatal care seekers is robust and encouraging. The relatively low prevalence and the weak existing healthcare system require prevention of mother-to-child transmission interventions that strengthen maternal and child healthcare service delivery. Complacency would be unwarranted: assuming a uniform national crude birth rate of 50/1000 and 1.8% antenatal HIV prevalence, approximately 7000 pregnant HIV infected women in Kinshasa, and 60,000 nationwide, are in need of care and prevention services yearly.
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Affiliation(s)
- Frieda Behets
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
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Hanson BW, Wodak A, Fiamma A, Coates TJ. Refocusing and prioritizing HIV programmes in conflict and post-conflict settings: funding recommendations. AIDS 2008; 22 Suppl 2:S95-103. [PMID: 18641476 PMCID: PMC2853944 DOI: 10.1097/01.aids.0000327441.66656.da] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conflict and post-conflict settings pose specific challenges to HIV prevention and care efforts. Whereas armed conflicts have decreased very considerably in number, the interactions between HIV epidemiology and conflict remain problematic. This review describes factors that affect HIV in conflict and post-conflict settings, identifies challenges to addressing HIV, and presents actionable and measurable programming and funding recommendations that can be implemented immediately. Funding priorities include prevention and care efforts such as the provision and monitoring of universal precautions for HIV infection, health services for sexual violence and antiretroviral therapy. Policy efforts should prioritize enforcing appropriate conduct by peacekeepers and aid workers, interventions targeted at specific phases and contexts of conflicts, supporting the continuity of programmes from emergency to post emergency and reconstruction efforts and simplifying and accelerating funding mechanisms.
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Affiliation(s)
- Brent W Hanson
- University of California, Los Angeles Program in Global Health, Johannesburg, South Africa.
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