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Simiyu A, Atuheire CGK, Taremwa M, Ssali SN, Mwiine FN, Kankya C, Mugimba KK. Sero-prevalence of syphilis and associated risk factors among pregnant women attending antenatal care at an urban-poor health centre in Kampala, Uganda: a cross-sectional study. Pan Afr Med J 2024; 47:129. [PMID: 38854863 PMCID: PMC11161699 DOI: 10.11604/pamj.2024.47.129.31622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/05/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction syphilis and its outcomes remain a healthcare system burden with adverse consequences such as stillbirths, neonatal deaths and spontaneous abortions among others. The situation might have worsened because the COVID-19 pandemic has caused a major attention drift from other diseases. Additionally, much as testing for syphilis is a routine practice among pregnant mothers, its proportion is not known in urban health care setting. A study to determine the prevalence of syphilis among pregnant mothers in an urban poor setting is warranted. Methods a cross-sectional study was conducted among pregnant women who attended antenatal care at Kawaala Health Centre IV in Kampala Capital City between December 2019 to March 2020. Informed consent was sought from study participants prior to data collection using structured questionnaires. Whole blood was collected and tested using SD Bioline HIV/syphilis duo rapid test kit (SD Standard Diagnostics, INC, Korea). Data analysis was done using STATA 14.2. Results one thousand one hundred and sixty-nine pregnant women participated in the study, with a mean age of 25 years. About 27% of them had completed only primary-level education. Approximately 6% of the participants were HIV seropositive. The prevalence of syphilis was 5.9% (69/1169). HIV positivity (aOR: 4.13, 95%CI: 2.05-8.34), elevated blood pressure (aOR: 2.84, 95%CI: 1.42-5.69), and status of previous pregnancy (aOR: 0.21, 95%CI: 0.05-0.89) were significant predictors of the risk of syphilis among pregnant women in this setting. Conclusion the prevalence of syphilis among pregnant women in urban poor settings is not low and so must not be underestimated. The potential drivers of syphilis among pregnant women are HIV, elevated blood pressure, and status of previous pregnancy. There should be increased awareness about routine syphilis testing among pregnant mothers attending antenatal care.
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Affiliation(s)
- Andrew Simiyu
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Collins Grace Kalanga Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Martha Taremwa
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Sarah Nabwire Ssali
- School of Women and Gender Studies, College of Humanities, Makerere University, Kampala, Uganda
| | - Frank Norbert Mwiine
- Department of Biomolecular and Biolaboratory Sciences (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Clovice Kankya
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Kizito Kahooza Mugimba
- Department of Biomolecular and Biolaboratory Sciences (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
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Cuadros DF, Chowdhury T, Milali M, Citron DT, Nyimbili S, Vlahakis N, Savory T, Mulenga L, Sivile S, Zyambo KD, Bershteyn A. Geospatial patterns of progress towards UNAIDS '95-95-95' targets and community vulnerability in Zambia: insights from population-based HIV impact assessments. BMJ Glob Health 2023; 8:e012629. [PMID: 37899088 PMCID: PMC10619088 DOI: 10.1136/bmjgh-2023-012629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the '95-95-95' targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the '95-95-95' indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. METHODS This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimised hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access and social determinants of healthcare utilisation. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioural covariates and the three main outcomes of study. RESULTS Varied progress towards the '95-95-95' targets were observed in different regions of Zambia. Each '95' displayed a unique geographical pattern, independent of HIV prevalence, resulting in four distinct geographical clusters. Factors associated with gaps in the '95s' include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on antiretroviral therapy and having detectable viral loads. CONCLUSIONS Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographical patterns and levels of performance in the '95-95-95' targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors and developing innovative strategies to improve local HIV care continuum outcomes.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Tuhin Chowdhury
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Masabho Milali
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Daniel T Citron
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Sulani Nyimbili
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Natalie Vlahakis
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Theodora Savory
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lloyd Mulenga
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | | | | | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Cuadros DF, Chowdhury T, Milali M, Citron D, Nyimbili S, Vlahakis N, Savory T, Mulenga L, Sivile S, Zyambo K, Bershteyn A. Geospatial Patterns of Progress towards UNAIDS "95-95-95" Targets and Community Vulnerability in Zambia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23289044. [PMID: 37163012 PMCID: PMC10168516 DOI: 10.1101/2023.04.24.23289044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the "95-95-95" targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the "95-95-95" indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimized hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access, and social determinants of healthcare utilization. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioral covariates and the three main outcomes of study. Varied progress towards the "95-95-95" targets were observed in different regions of Zambia. Each "95" displayed a unique geographic pattern, independent of HIV prevalence, resulting in four distinct geographic clusters. Factors associated with gaps in the "95s" include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on ART and having detectable viral loads. Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographic patterns and levels of performance in the "95-95-95" targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors, and developing innovative strategies to improve local HIV care continuum outcomes.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Tuhin Chowdhury
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Masabho Milali
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Citron
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Sulani Nyimbili
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Natalie Vlahakis
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Theodora Savory
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lloyd Mulenga
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | | | - Khozya Zyambo
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Ruangtragool L, Silver R, Machiha A, Gwanzura L, Hakim A, Lupoli K, Musuka G, Patel H, Mugurungi O, Tippett Barr BA, Rogers JH. Factors associated with active syphilis among men and women aged 15 years and older in the Zimbabwe Population-based HIV Impact Assessment (2015–2016). PLoS One 2022; 17:e0261057. [PMID: 35298475 PMCID: PMC8929562 DOI: 10.1371/journal.pone.0261057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe’s national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015–2016) to describe factors associated with active syphilis among men and women ages 15 years and older. Methods ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio’s Dual-Path Platform Syphilis Screen & Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender. Results The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3–5.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9–14.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0–12.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males. Conculsion HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals’ diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe.
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Affiliation(s)
- Leala Ruangtragool
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Rachel Silver
- Public Health Institute / CDC Global HIV Surveillance Fellow, Harare, Zimbabwe
| | - Anna Machiha
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Avi Hakim
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Katie Lupoli
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Hetal Patel
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Beth A. Tippett Barr
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - John H. Rogers
- Division of Global HIV/TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
- * E-mail:
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Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil. Sci Rep 2022; 12:585. [PMID: 35022472 PMCID: PMC8755837 DOI: 10.1038/s41598-021-04530-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development.
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Kalichman SC, Eaton LA, Kalichman MO. Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention. Int J STD AIDS 2021; 33:73-80. [PMID: 34628983 DOI: 10.1177/09564624211046516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
| | - Lisa A Eaton
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Institute for Collaboration on Health Intervention and Policy (InCHIP), 7712University of Connecticut, Storrs, CT, USA
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Porter L, Bello G, Nkambule R, Justman J. HIV General Population Surveys: Shedding Light on the Status of HIV Epidemics and Informing Future Actions. J Acquir Immune Defic Syndr 2021; 87:S2-S5. [PMID: 34166307 DOI: 10.1097/qai.0000000000002701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Nationally representative household surveys of the general population can provide critical assessments of the status of HIV epidemics and the impact of national HIV programs. With lessons learned from earlier surveys, PEPFAR has supported HIV-focused surveys in high burden countries to measure known HIV status, access to HIV treatment, and viral suppression, and, by using novel HIV recency assays, to estimate HIV incidence. The results from the initial population-based HIV impact assessments have transformed global HIV programming, demonstrating unexpected progress in population viral suppression and the persistent burden of high HIV incidence among adolescent girls and young women. The findings highlight the importance of tailoring programs to engage men more effectively in HIV testing and treatment. The collection of manuscripts summarized in this overview of the Supplement describe the methods and selected key findings from the initial population-based HIV impact assessment surveys. Taken together, the efforts described in these manuscripts have advanced survey and laboratory capacity and guided HIV programs toward the goal of ending the global epidemic.
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Affiliation(s)
- Laura Porter
- Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - George Bello
- Epidemiology Unit, Ministry of Health, Lilongwe, Malawi
| | - Rejoice Nkambule
- Department of Health Services, Ministry of Health, Manzini, Kingdom of Eswatini; and
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