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Oluoch L, Tapia K, Kiptinness C, Casmir E, Maina SG, Makena L, Selke S, Wang M, Chohan B, Sycuro L, Wald A, Ngure K, Mugo N, Roxby A. Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women. BMJ Open 2023; 13:e071746. [PMID: 37813538 PMCID: PMC10565234 DOI: 10.1136/bmjopen-2023-071746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status. DESIGN Longitudinal cohort study. SETTING Thika, Kenya. PARTICIPANTS AGYW aged 16-20 years enrolled prior to first sex or reporting only a single lifetime partner. MAIN OUTCOME MEASURES The primary outcome was relative risk (RR) of BV during pregnancy compared with before pregnancy by analysing longitudinal trends in BV over time. BV risk was estimated using Poisson regression models. RESULTS A total of 121 AGYW became pregnant in the parent cohort and had BV results before, during or after pregnancy. Point prevalence of BV was 11.0% at visits >12 months pre-pregnancy, 13.0% at 3-12 months pre-pregnancy, 22.1% at <3 months pre-pregnancy and 13.4% during pregnancy. Compared with visits during pregnancy, RR of BV was 1.65 (95% CI: 1.00 to 2.71; p=0.05) at visits <3 months pre-pregnancy, 0.97 (95% CI: 0.62 to 1.52; p=0.90) at visits 3-12 months pre-pregnancy and 0.82 (95% CI: 0.44 to 1.53; p=0.53) at visits 12 months pre-pregnancy. An adjusted analysis including age, income, residence, date of first sex, recent sexual activity and positive sexually transmitted infection test resulted in small changes in risk estimates, with adjusted RR of BV of 1.66 (95% CI: 1.04 to 2.67; p=0.04) at visits <3 months pre-pregnancy compared with visits during pregnancy. CONCLUSIONS BV risk during pregnancy was lower than during the immediate pre-pregnancy period. Hormonal changes in pregnancy may reduce BV.
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Affiliation(s)
- Lynda Oluoch
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Tapia
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - L Makena
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stacy Selke
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Melody Wang
- Global Health, University of Washington, Seattle, Washington, USA
| | - Bhavna Chohan
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | - Laura Sycuro
- Department of Microbiology, Immunology and Infectious Diseases; Obstetrics and Gynecology; Snyder Institute for Chronic Diseases; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anna Wald
- Medicine, Laboratory Medicine and Pathology, Epidemiology, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kenneth Ngure
- Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | - Alison Roxby
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Global Health, Medicine, Epidemiology, University of Washington, Seattle, Washington, USA
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Oluoch LM, Roxby A, Mugo N, Wald A, Ngure K, Selke S, Chohan B, Kiptinness C, Tapia K, Micheni M, Maina SG, Casmir E. Does providing laboratory confirmed STI results impact uptake of HIV pre-exposure prophylaxis (PrEP) uptake among Kenyan adolescents girls and young women? A descriptive analysis. Sex Transm Infect 2020; 97:467-468. [PMID: 32917766 DOI: 10.1136/sextrans-2020-054637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lynda Myra Oluoch
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alison Roxby
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stacy Selke
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Murugi Micheni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen Gakuo Maina
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edinah Casmir
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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Angelino AC, Bell S, Roxby A, Thomas M, Leston J, Coker TR, Crouch JM. Developing Resources for American Indian/Alaska Native Transgender and Two-Spirit Youth, Their Relatives, and Healthcare Providers. Prog Community Health Partnersh 2020; 14:509-516. [PMID: 33416771 PMCID: PMC8025289 DOI: 10.1353/cpr.2020.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
American Indian and Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare, including lack of access to culturally specific resources. This article details the creation of a culturally-specific Toolkit for AI/AN transgender and Two-Spirit youth, their relatives, and their healthcare providers across the United States. The Toolkit aims to 1) deliver culturally grounded resources to youth with diverse gender identities, 2) provide resources for families, and 3) increase healthcare provider awareness. A culturally appropriate Toolkit, "Celebrating Our Magic," was created from continual engagement with community partners over a 6-month period to address identified needs. The Toolkit has been shared regionally with partners who helped with its creation and nationally with Indian Health Service, Tribal, and Urban clinics serving AI/AN youth. This Toolkit creation process could be applied to manuals or guides for work in other underserved communities.
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Abstract
The role of antibiotic prophylaxis for prevention of infective endocarditis is unknown. Endocarditis prophylaxis is recommended for certain high-risk individuals prior to dental procedures. To our knowledge, this is the first case reported in the literature of a patient with complex congenital heart disease developing endocarditis in the period immediately following otherwise uncomplicated intrauterine device insertion.
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Affiliation(s)
- Eric Allan Meyerowitz
- Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Karen Stout
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - Alison Roxby
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Andersen M, Roxby A, Marx G, Bosire R, Farquhar C, Kiarie J, Unger J. Reproductive desires and family planning and safer conception knowledge among women in HIV-serodiscordant relationships in Kenya: a qualitative study. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Slyker J, Farquhar C, Atkinson C, Ásbjörnsdóttir K, Roxby A, Drake A, Kiarie J, Wald A, Boeckh M, Richardson B, Odem-Davis K, John-Stewart G, Emery V. Compartmentalized cytomegalovirus replication and transmission in the setting of maternal HIV-1 infection. Clin Infect Dis 2013; 58:564-72. [PMID: 24192386 DOI: 10.1093/cid/cit727] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is associated with adverse outcomes in human immunodeficiency virus (HIV)-exposed infants. Determinants of vertical CMV transmission in the setting of maternal HIV-1 infection are not well-defined. METHODS CMV and HIV-1 levels were measured in plasma, cervical secretions, and breast milk of 147 HIV-1-infected women to define correlates of maternal CMV replication and infant CMV acquisition. RESULTS Although few women had detectable CMV in plasma (4.8%), the majority had detectable CMV DNA in cervical secretions (66%) and breast milk (99%). There was a strong association between cervical CMV detection during pregnancy and later breast milk levels (β = 0.47; P = .005). Plasma HIV-1 level and CD4 counts were associated with CMV in the cervix and breast milk. However HIV-1 levels within the cervix and breast milk were not associated with CMV within these compartments. Maternal breast milk CMV levels (hazard ratio [HR], 1.4; P = .003) and maternal CD4 < 450 cells/mm(3) (HR, 1.8; P = .008) were independently associated with infant CMV acquisition; each log10 increase in breast milk CMV was associated with a 40% increase in infant infection. The breast milk CMV level required to attain a 50% probability of CMV transmission increased with higher maternal CD4 counts, increasing from 3.55 log10 CMV DNA copies/mL at a CD4 count of 350 cells/mm(3) to 5.50 log10 CMV DNA copies/mL at a CD4 count of 1000 cells/mm(3). CONCLUSIONS Breast milk CMV levels and maternal CD4 count are major determinants of CMV transmission in the setting of maternal HIV-1. Maternal immune reconstitution or lowering breast milk CMV levels may reduce vertical CMV transmission.
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Drake A, Roxby A, Kiarie J, Richardson B, Stewart G, Farquhar C. Prevalence and correlates of contraception, method type, and condom use among HIV-1 infected postpartum women. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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