1
|
Popoola VO, Kagaayi J, Ssekasanvu J, Ssekubugu R, Kigozi G, Ndyanabo A, Nalugoda F, Chang LW, Lutalo T, Tobian AAR, Kabatesi D, Alamo S, Mills LA, Kigozi G, Wawer MJ, Santelli J, Gray RH, Reynolds SJ, Serwadda D, Lessler J, Grabowski MK. HIV epidemiologic trends among occupational groups in Rakai, Uganda: A population-based longitudinal study, 1999-2016. PLOS Glob Public Health 2024; 4:e0002891. [PMID: 38377078 PMCID: PMC10878534 DOI: 10.1371/journal.pgph.0002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23-0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18-0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.
Collapse
Affiliation(s)
- Victor O. Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | - Larry W. Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Aaron A. R. Tobian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Donna Kabatesi
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Stella Alamo
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Lisa A. Mills
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | | | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - John Santelli
- Department of Population and Family Health and Pediatrics, Columbia University, New York, New York, United States of America
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J. Reynolds
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - M. Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
2
|
Hunt JH, Mwinnyaa G, Patel EU, Grabowski MK, Kagaayi J, Gray RH, Ssekasanvu J, Wawer MJ, Kigozi G, Chang LW, Kalibbala S, Nakalanzi M, Ndyanabo A, Quinn TC, Serwadda D, Reynolds SJ, Galiwango RM, Laeyendecker O. Longitudinal patterns in indeterminate HIV rapid antibody test results: a population-based, prospective cohort study. Microbiol Spectr 2024; 12:e0325323. [PMID: 38189332 PMCID: PMC10845946 DOI: 10.1128/spectrum.03253-23] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024] Open
Abstract
Rapid HIV tests are critical to HIV surveillance and universal testing and treatment programs. We assessed longitudinal patterns in indeterminate HIV rapid test results in an African population-based cohort. Prospective HIV rapid antibody test results, defined by two parallel rapid tests, among participants aged 15-49 years from three survey rounds of the Rakai Community Cohort Study, Uganda, from 2013 to 2018, were assessed. An indeterminate result was defined as any weak positive result or when one test was negative and the other was positive. A total of 31,405 participants contributed 54,459 person-visits, with 15,713 participants contributing multiple visits and 7,351 participants contributing 3 visits. The prevalence of indeterminate results was 2.7% (1,490/54,469). Of the participants with multiple visits who initially tested indeterminate (n = 591), 40.4% were negative, 18.6% were positive, and 41.0% were indeterminate at the subsequent visit. Of the participants with two consecutive indeterminate results who had a third visit (n = 67), 20.9% were negative, 9.0% were positive, and 70.2% remained indeterminate. Compared to a prior negative result, a prior indeterminate result was strongly associated with a subsequent indeterminate result [adjusted prevalence ratio, 23.0 (95% CI = 20.0-26.5)]. Compared to men, women were more likely to test indeterminate than negative [adjusted odds ratio, 2.3 (95% CI = 2.0-2.6)]. Indeterminate rapid HIV test results are highly correlated within an individual and 0.6% of the population persistently tested indeterminate over the study period. A substantial fraction of people with an indeterminate result subsequently tested HIV positive at the next visit, underscoring the importance of follow-up HIV testing protocols.IMPORTANCERapid HIV tests are a critical tool for expanding HIV testing and treatment to end the HIV epidemic. The interpretation and management of indeterminate rapid HIV test results pose a unique challenge for connecting all people living with HIV to the necessary care and treatment. Indeterminate rapid HIV test results are characterized by any weak positive result or discordant results (when one test is negative and the other is positive). We systematically tested all participants of a Ugandan population-based, longitudinal cohort study regardless of prior test results or HIV status to quantify longitudinal patterns in rapid HIV test results. We found that a substantial fraction (>15%) of participants with indeterminate rapid test results subsequently tested positive upon follow-up testing at the next visit. Our findings demonstrate the importance of follow-up HIV testing protocols for indeterminate rapid HIV test results.
Collapse
Affiliation(s)
- Joanne H. Hunt
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - George Mwinnyaa
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Eshan U. Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - M. Kate Grabowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Ronald H. Gray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Maria J. Wawer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Larry W. Chang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | | | - Thomas C. Quinn
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University, Kampala, Uganda
| | - Steven J. Reynolds
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Rosen JG, Ssekubugu R, Chang LW, Ssempijja V, Galiwango RM, Ssekasanvu J, Ndyanabo A, Kisakye A, Nakigozi G, Rucinski KB, Patel EU, Kennedy CE, Nalugoda F, Kigozi G, Ratmann O, Nelson LJ, Mills LA, Kabatesi D, Tobian AAR, Quinn TC, Kagaayi J, Reynolds SJ, Grabowski MK. Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study. J Int AIDS Soc 2024; 27:e26200. [PMID: 38332519 PMCID: PMC10853573 DOI: 10.1002/jia2.26200] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Population-level data on durable HIV viral load suppression (VLS) following the implementation of Universal Test and Treat (UTT) in Africa are limited. We assessed trends in durable VLS and viraemia among persons living with HIV in 40 Ugandan communities during the UTT scale-up. METHODS In 2015-2020, we measured VLS (<200 RNA copies/ml) among participants in the Rakai Community Cohort Study, a longitudinal population-based HIV surveillance cohort in southern Uganda. Persons with unsuppressed viral loads were characterized as having low-level (200-999 copies/ml) or high-level (≥1000 copies/ml) viraemia. Individual virologic outcomes were assessed over two consecutive RCCS survey visits (i.e. visit-pairs; ∼18-month visit intervals) and classified as durable VLS (<200 copies/ml at both visits), new/renewed VLS (<200 copies/ml at follow-up only), viral rebound (<200 copies/ml at initial visit only) or persistent viraemia (≥200 copies/ml at both visits). Population prevalence of each outcome was assessed over calendar time. Community-level prevalence and individual-level predictors of persistent high-level viraemia were also assessed using multivariable Poisson regression with generalized estimating equations. RESULTS Overall, 3080 participants contributed 4604 visit-pairs over three survey rounds. Most visit-pairs (72.4%) exhibited durable VLS, with few (2.5%) experiencing viral rebound. Among those with any viraemia at the initial visit (23.5%, n = 1083), 46.9% remained viraemic through follow-up, 91.3% of which was high-level viraemia. One-fifth (20.8%) of visit-pairs exhibiting persistent high-level viraemia self-reported antiretroviral therapy (ART) use for ≥12 months. Prevalence of persistent high-level viraemia varied substantially across communities and was significantly elevated among young persons aged 15-29 years (vs. 40- to 49-year-olds; adjusted risk ratio [adjRR] = 2.96; 95% confidence interval [95% CI]: 2.21-3.96), males (vs. females; adjRR = 2.40, 95% CI: 1.87-3.07), persons reporting inconsistent condom use with non-marital/casual partners (vs. persons with marital/permanent partners only; adjRR = 1.38, 95% CI: 1.10-1.74) and persons reporting hazardous alcohol use (adjRR = 1.09, 95% CI: 1.03-1.16). The prevalence of persistent high-level viraemia was highest among males <30 years (32.0%). CONCLUSIONS Following universal ART provision, most persons living with HIV in south-central Uganda are durably suppressed. Among persons exhibiting any viraemia, nearly half exhibited high-level viraemia for ≥12 months and reported higher-risk behaviours associated with onward HIV transmission. Intensified efforts linking individuals to HIV treatment services could accelerate momentum towards HIV epidemic control.
Collapse
Affiliation(s)
- Joseph Gregory Rosen
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Larry W. Chang
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Victor Ssempijja
- Rakai Health Sciences ProgramEntebbeUganda
- Clinical Monitoring Research Program DirectorateFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | | | - Joseph Ssekasanvu
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
| | | | | | | | - Katherine B. Rucinski
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Eshan U. Patel
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Caitlin E. Kennedy
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
| | | | | | | | - Lisa J. Nelson
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Lisa A. Mills
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Donna Kabatesi
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Aaron A. R. Tobian
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Thomas C. Quinn
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Steven J. Reynolds
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences ProgramEntebbeUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
4
|
Rosen JG, Ndyanabo A, Nakawooya H, Galiwango RM, Ssekubugu R, Ssekasanvu J, Kim S, Rucinski KB, Nakigozi G, Nalugoda F, Kigozi G, Quinn TC, Chang LW, Kennedy CE, Reynolds SJ, Kagaayi J, Grabowski MK. Incidence of health facility switching and associations with HIV viral rebound among persons on antiretroviral therapy (ART) in Uganda: a population-based study. Clin Infect Dis 2023:ciad773. [PMID: 38114162 DOI: 10.1093/cid/ciad773] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND A substantial fraction of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their HIV care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. METHODS We used data from 40 communities (2015-2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15-49 years with serologically confirmed HIV infection self-reporting ART use and contributing ≥1 follow-up visits were included. Facility switching and virologic outcomes were assessed between two consecutive study visits (i.e., index and follow-up visits, ∼18-month interval). Those reporting different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. RESULTS Overall, 2,257 persons self-reporting ART use (median age: 35 years, 65% women, 92% initially suppressed) contributed 3,335 visit-pairs and 5,959 person-years (py) to the analysis. Facility switching was common (4.8 per 100 py, 95%CI 4.2-5.5) and most pronounced in persons <30 years and fishing community residents. Among persons suppressed at their index visit (n=2,076), incidence of viral rebound was over twice as high in persons who switched facilities (adjIRR=2.27, 95%CI 1.16-4.45). CONCLUSIONS Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.
Collapse
Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | | | | | | | | | - Seungwon Kim
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Katherine B Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | | | | | - Thomas C Quinn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Larry W Chang
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Caitlin E Kennedy
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | | | - M Kate Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| |
Collapse
|
5
|
Whittles LK, Galiwango RM, Mpagazi J, Tobian AAR, Ssekubugu R, Jackson J, Peer AD, Kennedy C, Nakalanzi M, Ndyanabo A, Kigozi G, Chang LW, Serwadda D, Manabe YC, Gaydos CA, Laeyendecker O, Quinn TC, Reynolds SJ, Kagaayi J, Eaton JW, Grabowski MK. Age Patterns of HSV-2 Incidence and Prevalence in Two Ugandan Communities: A Catalytic Incidence Model Applied to Population-Based Seroprevalence Data. J Infect Dis 2023; 228:1198-1207. [PMID: 37079374 PMCID: PMC10629710 DOI: 10.1093/infdis/jiad113] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) is an incurable sexually transmitted infection associated with increased risk of acquiring and transmitting human immunodeficiency virus (HIV). HSV-2 is highly prevalent in sub-Saharan Africa, but population-level estimates of incidence are sparse. METHODS We measured HSV-2 prevalence from cross-sectional serological data among adults aged 18-49 years in 2 south-central Uganda communities (fishing, inland). We identified risk factors for seropositivity, then inferred age patterns of HSV-2 with a Bayesian catalytic model. RESULTS HSV-2 prevalence was 53.6% (n = 975/1819; 95% confidence interval, 51.3%-55.9%). Prevalence increased with age, was higher in the fishing community, and among women, reaching 93.6% (95% credible interval, 90.2%-96.6%) by age 49 years. Factors associated with HSV-2 seropositivity included more lifetime sexual partners, HIV positive status, and lower education. HSV-2 incidence peakied at age 18 years for women and 19-20 years for men. HIV prevalence was up to 10-fold higher in HSV-2-positive individuals. CONCLUSIONS HSV-2 prevalence and incidence were extremely high, with most infections occurring in late adolescence. Interventions against HSV-2, such as future vaccines or therapeutics, must target young populations. Remarkably higher HIV prevalence among HSV-2-positive individuals underscores this population as a priority for HIV prevention.
Collapse
Affiliation(s)
- Lilith K Whittles
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, and NIHR Health Protection Research Unit in Modelling and Health Economics, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jade Jackson
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Austin D Peer
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Caitlin Kennedy
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Yukari C Manabe
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas C Quinn
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Kagaayi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Jeffrey W Eaton
- Medical Research Council Centre for Global Infectious Disease Analysis, and NIHR Health Protection Research Unit in Modelling and Health Economics, School of Public Health, Imperial College London, London, United Kingdom
| | - M Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Khalifa A, Ssekubugu R, Lessler J, Wawer M, Santelli JS, Hoffman S, Nalugoda F, Lutalo T, Ndyanabo A, Ssekasanvu J, Kigozi G, Kagaayi J, Chang LW, Grabowski MK. Implications of rapid population growth on survey design and HIV estimates in the Rakai Community Cohort Study (RCCS), Uganda. BMJ Open 2023; 13:e071108. [PMID: 37495389 PMCID: PMC10373715 DOI: 10.1136/bmjopen-2022-071108] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Since rapid population growth challenges longitudinal population-based HIV cohorts in Africa to maintain coverage of their target populations, this study evaluated whether the exclusion of some residents due to growing population size biases key HIV metrics like prevalence and population-level viremia. DESIGN, SETTING AND PARTICIPANTS Data were obtained from the Rakai Community Cohort Study (RCCS) in south central Uganda, an open population-based cohort which began excluding some residents of newly constructed household structures within its surveillance boundaries in 2008. The study includes adults aged 15-49 years who were censused from 2019 to 2020. MEASURES We fit ensemble machine learning models to RCCS census and survey data to predict HIV seroprevalence and viremia (prevalence of those with viral load >1000 copies/mL) in the excluded population and evaluated whether their inclusion would change overall estimates. RESULTS Of the 24 729 census-eligible residents, 2920 (12%) residents were excluded from the RCCS because they were living in new households. The predicted seroprevalence for these excluded residents was 10.8% (95% CI: 9.6% to 11.8%)-somewhat lower than 11.7% (95% CI: 11.2% to 12.3%) in the observed sample. Predicted seroprevalence for younger excluded residents aged 15-24 years was 4.9% (95% CI: 3.6% to 6.1%)-significantly higher than that in the observed sample for the same age group (2.6% (95% CI: 2.2% to 3.1%)), while predicted seroprevalence for older excluded residents aged 25-49 years was 15.0% (95% CI: 13.3% to 16.4%)-significantly lower than their counterparts in the observed sample (17.2% (95% CI: 16.4% to 18.1%)). Over all ages, the predicted prevalence of viremia in excluded residents (3.7% (95% CI: 3.0% to 4.5%)) was significantly higher than that in the observed sample (1.7% (95% CI: 1.5% to 1.9%)), resulting in a higher overall population-level viremia estimate of 2.1% (95% CI: 1.8% to 2.4%). CONCLUSIONS Exclusion of residents in new households may modestly bias HIV viremia estimates and some age-specific seroprevalence estimates in the RCCS. Overall, HIV seroprevalence estimates were not significantly affected.
Collapse
Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- ICAP, Columbia University, New York, New York, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Global and Sexual Health, Karolinska Institutet, Stockholm, Sweden
| | - Justin Lessler
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Santelli
- Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Centre for Clinical and Behavioural Studies, Columbia University Irving Medical Centre, New York, New York, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Rosen JG, Reynolds SJ, Galiwango RM, Kigozi G, Quinn TC, Ratmann O, Ndyanabo A, Nelson LJ, Nakigozi G, Nalugemwa M, Rucinski KB, Kennedy CE, Chang LW, Kagaayi J, Serwadda D, Grabowski MK. A moving target: impacts of lowering viral load suppression cutpoints on progress towards HIV epidemic control goals. AIDS 2023; 37:1486-1489. [PMID: 37395255 PMCID: PMC10328551 DOI: 10.1097/qad.0000000000003593] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Redefining viral load suppression (VLS) using lower cutpoints could impact progress towards the United Nations Programme on HIV/AIDS 95-95-95 targets. We assessed impacts of lowering the VLS cutpoint on achieving the 'third 95' in the Rakai Community Cohort Study. Population VLS would fall from 86% to 84% and 76%, respectively, after lowering VLS cutpoints from <1000 to <200 and <50 copies/ml. The fraction of viremic persons increased by 17% after lowering the VLS cutpoint from <1000 to <200 copies/ml.
Collapse
Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven J. Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Thomas C. Quinn
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Oliver Ratmann
- Department of Mathematics, Imperial College, London, United Kingdom
| | | | - Lisa J. Nelson
- Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | - Katherine B. Rucinski
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Larry W. Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - M. Kate Grabowski
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Rosen JG, Ssekubugu R, Chang LW, Ssempijja V, Galiwango RM, Ssekasanvu J, Ndyanabo A, Kisakye A, Nakigozi G, Rucinski KB, Patel EU, Kennedy CE, Nalugoda F, Kigozi G, Ratmann O, Nelson LJ, Mills LA, Kabatesi D, Tobian AAR, Quinn TC, Kagaayi J, Reynolds SJ, Grabowski MK. Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viremia during Universal Test and Treat scale-up in Uganda: a population-based study. medRxiv 2023:2023.06.15.23291445. [PMID: 37398460 PMCID: PMC10312875 DOI: 10.1101/2023.06.15.23291445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction Population-level data on durable HIV viral load suppression (VLS) following implementation of Universal Test and Treat (UTT) in Africa are limited. We assessed trends in durable VLS and viremia among persons living with HIV in 40 Ugandan communities during UTT scale-up. Methods In 2015-2020, we measured VLS (defined as <200 RNA copies/mL) among participants in the Rakai Community Cohort Study, a longitudinal population-based HIV surveillance cohort in southern Uganda. Persons with unsuppressed viral loads were characterized as having low-level (200-999 copies/mL) or high-level (≥1,000 copies/mL) viremia. Individual virologic outcomes were assessed over two consecutive RCCS survey visits (i.e., visit-pairs; ∼18 month visit intervals) and classified as durable VLS (<200 copies/mL at both visits), new/renewed VLS (<200 copies/mL at follow-up only), viral rebound (<200 copies/mL at initial visit only), or persistent viremia (<200 copies/mL at neither visit). Population prevalence of each outcome was assessed over calendar time. Community-level prevalence and individual-level predictors of persistent high-level viremia were also assessed using multivariable Poisson regression with generalized estimating equations. Results Overall, 3,080 participants contributed 4,604 visit-pairs over three survey rounds. Most visit-pairs (72.4%) exhibited durable VLS, with few (2.5%) experiencing viral rebound. Among those with viremia at the initial visit ( n =1,083), 46.9% maintained viremia through follow-up, 91.3% of which was high-level viremia. One-fifth (20.8%) of visit-pairs exhibiting persistent high-level viremia self-reported antiretroviral therapy (ART) use for ≥12 months. Prevalence of persistent high-level viremia varied substantially across communities and was significantly elevated among young persons aged 15-29 years (versus 40-49-year-olds; adjusted risk ratio [adjRR]=2.96; 95% confidence interval [95%CI]:2.21-3.96), men (versus women; adjRR=2.40, 95%CI:1.87-3.07), persons reporting inconsistent condom use with non-marital/casual partners (versus persons with marital/permanent partners only; adjRR=1.38, 95%CI:1.10-1.74), and persons exhibiting hazardous alcohol use (adjRR=1.09, 95%CI:1.03-1.16). The prevalence of persistent high-level viremia was highest among men <30 years (32.0%). Conclusions Following universal ART provision, most persons living with HIV in south-central Uganda are durably suppressed. Among persons exhibiting viremia, nearly half maintain high-level viremia for ≥12 months and report higher-risk behaviors associated with onward HIV transmission. Enhanced linkage to HIV care and optimized treatment retention could accelerate momentum towards HIV epidemic control.
Collapse
|
9
|
Ndyanabo A, Footer K, Ahmed T, Glogowski A, Whalen C, Ssekasanvu J, Ssentongo L, Lutalo T, Nalugoda F, Ha GK, Rosenthal A. Establishing a centralized data mart from the Rakai community cohort study to improve HIV research in Rakai, Uganda. JAMIA Open 2022; 5:ooac032. [PMID: 37206994 PMCID: PMC9118983 DOI: 10.1093/jamiaopen/ooac032] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/08/2022] [Accepted: 05/07/2022] [Indexed: 09/21/2023] Open
Abstract
To improve timely access to quality HIV research data, the Rakai Health Sciences Program (RHSP) Data Mart was developed to store cohort study data from a legacy database platform in a modernized system using standard data management processes. The RHSP Data Mart was developed on a Microsoft SQL Server platform using Microsoft SQL Server Integration Services with custom data mappings and queries. The data mart stores 20+ years of longitudinal HIV research data and includes standard processes for managing data, data dictionary, training materials, and a library of queries to fulfill data requests and load new data from completed survey rounds. The RHSP Data Mart enables efficient querying and analysis of multidimensional research data by simplifying data integration and processing. A sustainable database platform with well-defined data management processes promotes data accessibility and reproducibility, enabling researchers to advance their understanding and management of infectious diseases.
Collapse
Affiliation(s)
| | - Kevin Footer
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanvir Ahmed
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alex Glogowski
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Whalen
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph Ssekasanvu
- Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lloyd Ssentongo
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Grace K Ha
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alex Rosenthal
- Office of Cyber Infrastructure & Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Enriquez R, Ssekubugu R, Ndyanabo A, Marrone G, Gigante B, Chang LW, Reynolds SJ, Nalugoda F, Ekstrom AM, Sewankambo NK, Serwadda DM, Nordenstedt H. Prevalence of cardiovascular risk factors by HIV status in a population-based cohort in South Central Uganda: a cross-sectional survey. J Int AIDS Soc 2022; 25:e25901. [PMID: 35419976 PMCID: PMC9008150 DOI: 10.1002/jia2.25901] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda. METHODS A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia. RESULTS Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52). CONCLUSIONS In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.
Collapse
Affiliation(s)
- Rocio Enriquez
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | | | | | - Gaetano Marrone
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Bruna Gigante
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Larry W. Chang
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Steven J. Reynolds
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Laboratory of ImmunoregulationDivision of Intramural ResearchNational Institute for Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Anna Mia Ekstrom
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Infectious DiseasesSouth Central HospitalStockholmSweden
| | - Nelson K. Sewankambo
- Rakai Health Sciences ProgramKalisizoUganda
- Department of MedicineMakerere University School of MedicineKampalaUganda
| | - David M. Serwadda
- Rakai Health Sciences ProgramKalisizoUganda
- Department of Disease Control and Environmental HealthMakerere University School of Public HealthKampalaUganda
| | - Helena Nordenstedt
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
- Department of Internal Medicine and Infectious DiseasesDanderyd University HospitalStockholmSweden
| |
Collapse
|
11
|
Galiwango RM, Ssuuna C, Kaleebu P, Kigozi G, Kagaayi J, Nakigozi G, Reynolds SJ, Lutalo T, Kankaka EN, Wasswa JB, Kalibbala SN, Kigozi AN, Watera C, Ejang J, Ndyanabo A, Anok AJ, Ssemwanga D, Kibengo FM, Quinn TC, Grabowski M, Chang LW, Wawer M, Gray R, Laeyendecker O, Serwadda D. Short Communication: Validation of the Asante HIV-1 Rapid Recency Assay for Detection of Recent HIV-1 Infections in Uganda. AIDS Res Hum Retroviruses 2021; 37:893-896. [PMID: 33499732 DOI: 10.1089/aid.2020.0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/12/2022] Open
Abstract
Point of care rapid recency testing for HIV-1 may be a cost-effective tool to identify recently infected individuals for incidence estimation, and focused HIV prevention through intensified contact tracing. We validated the Asante™ HIV-1 rapid recency® assay for use in Uganda. Archived specimens (serum/plasma), collected from longitudinally observed HIV-1 recently and long-term infected participants, were tested with the Asante HIV-1 rapid recency assay per manufacturer's instructions. Previously identified antiretroviral therapy (ART)-naive samples with known seroconversions within 6 months of follow-up were tested in independent laboratories: the Rakai Health Sciences Program (RHSP) and the Uganda Virus Research Institute HIV Reference Laboratory (UVRI-HRL). In addition, samples from participants who seroconverted within 6-18 months and samples from individuals with chronic HIV-1 infection of at least 18 months duration were classified into three categories: ART naive, ART exposed with suppressed viral loads, and ART exposed with detectable viremia. Of the 85 samples seroconverting in ≤6 months, 27 and 42 samples were identified as "recent" by the Asante HIV-1 rapid recency test at the RHSP laboratory and UVRI-HRL, corresponding to sensitivities of 32% and 49%, respectively. There was 72% agreement between the laboratories (Cohen's kappa = 0.481, 95% CI = 0.317-0.646, p < .0001). Specificity was 100% (200/200) among chronically infected ART-naive samples. The Asante HIV-1 rapid recency assay had low sensitivity for detection of recent HIV-1 infections in Uganda, with substantial interlaboratory variability due to differential interpretation of the test strip bands. Specificity was excellent. Assessment of assay performance in other settings is needed to guide decisions on test utility.
Collapse
Affiliation(s)
| | | | - Pontiano Kaleebu
- Uganda Virus Research Institute, Entebbe, Uganda
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | | | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Steven James Reynolds
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | | | | | | | - Julia Ejang
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Deogratius Ssemwanga
- Uganda Virus Research Institute, Entebbe, Uganda
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Freddie M. Kibengo
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Thomas C. Quinn
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mary Grabowski
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Larry W. Chang
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ronald Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
12
|
Brophy JE, Lessler J, Ssekubugu R, Kennedy CE, Chang LW, Kigozi G, Ndyanabo A, Kigozi G, Nalugoda F, Gray RH, Wawer MJ, Serwadda DM, Reynolds SJ, Kagaayi J, Grabowski MK. Prevalence of Untreated HIV and Associated Risk Behaviors Among the Sexual Partners of Recent Migrants and Long-term Residents in Rakai, Uganda. J Acquir Immune Defic Syndr 2021; 88:243-251. [PMID: 34354009 PMCID: PMC8526377 DOI: 10.1097/qai.0000000000002764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migrants in sub-Saharan Africa are at increased risk of HIV acquisition after migration, but little is known about their sexual partners at place of destination. SETTING Rakai Community Cohort Study (RCCS) in Uganda. METHODS From 1999 to 2016, persons aged 15-49 years were surveyed in the RCCS and reported on their 4 most recent sexual partners in the last year. We compared the characteristics of sexual partners reported by migrants moving into RCCS communities in the last 2 years (ie, in-migrants) with those of long-term residents with no recent migration history. Among a subset of participants in cohabitating epidemiologically linked couples of known HIV serostatus, we also assessed prevalence of having ≥1 untreated HIV-positive partner among in-migrants and long-term residents. RESULTS One hundred sixteen thousand seven hundred forty-four sexual partners were reported by 29,423 participants. The sexual partnerships of in-migrants were significantly less likely to be marital, more likely to span community boundaries, and shorter in duration than those of long-term residents. In-migrants also reported more sexual partners and were less likely to know their partner's HIV status or to have told their partner their HIV status. Among 7558 epidemiologically linked couples, HIV-negative in-migrants were more likely to partner with untreated HIV-positive persons compared with HIV-negative long-term residents (women: 6.3% vs. 4.1%; prevalence risk ratio = 1.77, 95% confidence interval: 1.49 to 2.11; men: 6.9% vs. 3.9%; prevalence risk ratio = 1.72, 95% confidence interval: 1.38-2.14). CONCLUSION There is a higher frequency of risky sexual behaviors among the partnerships of in-migrants compared with those of long-term residents. Among cohabitating couples, in-migrants are more likely to partner with untreated HIV-positive individuals.
Collapse
Affiliation(s)
- Jennifer E Brophy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | | | | | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
| | - David M Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Steven J Reynolds
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; and
| | | | - Mary K Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
13
|
Ssuuna C, Galiwango RM, Kankaka EN, Kagaayi J, Ndyanabo A, Kigozi G, Nakigozi G, Lutalo T, Ssekubugu R, Wasswa JB, Mayinja A, Nakibuuka MC, Jamiru S, Oketch JB, Muwanga E, Chang LW, Grabowski MK, Wawer M, Gray R, Anderson M, Stec M, Cloherty G, Laeyendecker O, Reynolds SJ, Quinn TC, Serwadda D. Severe Acute Respiratory Syndrome Coronavirus-2 Seropositivity in South-Central Uganda, During 2019 - 2021. Res Sq 2021:rs.3.rs-960585. [PMID: 34704090 PMCID: PMC8547523 DOI: 10.21203/rs.3.rs-960585/v1] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Globally, key subpopulations such as healthcare workers (HCWs) have a higher risk of contracting SARS-CoV-2. In Uganda, limited access to personal protective equipment amidst lack of clarity on the extent and pattern of the community disease burden may exacerbate this situation. We assessed SARS-CoV-2 antibody seroprevalence among high-risk sub-populations in South-central Uganda, including HCWs, persons within the general population previously reporting experiencing key COVID-19 like symptoms (fever, cough, loss of taste and smell) and archived plasma specimens collected between October 2019 â€" 18 th March 2020, prior to confirmation of COVID-19 in Uganda. Methods: From November 2020 - January 2021, we collected venous blood from HCWs at selected health facilities in South-Central Uganda and from population-cohort participants who reported specific COVID-19 like symptoms in a prior phone-based survey conducted (between May to August 2020) during the first national lockdown. Pre-lockdown plasma collected (between October 2019 and March 18 th , 2020) from individuals considered high risk for SARS-CoV-2 infection was retrieved. Specimens were tested for antibodies to SARS-CoV-2 using the CoronaChek TM rapid COVID-19 IgM/IgG lateral flow test assay. IgM only positive samples were confirmed using a chemiluminescent microparticle immunoassay (CMIA) (Architect AdviseDx SARS-CoV-2 IgM) which targets the spike protein. SARS-CoV-2 exposure was defined as either confirmed IgM, both IgM and IgG or sole IgG positivity. Results: The seroprevalence of antibodies to SARS-CoV-2 in HCWs was 21.1% [95%CI: 18.2-24.2]. Of the phone-based survey participants, 11.9% [95%CI: 8.0-16.8] had antibodies to SARS-CoV-2. Among 636 pre-lockdown plasma specimens, 1.7% [95%CI: 0.9-3.1] were reactive. Conclusions: Findings suggest a high seroprevalence of antibodies to SARS-CoV-2 among HCWs and substantial exposure in persons presenting with specific COVID-19 like symptoms in the general population of South-central Uganda. Based on current limitations in serological test confirmation, it remains unclear whether pre-lockdown seropositivity implies prior SARS-CoV-2 exposure in Uganda.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Larry William Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mary Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ronald Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mark Anderson
- Abbott Laboratories, Abbott Diagnostics Division, Abbott Park, Illinois
| | - Michael Stec
- Abbott Laboratories, Abbott Diagnostics Division, Abbott Park, Illinois
| | - Gavin Cloherty
- Abbott Laboratories, Abbott Diagnostics Division, Abbott Park, Illinois
| | - Oliver Laeyendecker
- Division of Infectious Disease, Division of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Steven James Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
14
|
Grabowski MK, Patel EU, Nakigozi G, Ssempijja V, Ssekubugu R, Ssekasanvu J, Ndyanabo A, Kigozi G, Nalugoda F, Gray RH, Kalibbala S, Serwadda DM, Laeyendecker O, Wawer MJ, Chang LW, Quinn TC, Kagaayi J, Tobian AAR, Reynolds SJ. Prevalence and Predictors of Persistent Human Immunodeficiency Virus Viremia and Viral Rebound After Universal Test and Treat: A Population-Based Study. J Infect Dis 2021; 223:1150-1160. [PMID: 33471100 PMCID: PMC8030722 DOI: 10.1093/infdis/jiab021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are limited data on individual human immunodeficiency virus (HIV) viral load (VL) trajectories at the population-level after the introduction of universal test and treat (UTT) in sub-Saharan Africa. METHODS Human immunodeficiency virus VLs were assessed among HIV-positive participants through 3 population-based surveys in 4 Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (2 consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed VL suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95% confidence intervals (CIs) of persistent viremia were estimated using multivariate Poisson regression. RESULTS There were 1346 HIV-positive participants (n = 1883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.8% to 13.3%. Younger age (15-29 vs 40-49 years; adjRR = 1.80; 95% CI = 1.19-2.71), male sex (adjRR = 2.09, 95% CI = 1.47-2.95), never being married (vs currently married; adjRR = 1.88, 95% CI = 1.34-2.62), and recent migration to the community (vs long-term resident; adjRR = 1.91, 95% CI = 1.34-2.73) were factors associated with persistent viremia. CONCLUSIONS Despite increases in durable VL suppression during roll out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.
Collapse
Affiliation(s)
- M Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Victor Ssempijja
- Rakai Health Sciences Program, Entebbe, Uganda
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | | | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | - David M Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Oliver Laeyendecker
- Makerere University School of Public Health, Kampala, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, Bethesda, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Mwinnyaa G, Grabowski MK, Gray RH, Wawer M, Chang LW, Ssekasanvu J, Kagaayi J, Kigozi G, Kalibbala S, Galiwango RM, Ndyanabo A, Serwadda D, Quinn TC, Reynolds SJ, Laeyendecker O. HIV serologically indeterminate individuals: Future HIV status and risk factors. PLoS One 2020; 15:e0237633. [PMID: 32845933 PMCID: PMC7449388 DOI: 10.1371/journal.pone.0237633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indeterminate HIV test results are common, but little is known about the evolution of indeterminate serology and its sociodemographic and behavioral correlates. We assessed future HIV serological outcomes for individuals with indeterminate results and associated factors in Rakai, Uganda. METHODS 115,944 serological results, defined by two enzyme immunoassay (EIAs), among 39,440 individuals aged 15-49 years in the Rakai Community Cohort Study were assessed. Indeterminate results were defined as contradictory EIAs. Modified Poisson regression models with generalized estimating equations were used to assess prevalence ratios (PRs) of subsequent HIV serological outcomes and factors associated with HIV indeterminate results. RESULTS The prevalence of HIV serologically indeterminate results was 4.9%. Indeterminate results were less likely among women than men (adjPR 0.76, 95% CI 0.71,0.81), in unmarried participants than married participants (adjPR 0.92, 95% CI 0.85,99), and in individuals with primary (adjPR 0.90, 95% CI 0.80,1.02), secondary (adjPR 0.83, 95% CI 0.73,0.96) and post-secondary (adjPR 0.75, 95% CI 0.60,0.94) education, relative to no education. The proportions of persons with indeterminate results progressing to HIV positive, negative or indeterminate results in subsequent visits was 5%, 71% and 24%, respectively. CONCLUSION HIV serologically indeterminate results were associated with gender and marital status. HIV surveillance programs should develop a protocol for reporting individuals with mixed or persistently indeterminate HIV results on multiple follow-up visits. Most indeterminate results became HIV-negative over time, but follow-up is still needed to detect positive serologies.
Collapse
Affiliation(s)
| | - Mary K. Grabowski
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ronald H. Gray
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Maria Wawer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Larry W. Chang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joseph Ssekasanvu
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Ssempijja V, Nason M, Nakigozi G, Ndyanabo A, Gray R, Wawer M, Chang LW, Gabriel E, Quinn TC, Serwadda D, Reynolds SJ. Adaptive Viral Load Monitoring Frequency to Facilitate Differentiated Care: A Modeling Study From Rakai, Uganda. Clin Infect Dis 2020; 71:1017-1021. [PMID: 31532827 PMCID: PMC7428397 DOI: 10.1093/cid/ciz880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND After scale-up of antiretroviral therapy (ART), routine annual viral load monitoring has been adopted by most countries, but reduced frequency of viral load monitoring may offer cost savings in resource-limited settings. We investigated if viral load monitoring frequency could be reduced while maintaining detection of treatment failure. METHODS The Rakai Health Sciences Program performed routine, biannual viral load monitoring on 2489 people living with human immunodeficiency virus (age ≥15 years). On the basis of these data, we built a 2-stage simulation model to compare different viral load monitoring schemes. We fit Weibull regression models for time to viral load >1000 copies/mL (treatment failure), and simulated data for 10 000 individuals over 5 years to compare 5 monitoring schemes to the current viral load testing every 6 months and every 12 months. RESULTS Among 7 monitoring schemes tested, monitoring every 6 months for all subjects had the fewest months of undetected failure but also had the highest number of viral load tests. Adaptive schemes using previous viral load measurements to inform future monitoring significantly decreased the number of viral load tests without markedly increasing the number of months of undetected failure. The best adaptive monitoring scheme resulted in a 67% reduction in viral load measurements, while increasing the months of undetected failure by <20%. CONCLUSIONS Adaptive viral load monitoring based on previous viral load measurements may be optimal for maintaining patient care while reducing costs, allowing more patients to be treated and monitored. Future empirical studies to evaluate differentiated monitoring are warranted.
Collapse
Affiliation(s)
- Victor Ssempijja
- Clinical Monitoring Research Program Directorate, Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Martha Nason
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | | | | | - Ron Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin Gabriel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Thomas C Quinn
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Intramural Research, NIAID, NIH, Bethesda, Maryland, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Intramural Research, NIAID, NIH, Bethesda, Maryland, USA
| |
Collapse
|
17
|
Boon D, Redd AD, Laeyendecker O, Engle RE, Nguyen H, Ocama P, Boaz I, Ndyanabo A, Kiggundu V, Reynolds SJ, Gray RH, Wawer MJ, Purcell RH, Kirk GD, Quinn TC, Stabinski L. Hepatitis E Virus Seroprevalence and Correlates of Anti-HEV IgG Antibodies in the Rakai District, Uganda. J Infect Dis 2019; 217:785-789. [PMID: 29186448 DOI: 10.1093/infdis/jix610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
A cross-sectional study was conducted of 500 human immunodeficiency virus (HIV)-infected adults frequency matched on age, sex, and community to 500 HIV-uninfected individuals in the Rakai District, Uganda to evaluate seroprevalence of anti-hepatitis E virus (HEV) IgG antibodies. HEV seroprevalence was 47%, and 1 HIV-infected individual was actively infected with a genotype 3 virus. Using modified Poisson regression, male sex (prevalence ratios [PR] = 1.247; 95% confidence interval [CI], 1.071-1.450) and chronic hepatitis B virus infection (PR = 1.377; 95% CI, 1.090-1.738) were associated with HEV seroprevalence. HIV infection status (PR = 0.973; 95% CI, 0.852-1.111) was not associated with HEV seroprevalence. These data suggest there is a large burden of prior exposure to HEV in rural Uganda.
Collapse
Affiliation(s)
- Denali Boon
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ronald E Engle
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Hanh Nguyen
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ponsiano Ocama
- Department of Medicine Makerere University, Kampala, Uganda
| | - Iga Boaz
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ronald H Gray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Rakai Health Sciences Program, Entebbe, Uganda
| | - Maria J Wawer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Rakai Health Sciences Program, Entebbe, Uganda
| | - Robert H Purcell
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gregory D Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lara Stabinski
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | |
Collapse
|
18
|
Laeyendecker O, Gray RH, Grabowski MK, Reynolds SJ, Ndyanabo A, Ssekasanvu J, Fernandez RE, Wawer MJ, Serwadda D, Quinn TC. Validation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D Epidemic in Rakai, Uganda. AIDS Res Hum Retroviruses 2019; 35:364-367. [PMID: 30560723 DOI: 10.1089/aid.2018.0207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The limiting-antigen avidity (LAg-Avidity) assay with viral load (VL) >1,000 copies/mL is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Sera from persons seen in two surveys (2008-2009 and 2012-2013) limited to those who attended the previous round of the Rakai Community Cohort in Uganda were analyzed. The performance of the current LAg-Avidity protocol, with a mean duration of recent infection (MDRI) of 130 days and false recent rate (FRR) of 0%, was compared with subtype-specific MDRI and FRR, adjusted to subtype distributions. The observed incidence was 1.05/100 person years (py) [95% confidence interval (CI) 0.90-1.23] in 2008-2009 and 0.66/100 py (95% CI 0.52-0.83) in 2012-2013. In contrast, the per-protocol LAg-Avidity incidence estimates were 1.63/100 py (95% CI 0.97-2.30) in 2008-2009 and 2.55/100 py (95% CI 1.51-3.59) in 2012-2013 (a significant increase, p < .05.) However, using a subtype-specific MDRI and FRR, the subtype adjusted incidence was 0.88% (95% CI 0.44-1.33) in 2008-2009 and 0.67% (95% CI 0.00-1.68) in 2012-2013, approximating to the observed incidence trends. In this subtype A/D epidemic, the per protocol LAg-Avidity + VL assay overestimated HIV incidence and failed to detect declines in incidence. Adjustment for FRR, MDRI, and subtype distribution provided incidence estimates similar to empirically observed incidence level and trends. Thus, use of the LAg-Avidity assay in an A/D epidemic requires adjustment for subtype.
Collapse
Affiliation(s)
- Oliver Laeyendecker
- 1 National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) , Baltimore, Maryland
- 2 Department of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ronald H Gray
- 3 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
- 4 Rakai Health Sciences Program , Kalisizo, Uganda
| | - M Kate Grabowski
- 4 Rakai Health Sciences Program , Kalisizo, Uganda
- 5 Department of Pathology, Johns Hopkins University , School of Medicine, Baltimore, Maryland
| | - Steven J Reynolds
- 1 National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) , Baltimore, Maryland
- 2 Department of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | | | - Reinaldo E Fernandez
- 2 Department of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Maria J Wawer
- 3 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
- 4 Rakai Health Sciences Program , Kalisizo, Uganda
| | - David Serwadda
- 4 Rakai Health Sciences Program , Kalisizo, Uganda
- 6 School of Public Health, Makerere University , Kampala, Uganda
| | - Thomas C Quinn
- 1 National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) , Baltimore, Maryland
- 2 Department of Infectious Diseases, Johns Hopkins University School of Medicine , Baltimore, Maryland
| |
Collapse
|
19
|
McPhee E, Grabowski MK, Gray RH, Ndyanabo A, Ssekasanvu J, Kigozi G, Makumbi F, Serwadda D, Quinn TC, Laeyendecker O. Short Communication: The Interaction of HIV Set Point Viral Load and Subtype on Disease Progression. AIDS Res Hum Retroviruses 2019; 35:49-51. [PMID: 30520309 DOI: 10.1089/aid.2018.0165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/12/2022] Open
Abstract
HIV-1 subtype and viral load set point have been implicated as strong predictors of HIV-1 disease progression; however, the relationship between these two variables has not been investigated. We used data from the Rakai Community Cohort Study to investigate whether the association between viral load set point and disease progression is modified by HIV subtype. Time to AIDS or AIDS-related death was estimated by Kaplan-Meier survival analysis stratified by subtype and viral set point, and Cox proportional hazards regression with an interaction term between viral load set point and HIV subtype. The interaction term did not indicate effect measure modification between viral load set point and progression to AIDS by HIV-1 subtype [adjusted hazard ratio (aHR), 0.99; 95% confidence interval (CI) 0.61-1.61; p = .968]. Stratifed analysis by subtype was also not indicative of a difference in relationship between viral load set point and time to AIDS with overlapping 95% CIs between subtypes A and D (subtype A aHR: 2.40, 95% CI 1.45-3.99, subtype D aHR: 1.96, 95% CI 1.60-2.40). These results indicate that the higher mortality in subtype D-infected individuals is independent of viral load set point.
Collapse
Affiliation(s)
- Emily McPhee
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - M. Kate Grabowski
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | | | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Thomas C. Quinn
- National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland
- Department of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Oliver Laeyendecker
- National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland
- Department of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| |
Collapse
|
20
|
Ssempijja V, Chang LW, Nakigozi G, Ndyanabo A, Quinn TC, Cobelens F, Wawer M, Gray R, Serwadda D, Reynolds SJ. Results of Early Virologic Monitoring May Facilitate Differentiated Care Monitoring Strategies for Clients on ART, Rakai, Uganda. Open Forum Infect Dis 2018; 5:ofy212. [PMID: 30320148 PMCID: PMC6176337 DOI: 10.1093/ofid/ofy212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background Viral load (VL) monitoring is standard of care in HIV-infected persons initiated on antiretroviral therapy (ART). We evaluated the predictive value of VL measurements at 6 and 12 months after initiation of firstline ART to estimate the future risk of virologic failure (VF). Methods HIV-infected persons with VL measurements at 6 and 12 months post-ART initiation and at least 2 additional VL measurements thereafter were assessed for risk of future VF, defined per World Health Organization guidelines. VL at 6 or 12 months post-ART was categorized into <400, 400–1000, 1001–2000, and >2000 copies/mL. Cox proportional hazard models were used to compare VF incidence associated with 6-month, 12-month, and a composite of 6- and 12-month VL prediction indicators. Results Overall, 1863 HIV-infected adults had a 6- and 12-month VL measurement, and 1588 had at least 2 additional VLs thereafter for predicting future VF. The majority (67%) were female (median age: females 33 years and males 37 years). At 12 months post-ART, 90% had VL<400 copies/mL (cumulative incidence of VF at 1.5%), 3% had 400–1000 copies/mL (VF 12%), 2% had 1001–2000 copies/mL (VF 22%), and 5% had >2000 copies/mL (VF 71%). The predictive value of the 12-month VL measurement was comparable to the composite of both the 6- and 12-month VL measurements and better than the 6-month VL measurement. Conclusions At 12 months after ART initiation, 90% of patients were virally suppressed with a low likelihood of future VF. VL measurement at 12 months post–ART initiation predicts risk of VF and could inform differentiated virologic monitoring strategies.
Collapse
Affiliation(s)
- Victor Ssempijja
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland.,Rakai Health Sciences Program, Kalisizo, Uganda
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Thomas C Quinn
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Frank Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ronald Gray
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda.,Makerere University School of Public Health, Kampala, Uganda
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda.,Johns Hopkins School of Medicine, Baltimore, Maryland.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
21
|
Nelson Kankaka E, Ssekasanvu J, Prodger J, Nabukalu D, Nakawooya H, Ndyanabo A, Kigozi G, Gray R. Sexual risk behaviors following circumcision among HIV-positive men in Rakai, Uganda. AIDS Care 2018; 30:990-996. [PMID: 29433386 PMCID: PMC6284241 DOI: 10.1080/09540121.2018.1437253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether circumcision of HIV-positive men is associated with increased subsequent sexual risk behaviors which may place their female partners at risk. METHODS Newly circumcised and uncircumcised HIV-positive men in the Rakai Community Cohort Study were followed from baseline (July 2013-January 2015) to determine trend in sexual risk behaviors and association of circumcision with subsequent sexual risk behaviors at follow up (February 2015-September 2016). Risk behaviors included sexual activity, alcohol before sex, transactional sex, multiple sex partners, casual sex partners, and inconsistent condom use with casual partners. The association was evaluated using modified Poisson regression, and sensitivity analyses were performed after multiple imputation with chained equations for missing data. RESULTS We identified 538 eligible men, of whom 113(21.0%) were circumcised at baseline and 425(79.0%) were uncircumcised. Men in fishing communities were more likely to be circumcised (p = 0.032) as well as those exposed to targeted HIV messaging (p < 0.001). Overall, 188(34.9%) men were lost to follow up and most were uncircumcised (p = 0.020). Among those followed up, behaviors remained largely unchanged with no differences by circumcision status. Transactional sex appeared to be associated with circumcision in unadjusted analyses (PR = 1.58, 95%CI = 1.01,2.48; p = 0.045, p = 0.05) and adjusted analyses (adj.PR = 1.54, 95%CI = 1.06,2.23; p = 0.022). However, the association was no longer significant in sensitivity analyses after accounting for loss to follow up (adj.PR = 1.43, 95%CI = 0.98,2.08; p = 0.066). No association with circumcision was observed for other sexual risk behaviors. CONCLUSION We found no association between circumcision of HIV-positive men and subsequent sexual risk behavior.
Collapse
Affiliation(s)
- Edward Nelson Kankaka
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica Prodger
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Ronald Gray
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
22
|
Maxwell L, Brahmbhatt H, Ndyanabo A, Wagman J, Nakigozi G, Kaufman JS, Nalugoda F, Serwadda D, Nandi A. The impact of intimate partner violence on women's contraceptive use: Evidence from the Rakai Community Cohort Study in Rakai, Uganda. Soc Sci Med 2018; 209:25-32. [DOI: 10.1016/j.socscimed.2018.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
|
23
|
Nakiganda LJ, Nakigozi G, Kagaayi J, Nalugoda F, Serwadda D, Sewankambo N, Gray R, Ndyanabo A, Muwanika R, Asamoah BO. Cross-sectional comparative study of risky sexual behaviours among HIV-infected persons initiated and waiting to start antiretroviral therapy in rural Rakai, Uganda. BMJ Open 2017; 7:e016954. [PMID: 28893749 PMCID: PMC5722091 DOI: 10.1136/bmjopen-2017-016954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To compare risky sexual behaviours between HIV-positive persons initiated on antiretroviral therapy (ART) (ART-experienced) and persons waiting to start on ART (ART-naive) and assess predictors of risky sexual behaviours among HIV-infected patients in rural Rakai district, Uganda. STUDY DESIGN This is a cross-sectional study that used data from the Rakai Community Cohort Study (RCCS) database between 2013 and 2014. A structured questionnaire was used for data collection. We used stepwise logistic regression as an index to estimate the adjusted ORs for the association between risky sexual behaviours and ART treatment status. STUDY SETTING This study was conducted in Rakai district, located in south-western Uganda. The data for this study were extracted from the RCCS. RCCS is an open prospective cohort of approximately 15 000 consenting participants aged 15-49 years. PARTICIPANTS HIV-positive participants aged 18-49 years who had sex at least once a month with any partner prior to the start of the study. MAIN OUTCOME MEASURES Inconsistent/no condom use in the last 12 months, alcohol use at last sexual encounter, and two or more sexual partners. RESULTS ART-naive participants were more likely to report inconsistent condom use (OR=1.74, 95% CI 1.11 to 2.73) and more likely to drink alcohol at last sexual encounter (OR=1.65, 95% CI 1.11 to 2.46), compared with ART-experienced patients. ART treatment status (p<0.001) was a significant predictor of risky sexual behaviours. Both marital status (p=0.016) and occupation level (p=0.009) were positively associated with inconsistent condom use, while sex (p<0.001) correlated with alcohol use at last sexual encounter. CONCLUSION ART-naive participants were more likely to exhibit risky sexual behaviours than the ART-experienced participants. The intensity of risk reduction counselling should be increased for HIV-positive persons waiting to start ART but already in HIV care.
Collapse
Affiliation(s)
- Lydia Jacenta Nakiganda
- International Master Programme in Public Health, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | | | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Ronald Gray
- School of Public Health, John Hopkins University, Maryland, USA
| | | | | | - Benedict Oppong Asamoah
- Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| |
Collapse
|
24
|
Ssempijja V, Nakigozi G, Chang L, Gray R, Wawer M, Ndyanabo A, Kasule J, Serwadda D, Castelnuovo B, Hoog AV, Reynolds SJ. Rates of switching to second-line antiretroviral therapy and impact of delayed switching on immunologic, virologic, and mortality outcomes among HIV-infected adults with virologic failure in Rakai, Uganda. BMC Infect Dis 2017; 17:582. [PMID: 28830382 PMCID: PMC5568262 DOI: 10.1186/s12879-017-2680-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/13/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Switch from first to second-line ART is recommended by WHO for patients with virologic failure. Delays in switching may contribute to accumulated drug resistance, advanced immunosuppression, increased morbidity and mortality. The 3rd 90' of UNAIDS 90:90:90 targets 90% viral suppression for persons on ART. We evaluated the rate of switching to second-line antiretroviral therapy (ART), and the impact of delayed switching on immunologic, virologic, and mortality outcomes in the Rakai Health Sciences Program (RHSP) Clinical Cohort Study which started providing ART in 2004 and implemented 6 monthly routine virologic monitoring beginning in 2005. METHODS Retrospective cohort study of HIV-infected adults on first-line ART who had two consecutive viral loads (VLs) >1000 copies/ml after 6 months on ART between June 2004 and June 2011 was studied for switching to second-line ART. Immunologic decline after virologic failure was defined as decrease in CD4 count of ≥50 cells/ul and virologic increase was defined as increase of 0.5 log 10 copies/ml. Competing risk models were used to summarize rates of switching to second-line ART while cox proportional hazard marginal structural models were used to assess the risk of virologic increase or immunologic decline associated with delay to switch first line ART failing patients. RESULTS The cumulative incidence of switching at 6, 12, and 24 months following virologic failure were 30.2%, 44.6%, and 65.0%, respectively. The switching rate was increased with higher VL at the time of virologic failure; compared to those with VLs ≤ 5000 copies/ml, patients with VLs = 5001-10,000 copies/ml had an aHR = 1.81 (95% CI = 0.9-3.6), and patients with VLs > 10,000 copies/ml had an aHR = 3.38 (95%CI = 1.9-6.2). The switching rate was also increased with CD4 < 100 cells/ul at ART initiation, compared to those with CD4 ≥ 100 cells/ul (aHR = 2.30, 95% CI = 1.5-3.6). Mortality in patients not switched to second-line ART was 11.9%, compared to 1.2% for those who switched (p = 0.009). Patients switched after 12 months of of virologic failure were more likely to experience CD4 decline and/or further VL increases. CONCLUSIONS Intervention strategies that aid clinicians to promptly switch patients to second-line ART as soon as virologic failure on 1st line ART is confirmed should be prioritized.
Collapse
Affiliation(s)
- Victor Ssempijja
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD 21702 USA
- Clinical Monitoring Research Program (CMRP), Leidos Biomedical Research, Inc., 5705 Industry Lane, Frederick, MD 21704 USA
| | | | - Larry Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Johns Hopkins School of Medicine, Baltimore, MD USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ron Gray
- Rakai Health Sciences Program, Kalisizo, Uganda
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anja van’t Hoog
- Department of Global Health –Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Steven James Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Johns Hopkins School of Medicine, Baltimore, MD USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| |
Collapse
|
25
|
Reynolds SJ, Ssempijja V, Galiwango R, Ndyanabo A, Nakigozi G, Lyagoba F, Nazziwa J, Redd A, Lamers SL, Gray R, Wawer M, Serwadda D, Quinn TC. Low Rates of Transmitted Drug Resistance Among Newly Identified HIV-1 Seroconverters in Rural Rakai, Uganda. AIDS Res Hum Retroviruses 2017; 33:448-451. [PMID: 27798967 DOI: 10.1089/aid.2015.0370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
We investigated the rate of transmitted drug resistance (TDR) among HIV-1 seroconverters identified from the Rakai Community Cohort Study (RCCS) survey, a population-based cohort in Rakai District, Uganda. Participants aged 15-49 are interviewed at study visits approximately every 12-18 months and provided a serological sample. Antiretroviral therapy (ART) has been provided free of charge since 2004. RCCS participants with documented negative HIV-1 serology between January 2011 and August 2012 and confirmed seroconversion between November 2012 and October 2013 were included in this analysis. Serum was genotyped for HIV drug resistance mutations in reverse transcriptase and protease genes. Mutations were classified according to the 2009 World Health Organization surveillance of transmitted HIV-1 drug resistance update. Seventy-five (75) seroconverters were identified and genotyped. The mean age was 28 years (range 18-49) and the majority were male, n = 44 (58%). The HIV-1 subtype frequencies were A = 19 (25%), D = 44 (59%), C = 4 (5%), A/D recombinant = 5 (7%), and C/D recombinant = 3 (4%). The majority (72/75, 96%) of individuals were infected with wild-type virus with no evidence of TDR. Two individuals had a single non-nucleoside reverse transcriptase inhibitor mutation each, K101E and K103N, and one had a single protease inhibitor mutation, M46I. No mutations were identified involving nucleoside reverse transcriptase inhibitors. In conclusion, almost 10 years after the introduction of ART in rural Uganda, rates of TDR remain low. Ongoing surveillance for TDR remains an important public health priority and should be conducted among known seroconverters to estimate TDR.
Collapse
Affiliation(s)
- Steven J. Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Rakai Health Sciences Program, Kalisizo, Uganda
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Victor Ssempijja
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | | | | | - Fred Lyagoba
- British Medical Research Council Unit on HIV/AIDS, Entebbe, Uganda
| | - Jamirah Nazziwa
- British Medical Research Council Unit on HIV/AIDS, Entebbe, Uganda
| | - Andrew Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Ron Gray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Wawer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
26
|
Mafigiri R, Matovu JKB, Makumbi FE, Ndyanabo A, Nabukalu D, Sakor M, Kigozi G, Nalugoda F, Wanyenze RK. HIV prevalence and uptake of HIV/AIDS services among youths (15-24 Years) in fishing and neighboring communities of Kasensero, Rakai District, South Western Uganda. BMC Public Health 2017; 17:251. [PMID: 28288604 PMCID: PMC5348807 DOI: 10.1186/s12889-017-4166-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although fishing communities have a significantly higher HIV prevalence than the general population, there is paucity of data on the burden of HIV and service utilization, particularly among the youth. We assessed the HIV prevalence and utilization of HIV prevention and treatment services among youth in Kasensero fishing community and the neighboring communities. METHOD Data were derived from the Rakai Community Cohort Study (RCCS) surveys conducted between 2013 and 2014. The RCCS is a population-based household survey that collects data annually from individuals aged 15-49 years, resident in 48 communities in Rakai and neighboring districts in Uganda. For this analysis, socio-demographic, behavioral and HIV-related data were obtained for 792 individuals aged 15-24 years. We used logistic regression to conduct bivariate and multivariable analysis to determine the factors that are independently associated with HIV-positive status and their corresponding 95% confidence intervals. Data were analyzed using STATA version 13. RESULTS Overall HIV prevalence was 19.7% (n = 155); higher in Kasensero (n = 141; 25.1%) and Gwanda (n = 8; 11%) than in Kyebe (n = 6; 3.9%), p < 0.001 and among females (n = 112; 26.0%) than males (n = 43; 12.0%), p < 0.001. Uptake of HIV testing was high in both HIV-positive (n = 136; 89.5%) and HIV-negative youth (n = 435; 92%). Consistent condom use was virtually non-existent in HIV-positive youth (n = 1; 0.6%) compared to HIV-negative youth (n = 20; 4.2%). Only 22.4% (n = 34) of the HIV-positive youth were receiving antiretroviral therapy (ART) in 2013-2014; higher in the HIV-positive females (n = 31; 28.4%) than HIV-positive males (n = 03; 6.7%). Slightly more than half of males (n = 134; 53.8%) reported that they were circumcised; the proportion of circumcised youth was higher among HIV-negative males (n = 122; 58%) than HIV-positive males (n = 12; 27.9%). Factors significantly associated with HIV-positive status included living in Kasensero landing site (adjusted Odds Ratio [aOR] = 5.0; 95%CI: 2.22-13.01) and reporting one (aOR = 5.0; 95%CI: 1.33-15.80) or 2+ sexual partners in the past 12 months (aOR = 11.0; 95% CI; 3.04-36.72). CONCLUSION The prevalence of HIV is high especially among young females and in landing site communities than in the peripheral communities. Uptake of HIV prevention and treatment services is very low. There is an urgent need for youth-friendly services in these communities.
Collapse
Affiliation(s)
- Richardson Mafigiri
- Public Health Fellowship Program (PHFP) – Field Epidemiology Track, Ministry of Health-Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Joseph K. B. Matovu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Edward Makumbi
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Rakai Health Sciences Program, Kampala, Uganda
| | | | | | - Moses Sakor
- Rakai Health Sciences Program, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
27
|
Kong X, Kigozi G, Ssekasanvu J, Nalugoda F, Nakigozi G, Ndyanabo A, Lutalo T, Reynolds SJ, Ssekubugu R, Kagaayi J, Bugos E, Chang LW, Nanlesta P, Mary G, Berman A, Quinn TC, Serwadda D, Wawer MJ, Gray RH. Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda. JAMA 2016; 316:182-90. [PMID: 27404186 PMCID: PMC5027874 DOI: 10.1001/jama.2016.7292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Medical male circumcision (MMC) and antiretroviral therapy (ART) are proven HIV prevention interventions, but there are limited data on the population-level effect of scale-up of these interventions in sub-Saharan Africa. Such evaluation is important for planning and resource allocation. OBJECTIVE To examine whether increasing community MMC and ART coverage was associated with reduced community HIV incidence in Rakai District, Uganda. DESIGN, SETTING, AND PARTICIPANTS Using person-level data from population-based surveys conducted from 1999 through 2013 in 45 rural Rakai communities, community-level ART and MMC coverage, sociodemographics, sexual behaviors, and HIV prevalence and incidence were estimated in 3 periods: prior to the availability of ART and MMC (1999-2004), during early availability of ART and MMC (2004-2007), and during mature program scale-up (2007-2013). EXPOSURES Community MMC coverage in males and ART coverage in HIV-positive persons of the opposite sex based on self-reported MMC status and ART use. MAIN OUTCOMES AND MEASURES Adjusted incidence rate ratios (IRRs) for sex-specific community HIV incidence estimated using multivariable Poisson regression with generalized estimating equations. RESULTS From 1999 through 2013, 44,688 persons participated in 1 or more surveys (mean age at the first survey, 24.6 years [range, 15-49]; female, 56.5%; mean survey participation rate, 92.6% [95% CI, 92.4%-92.7%]). Median community MMC coverage increased from 19% to 39%, and median community ART coverage rose from 0% to 21% in males and from 0% to 26% in females. Median community HIV incidence declined from 1.25 to 0.84 per 100 person-years in males, and from 1.25 to 0.99 per 100 person-years in females. Among males, each 10% increase in community MMC coverage was associated with an adjusted IRR of 0.87 (95% CI, 0.82-0.93). Comparing communities with MMC coverage more than 40% (mean male community incidence, 1.03 per 100 person-years) with communities with coverage of 10% or less (mean male incidence, 1.69 per 100 person-years), the adjusted IRR was 0.61 (95% CI, 0.43-0.88). For each 10% increase in female self-reported ART coverage, there was no significant reduction in male HIV incidence (adjusted IRR, 0.95 [95% CI, 0.81-1.13]). Comparing communities with female ART coverage more than 20% (mean male incidence, 0.87 per 100 person-years) to communities with female ART coverage of 20% or less (mean male incidence, 1.17 per 100 person-years), the adjusted IRR was 0.77 (95% CI, 0.61-0.98). Neither MMC nor male ART coverage was associated with lower female community HIV incidence. CONCLUSIONS AND RELEVANCE In Rakai, Uganda, increasing community MMC and female ART coverage was associated with lower community HIV incidence in males. If similar associations are found elsewhere, this would support further scale-up of MMC and ART for HIV prevention in sub-Saharan Africa.
Collapse
Affiliation(s)
- Xiangrong Kong
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Department of Biostatistics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | | | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J Reynolds
- Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Eva Bugos
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Larry W. Chang
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Grabowski Mary
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Amanda Berman
- Center for Communications Programs, Johns Hopkins University, Baltimore, MD
| | - Thomas C. Quinn
- Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
- Rakai Health Sciences Program, Entebbe, Uganda
| |
Collapse
|
28
|
Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, Nalugoda F, Kagaayi J, Nakigozi G, Serwadda D, Brahmbhatt H. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. Lancet Glob Health 2014; 3:e23-33. [PMID: 25539966 DOI: 10.1016/s2214-109x(14)70344-4] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. METHODS We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with ClinicalTrials.gov, number NCT02050763. FINDINGS Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). INTERPRETATION SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. FUNDING Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center.
Collapse
Affiliation(s)
- Jennifer A Wagman
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Marie Thoma
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Ndyanabo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Gertrude Nakigozi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - David Serwadda
- School of Public Health, New Mulago Hospital Complex, Makerere University, Kampala, Uganda
| | - Heena Brahmbhatt
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
29
|
Hirbod T, Kong X, Kigozi G, Ndyanabo A, Serwadda D, Prodger JL, Tobian AA, Nalugoda F, Wawer MJ, Shahabi K, Rojas OL, Gommerman JL, Broliden K, Kaul R, Gray RH. HIV acquisition is associated with increased antimicrobial peptides and reduced HIV neutralizing IgA in the foreskin prepuce of uncircumcised men. PLoS Pathog 2014; 10:e1004416. [PMID: 25275513 PMCID: PMC4183701 DOI: 10.1371/journal.ppat.1004416] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 08/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The foreskin is the site of most HIV acquisition in uncircumcised heterosexual men. Although HIV-exposed, seronegative (HESN) uncircumcised men demonstrate HIV-neutralizing IgA and increased antimicrobial peptides (AMPs) in the foreskin prepuce, no prospective studies have examined the mucosal immune correlates of HIV acquisition. METHODS To assess the association of foreskin immune parameters with HIV acquisition, antimicrobial peptides and IgA with the capacity to neutralize a primary clade C HIV strain were quantified by blinded investigators, using sub-preputial swabs collected longitudinally during a randomized trial of male circumcision for HIV prevention in Rakai, Uganda. RESULTS Participants were 99 men who acquired HIV (cases) and 109 randomly selected controls who remained HIV seronegative. At enrollment, 44.4% of cases vs. 69.7% of controls demonstrated IgA neutralization (adjusted OR = 0.31; 95% CI, 0.16-0.61). IgA neutralization was detected in 38.7% of cases and 70.7% of controls at the last seronegative case visit prior to HIV acquisition and the comparable control visit (adjusted OR 0.21; 95% CI, 0.11-0.39). Levels of the α-defensins and secretory leukocyte protease inhibitor (SLPI) were over ten-fold higher in the foreskin prepuce of cases who acquired HIV, both at enrollment (mean 4.43 vs. 3.03 and 5.98 vs. 4.61 log(n) pg/mL, P = 0.005 and 0.009, respectively), and at the last seronegative visit (mean 4.81 vs. 3.15 and 6.46 vs. 5.20 log(n) pg/mL, P = 0.0002 and 0.013). CONCLUSIONS This prospective, blinded analysis is the first to assess the immune correlates of HIV acquisition in the foreskin. HIV-neutralizing IgA, previously associated with the HESN phenotype, was a biomarker of HIV protection, but other HESN associations correlated with increased HIV acquisition. This emphasizes the importance of prospective epidemiological studies or in vitro tissue studies to define the impact of mucosal parameters on HIV risk.
Collapse
Affiliation(s)
- Taha Hirbod
- Infectious Diseases Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Xiangrong Kong
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Public Health, College of Medicine, Makerere University, Kampala, Uganda
| | - Jessica L. Prodger
- Departments of Medicine and Immunology, University of Toronto, Toronto, Canada
| | - Aaron A. Tobian
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Maria J. Wawer
- Infectious Diseases Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Kamnoosh Shahabi
- Departments of Medicine and Immunology, University of Toronto, Toronto, Canada
| | - Olga L. Rojas
- Departments of Medicine and Immunology, University of Toronto, Toronto, Canada
| | | | - Kristina Broliden
- Infectious Diseases Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Rupert Kaul
- Departments of Medicine and Immunology, University of Toronto, Toronto, Canada
- * E-mail:
| | - Ronald H. Gray
- Infectious Diseases Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Rakai Health Sciences Program, Kalisizo, Uganda
| |
Collapse
|
30
|
Grabowski MK, Lessler J, Redd AD, Kagaayi J, Laeyendecker O, Ndyanabo A, Nelson MI, Cummings DAT, Bwanika JB, Mueller AC, Reynolds SJ, Munshaw S, Ray SC, Lutalo T, Manucci J, Tobian AAR, Chang LW, Beyrer C, Jennings JM, Nalugoda F, Serwadda D, Wawer MJ, Quinn TC, Gray RH. The role of viral introductions in sustaining community-based HIV epidemics in rural Uganda: evidence from spatial clustering, phylogenetics, and egocentric transmission models. PLoS Med 2014; 11:e1001610. [PMID: 24595023 PMCID: PMC3942316 DOI: 10.1371/journal.pmed.1001610] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 01/20/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is often assumed that local sexual networks play a dominant role in HIV spread in sub-Saharan Africa. The aim of this study was to determine the extent to which continued HIV transmission in rural communities--home to two-thirds of the African population--is driven by intra-community sexual networks versus viral introductions from outside of communities. METHODS AND FINDINGS We analyzed the spatial dynamics of HIV transmission in rural Rakai District, Uganda, using data from a cohort of 14,594 individuals within 46 communities. We applied spatial clustering statistics, viral phylogenetics, and probabilistic transmission models to quantify the relative contribution of viral introductions into communities versus community- and household-based transmission to HIV incidence. Individuals living in households with HIV-incident (n = 189) or HIV-prevalent (n = 1,597) persons were 3.2 (95% CI: 2.7-3.7) times more likely to be HIV infected themselves compared to the population in general, but spatial clustering outside of households was relatively weak and was confined to distances <500 m. Phylogenetic analyses of gag and env genes suggest that chains of transmission frequently cross community boundaries. A total of 95 phylogenetic clusters were identified, of which 44% (42/95) were two individuals sharing a household. Among the remaining clusters, 72% (38/53) crossed community boundaries. Using the locations of self-reported sexual partners, we estimate that 39% (95% CI: 34%-42%) of new viral transmissions occur within stable household partnerships, and that among those infected by extra-household sexual partners, 62% (95% CI: 55%-70%) are infected by sexual partners from outside their community. These results rely on the representativeness of the sample and the quality of self-reported partnership data and may not reflect HIV transmission patterns outside of Rakai. CONCLUSIONS Our findings suggest that HIV introductions into communities are common and account for a significant proportion of new HIV infections acquired outside of households in rural Uganda, though the extent to which this is true elsewhere in Africa remains unknown. Our results also suggest that HIV prevention efforts should be implemented at spatial scales broader than the community and should target key populations likely responsible for introductions into communities.
Collapse
Affiliation(s)
- Mary K. Grabowski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Justin Lessler
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Andrew D. Redd
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Oliver Laeyendecker
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Martha I. Nelson
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Derek A. T. Cummings
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Amy C. Mueller
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Steven J. Reynolds
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Supriya Munshaw
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stuart C. Ray
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Jordyn Manucci
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Aaron A. R. Tobian
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Larry W. Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Chris Beyrer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jacky M. Jennings
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- School of Public Health, College of Medicine, Makerere University, Kampala, Uganda
| | - Maria J. Wawer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Thomas C. Quinn
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ronald H. Gray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | |
Collapse
|
31
|
Tobian AAR, Gaydos C, Gray RH, Kigozi G, Serwadda D, Quinn N, Grabowski MK, Musoke R, Ndyanabo A, Nalugoda F, Wawer MJ, Quinn TC. Male circumcision and Mycoplasma genitalium infection in female partners: a randomised trial in Rakai, Uganda. Sex Transm Infect 2013; 90:150-4. [PMID: 24259189 DOI: 10.1136/sextrans-2013-051293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 12/21/2022] Open
Abstract
OBJECTIVE Previous randomised trial data have demonstrated that male circumcision reduces Mycoplasma genitalium prevalence in men. We assessed whether male circumcision also reduces M genitalium infection in female partners of circumcised men. METHODS HIV-negative men were enrolled and randomised to either male circumcision or control. Female partners of male trial participants from the intervention (n=437) and control (n=394) arms provided interview information and self-collected vaginal swabs that were tested for M genitalium by APTIMA transcription-mediated amplification-based assay. Prevalence risk ratios (PRR) and 95% CI of M genitalium prevalence in intervention versus control group were estimated using Poisson regression. Analysis was by intention-to-treat. An as-treated analysis was conducted to account for study-group crossovers. RESULTS Male and female partner enrolment sociodemographic characteristics, sexual behaviours, and symptoms of sexually transmitted infections were similar between study arms. Female M genitalium prevalence at year 2 was 3.2% (14/437) in the intervention arm and 3.6% (14/394) in the control arm (PRR=0.90, 95% CI 0.43 to 1.89, p=0.78). In an as-treated analysis, the prevalence of M genitalium was 3.4% in female partners of circumcised men and 3.3% in female partners of uncircumcised men (PRR=1.01, 95% CI 0.48 to 2.12, p=0.97). CONCLUSIONS Contrary to findings in men, male circumcision did not affect M genitalium infection in female partners.
Collapse
Affiliation(s)
- Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, , Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Auerbach BJ, Reynolds SJ, Lamorde M, Merry C, Kukunda-Byobona C, Ocama P, Semeere AS, Ndyanabo A, Boaz I, Kiggundu V, Nalugoda F, Gray RH, Wawer MJ, Thomas DL, Kirk GD, Quinn TC, Stabinski L. Traditional herbal medicine use associated with liver fibrosis in rural Rakai, Uganda. PLoS One 2012; 7:e41737. [PMID: 23209545 PMCID: PMC3507824 DOI: 10.1371/journal.pone.0041737] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/28/2012] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic. However little is known about the effect of herbal medicines on liver disease in sub-Saharan Africa. METHODS 500 HIV-infected participants in a rural HIV care program in Rakai, Uganda, were frequency matched to 500 HIV-uninfected participants. Participants were asked about traditional herbal medicine use and assessed for other potential risk factors for liver disease. All participants underwent transient elastography (FibroScan®) to quantify liver fibrosis. The association between herb use and significant liver fibrosis was measured with adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CI) using modified Poisson multivariable logistic regression. RESULTS 19 unique herbs from 13 plant families were used by 42/1000 of all participants, including 9/500 HIV-infected participants. The three most-used plant families were Asteraceae, Fabaceae, and Lamiaceae. Among all participants, use of any herb (adjPRR = 2.2, 95% CI 1.3-3.5, p = 0.002), herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 2.9-8.7, p<0.001), and herbs from the Lamiaceae family (adjPRR = 3.4, 95% CI 1.2-9.2, p = 0.017) were associated with significant liver fibrosis. Among HIV infected participants, use of any herb (adjPRR = 2.3, 95% CI 1.0-5.0, p = 0.044) and use of herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 1.7-14.7, p = 0.004) were associated with increased liver fibrosis. CONCLUSIONS Traditional herbal medicine use was independently associated with a substantial increase in significant liver fibrosis in both HIV-infected and HIV-uninfected study participants. Pharmacokinetic and prospective clinical studies are needed to inform herb safety recommendations in sub-Saharan Africa. Counseling about herb use should be part of routine health counseling and counseling of HIV-infected persons in Uganda.
Collapse
Affiliation(s)
- Brandon J Auerbach
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Polis CB, Nakigozi G, Ssempijja V, Makumbi FE, Boaz I, Reynolds SJ, Ndyanabo A, Lutalo T, Wawer MJ, Gray RH. Effect of injectable contraceptive use on response to antiretroviral therapy among women in Rakai, Uganda. Contraception 2012; 86:725-30. [PMID: 22717186 DOI: 10.1016/j.contraception.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is limited evidence on the effect of injectable contraception on response to antiretroviral therapy (ART). DESIGN Using modified Poisson regression, we assessed data from 418 female Ugandan ART initiators to examine the effect of injectable contraceptive use on a composite virologic failure outcome (defined as failure to achieve virologic suppression, switch to second line therapy, or death within 12 months of ART initiation) and also assessed ART adherence. RESULTS About 12% of women reported using injectable contraceptives at ART initiation, and their composite virologic failure rates 12 months later were similar to women not using injectable contraceptives at ART initiation (11% vs. 12%, p=0.99). Multivariable Poisson regression suggested no significant differences in virologic failure by injectable contraceptive use at baseline (prevalence risk ratio: 0.85, p=0.71), but power was limited. Adherence to ART increased with time since ART initiation, and did not appear to differ between injectable contraceptive users and non-users. CONCLUSIONS Consistent with current World Health Organization guidelines, our results suggest no deleterious effect of injectable contraceptive use on response to ART, but power was limited, injectable contraceptive use patterns over time were inconsistent and additional evidence is needed.
Collapse
Affiliation(s)
- Chelsea B Polis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Stabinski L, Reynolds SJ, Ocama P, Laeyendecker O, Ndyanabo A, Kiggundu V, Boaz I, Gray RH, Wawer M, Thio C, Thomas DL, Quinn TC, Kirk GD. High prevalence of liver fibrosis associated with HIV infection: a study in rural Rakai, Uganda. Antivir Ther 2011; 16:405-11. [PMID: 21555823 DOI: 10.3851/imp1783] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Liver disease is a leading cause of mortality among HIV-infected persons in the United States and Europe. However, data regarding the effects of HIV and antiretroviral therapy (ART) on liver disease in Africa are sparse. METHODS A total of 500 HIV-infected participants in an HIV care programme in rural Rakai, Uganda were frequency-matched by age, gender and site to 500 HIV-uninfected participants in a population cohort. All participants underwent transient elastography (FibroScan(®)) to quantify liver stiffness measurements (LSM) and identify participants with significant liver fibrosis, defined as LSM≥9.3 kPa (≈ Metavir F≥2). Risk factors for liver fibrosis were identified by estimating adjusted prevalence risk ratios (adjPRR) and 95% CI using modified Poisson multivariate regression. RESULTS The prevalence of hepatitis B coinfection in the study population was 5%. The prevalence of significant fibrosis was 17% among HIV-infected and 11% in HIV-uninfected participants (P=0.008). HIV infection was associated with a 50% increase in liver fibrosis (adjPRR 1.5, 95% CI 1.1-2.1; P=0.010). Fibrosis was also associated with male gender (adjPRR 1.4, 95% CI 1.0-1.9; P=0.045), herbal medicine use (adjPRR 2.0, 95% CI 1.2-3.3; P=0.005), heavy alcohol consumption (adjPRR 2.3, 95% CI 1.3-3.9; P=0.005), occupational fishing (adjPRR 2.5, 95% CI 1.2-5.3; P=0.019) and chronic HBV infection (adjPRR 1.7, 95% CI 1.0-3.1; P=0.058). Among HIV-infected participants, ART reduced fibrosis risk (adjPRR 0.6, 95% CI 0.4-1.0; P=0.030). CONCLUSIONS The burden of liver fibrosis among HIV-infected rural Ugandans is high. These data suggest that liver disease may represent a significant cause of HIV-related morbidity and mortality in Africa.
Collapse
Affiliation(s)
- Lara Stabinski
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Redd AD, Ciccone EJ, Nakigozi G, Keruly JC, Ndyanabo A, Iga B, Gray RH, Serwadda D, Quinn TC. T-cell enumeration from dried blood spots by quantifying rearranged T-cell receptor-beta genes. J Immunol Methods 2010; 354:40-4. [PMID: 20109463 PMCID: PMC2844472 DOI: 10.1016/j.jim.2010.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/14/2010] [Accepted: 01/19/2010] [Indexed: 11/30/2022]
Abstract
Significant hurdles remain to large-scale implementation of medical interventions in the developing world due to the lack of a modern diagnostic infrastructure. This is especially pertinent to the international roll-out of antiretroviral drugs to treat HIV, which ideally includes a CD4 T-cell count to determine eligibility. We designed a novel technique to estimate mature T-cell numbers by calculating the amount of rearranged T-cell receptor beta genes from dried blood spots of HIV-infected individuals in the United States and Uganda. It was observed that the rearranged T-cell receptor beta count correlated well with total lymphocyte counts from both study populations (Baltimore R=0.602, Uganda R=0.497; p<0.001) and the ability for this measurement to determine antiretroviral initiation was similar to total lymphocyte counts, which can be used to determine eligibility in HIV+children. This technique as well as other dried blood spot based technologies could increase the diagnostic and monitoring capabilities in resource-limited settings.
Collapse
Affiliation(s)
- Andrew D Redd
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Marston M, Slaymaker E, Cremin I, Floyd S, McGrath N, Kasamba I, Lutalo T, Nyirenda M, Ndyanabo A, Mupambireyi Z, Zaba B. Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys. Sex Transm Infect 2009; 85 Suppl 1:i64-71. [PMID: 19307343 PMCID: PMC2654103 DOI: 10.1136/sti.2008.034249] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe trends in age at first sex (AFS), age at first marriage (AFM) and time spent single between events and to compare age-specific trends in marital status in six cohort studies. METHODS Cohort data from Uganda, Tanzania, South Africa, Zimbabwe and Malawi and Demographic and Health Survey (DHS) data from Uganda, Tanzania and Zimbabwe were analysed. Life table methods were used to calculate median AFS, AFM and time spent single. In each study, two surveys were chosen to compare marital status by age and identify changes over time. RESULTS Median AFM was much higher in South Africa than in the other sites. Between the other populations there were considerable differences in median AFS and AFM (AFS 17-19 years for men and 16-19 years for women, AFM 21-24 years and 18-19 years, respectively, for the 1970-9 birth cohort). In all surveys, men reported a longer time spent single than women (median 4-7 years for men and 0-2 years for women). Median years spent single for women has increased, apart from in Manicaland. For men in Rakai it has decreased slightly over time but increased in Kisesa and Masaka. The DHS data showed similar trends to those in the cohort data. The age-specific proportion of married individuals has changed little over time. CONCLUSIONS Median AFS, AFM and time spent single vary considerably among these populations. These three measures are underlying determinants of sexual risk and HIV infection, and they may partially explain the variation in HIV prevalence levels between these populations.
Collapse
Affiliation(s)
- M Marston
- Centre for Population Studies, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Wandel S, Egger M, Rangsin R, Nelson KE, Costello C, Lewden C, Lutalo T, Ndyanabo A, Todd J, Van der Paal L, Minga A, Zwahlen M. Duration from seroconversion to eligibility for antiretroviral therapy and from ART eligibility to death in adult HIV-infected patients from low and middle-income countries: collaborative analysis of prospective studies. Sex Transm Infect 2008; 84 Suppl 1:i31-i36. [PMID: 18647863 PMCID: PMC2569418 DOI: 10.1136/sti.2008.029793] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2008] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Estimation of the number of people in need of antiretroviral therapy (ART) in resource-limited settings requires information on the time from seroconversion to ART eligibility and from ART eligibility to death. OBJECTIVES To estimate duration from seroconversion to different ART eligibility criteria and from ART eligibility to death in HIV-infected adults in low-income and middle-income countries. METHODS Participants with documented seroconversion from five cohorts (two cohorts from Uganda, two from Thailand and one from Côte d'Ivoire) were analysed. We used Weibull survival models and Bayesian simulation methods to model true (unobserved) first time of treatment eligibility. We set a consistency constraint so that the mean duration from seroconversion to death was equal to the mean from seroconversion to ART eligibility plus the mean from eligibility to death. RESULTS We analysed data from 2072 participants, 16 157 person-years of follow-up and 794 deaths. For the criterion CD4 T-lymphocyte count <200 cells x10(6)/l, the median duration from seroconversion to ART eligibility was 6.1 years (95% credibility interval 3.3-10.4) for all studies and 7.6 years (95% credibility interval 3.4-15.2) for all but the Thai cohorts. Corresponding estimates for the time from CD4 T-lymphocyte count <200 cells x10(6)/l to death were 2.1 years (0.7-4.8) and 2.7 years (0.8-8.4). When including all cohorts, the mean time from serconversion to CD4 T-lymphocyte count <200 cells x10(6)/l and from CD4 T-lymphocyte count <200 cells x10(6)/l to death represented 66% (38-87%) and 34% (13-62%), respectively of the total survival time. CONCLUSIONS The duration of different ART eligibility criteria to death was longer than the estimates used in previous calculations of the number of people needing ART. However, uncertainty in estimates was considerable and heterogeneity across cohorts important.
Collapse
|