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Peck ME, Bronson M, Djomand G, Basile I, Collins K, Kankindi I, Kayirangwa E, Malamba SS, Mugisha V, Nsanzimana S, Remera E, Kazaura KJ, Amuri M, Mmbando S, Mgomella GS, Simbeye D, Colletar Awor A, Biraro S, Kabuye G, Kirungi W, Chituwo O, Hanunka B, Kamboyi R, Mulenga L, Musonda B, Muyunda B, Nkumbula T, Malaba R, Mandisarisa J, Musuka G, Peterson AE, Toledo C. HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment surveys, 2015-2019. PLOS Glob Public Health 2023; 3:e0002326. [PMID: 37721926 PMCID: PMC10506706 DOI: 10.1371/journal.pgph.0002326] [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: 03/21/2023] [Accepted: 08/06/2023] [Indexed: 09/20/2023]
Abstract
Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15-59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52-0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73-0.98, and HIV = 0.53 aOR, 95% CI, 0.47-0.61). No difference between circumcised and uncircumcised men was identified for HBV infection (P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection.
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Affiliation(s)
- Megan E. Peck
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Megan Bronson
- Division of Global HIV & TB, Epidemiology and Surveillance Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Gaston Djomand
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Ikuzo Basile
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | | | - Ida Kankindi
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eugenie Kayirangwa
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Samuel S. Malamba
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | | | - Sabin Nsanzimana
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | - Eric Remera
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | - Kokuhumbya J. Kazaura
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Mbaraka Amuri
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Susan Mmbando
- National AIDS Control Program, Ministry of Health, Dar-es-Salaam, Tanzania
| | - George S. Mgomella
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Daimon Simbeye
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Anna Colletar Awor
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Geoffrey Kabuye
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Omega Chituwo
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Brave Hanunka
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Royd Kamboyi
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Lloyd Mulenga
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Brian Muyunda
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Rickie Malaba
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - John Mandisarisa
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Amy E. Peterson
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Carlos Toledo
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
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Peck ME, Ong K, Lucas T, Thomas AG, Wandira R, Ntwaaga B, Mkhontfo M, Zegeye T, Yohannes F, Mulatu D, Gultie T, Juma AW, Odoyo-June E, Maida A, Msungama W, Canda M, Mutandi G, Zemburuka BLT, Kankindi I, Vranken P, Maphothi N, Loykissoonlal D, Bunga S, Grund JM, Kazaura KJ, Kabuye G, Chituwo O, Muyunda B, Kamboyi R, Lingenda G, Mandisarisa J, Peterson A, Malaba R, Xaba S, Moyo T, Toledo C. Preventing HIV Among Adolescent Boys and Young Men Through PEPFAR-Supported Voluntary Medical Male Circumcision in 15 Sub-Saharan African Countries, 2018-2021. AIDS Educ Prev 2023; 35:67-81. [PMID: 37406146 PMCID: PMC11002756 DOI: 10.1521/aeap.2023.35.suppa.67] [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] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Voluntary medical male circumcision (VMMC) is an HIV prevention intervention that has predominantly targeted adolescent and young men, aged 10-24 years. In 2020, the age eligibility for VMMC shifted from 10 to 15 years of age. This report describes the VMMC client age distribution from 2018 to 2021, at the site, national, and regional levels, among 15 countries in southern and eastern Africa. Overall, in 2018 and 2019, the highest proportion of VMMCs were performed among 10-14-year-olds (45.6% and 41.2%, respectively). In 2020 and 2021, the 15-19-year age group accounted for the highest proportion (37.2% and 50.4%, respectively) of VMMCs performed across all age groups. Similarly, in 2021 at the site level, 68.1% of VMMC sites conducted the majority of circumcisions among men aged 15-24 years. This analysis highlights that adolescent boys and young men are the primary recipients of VMMC receiving an important lifetime reduction in HIV risk.
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Affiliation(s)
- Megan E Peck
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Katherine Ong
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Todd Lucas
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Anne G Thomas
- HIV/AIDS Prevention Program, U.S. Department of Defense, San Diego, California
| | - Ronald Wandira
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Mandzisi Mkhontfo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Tiruneh Zegeye
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Fikirte Yohannes
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Dejene Mulatu
- Disease Prevention and Control Directorate Senior, HIV Prevention and Control Expert, Addis Ababa, Ethiopia
| | | | | | - Elijah Odoyo-June
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Alice Maida
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Wezi Msungama
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Marcos Canda
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Gram Mutandi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Brigitte L T Zemburuka
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Ida Kankindi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Peter Vranken
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Nandi Maphothi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Sudhir Bunga
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Jonathan M Grund
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Kokuhumbya J Kazaura
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Geoffrey Kabuye
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Omega Chituwo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Brian Muyunda
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | | | - John Mandisarisa
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Amy Peterson
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Rickie Malaba
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Talent Moyo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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3
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Ong KS, Laube C, Mohan D, Iverson L, Kaonga A, Chituwo O, Kamboyi R, Kabila M, Toledo C. Factors Beyond Compensation Associated with Uptake of Voluntary Medical Male Circumcision in Zambia. AIDS Behav 2023; 27:1836-1848. [PMID: 36357807 PMCID: PMC10979468 DOI: 10.1007/s10461-022-03915-y] [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] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
Voluntary medical male circumcision (VMMC) provides partial protection against female-to-male transmission of HIV. The Maximizing the Impact of Voluntary Medical Male Circumcision in Zambia (MAXZAM) project was a phased implementation of a demand generation strategy for VMMC through economic compensation. Previously published findings showed increased uptake of VMMC when compensation was provided. This paper is a follow-up evaluation of the MAXZAM project exploring additional factors associated with uptake of VMMC. Factors found associated include the outreach setting in which men were approached, number of information sources seen, heard, or read about VMMC, their self-reported HIV risk behaviors, their self-reported intention to go through the procedure, and their behavioral-psychographic profile. The findings highlight the importance of considering general (e.g., intensifying mass communications and targeting specific settings) and person-centered demand generation approaches (e.g., considering the client's psychographic profile and HIV risk level) to maximize effect on VMMC uptake.
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Affiliation(s)
- Katherine S Ong
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, 1 Corporate Boulevard NE, Atlanta, GA, Mailstop US1-1, USA.
| | | | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Omega Chituwo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | - Carlos Toledo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, 1 Corporate Boulevard NE, Atlanta, GA, Mailstop US1-1, USA
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Peck ME, Ong KS, Lucas T, Harvey P, Lekone P, Letebele M, Thomas VT, Maziya V, Mkhontfo M, Gultie T, Mulatu D, Shimelis M, Zegeye T, Juma AW, Odoyo-June E, Musingila PK, Njenga J, Auld A, Kapito M, Maida A, Msungama W, Canda M, Come J, Malimane I, Aupokolo M, Zemburuka B, Kankindi I, Malamba S, Remera E, Tubane E, Machava R, Maphothi N, Vranken P, Amuri M, Kazaura KJ, Simbeye D, Alamo S, Kabuye G, Chituwo O, Kamboyi R, Masiye J, Mandisarisa J, Xaba S, Toledo C. Voluntary Medical Male Circumcisions for HIV Prevention - 13 Countries in Eastern and Southern Africa, 2017-2021. MMWR Morb Mortal Wkly Rep 2023; 72:256-260. [PMID: 36893046 PMCID: PMC10010757 DOI: 10.15585/mmwr.mm7210a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
In 2007, voluntary medical male circumcision (VMMC) was endorsed by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS after it was found to be associated with approximately a 60% reduction in the risk for female-to-male transmission of HIV (1). As a result of this endorsement, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), through partnerships with U.S. government agencies, including CDC, the U.S. Department of Defense, and the U.S. Agency for International Development, started supporting VMMCs performed in prioritized countries in southern and eastern Africa. During 2010-2016, CDC supported 5,880,372 VMMCs in 12 countries (2,3). During 2017-2021, CDC supported 8,497,297 VMMCs performed in 13 countries. In 2020, the number of VMMCs performed declined 31.8% compared with the number in 2019, primarily because of COVID-19-related disruptions to VMMC service delivery. PEPFAR 2017-2021 Monitoring, Evaluation, and Reporting data were used to provide an update and describe CDC's contribution to the scale-up of the VMMC program, which is important to meeting the 2025 Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90% of males aged 15-59 years having access to VMMC services in prioritized countries to help end the AIDS epidemic by 2030 (4).
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Bansi-Matharu L, Mudimu E, Martin-Hughes R, Hamilton M, Johnson L, Ten Brink D, Stover J, Meyer-Rath G, Kelly SL, Jamieson L, Cambiano V, Jahn A, Cowan FM, Mangenah C, Mavhu W, Chidarikire T, Toledo C, Revill P, Sundaram M, Hatzold K, Yansaneh A, Apollo T, Kalua T, Mugurungi O, Kiggundu V, Zhang S, Nyirenda R, Phillips A, Kripke K, Bershteyn A. Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models. Lancet Glob Health 2023; 11:e244-e255. [PMID: 36563699 PMCID: PMC10005968 DOI: 10.1016/s2214-109x(22)00515-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/05/2022] [Revised: 10/11/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Voluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources. METHODS Using five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used. FINDINGS In South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15-49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years. INTERPRETATION VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years. FUNDING Bill & Melinda Gates Foundation for the HIV Modelling Consortium.
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Affiliation(s)
| | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | | | | | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | | | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andreas Jahn
- Ministry of Health, Lilongwe, Malawi; International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Frances M Cowan
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Collin Mangenah
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Webster Mavhu
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Carlos Toledo
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Maaya Sundaram
- Global Development Program, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Karin Hatzold
- Population Services International, Washington, DC, USA
| | - Aisha Yansaneh
- United States Agency for International Development, Washington, DC, USA
| | - Tsitsi Apollo
- Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Thoko Kalua
- Department of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Valerian Kiggundu
- United States Agency for International Development, Washington, DC, USA
| | - Shufang Zhang
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi
| | | | | | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Peck ME, Ong KS, Lucas T, Prainito A, Thomas AG, Brun A, Kiggundu V, Yansaneh A, Busang L, Kgongwana K, Kelaphile D, Seipone K, Letebele MH, Makadzange PF, Marwiro A, Sesinyi M, Lapidos T, Lukhele N, Maziya V, Mkhontfo M, Gultie T, Mulatu D, Shimelis M, Zegeye T, Teka T, Bulterys M, Njenga JN, Odoyo-June E, Juma AW, Soo L, Talam N, Brown M, Chakare T, Nonyana N, Khoabane MA, Auld AF, Maida A, Msungama W, Kapito M, Nyirenda R, Matchere F, Odek J, Canda M, Malimane I, Come J, Gaspar N, Langa A, Aupokolo MA, Vejorerako KC, Kahindi L, Mali D, Zegeye A, Mangoya D, Zemburuka BL, Bamwesigye J, Kankindi I, Kayirangwa E, Malamba SS, Roels T, Kayonde L, Zimulinda E, Ndengo E, Nsanzimana S, Remera E, Rwibasira GN, Sangwayire B, Semakula M, Rugira E, Rugwizangoga E, Tubane E, Yoboka E, Lawrence J, Loykissoonlal D, Maphothi N, Achut V, Bunga S, Moi M, Amuri M, Kazaura K, Simbeye D, Fida N, Kayange AA, Seleman M, Akao J, Alamo ST, Kabuye G, Kyobutungi S, Makumbi FE, Mudiope P, Nantez B, Chituwo O, Godfrey L, Muyunda B, Kamboyi R, Masiye J, Lifuka E, Mandisarisa J, Mhangara M, Xaba S, Toledo C. Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020. Emerg Infect Dis 2022; 28:S262-S269. [PMID: 36502454 DOI: 10.3201/eid2813.212455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Beginning in March 2020, to reduce COVID-19 transmission, the US President's Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.
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7
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Lukobo-Durrell M, Aladesanmi L, Suraratdecha C, Laube C, Grund J, Mohan D, Kabila M, Kaira F, Habel M, Hines JZ, Mtonga H, Chituwo O, Conkling M, Chipimo PJ, Kachimba J, Toledo C. Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation. AIDS Behav 2022; 26:3597-3606. [PMID: 35900708 PMCID: PMC9550704 DOI: 10.1007/s10461-022-03767-6] [Citation(s) in RCA: 1] [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] [Accepted: 03/01/2022] [Indexed: 01/26/2023]
Abstract
A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.
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Affiliation(s)
- M Lukobo-Durrell
- Jhpiego, Baltimore, MD, USA. .,Jhpiego, 1615 Thames Street, MD, 21231, Baltimore, USA.
| | | | - C Suraratdecha
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - J Grund
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - M Habel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Z Hines
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - O Chituwo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - M Conkling
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - P J Chipimo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - C Toledo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Lucas T, Cooney C, Prainito A, Godfrey C, Kiggundu V, Thomas AG, Ridzon R, Toledo C. Consolidated Overview of Notifiable Adverse Events in the U.S. President's Emergency Plan for AIDS Relief's Voluntary Medical Male Circumcision Program Through 2020. Curr HIV/AIDS Rep 2022; 19:508-515. [PMID: 36348185 PMCID: PMC9643893 DOI: 10.1007/s11904-022-00636-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Accepted: 08/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Through December 2020, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30 days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described. RECENT FINDINGS Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56/446 (13%) with 24/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety. Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.
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Affiliation(s)
- Todd Lucas
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, HIV Prevention Branch, Atlanta, GA, USA.
| | - Caroline Cooney
- U.S. Department of State, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, DC, USA
| | - Amber Prainito
- U.S. Department of State, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, DC, USA
| | - Catherine Godfrey
- U.S. Department of State, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, DC, USA
| | - Valerian Kiggundu
- U.S. Agency for International Development, Global Health, Office of HIV/AIDS, Washington, DC, USA
| | - Anne Goldzier Thomas
- U.S. Department of Defense HIV/AIDS Prevention Program, Defense Health Agency, San Diego, CA, USA
| | - Renee Ridzon
- U.S. Department of State, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, DC, USA
| | - Carlos Toledo
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, HIV Prevention Branch, Atlanta, GA, USA
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Tavares M, Leite L, Cesca M, Campos F, Santana D, Saldanha E, Guimarães P, Sá D, Simões M, Viana R, Loose S, Rocha F, Silva S, Piroll R, Fogassa C, Pondé N, Sanches S, Toledo C, Makdissi F, Lima V. 176P Pathological complete response to neoadjuvant systemic therapy in 1160 initial and locally advanced breast cancer patients: Real life data on outcomes. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Hines JZ, Sachathep K, Pals S, Davis SM, Toledo C, Bronson M, Parekh B, Carrasco M, Xaba S, Mandisarisa J, Kamobyi R, Chituwo O, Kirungi WL, Alamo S, Kabuye G, Awor AC, Mmbando S, Simbeye D, Aupokolo MA, Zemburuka B, Nyirenda R, Msungama W, Tarumbiswa T, Manda R, Nuwagaba-Biribonwoha H, Kiggundu V, Thomas AG, Watts H, Voetsch AC, Williams DB. HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017. J Acquir Immune Defic Syndr 2021; 87:S89-S96. [PMID: 33765683 DOI: 10.1097/qai.0000000000002658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. METHODS Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. RESULTS Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14]. DISCUSSION Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.
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Affiliation(s)
- Jonas Z Hines
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karampreet Sachathep
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York
| | - Sherri Pals
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie M Davis
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Bronson
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bharat Parekh
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Carrasco
- Office of HIV and AIDS, U.S. Agency for International Development, Washington, District of Columbia
| | | | - John Mandisarisa
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Omega Chituwo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Stella Alamo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Geoffrey Kabuye
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Anna Colletar Awor
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Susan Mmbando
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Daimon Simbeye
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Mekondjo A Aupokolo
- National HIV/AIDS, STI and Hepatitis Control Program, Ministry of Health and Social Services, Windhoek, Namibia
| | - Brigitte Zemburuka
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Wezi Msungama
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Robert Manda
- U.S. Agency for International Development, Maseru, Lesotho
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, Mbabane, Eswatini
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Valerian Kiggundu
- Office of HIV and AIDS, U.S. Agency for International Development, Washington, District of Columbia
| | - Anne G Thomas
- Defense Health Agency, U.S. Department of Defense, San Diego, California; and
| | - Heather Watts
- Office of Global AIDS Coordinator, Washington, District of Columbia
| | - Andrew C Voetsch
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dan B Williams
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Odoyo-June E, Davis S, Owuor N, Laube C, Wambua J, Musingila P, Young PW, Aoko A, Agot K, Joseph R, Mwandi Z, Ojiambo V, Lucas T, Toledo C, Wanyonyi A. Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019. PLoS One 2021; 16:e0254140. [PMID: 34264971 PMCID: PMC8281999 DOI: 10.1371/journal.pone.0254140] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10–29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates. Methods Beginning July to September 2019, a total of 3,569 adolescents and men aged 10–29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance. Results The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0–81.2]), Kisumu 77.9% (95% CI [73.1–82.1]), Siaya 80.3% (95% CI [73.7–85.5]), and Migori 85.3% (95% CI [75.3–91.7]) but were 0.9–12.4% lower than DMPPT2-modelled estimates. For young adolescents 10–14 years, the observed prevalence ranged from 55.3% (95% CI [40.2–69.5]) in Migori to 74.9% (95% CI [68.8–80.2]) in Siaya and were 25.1–32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001). Conclusion This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.
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Affiliation(s)
- Elijah Odoyo-June
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya
- * E-mail:
| | - Stephanie Davis
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB Atlanta, GA, United States of America
| | | | - Catey Laube
- Jhpiego, Baltimore, Maryland, United States of America
| | | | - Paul Musingila
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya
| | - Peter W. Young
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya
| | - Appolonia Aoko
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization (IRDO), Kisumu, Kenya
| | - Rachael Joseph
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya
| | | | | | - Todd Lucas
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB Atlanta, GA, United States of America
| | - Carlos Toledo
- U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB Atlanta, GA, United States of America
| | - Ambrose Wanyonyi
- National AIDS and STI Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
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Hines JZ, Thompson R, Toledo C, Nelson R, Casavant I, Pals S, Canda M, Bonzela J, Jaramillo A, Cardoso J, Ujamaa D, Tamele S, Chivurre V, Malimane I, Pathmanathan I, Heitzinger K, Wei S, Couto A, Come J, Vergara A, MacKellar D. Prevalence of Voluntary Medical Male Circumcision for HIV Infection Prevention - Chókwè District, Mozambique, 2014-2019. MMWR Morb Mortal Wkly Rep 2021; 70:942-946. [PMID: 34197361 PMCID: PMC8248593 DOI: 10.15585/mmwr.mm7026a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Davis SM, Owuor N, Odoyo-June E, Wambua J, Omanga E, Lukobo M, Laube C, Mwandi Z, Suraratdecha C, Kioko UM, Rotich W, Kataka J, Ng’eno C, Mohan D, Toledo C, Aoko A, Anyango J, Oneya D, Orenjuro K, Mgamb E, Serrem K, Juma A. Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. PLoS One 2021; 16:e0252725. [PMID: 34115784 PMCID: PMC8195380 DOI: 10.1371/journal.pone.0252725] [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: 01/18/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model's sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45-140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program.
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Affiliation(s)
- Stephanie M. Davis
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Elijah Odoyo-June
- US Centers for Disease Control and Prevention, Nairobi, Kenya
- * E-mail:
| | | | | | - Mainza Lukobo
- Jhpiego, Baltimore, Maryland, United States of America
| | | | | | - Chutima Suraratdecha
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Jacquin Kataka
- Center for Health Solutions, Shinda Project, Siaya, Kenya
| | - Caroline Ng’eno
- University of Maryland, Baltimore, Maryland, United States of America
- Timiza Project, Migori, Kenya
| | - Diwakar Mohan
- Jhpiego, Baltimore, Maryland, United States of America
| | - Carlos Toledo
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Appolonia Aoko
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | | | | | - Kennedy Serrem
- National STD/AIDS Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Ambrose Juma
- National STD/AIDS Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
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Davis SM, Habel MA, Pretorius C, Yu T, Toledo C, Farley T, Kabuye G, Samuelson J. Brief Report: Modeling the Impact of Voluntary Medical Male Circumcision on Cervical Cancer in Uganda. J Acquir Immune Defic Syndr 2021; 86:323-328. [PMID: 33136817 PMCID: PMC7879825 DOI: 10.1097/qai.0000000000002552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/27/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In addition to providing millions of men with lifelong lower risk for HIV infection, voluntary medical male circumcision (VMMC) also provides female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC). SETTING We modeled potential impacts of VMMC on CC incidence and mortality in Uganda as an additional benefit beyond HIV prevention. METHODS HPV and CC outcomes were modeled using the CC model from the Spectrum policy tool suite, calibrated for Uganda, to estimate HPV infection incidence and progression to CC, using a 50-year (2018-2067) time horizon. 2016 Demographic Health Survey data provided baseline VMMC coverage. The baseline (no VMMC scale-up beyond current coverage, minimal HPV vaccination coverage) was compared with multiple scenarios to assess the varying impact of VMMC according to different implementations of HPV vaccination and HPV screening programs. RESULTS Without further intervention, annual CC incidence was projected to rise from 16.9 to 31.2 per 100,000 women in 2067. VMMC scale-up alone decreased 2067 annual CC incidence to 25.3, averting 13,000 deaths between 2018 and 2067. With rapidly-achieved 90% HPV9 vaccination coverage for adolescent girls and young women, 2067 incidence dropped below 10 per 100,000 with or without a VMMC program. With 45% vaccine coverage, the addition of VMMC scaleup decreased incidence by 2.9 per 100,000 and averted 8000 additional deaths. Similarly, with HPV screen-and-treat without vaccination, the addition of VMMC scaleup decreased incidence by 5.1 per 100,000 and averted 10,000 additional deaths. CONCLUSIONS Planned VMMC scale-up to 90% coverage from current levels could prevent a substantial number of CC cases and deaths in the absence of rapid scale-up of HPV vaccination to 90% coverage.
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Affiliation(s)
- Stephanie M. Davis
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa A. Habel
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carel Pretorius
- Modeling, Planning and Policy Analysis Center of Excellence, Avenir Health, Glastonbury, CT
| | - Teng Yu
- Modeling, Planning and Policy Analysis Center of Excellence, Avenir Health, Glastonbury, CT
| | - Carlos Toledo
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Geoffrey Kabuye
- Centers for Disease Control and Prevention, Kampala, Uganda; and
| | - Julia Samuelson
- Department of HIV, AIDS and Hepatitis; Key Populations and Innovative Prevention Team, World Health Organization, Geneva, Switzerland
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Figueroa-Muñoz G, Ríos-Escalante PDL, Dantagnan P, Toledo C, Oyarzún R, Vargas-Chacoff L, Esse C, Vega-Aguayo R. Proximal composition and fatty acid profile of Hemigrapsus crenulatus (H. Milne Edwards, 1837) as one of the main foods of "patagonian blenny"Eleginops maclovinus (Cuvier, 1830). BRAZ J BIOL 2021; 81:797-805. [PMID: 33605301 DOI: 10.1590/1519-6984.231834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/07/2020] [Indexed: 11/22/2022] Open
Abstract
The Patagonian blenny (Eleginops maclovinus) is species endemic to South America with physiological characteristics that would facilitate its incorporation into Chilean aquaculture. However, there is currently no specific artificial food that can be used to raise E. maclovinus. In light of this problem, this study describes the proximal composition and fatty acid profile of the crab Hemigrapsus crenulatus, one of the main foods of E. maclovinus. The purpose of the study is to serve as basic information for the development of a specific artificial diet for juveniles of this fish species. The proximal analysis of the complete body of H. crenulatus indicates that it is mainly composed of ash (35.9%), proteins (32.2%), glucides (19.8%) and minor lipids (3.6%). The fatty acid profile is 40.7% PUFAs, 29.7% MUFAs and 29.5% SAFAs, and the most abundant acids are Eicosapentaenoic (18.8%), Oleic (6.8%) and Palmitic (16.6%), respectively. H. crenulatus has highest level of proteins, lipids and PUFAs among the species of the Brachyura infraorder.
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Affiliation(s)
- G Figueroa-Muñoz
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Agropecuarias y Acuícolas, Temuco, Chile
| | - P De Los Ríos-Escalante
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Biológicas y Químicas, Núcleo de Estudios Ambientales, Temuco, Chile
| | - P Dantagnan
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Agropecuarias y Acuícolas, Núcleo de Investigación en Producción Alimentaria, Temuco, Chile
| | - C Toledo
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Programa de Doctorado en Ciencias Agropecuarias, Temuco, Chile
| | - R Oyarzún
- Universidad Austral de Chile, Centro de Investigación Dinámica de Ecosistemas Marinos de Altas Latitudes-IDEAL, Instituto de Ciencias Marinas y Limnológicas, Valdivia, Chile
| | - L Vargas-Chacoff
- Universidad Austral de Chile, Centro de Investigación Dinámica de Ecosistemas Marinos de Altas Latitudes-IDEAL, Instituto de Ciencias Marinas y Limnológicas, Valdivia, Chile
| | - C Esse
- Universidad Autónoma de Chile, Facultad de Arquitectura y Construcción, Instituto de Estudios del Hábitat - IEH, Unidad de Cambio Climático y Medio Ambiente - UCCMA, Temuco, Chile
| | - R Vega-Aguayo
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Agropecuarias y Acuícolas, Núcleo de Investigación en Producción Alimentaria, Temuco, Chile
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Lucas T, Hines JZ, Samuelson J, Hargreave T, Davis SM, Fellows I, Prainito A, Watts DH, Kiggundu V, Thomas AG, Ntsuape OC, Dare K, Odoyo-June E, Soo L, Toti-Mokoteli L, Manda R, Kapito M, Msungama W, Odek J, Come J, Canda M, Gaspar N, Mekondjo A, Zemburuka B, Bonnecwe C, Vranken P, Mmbando S, Simbeye D, Rwegerera F, Wamai N, Kyobutungi S, Zulu JE, Chituwo O, Xaba S, Mandisarisa J, Toledo C. Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention-15 African Countries, 2015-2019. BMC Urol 2021; 21:23. [PMID: 33579261 PMCID: PMC7881669 DOI: 10.1186/s12894-021-00790-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/01/2021] [Indexed: 02/01/2023] Open
Abstract
Background Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. Methods Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. Results In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6–2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14–27). Conclusions Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2–3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR’s recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years.
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Affiliation(s)
- Todd Lucas
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jonas Z Hines
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia Samuelson
- Global HIV, Hepatitis, and STIs Programmes, World Health Organization, Geneva, Switzerland
| | | | - Stephanie M Davis
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ian Fellows
- Fellows Statistics, Contractor, Centers for Disease Control and Prevention, San Diego, CA, USA
| | - Amber Prainito
- U.S. Office of the Global HIV/AIDS Coordinator, Washington, DC, USA
| | - D Heather Watts
- U.S. Office of the Global HIV/AIDS Coordinator, Washington, DC, USA
| | - Valerian Kiggundu
- Office of HIV/AIDS, U.S. Agency for International Development, Washington, DC, USA
| | - Anne G Thomas
- Department of Defense, Defense Health Agency, San Diego, CA, USA
| | | | - Kunle Dare
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Elijah Odoyo-June
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Soo
- U.S. Agency for International Development, Nairobi, Kenya
| | | | - Robert Manda
- U.S. Agency for International Development, Maseru, Lesotho
| | | | - Wezi Msungama
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - James Odek
- U.S. Agency for International Development, Lilongwe, Malawi
| | | | - Marcos Canda
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Nuno Gaspar
- U.S. Agency for International Development, Maputo, Mozambique
| | | | - Brigitte Zemburuka
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Peter Vranken
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Daimon Simbeye
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | - Nafuna Wamai
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | | | - Omega Chituwo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - John Mandisarisa
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Reina R, Iturricastillo A, Castillo D, Roldan A, Toledo C, Yanci J. Is impaired coordination related to match physical load in footballers with cerebral palsy of different sport classes? J Sports Sci 2021; 39:140-149. [PMID: 33525957 DOI: 10.1080/02640414.2021.1880740] [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: 10/22/2022]
Abstract
Impaired coordination is a characteristic feature in cerebral palsy (CP) football players. This study aimed to determine the relationships of three coordination tests with match physical load during competition of para-footballers from different sport classes. Records from 259 para-footballers from 25 national teams were obtained in four international competitions held in 2018 and 2019. The three coordination tests were conducted prior to competition (i.e., rapid heel-toe, side-stepping, and split jumps), and physical match load was recorded by GPS devices during the real game: i.e., maximum/mean, total distance, distance covered at different speed zones, number of accelerations/decelerations at different intensities, and player load. FT1 and FT3 players have the lowest and highest performance in all the coordination tests, respectively, but inconclusive between-groups differences were obtained (p=0.022‒0.238). Split jumps and side-stepping tests are associated with the performance of moderate and high accelerations during competition (r = -0.20‒0.71; p<0.01). Significant correlations (r = 0.36‒0.71; p<0.01) were obtained between all the coordination measures. Coordination tests better discriminate those with more severe impairments and some evidence for the validity of the new CP football sport classes is provided. Further research is necessary to identify the portion of the variance in sports performance that coordination explains.
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Affiliation(s)
- Raúl Reina
- Department of Sport Sciences, Miguel Hernández University, Elche, Spain.,Head of Classification, International Federation of Cerebral Palsy Football, Nijmegen, The Netherlands
| | - Aitor Iturricastillo
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Daniel Castillo
- Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain
| | - Alba Roldan
- Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - Carlos Toledo
- Department of Sport Sciences, Miguel Hernández University, Elche, Spain
| | - Javier Yanci
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
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Msungama W, Menego G, Shaba F, Flowers N, Habel M, Bonongwe A, Banda M, Shire S, Maida A, Auld A, Phiri SJP, Dumbani K, Buono N, Luhanga M, Kapito M, Gibson H, Laube C, Toledo C, Kim E, Davis SM. Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services. Sex Transm Infect 2021; 97:345-350. [PMID: 33397801 PMCID: PMC8311083 DOI: 10.1136/sextrans-2020-054776] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction Voluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More targeted interventions to reach older men and others at higher short-term HIV risk are needed. Methods We implemented a quality improvement project testing the effectiveness of an active referral-based VMMC recruitment approach, targeting men attending STI clinics and those escorting partners to antenatal care (ANC) clinics, at Bwaila Hospital in Lilongwe, Malawi. We compared the proportions aged older than 15 years among men who received VMMC following referral from STI and ANC clinics with those among men referred from standard community mobilisation. We also analysed referral cascades to VMMC. Results In total, 330 clients were circumcised after referral from STI (242) and ANC (88) clinics, as compared with 3839 other clients attributed to standard community mobilisation. All clients from ANC and STI clinics were aged over 15 years, as compared with 69% from standard community mobilisation. STI clinics had a higher conversion rate from counselling to VMMC than ANC (12% vs 9%) and a higher contribution to total circumcisions performed at the VMMC clinic (6% vs 2%). Conclusions Integrating VMMC recruitment and follow-up in STI and ANC clinics co-located with VMMC services can augment demand creation and targeting of men at risk of HIV, based on age and STI history. This approach can be replicated at least in similar health facilities with ANC and STI services in close proximity to VMMC service delivery.
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Affiliation(s)
- Wezi Msungama
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Frackson Shaba
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Nicole Flowers
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Habel
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Masford Banda
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Steven Shire
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Alice Maida
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew Auld
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Kayira Dumbani
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Nicole Buono
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Mishek Luhanga
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Martin Kapito
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Hannah Gibson
- HIV and Infectious Disease Unit, Jhpiego, Lilongwe, Malawi
| | - Catey Laube
- HIV and Infectious Disease Unit, Jhpiego, Nairobi, Kenya
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Evelyn Kim
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Stephanie Marie Davis
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Davis SM, Baker H, Gross JM, Leslie SL, Chasokela CMZ, Samuelson J, Toledo C. The Role of Nurses and Midwives in Expanding and Sustaining Voluntary Medical Male Circumcision Services for HIV Prevention: A Systematic and Policy Review. J Assoc Nurses AIDS Care 2021; 32:3-28. [PMID: 33298685 PMCID: PMC9295017 DOI: 10.1097/jnc.0000000000000222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
ABSTRACT Male circumcision reduces men's risk of acquiring HIV through heterosexual sex, and voluntary medical male circumcision (VMMC) is central to HIV prevention strategies in 15 sub-Saharan African countries. Nurses have emerged as primary VMMC providers; however, barriers remain to institutionalizing nurse-led VMMC. Patient safety concerns have hindered task sharing, and regulations governing nurse-performed VMMC are not always supportive or clear. We performed a systematic review on VMMC safety by provider cadre and a desk review of national policies governing the VMMC roles of nurses and midwives. Also, VMMC by nurses is safe and has become standard practice. Countries had multiple policy combinations among different documents, with only one disallowing VMMC by these cadres. Countries with alignment between policies often ensured that nursing workforces were equipped with clinical competencies through national certification. Regulatory clarity and formalized certification for nurse-performed VMMC can increase program sustainability and build nursing capacity to meet other critical basic surgical needs.
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Affiliation(s)
- Stephanie M. Davis
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helen Baker
- Lillian Carter Center for Global Health and Social Responsibility, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jessica M. Gross
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon L. Leslie
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia, USA
| | | | - Julia Samuelson
- Department of HIV, Hepatitis, and STIs, World Health Organization, Geneva, Switzerland
| | - Carlos Toledo
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kharsany ABM, McKinnon LR, Lewis L, Cawood C, Khanyile D, Maseko DV, Goodman TC, Beckett S, Govender K, George G, Ayalew KA, Toledo C. Population prevalence of sexually transmitted infections in a high HIV burden district in KwaZulu-Natal, South Africa: Implications for HIV epidemic control. Int J Infect Dis 2020; 98:130-137. [PMID: 32562845 PMCID: PMC7484252 DOI: 10.1016/j.ijid.2020.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) and Human immunodeficiency virus (HIV) share a complex bidirectional relationship, however, population prevalence and the association between the presence of STIs and HIV in a high HIV burden district in KwaZulu-Natal, South Africa is not known. METHODS A total of 9812 participants aged 15-49 years were enrolled in a cross-sectional population-based household survey. Participants completed a structured questionnaire and provided first-pass urine (males) or self-collected vulvo-vaginal swabs (females) for the detection of STIs. RESULTS Prevalence of herpes simplex virus type-2 (HSV-2) was 57.8%, syphilis was 1.6%, Neisseria gonorrhoeae was 2.8%, Chlamydia trachomatis was 7.1%, Trichomonas vaginalis was 9.0%, Mycoplasma genitalium was 5.5% and HIV was 36.3%. HIV positive status was associated with an increased probability of having M. genitalium (aPR = 1.49, 95% CI 1.02-2.19) among males and syphilis (aPR = 2.54, 95% CI 1.32-4.86), N. gonorrhoeae (aPR = 2.39, 95% CI 1.62-3.52), T. vaginalis (aPR = 1.70, 95% CI 1.43-2.01) and M. genitalium (aPR = 1.60, 95% CI 1.15-2.22) among females. HIV viral load ≥400 copies per mL was associated with an increased probability of N. gonorrhoeae (aPR = 1.91, 95% CI 1.36-2.70), C. trachomatis (aPR = 1.52, 95% CI 1.12-2.05) and M. genitalium (aPR = 1.83, 95% CI 1.27-2.63). CONCLUSIONS The high prevalence of STIs and the association between STIs and HIV, and HIV viral load underscores the public health implications of sustained transmission risk of STIs and HIV. These findings highlight the urgent need for expanding STI surveillance and implementing interventions to monitor and reduce the STI burden.
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Affiliation(s)
- Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - Domiciled Venessa Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - Tawni C Goodman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | | | - Carlos Toledo
- Centers for Disease Control and Prevention (CDC), Atlanta, United States
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Santos F, Urbina A, Abad J, López R, Toledo C, Fernández Romero AJ. Environmental and economical assessment for a sustainable Zn/air battery. Chemosphere 2020; 250:126273. [PMID: 32120147 DOI: 10.1016/j.chemosphere.2020.126273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
Metal/Air batteries are being developed and soon could become competitive with other battery technologies already in the market, such as Li-ion battery. The main problem to be addressed is the cyclability, although some progress has been recently achieved. A Life Cycle Assessment (LCA) of the manufacturing process of a Zn/Air battery is presented in this article, including raw extraction and process of materials and battery assembly at laboratory scale (cradle to gate approach). The results indicate that Zn/Air battery can be fabricated with low environmental impacts in most categories and only four deserve attention (still being low impacts), such as Human Toxicity (cancer and non-cancer), Freshwater Ecotoxicity and Resource Depletion (the later one depending mainly on Zn use, which is not a critical material, but has a strong impact on this category). Cathode fabrication arises as the subassembly with higher impacts, followed by membrane, then anode and finally electrolyte. An economic cost calculation indicates that if cyclability of Zn/Air batteries is achieved, they can become competitive with other technologies already in the market.
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Affiliation(s)
- F Santos
- Grupo de Materiales Avanzados para la Producción y Almacenamiento de Energía, Univ. Politécnica de Cartagena, Campus de Alfonso XIII, Cartagena, Spain.
| | - A Urbina
- Departamento de Electrónica, Univ. Politécnica de Cartagena, Plaza del Hospital 1, Cartagena, Spain.
| | - J Abad
- Grupo de Materiales Avanzados para la Producción y Almacenamiento de Energía, Univ. Politécnica de Cartagena, Campus de Alfonso XIII, Cartagena, Spain
| | - R López
- Departamento de Electrónica, Univ. Politécnica de Cartagena, Plaza del Hospital 1, Cartagena, Spain
| | - C Toledo
- Departamento de Electrónica, Univ. Politécnica de Cartagena, Plaza del Hospital 1, Cartagena, Spain
| | - A J Fernández Romero
- Grupo de Materiales Avanzados para la Producción y Almacenamiento de Energía, Univ. Politécnica de Cartagena, Campus de Alfonso XIII, Cartagena, Spain
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Lucas TJ, Toledo C, Davis SM, Watts DH, Cavanaugh JS, Kiggundu V, Thomas AG, Odoyo-June E, Bonnecwe C, Maringa TH, Martin E, Juma AW, Xaba S, Balachandra S, Come J, Canda M, Nyirenda R, Msungama W, Odek J, Lija GJI, Mlanga E, Zulu JE, O'Bra H, Chituwo O, Aupokolo M, Mali DA, Zemburuka B, Malaba KD, Ntsuape OC, Hines JZ. Case series of glans injuries during voluntary medical male circumcision for HIV prevention - eastern and southern Africa, 2015-2018. BMC Urol 2020; 20:45. [PMID: 32334596 PMCID: PMC7183662 DOI: 10.1186/s12894-020-00613-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/06/2019] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Male circumcision confers partial protection against heterosexual HIV acquisition among men. The President's Emergency Plan for AIDS Relief (PEPFAR) has supported > 18,900,000 voluntary medical male circumcisions (VMMC). Glans injuries (GIs) are rare but devastating adverse events (AEs) that can occur during circumcision. To address this issue, PEPFAR has supported multiple interventions in the areas of surveillance, policy, education, training, supply chain, and AE management. METHODS Since 2015, PEPFAR has conducted surveillance of GIs including rapid investigation by the in-country PEPFAR team. This information is collected on standardized forms, which were reviewed for this analysis. RESULTS Thirty-six GIs were reported from 2015 to 2018; all patients were < 15 years old (~ 0·7 per 100,000 VMMCs in this age group) with a decreasing annual rate (2015: 0.7 per 100,000 VMMCs; 2018: 0.4 per 100,000 VMMC; p = 0.02). Most (64%) GIs were partial or complete amputations. All amputations among 10-14 year-olds occurred using the forceps-guided (FG) method, as opposed to the dorsal-slit (DS) method, and three GIs among infants occurred using a Mogen clamp. Of 19 attempted amputation repairs, reattached tissue was viable in four (21%) in the short term. In some cases, inadequate DS method training and being overworked, were found. CONCLUSION Following numerous interventions by PEPFAR and other stakeholders, GIs are decreasing; however, they have not been eliminated and remain a challenge for the VMMC program. Preventing further cases of complete and partial amputation will likely require additional interventions that prevent use of the FG method in young patients and the Mogen clamp in infants. Improving management of GIs is critical to optimizing outcomes.
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Affiliation(s)
- Todd J Lucas
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie M Davis
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Heather Watts
- U.S. Office of the Global HIV/AIDS Coordinator, Washington, D.C, USA
| | | | - Valerian Kiggundu
- Office of HIV/AIDS, U.S. Agency for International Development, Washington, D.C, USA
| | - Anne G Thomas
- Defense Health Agency, Department of Defense, San Diego, CA, USA
| | - Elijah Odoyo-June
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Tintswalo Hilda Maringa
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Enilda Martin
- U.S. Agency for International Development, Pretoria, South Africa
| | | | | | - Shirish Balachandra
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Marcos Canda
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Wezi Msungama
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - James Odek
- U.S. Agency for International Development, Lilongwe, Malawi
| | - Gissenge J I Lija
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Erick Mlanga
- U.S. Agency for International Development, Dar es Salaam, Tanzania
| | | | - Heidi O'Bra
- U.S. Agency for International Development, Lusaka, Zambia
| | - Omega Chituwo
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Denis A Mali
- U.S. Agency for International Development, Windhoek, Namibia
| | - Brigitte Zemburuka
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Kananga Dany Malaba
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Jonas Z Hines
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Marquez A, Gómez-Fontela M, Lauzurica S, Candorcio-Simón R, Munoz-Martin D, Morales M, Ubago M, Toledo C, Lauzurica P, Molpeceres C. Fluorescence enhanced BA-LIFT for single cell detection and isolation. Biofabrication 2020; 12:025019. [DOI: 10.1088/1758-5090/ab6138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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24
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Grund JM, Bryant TS, Toledo C, Jackson I, Curran K, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Bock N, Taliano J, Davis SM. Correction to: Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review. AIDS Behav 2020; 24:344. [PMID: 31214865 DOI: 10.1007/s10461-019-02553-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The article Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review, written by Jonathan M. Grund, Tyler S. Bryant, Carlos Toledo, Inimfon Jackson, Kelly Curran, Sheng Zhou, Jorge Martin del Campo, Ling Yang, Apollo Kivumbi, Peizi Li, Naomi Bock, Joanna Taliano, Stephanie M. Davis was originally published electronically on the publisher's internet portal (currently SpringerLink) on 24 October 2018 without open access.
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Affiliation(s)
- Jonathan M Grund
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Joanna Taliano
- Division of Public Health Information Dissemination (DPHID), Library Science Branch, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Atlanta, GA, USA
| | - Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA.
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25
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Kharsany ABM, Cawood C, Lewis L, Yende-Zuma N, Khanyile D, Puren A, Madurai S, Baxter C, George G, Govender K, Beckett S, Samsunder N, Toledo C, Ayalew KA, Diallo K, Glenshaw M, Herman-Roloff A, Wilkinson E, de Oliveira T, Abdool Karim SS, Abdool Karim Q. Trends in HIV Prevention, Treatment, and Incidence in a Hyperendemic Area of KwaZulu-Natal, South Africa. JAMA Netw Open 2019; 2:e1914378. [PMID: 31675082 PMCID: PMC6826647 DOI: 10.1001/jamanetworkopen.2019.14378] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE In Africa, the persistently high HIV incidence rate among young women is the major obstacle to achieving the goal of epidemic control. OBJECTIVE To determine trends in coverage of HIV prevention and treatment programs and HIV incidence. DESIGN, SETTING, AND PARTICIPANTS This cohort study consisted of 2 sequential, community-based longitudinal studies performed in the Vulindlela and Greater Edendale area in KwaZulu-Natal, South Africa. Participants enrolled from June 11, 2014, to June 22, 2015 (2014 survey), with a single follow-up visit from June 24, 2016, to April 3, 2017 (2016 cohort), or enrolled from July 8, 2015, to June 7, 2016 (2015 survey), with a single follow-up visit from November 7, 2016, to August 30, 2017 (2017 cohort). Men and women aged 15 to 49 years were enrolled in the 2014 and 2015 surveys, and HIV-seronegative participants aged 15 to 35 years were followed up in the 2016 and 2017 cohorts. Analysis was conducted from January 1 through December 31, 2018. EXPOSURES HIV prevention and treatment programs in a real-world, nontrial setting. MAIN OUTCOMES AND MEASURES Trends in sex- and age-specific HIV incidence rates, condom use, voluntary medical male circumcision, knowledge of HIV-seropositive status, uptake of antiretroviral therapy, and viral suppression. RESULTS A total of 9812 participants (6265 women [63.9%]; median age, 27 years [interquartile range, 20-36 years]) from 11 289 households were enrolled in the 2014 survey, and 10 236 participants (6341 women [61.9%]; median age, 27 years [interquartile range, 20-36 years]) from 12 247 households were enrolled in the 2015 survey. Of these, 3536 of 4539 (annual retention rate of 86.7%) completed follow-up in the 2016 cohort, and 3907 of 5307 (annual retention rate of 81.4%) completed follow-up in the 2017 cohort. From 2014 to 2015, condom use with last sex partner decreased by 10% from 24.0% (n = 644 of 3547) to 21.6% (n = 728 of 3895; P = .12) in men and by 17% from 19.6% (n = 1039 of 6265) to 16.2% (n = 871 of 6341; P = .002) in women. Voluntary medical male circumcision increased by 13% from 31.9% (1102 of 3547) to 36.1% (n = 1472 of 3895); P = .007) in men, and the proportion of women reporting that their partner was circumcised increased by 35% from 35.7% (n = 1695 of 4766) to 48.2% (n = 2519 of 5207; P < .001). Knowledge of HIV-seropositive status increased by 21% from 51.8% (n = 504 of 3547) to 62.9% (n = 570 of 3895; P < .001) in men and by 14% from 64.6% (n = 1833 of 6265) to 73.4% (n = 2182 of 6341; P < .001) in women. Use of antiretroviral therapy increased by 32% from 36.7% (n = 341 of 3547) to 48.6% (n = 432 of 3895; P < .001) in men and by 29% from 45.6% (n = 1251 of 6265) to 58.8% (n = 1743 of 6341; P < .001) in women; HIV viral suppression increased by 20% from 41.9% (n = 401 of 3547) to 50.3% (n = 456 of 3895; P = .005) in men and by 13% from 54.8% (n = 1547 of 6265) to 61.9% (n = 1828 of 6341; P < .001) in women. Incidence of HIV declined in women aged 15 to 19 years from 4.63 (95% CI, 3.29-6.52) to 2.74 (95% CI, 1.84-4.09) per 100 person-years (P = .04) but declined marginally or remained unchanged among men and women in other age groups. CONCLUSIONS AND RELEVANCE This study showed a significant decline in HIV incidence in young women; however, to further reduce HIV incidence, HIV prevention and treatment program coverage must be intensified and scaled up.
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Affiliation(s)
- Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDs Risk Management, Cape Town, South Africa
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carlos Toledo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Karidia Diallo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Glenshaw
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Eduan Wilkinson
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | - Tulio de Oliveira
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
| | - Salim S. Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Quinaglia TQ, Ferreira De Souza T, Bianchini Cardoso F, Silva LM, Toledo C, Neilan T, Antunes-Correa L, Herold MJ, Coelho-Filho OR. P2596Right ventricular function after anthracycline therapy: specificities of myocardial necrosis markers. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Anthracycline therapy may induce left ventricle (LV) dysfunction. However, few studies investigated how it may affect the right ventricle (RV).
Purpose
The goal of this study was to assess RV systolic function and biomarkers that may predict early dysfunction in breast cancer patients treated with anthracyclines.
Methods
Twenty-seven women with breast cancer (51.8±8.9 years), underwent CMR prior, and up to 3-times after doxorubicin with matching measurements of biomarkers: high-sensitive troponin T (TnT), creatinine-kinase MB isoenzyme (CK-MB) and C reactive protein (CRP).
Results
Before anthracyclines, all subjects had normal LVEF (69.4±3.6%) and RVEF (55.1±9%) and LV and RV EF correlated significantly (ρ=0.42; p=0.031). At 351–700 days after anthracycline, LVEF and LV mass index declined to 58±6% (P<0.001) and 36±6 g/m2 (P<0.001) (table). RVEF also decreased, reaching 46±8% at 231,4 days after (P<0.001), but lost the correlation with LVEF seen at baseline (r=0.22; P=0.068). RVEF showed strong negative association with serum CK-MB (r=−0.4, p=0.004) and no significant correlation with TnT (r=−0.18, p=0.28) or CRP (r=0.03, p=0.932) (figure). In patients with a peak TnT of >10 pg/ml the change of RVEF overtime was significant (Regression Splines coefficients for RVEF: 1.0, p=0.731–peak TnT ≤10pg/ml; 2.51, p<0.001–peak TnT >10 pg/ml). LVEF was not associated with CK-MB (p=ns).
Baseline and Follow-Up CMR Findings Median days after anthracycline Pre-DOX (79,146] (146,231] (231,350] (350,700] N 27 16 19 14 16 LVEF, % 69.4±3.6 61.1±7.6† 55.99±5.0† 53.8±8.4† 57.5±6.1† LVEDV index, ml/m2 60.2±9.9 64.3±9.6 66.7±17.7 * 56.9±18.5 59.2±12.6 LVESV index, ml/m2 18.3±4.0 24.7±7.3# 29.0±7.3† 26.2±9.7† 25.3±8.2† LV mass index, g/m2 51.4±8.0 45.3±3.8† 43.2±4.9† 39.9±5.4† 36.0±6.1† RVEF, % 55.1±9.4 51±8.1 48±8.5 46±8.5 50±7.4 RVEDV index, ml/m2 45.07±6.6 46.5±11.31 47.35±9.16 41.14±9.7 46.16±7.3 RVESV index, ml/m2 20.45±5.4 22.31±5.8 24.77±6.6 21.96±6.4 22.24±4.7 Data are presented as mean ± SD. LV: left ventricle; RV: right ventricle; EF: ejection fraction; EDV: end diastolic volume; ESV: end systolic volume (average±SD). *Significantly different from Pre-DOX level (p<0.05 from linear mixed effects model). #Significantly different from Pre-DOX level (p<0.01 from linear mixed effects model). †Significantly different from Pre-DOX level (p<0.001 from linear mixed effects model).
RVEF and correlate variables
Conclusions
RVEF reduction does not follow LVEF changes after anthracyclines and CK-MB may be a more specific biomarker to assess RV dysfunction. A higher peak cTnT could predict a greater change in RVEF during follow-up.
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Affiliation(s)
- T Q Quinaglia
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - T Ferreira De Souza
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - F Bianchini Cardoso
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - L M Silva
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - C Toledo
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - T Neilan
- Massachusetts General Hospital, Boston, United States of America
| | - L Antunes-Correa
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
| | - M J Herold
- Brigham and Womens Hospital, Boston, United States of America
| | - O R Coelho-Filho
- State University of Campinas (UNICAMP), Department of Internal Medicine, Campinas, Brazil
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Odoyo-June E, Owuor N, Kassim S, Davis S, Agot K, Serrem K, Otieno G, Awori Q, Hines J, Toledo C, Laube C, Kisia C, Aoko A, Ojiambo V, Mwandi Z, Juma A, Kigen B. Rollout of ShangRing circumcision with active surveillance for adverse events and monitoring for uptake in Kenya. PLoS One 2019; 14:e0222942. [PMID: 31557208 PMCID: PMC6762105 DOI: 10.1371/journal.pone.0222942] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since 2011, Kenya has been evaluating ShangRing device for use in its voluntary medical male circumcision (VMMC) program according to World Health Organization (WHO) guidelines. Compared to conventional surgical circumcision, the ShangRing procedure is shorter, does not require suturing and gives better cosmetic outcomes. After a pilot evaluation of ShangRing in 2011, Kenya conducted an active surveillance for adverse events associated with its use from 2016-2018 to further assess its safety, uptake and to identify any operational bottlenecks to its widespread use based on data from a larger pool of procedures in routine health care settings. METHODS From December 2017 to August 2018, HIV-negative VMMC clients aged 13 years or older seeking VMMC at six sites across five counties in Kenya were offered ShangRing under injectable local anesthetic as an alternative to conventional surgical circumcision. Providers described both procedures to clients before letting them make a choice. Outcome measures recorded for clients who chose ShangRing included the proportions who were clinically eligible, had successful device placement, experienced adverse events (AEs), or failed to return for device removal. Clients failing to return for follow up were sought through phone calls, text messages or home visits to ensure removal and complete information on adverse events. RESULTS Out of 3,692 eligible clients 1,079 (29.2%) chose ShangRing; of these, 11 (1.0%) were excluded due to ongoing clinical conditions, 17 (1.6%) underwent conventional surgery due to lack of appropriate device size at the time of the procedure, 97.3% (1051/1079) had ShangRing placement. Uptake of ShangRing varied from 11% to 97% across different sites. There was one severe AE, a failed ShangRing placement (0.1%) managed by conventional wound suturing, plus two moderate AEs (0.2%), post removal wound dehiscence and bleeding, that resolved without sequelae. The overall AE rate was 0.3%. All clients returned for device removal from fifth to eleventh day after placement. CONCLUSION ShangRing circumcision is effective and safe in the Kenyan context but its uptake varies widely in different settings. It should be rolled out under programmatic implementation for eligible males to take advantage of its unique benefits and the freedom of choice beyond conventional surgical MMC. Public education on its availability and unique advantages is necessary to optimize its uptake and to actualize the benefit of its inclusion in VMMC programs.
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Affiliation(s)
- Elijah Odoyo-June
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
- * E-mail:
| | | | - Saida Kassim
- MOH-NASCOP National STD/AIDS Control Program, Ministry of Health, Nairobi, Kenya
| | - Stephanie Davis
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kennedy Serrem
- MOH-NASCOP National STD/AIDS Control Program, Ministry of Health, Nairobi, Kenya
| | | | | | - Jonas Hines
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Carlos Toledo
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | | | - Appolonia Aoko
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Ambrose Juma
- MOH-NASCOP National STD/AIDS Control Program, Ministry of Health, Nairobi, Kenya
| | - Bartilol Kigen
- MOH-NASCOP National STD/AIDS Control Program, Ministry of Health, Nairobi, Kenya
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Toledo C, Andrade DC, Díaz HS, Inestrosa NC, Del Rio R. Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment. Mol Neurobiol 2019; 56:8035-8051. [PMID: 31165973 DOI: 10.1007/s12035-019-01655-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/06/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.
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Affiliation(s)
- C Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de investigación en fisiología del ejercicio, Universidad Mayor, Santiago, Chile
| | - H S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - N C Inestrosa
- Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
| | - R Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Center for Aging and Regeneration (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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Davis S, Toledo C, Lewis L, Maughan-Brown B, Ayalew K, Kharsany ABM. Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings? Findings of a household survey in KwaZulu-Natal, South Africa. BMJ Glob Health 2019; 4:e001389. [PMID: 31263584 PMCID: PMC6570991 DOI: 10.1136/bmjgh-2019-001389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Male circumcision (MC) confers partial protection to men against HIV and, in research settings, some sexually transmitted infections (STIs). It is also associated with protection from some STIs among female partners. However, real-world data on changes in STI transmission associated with large-scale public African medical male circumcision (MMC) conducted for HIV prevention are lacking and would improve estimates of the health impact of MMC. METHODS The HIV Incidence Provincial Surveillance System is a community-based surveillance platform for HIV prevalence, incidence and intervention coverage trends in KwaZulu-Natal province, South Africa. HIPPS collected cross-sectional self-reported data on circumcision status (from men), partner circumcision status for past three partners (from women) and demographic characteristics and behavioural risk factors; and tested participants for HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B, N eisseria gonorrhoeae, C hlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium. Bivariable and multivariable analyses were performed on associations between own (men) or partner's (women) circumcision status and each STI. Multivariable analyses adjusted for age, demographic characteristics and behavioural risk factors, and incorporated false discovery rate (FDR) correction. RESULTS Among men, MMC had a protective association with HSV-2 (OR 0.66, 95% CI 0.50 to 0.86), hepatitis B (OR 0.53, 95% CI 0.30 to 0.95), HIV (OR 0.50, 95% CI 0.38 to 0.65) and M. genitalium (OR 0.53, 95% CI 0.32 to 0.88). Among women, partner circumcision had a protective association with HSV-2 (OR 0.71, 95% CI 0.53 to 0.95) and HIV (OR 0.66, 95% CI 0.49 to 0.90). Associations with HIV and HSV-2 remained significant for men and all women after FDR correction. CONCLUSION These real-world data, supporting protective associations between MMC conducted for HIV prevention and STIs in men and women, can help clarify the full impact of MMC and support a role in broader sexual health programming.
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Affiliation(s)
- Stephanie Davis
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lara Lewis
- Nelson R. Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Kassahun Ayalew
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Durban, South Africa
| | - Ayesha B M Kharsany
- Nelson R. Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
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30
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Grund JM, Bryant TS, Toledo C, Jackson I, Curran K, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Bock N, Taliano J, Davis SM. Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review. AIDS Behav 2019; 23:1104-1114. [PMID: 30357642 PMCID: PMC6557870 DOI: 10.1007/s10461-018-2313-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Male circumcision (MC) is a key HIV prevention intervention for men in countries with high HIV prevalence. Women's understanding of MC is important but poorly understood. We conducted a systematic review including women's knowledge of MC's biomedical impacts and its association with female sexual satisfaction and function through October 2017. Thirty-eight articles were identified: thirty-two with knowledge outcomes, seven with sexual satisfaction, and four with sexual function (N = 38). Respondent proportions aware MC protects men from HIV were 9.84-91.8% (median 60.0%). Proportions aware MC protects men from STIs were 14.3-100% (72.6%). Proportions aware MC partially protects men from HIV were 37.5-82% (50.7%). Proportions aware MC is not proven to protect women from infection by an HIV-positive partner were 90.0-96.8% (93.0%). No increases over time were noted. Women's MC knowledge is variable. Education could help women support MC and make better-informed sexual decisions.
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Affiliation(s)
- Jonathan M Grund
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Joanna Taliano
- Division of Public Health Information Dissemination (DPHID), Library Science Branch, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Atlanta, GA, USA
| | - Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA.
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31
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Serrano-Luján L, Víctor-Román S, Toledo C, Sanahuja-Parejo O, Mansour AE, Abad J, Amassian A, Benito AM, Maser WK, Urbina A. Environmental impact of the production of graphene oxide and reduced graphene oxide. SN Appl Sci 2019. [DOI: 10.1007/s42452-019-0193-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Spezzano L, Toledo C, Zanichelli L, Totti F, Sanches L, Nascimento C, Jordão M. A profile of elderly whit dysphagia accompanied by multidisciplinary nutritional therapy team. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Davis SM, Hines JZ, Habel M, Grund JM, Ridzon R, Baack B, Davitte J, Thomas A, Kiggundu V, Bock N, Pordell P, Cooney C, Zaidi I, Toledo C. Progress in voluntary medical male circumcision for HIV prevention supported by the US President's Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data. BMJ Open 2018; 8:e021835. [PMID: 30173159 PMCID: PMC6120649 DOI: 10.1136/bmjopen-2018-021835] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This article provides an overview and interpretation of the performance of the US President's Emergency Plan for AIDS Relief's (PEPFAR's) male circumcision programme which has supported the majority of voluntary medical male circumcisions (VMMCs) performed for HIV prevention, from its 2007 inception to 2017, and client characteristics in 2017. DESIGN Longitudinal collection of routine programme data and disaggregations. SETTING 14 countries in sub-Saharan Africa with low baseline male circumcision coverage, high HIV prevalence and PEPFAR-supported VMMC programmes. PARTICIPANTS Clients of PEPFAR-supported VMMC programmes directed at males aged 10 years and above. MAIN OUTCOME MEASURES Numbers of circumcisions performed and disaggregations by age band, result of HIV test offer, procedure technique and follow-up visit attendance. RESULTS PEPFAR supported a total of 15 269 720 circumcisions in 14 countries in Southern and Eastern Africa. In 2017, 45% of clients were under 15 years of age, 8% had unknown HIV status, 1% of those tested were HIV+ and 84% returned for a follow-up visit within 14 days of circumcision. CONCLUSIONS Over 15 million VMMCs have been supported by PEPFAR since 2007. VMMC continues to attract primarily young clients. The non-trivial proportion of clients not testing for HIV is expected, and may be reassuring that testing is not being presented as mandatory for access to circumcision, or in some cases reflect test kit stockouts or recent testing elsewhere. While VMMC is extremely safe, achieving the highest possible follow-up rates for early diagnosis and intervention on complications is crucial, and programmes continue to work to raise follow-up rates. The VMMC programme has achieved rapid scale-up but continues to face challenges, and new approaches may be needed to achieve the new Joint United Nations Programme on HIV/AIDS goal of 27 million additional circumcisions through 2020.
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Affiliation(s)
- Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas Z Hines
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Habel
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan M Grund
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Renee Ridzon
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Brittney Baack
- Division of Global HIV and TB, Monitoring, Evaluation, and Data Analytics Branch, Clinical Monitoring and Evaluation Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Davitte
- US Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, California, USA
| | - Anne Thomas
- US Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, California, USA
| | - Valerian Kiggundu
- United States Agency for International Development, Global Health Bureau, Office of HIV/AIDS, Prevention, Care and Treatment Division, Washington, District of Columbia, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paran Pordell
- Division of Global HIV and TB, Monitoring, Evaluation, and Data Analytics Branch, Clinical Monitoring and Evaluation Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caroline Cooney
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Irum Zaidi
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kharsany ABM, Cawood C, Khanyile D, Lewis L, Grobler A, Puren A, Govender K, George G, Beckett S, Samsunder N, Madurai S, Toledo C, Chipeta Z, Glenshaw M, Hersey S, Abdool Karim Q. Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey. Lancet HIV 2018; 5:e427-e437. [PMID: 30021700 PMCID: PMC7498647 DOI: 10.1016/s2352-3018(18)30104-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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] [Received: 12/22/2017] [Revised: 04/28/2018] [Accepted: 05/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection. FINDINGS Between June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36·3% (95% CI 34·8-37·8, 3969 of 9812); 44·1% (42·3-45·9, 2955 of 6265) in women and 28·0% (25·9-30·1, 1014 of 3547) in men (p<0·0001). HIV prevalence in women aged 15-24 years was 22·3% (20·2-24·4, 567 of 2224) compared with 7·6% (6·0-9·3, 124 of 1472; p<0·0001) in men of the same age. Prevalence peaked at 66·4% (61·7-71·2, 517 of 760) in women aged 35-39 years and 59·6% (53·0-66·3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26·5% (24·1-28·8, 593 of 2356) in men and 22·7% (20·9-24·4, 994 of 4350) in women (p=0·0033); 35·7% (33·4-37·9, 1695 of 5447) of women's male partners and 31·9% (29·5-34·3, 1102 of 3547) of men were medically circumcised (p<0·0001), and 45·6% (42·9-48·2, 1251 of 2955) of women and 36·7% (32·3-41·2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0·0003). HIV viral suppression was achieved in 54·8% (52·0-57·5, 1574 of 2955) of women and 41·9% (37·1-46·7, 401 of 1014) of men (p<0·0001), and 87·2% (84·6-89·8, 1086 of 1251) of women and 83·9% (78·5-89·3, 284 of 341; p=0·3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status. INTERPRETATION The HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community. FUNDING The President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
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Affiliation(s)
- Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - Cherie Cawood
- Epicentre AIDs Risk Management (Pty) Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDs Risk Management (Pty) Limited, Cape Town, South Africa
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Anneke Grobler
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | | | - Carlos Toledo
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Zawadi Chipeta
- Centers for Disease Control and Prevention (CDC), Pretoria, South Africa; BroadReach, Cape Town, South Africa
| | - Mary Glenshaw
- Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Sara Hersey
- Centers for Disease Control and Prevention (CDC), Pretoria, South Africa; Centers for Disease Control and Prevention (CDC), Freetown, Sierra Leone
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Department of Epidemiology, Columbia University, New York, NY, USA
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Davis SM, Pals S, Yang C, Odoyo-June E, Chang J, Walters MS, Jaoko W, Bock N, Westerman L, Toledo C, Bailey RC. Circumcision status at HIV infection is not associated with plasma viral load in men: analysis of specimens from a randomized controlled trial. BMC Infect Dis 2018; 18:350. [PMID: 30055581 PMCID: PMC6064164 DOI: 10.1186/s12879-018-3257-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Male circumcision provides men with approximately 60% protection from acquiring HIV infection via heterosexual sex, and has become a key component of HIV prevention efforts in sub-Saharan Africa. Possible mechanisms for this protection include removal of the inflammatory anaerobic sub-preputial environment and the high concentration of Langerhans cells on the inside of the foreskin, both believed to promote local vulnerability to HIV infection. In people who do acquire HIV, viral load is partially determined by infecting partner viral load, potentially mediated by size of infecting inoculum. By removing a portal for virion entry, prior male circumcision could decrease infecting inoculum and thus viral load in men who become HIV-infected, conferring the known associated benefits of slower progression to disease and decreased infectiousness. METHODS We performed an as-treated analysis of plasma samples collected under a randomized controlled trial of male circumcision for HIV prevention, comparing men based on their circumcision status at the time of HIV acquisition, to determine whether circumcision is associated with lower viral load. Eligible men were seroconverters who had at least one plasma sample available drawn at least 6 months after infection, reported no potential exposures other than vaginal sex and, for those who were circumcised, were infected more than 6 weeks after circumcision, to eliminate the open wound as a confounder. Initial viral load testing indicated that quality of pre-2007 samples might have been compromised during storage and they were excluded, as were those with undetectable or unquantifiable results. Log viral loads were compared between groups using univariable and multivariable linear regression, adjusting for sample age and sexually transmitted infection diagnosis with 3.5 months of seroconversion, with a random effect for intra-individual clustering for samples from the same man. A per-protocol analysis was also performed. RESULTS There were no viral load differences between men who were circumcised and uncircumcised at the time of HIV infection (means 4.00 and 4.03 log10 copies/mL respectively, p = .88) in any analysis. CONCLUSION Circumcision status at the time of HIV infection does not affect viral load in men. TRIAL REGISTRATION The original RCT which provided the samples was ClinicalTrials.gov trial NCT00059371 .
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Affiliation(s)
- Stephanie M Davis
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA. .,Division of Global HIV and TB, HIV Prevention Branch US Centers for Disease Control and Prevention, 1600 Clifton Rd. NE Mail Stop E-04, Atlanta, GA, 30329, USA.
| | - Sherri Pals
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Chunfu Yang
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Elijah Odoyo-June
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Kisumu, Kenya
| | - Joy Chang
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Naomi Bock
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Larry Westerman
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Carlos Toledo
- Division of Global HIV/AIDS and Tuberculosis, US Centers for Disease Control, Atlanta, GA, USA
| | - Robert C Bailey
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, USA
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Hinkle LE, Toledo C, Grund JM, Byams VR, Bock N, Ridzon R, Cooney C, Njeuhmeli E, Thomas AG, Odhiambo J, Odoyo-June E, Talam N, Matchere F, Msungama W, Nyirenda R, Odek J, Come J, Canda M, Wei S, Bere A, Bonnecwe C, Choge IA, Martin E, Loykissoonlal D, Lija GJ, Mlanga E, Simbeye D, Alamo S, Kabuye G, Lubwama J, Wamai N, Chituwo O, Sinyangwe G, Zulu JE, Ajayi CA, Balachandra S, Mandisarisa J, Xaba S, Davis SM. Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2015-2016. MMWR Morb Mortal Wkly Rep 2018; 67:337-339. [PMID: 29565839 PMCID: PMC5868201 DOI: 10.15585/mmwr.mm6711a6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hines JZ, Ntsuape OC, Malaba K, Zegeye T, Serrem K, Odoyo-June E, Nyirenda RK, Msungama W, Nkanaunena K, Come J, Canda M, Nhaguiombe H, Shihepo EK, Zemburuka BL, Mutandi G, Yoboka E, Mbayiha AH, Maringa H, Bere A, Lawrence JJ, Lija GJ, Simbeye D, Kazaura K, Mwiru RS, Talisuna SA, Lubwama J, Kabuye G, Zulu JE, Chituwo O, Mumba M, Xaba S, Mandisarisa J, Baack BN, Hinkle L, Grund JM, Davis, SM, Toledo C. Scale-Up of Voluntary Medical Male Circumcision Services for HIV Prevention - 12 Countries in Southern and Eastern Africa, 2013-2016. MMWR Morb Mortal Wkly Rep 2017; 66:1285-1290. [PMID: 29190263 PMCID: PMC5708689 DOI: 10.15585/mmwr.mm6647a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM. Association between male circumcision and women's biomedical health outcomes: a systematic review. Lancet Glob Health 2017; 5:e1113-e1122. [PMID: 29025633 PMCID: PMC5728090 DOI: 10.1016/s2214-109x(17)30369-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 02/23/2017] [Revised: 07/21/2017] [Accepted: 08/25/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women's health outcomes to benefit women's health programmes. METHODS In this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women's health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency. FINDINGS 60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate. INTERPRETATION Scale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women's health programmes should be explored. FUNDING US Centers for Disease Control and Prevention and Jhpiego.
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Affiliation(s)
- Jonathan M Grund
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Naomi Bock
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Carlos Toledo
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Joanna Taliano
- LAC Group, Contractor to US Centers for Disease Control and Prevention, Library Science Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, USA
| | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherri Pals
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Stephanie M Davis
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA.
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Stoeckle BC, Araujo R, Geist J, Kuehn R, Toledo C, Machordom A. Strong genetic differentiation and low genetic diversity of the freshwater pearl mussel (Margaritifera margaritifera L.) in the southwestern European distribution range. CONSERV GENET 2016. [DOI: 10.1007/s10592-016-0889-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grund JM, Toledo C, Davis SM, Ridzon R, Moturi E, Scobie H, Naouri B, Reed JB, Njeuhmeli E, Thomas AG, Benson FN, Sirengo MW, Muyenzi LN, Lija GJI, Rogers JH, Mwanasalli S, Odoyo-June E, Wamai N, Kabuye G, Zulu JE, Aceng JR, Bock N. Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention--Eastern and Southern Africa, 2012-2015. MMWR Morb Mortal Wkly Rep 2016; 65:36-7. [PMID: 26797167 DOI: 10.15585/mmwr.mm6502a5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.
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Kharsany ABM, Cawood C, Khanyile D, Grobler A, Mckinnon LR, Samsunder N, Frohlich JA, Abdool Karim Q, Puren A, Welte A, George G, Govender K, Toledo C, Chipeta Z, Zembe L, Glenshaw MT, Madurai L, Deyde VM, Bere A. Strengthening HIV surveillance in the antiretroviral therapy era: rationale and design of a longitudinal study to monitor HIV prevalence and incidence in the uMgungundlovu District, KwaZulu-Natal, South Africa. BMC Public Health 2015; 15:1149. [PMID: 26588902 PMCID: PMC4654918 DOI: 10.1186/s12889-015-2179-2] [Citation(s) in RCA: 30] [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: 07/20/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has over 6,000,000 HIV infected individuals and the province of KwaZulu-Natal (KZN) is the most severely affected. As public health initiatives to better control the HIV epidemic are implemented, timely, detailed and robust surveillance data are needed to monitor, evaluate and inform the programmatic interventions and policies over time. We describe the rationale and design of the HIV Incidence Provincial Surveillance System (HIPSS) to monitor HIV prevalence and incidence. METHODS/DESIGN The household-based survey will include a sample of men and women from two sub-districts of the uMgungundlovu municipality (Vulindlela and the Greater Edendale) of KZN, South Africa. The study is designed as two sequential cross-sectional surveys of 10,000 randomly selected individuals aged 15-49 years to be conducted one year apart. From the cross sectional surveys, two sequential cohorts of HIV negative individuals aged 15-35 years will be followed-up one year later to measure the primary outcome of HIV incidence. Secondary outcomes include the laboratory measurements for pulmonary tuberculosis, sexually transmitted infections and evaluating tests for estimating population-level HIV incidence. Antiretroviral therapy (ART) access, HIV-1 RNA viral load, and CD4 cell counts in HIV positive individuals will assess the effectiveness of the HIV treatment cascade. Household and individual-level socio-demographic characteristics, exposure to HIV programmatic interventions and risk behaviours will be assessed as predictors of HIV incidence. The incidence rate ratio of the two cohorts will be calculated to quantify the change in HIV incidence between consecutive samples. In anticipation of better availability of population-level HIV prevention and treatment programmes leading to decreases in HIV incidence, the sample size provides 84% power to detect a reduction of 30% in the HIV incidence rate between surveys. DISCUSSION The results from HIPSS will provide critical data regarding HIV prevalence and incidence in this community and will establish whether HIV prevention and treatment efforts in a "real world", non-trial setting have an impact on HIV incidence at a population level. Importantly, the study design and methods will inform future methods for HIV surveillance.
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Affiliation(s)
- Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Cherie Cawood
- Epicentre AIDs Risk Management (Pty) Limited, P O Box 3484, Paarl, 7620, Cape Town, South Africa.
| | - David Khanyile
- Epicentre AIDs Risk Management (Pty) Limited, P O Box 3484, Paarl, 7620, Cape Town, South Africa.
| | - Anneke Grobler
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Lyle R Mckinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Janet A Frohlich
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa.
| | - Alex Welte
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa.
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Carlos Toledo
- Centres for Disease Control and Prevention (CDC) Atlanta, Atlanta, USA.
| | - Zawadi Chipeta
- Centres for Disease Control and Prevention (CDC), Pretoria, South Africa.
| | - Lycias Zembe
- Centres for Disease Control and Prevention (CDC), Pretoria, South Africa.
| | - Mary T Glenshaw
- Centres for Disease Control and Prevention (CDC), Pretoria, South Africa.
| | - Lorna Madurai
- Global Clinical and Virology Laboratory, 11 Dan Pienaar Place, Amanzimtoti, South Africa.
| | - Varough M Deyde
- Centres for Disease Control and Prevention (CDC), Pretoria, South Africa.
| | - Alfred Bere
- Centres for Disease Control and Prevention (CDC), Pretoria, South Africa.
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Balanzá R, Arrangoiz R, Cordera F, Muñoz M, Luque-de-León E, Moreno E, Toledo C, González E. Mammary analog secretory carcinoma of the parotid gland: A case report and literature review. Int J Surg Case Rep 2015; 16:187-91. [PMID: 26496413 PMCID: PMC4643465 DOI: 10.1016/j.ijscr.2015.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 11/25/2022] Open
Abstract
Mammary analog secretory carcinoma (MASC) is a newly described carcinoma of the salivary glands. MASC is characterized by morphologic and immunohistochemical features that strongly resemble a secretory carcinoma (SC) of the breast. MASC and SC of the breast share the presence of translocation t(12;15) (p13;q25), that results in the formation of an oncogenic fusion gene ETV6-NTK3. The majority of MASC present among men and arise from the parotid gland. MASC is a low-grade carcinoma with potential for high-grade transformation.
Background Mammary analog secretory carcinoma (MASC) was first described in 2010 by Skálová et al. This entity shares morphologic and immunohistochemical features with the secretory carcinoma (SC) of the breast. MASC usually presents as an asymptomatic mass in the parotid gland and predominantly affects men. This tumor is considered a low-grade carcinoma but has the potential for high-grade transformation. We report one MASC case and a review of world literature. Case report A 66-year-old male patient presented because he noticed a mass of approximately 3 × 3 cm on the right pre-auricular region. Physical examination demonstrated a 3 × 3.5 cm, firm, fixed, non-tender mass in the right pre-auricular region. An MRI of the head and neck showed an ovoid heterogeneous lesion, dependent of the right parotid gland of 27 × 28 mm. We performed a superficial parotidectomy with identification and preservation of the facial nerve. The immunophenotype was positive for epithelial membrane antigen (EMA), CK8/18, vimentin, S-100 protein, and mammoglobin. No further surgical interventions or adjuvant therapies were needed. The patient will have a close follow up. Conclusion The presence of t(12;15) (p13;q25) translocation which results in the ETV6-NTRK3 gene fusion or positive immunochemical studies for STAT5, mammoglobin and S100 protein, are necessary to confirm the diagnosis of MASC. MASC treatment should mimic the management of other low-grade malignant salivary gland neoplasms. The inhibition of ETV6-NTRK3 gene fusion could be used as treatment in the future.
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Affiliation(s)
- Ricardo Balanzá
- General Surgery Resident, Hospital Ángeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas Huixquilucan, Estado de México C.P. 52763, Mexico.
| | - Rodrigo Arrangoiz
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico.
| | - Fernando Cordera
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
| | - Manuel Muñoz
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
| | - Enrique Luque-de-León
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
| | - Eduardo Moreno
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
| | - Carlos Toledo
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
| | - Edgar González
- Department of Surgery, Centro Médico ABC, Av. Carlos Graef Fernández 154, Col. Tlaxala, Del. Cuajimalpa de Morelos, México Distrito Federal C.P. 05300, Mexico
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Mehta S, Fulton A, Quach C, Thistle M, Toledo C, Evans N. Measurement properties of the lower extremity functional scale: a systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Machordom A, Araujo R, Toledo C, Zouros E, Ladoukakis ED. Female-dependent transmission of paternal mtDNA is a shared feature of bivalve species with doubly uniparental inheritance (DUI) of mitochondrial DNA. J ZOOL SYST EVOL RES 2015. [DOI: 10.1111/jzs.12096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Annie Machordom
- Biodiversity and Evolutionary Biology Department; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
| | - Rafael Araujo
- Biodiversity and Evolutionary Biology Department; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
| | - Carlos Toledo
- Biodiversity and Evolutionary Biology Department; Museo Nacional de Ciencias Naturales (CSIC); Madrid Spain
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Cristi-Montero C, Bresciani G, Alvarez A, Arriagada V, Beneventi A, Canepa V, Espinoza P, Parraguez M, Toledo C, Valencia C, Rodriguez-Rodriguez F. Critical periods in the variation in body composition in school children. NUTR HOSP 2014; 30:782-6. [PMID: 25335662 DOI: 10.3305/nh.2014.30.4.7694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To identify critical periods in the variation in body composition during a school year and determine possible causes. METHODS A total of 363 boys and girls aged between 10 and 14 years participated in the study. Before and after the Winter Holidays (WIH) and National Holidays (NAH) (July and September, respectively), measurements were taken of body weight, body fat percentage, waist perimeter, time spent on physical activity and hours of sleep in order to determine the variations. The normality of the data was confirmed and the means were compared with an alpha significance level of p<0.05. RESULTS The school children increased in weight by 600 g and 510 g in the NAH and WIH, respectively (p<0.0001), and their body fat percentage was significantly increased during both periods (0.51%); however, the waist perimeter measurement saw no significant changes. It can also be seen that in NAH physical activity dropped by an important amount (-41 min, p<0.0001), though this did not occur in WIH. A significant increase in hours of sleep was also seen during the two holiday periods (~1 to 2 hours/day). CONCLUSION It is concluded that both NAH and WIH can be considered critical periods due to the sharp increase in body weight and body fat percentage in the school children, where a possible cause is the reduction in time spent on physical activity.
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Affiliation(s)
- Carlos Cristi-Montero
- Laboratorio de Motricidad Humana, Escuela de Educación Física. Pontificia Universidad Católica de Valparaíso..
| | | | - Ana Alvarez
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Valentina Arriagada
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Angelo Beneventi
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Valentina Canepa
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Paula Espinoza
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Melisa Parraguez
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Carlos Toledo
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
| | - Consuelo Valencia
- Carrera de Pedagogía en Educación Física, Universidad de Viña del Mar. Valparaíso. Chile..
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Rech D, Spyrelis A, Frade S, Perry L, Farrell M, Fertziger R, Toledo C, Castor D, Njeuhmeli E, Loykissoonlal D, Bertrand JT. Implications of the fast-evolving scale-up of adult voluntary medical male circumcision for quality of services in South Africa. PLoS One 2014; 9:e80577. [PMID: 24801209 PMCID: PMC4011681 DOI: 10.1371/journal.pone.0080577] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 08/28/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The scale-up of voluntary medical male circumcision (VMMC) services in South Africa has been rapid, in an attempt to achieve the national government target of 4.3 million adult male circumcisions for HIV prevention by 2016. This study assesses the effect of the scale-up on the quality of the VMMC program. METHODS AND FINDINGS This analysis compares the quality of services at 15 sites operational in 2011 to (1) the same 15 sites in 2012 and (2) to a set of 40 sites representing the expanded program in 2012. Trained clinicians scored each site on 29 items measuring readiness to provide quality services (abbreviated version of the WHO Quality Assessment [QA] Guide) and 29 items to assess quality of surgical care provided (pre-op, surgical technique and post-op) based on the observation of VMMC procedures at each site. Declines in quality far outnumbered improvements. The negative effects in terms of readiness to provide quality services were most evident in expanded sites, whereas the declines in provision of quality services tended to affect both repeat sites and expanded sites equally. Areas of notable concern included the monitoring of adverse events, external supervision, post-operative counselling, and some infection control issues. Scores on quality of surgical technique tended to be among the highest across the 58 items observed, and the South Africa program has clearly institutionalized three "best practices" for surgical efficiency. CONCLUSIONS These findings demonstrate the challenges of rapidly developing large numbers of new VMMC sites with the necessary equipment, supplies, and protocols. The scale-up in South Africa has diluted human resources, with negative effects for both the original sites and the expanded program.
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Affiliation(s)
- Dino Rech
- Centre for HIV/AIDS Prevention Studies (CHAPS), Johannesburg, South Africa
| | - Alexandra Spyrelis
- Centre for HIV/AIDS Prevention Studies (CHAPS), Johannesburg, South Africa
| | - Sasha Frade
- Centre for HIV/AIDS Prevention Studies (CHAPS), Johannesburg, South Africa
| | - Linnea Perry
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Margaret Farrell
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Rebecca Fertziger
- United States Agency for International Development, Pretoria, South Africa
| | - Carlos Toledo
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Delivette Castor
- United States Agency for International Development, Washington, DC, United States of America
| | - Emmanuel Njeuhmeli
- United States Agency for International Development, Washington, DC, United States of America
| | | | - Jane T. Bertrand
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Toledo C, Simon A, Muñoz R, Vera A, Leija L, Hargrove L. A comparison of direct and pattern recognition control for a two degree-of-freedom above elbow virtual prosthesis. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:4332-5. [PMID: 23366886 DOI: 10.1109/embc.2012.6346925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with a transhumeral amputation have a large functional deficit and require basic functions out of their prosthesis. Myoelectric prostheses have used amplitude control techniques for decades to restore one or two degrees of freedom to these patients. Pattern recognition control has also been investigated for transhumeral amputees, but in recent years, has been more focused on transradial amputees or high-level patients who have received targeted muscle reinnervation. This study seeks to use the most recent advances in pattern recognition control and investigate techniques that could be applied to the majority of the transhumeral amputee population that has not had the reinnervation surgery to determine if pattern recognition systems may provide them with improved control. In this study, able-bodied control subjects demonstrated that highly accurate two degree-of-freedom pattern recognition systems may be trained using four EMG channels. Such systems may be used to better control a prosthesis in real-time when compared to conventional amplitude control with mode switching.
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Affiliation(s)
- C Toledo
- Electrical Engineering Department, Bioelectronics Section, CINVESTAV-IPN, Mexico, D.F., Mexico
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Andrade W, Soares F, Lima E, Maciel M, Toledo C, Iyeyasu H, Cruz M, Fanelli M. Abstract P4-02-03: FDG PET/CT for early monitoring of response to neoadjuvant chemotherapy in breast cancer patients. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Neoadjuvant chemotherapy (NAC), initially used only for locally advanced breast cancer, is now commonly used in patients with operable but large breast cancer or unfavorable tumor/breast size index because increases the chances of performing breast conservative surgery (BCS) instead of mastectomy in this group of patients.
Patients and Methods: This is a prospective unicenter trial. FDG PET/CT were performed in 40 patients at baseline and after the second cycle of NAC. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response.
Pathologic complete response (pCR) was defined as no malignant cells (no invasive ductal carcinoma and no ductal carcinoma in situ) identifiable in sections from the site of the tumor in the breast and in the axillary lymph node.
Results: This prospectively study analyzed forty patients undergoing NAC, all female, age ranged 27–64 years (mean 41.0 years and median 38 years), all tumors were invasive ductal carcinoma, histological tumor grade 1, 2 and 3 were present respectively at 5%, 38.5% and 100% of the sample and nuclear grade 2 and 3 were present respectively at 12.5% and 87.5%. Estrogen receptor was positive in 60% of patients and the progesterone receptor was positive in 47.5% of patients. Her 2 was overexpressed in 12 patients (30%). Phenotype in this sample had the following distribution: 12.5% luminal A (5 patients), 50% Luminal B (20 patients: 14 patients with Ki-67> 14% and 6 cases with HER 2 overexpression), 15 % HER 2 (6 patients) and cases triple negative 9 (22.5%). size of the primary tumor ranged from 4.10 cm to 12.0 cm (mean 7.10 cm). The size of the primary tumor ranged from had a mean of 6.7 cm and a median of 6.0 cm. This group showed great uniformity in relation to primary chemotherapy. NAC with cyclophosphamide and adriamycin were administered to 38 patients. In this study, pCR was obtained in 12 patients (30%). Baseline FDG SUV referring to pCR group was 11.26 and 7.26 in non-pCR group (p = 0.04). FDG SUV after second cycle was 2.73 in pCR group and 4.64 in non-pCR group (p = 0.048). When analyzing ΔSUV (difference between baseline SUV and SUV after second cycle), pCR group had a mean reduction of 81.58% and non-pCR group had a mean reduction of 81.58% (p = 0.001). Receiver operating curve analyses were performed to deter mine optimal differentiation cut-off values of ΔSUV for differentiation of pCR and non-pCR. After two courses of NAC the optimal cutoff value to early differentiation between pCR from non-pCR were 59,1% in decrease of SUV. The sensitivity and specificity were 64,3% and 100,0%, respectively.
Conclusion: The optimum role of FDG PET in predicting the response of breast cancers to neoadjuvant chemotherapy is still not clearly defined and the SUV cut-off needs to be validated. FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after two cycles of chemotherapy and FDG-PET may be helpful for individual treatment stratification in breast cancer patients.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-02-03.
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Affiliation(s)
- W Andrade
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - F Soares
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - E Lima
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - MdS Maciel
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - C Toledo
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - H Iyeyasu
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - M Cruz
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
| | - M Fanelli
- A. C. Camargo Cancer Hospital, São Paulo, SP, Brazil
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Leonard A, Wolff J, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Pollack I, Jakacki R, Butterfield L, Okada H, Fangusaro J, Warren KE, Mullins C, Jurgen P, Julia S, Friedrich CC, Keir S, Saling J, Roskoski M, Friedman H, Bigner D, Moertel C, Olin M, Dahlheimer T, Gustafson M, Sumstad D, McKenna D, Low W, Nascene D, Dietz A, Ohlfest J, Sturm D, Witt H, Hovestadt V, Quan DAK, Jones DTW, Konermann C, Pfaff E, Korshunov A, Rizhova M, Milde T, Witt O, Zapatka M, Collins VP, Kool M, Reifenberger G, Lichter P, Lindroth AM, Plass C, Jabado N, Pfister SM, Pizer B, Salehzadeh A, Brodbelt A, Mallucci C, Brassesco M, Pezuk J, Morales A, de Oliveira J, Roberto G, Umezawa K, Valera E, Rego E, Scrideli C, Tone L, Veringa SJE, Van Vuurden DG, Wesseling P, Vandertop WP, Noske DP, Wurdinger T, Kaspers GJL, Hulleman E, Wright K, Broniscer A, Bendel A, Bowers D, Crawford J, Fisher P, Hassall T, Armstrong G, Baker J, Qaddoumi I, Robinson G, Wetmore C, Klimo P, Boop F, Onar-Thomas A, Ellison D, Gajjar A, Cruz O, de Torres C, Sunol M, Rodriguez E, Alonso L, Parareda A, Cardesa T, Salvador H, Celis V, Guillen A, Garcia G, Muchart J, Trampal C, Martin ML, Rebollo M, Mora J, Piotrowski A, Kowalska A, Coyle P, Smith S, Rogers H, Macarthur D, Grundy R, Puccetti D, Salamat S, Kennedy T, Fangusaro J, Patel N, Bradley K, Casey K, Iskandar B, Nakano Y, Okada K, Osugi Y, Yamasaki K, Fujisaki H, Fukushima H, Inoue T, Matsusaka Y, Sakamoto H, Hara J, De Vleeschouwer S, Ardon H, Van Calenbergh F, Sciot R, Wilms G, Van Loon J, Goffin J, Van Gool S, Puccetti D, Salamat S, Rusinak D, Patel N, Bradley K, Casey K, Knight P, Onel K, Wargowski D, Stettner A, Iskandar B, Al-Ghafari A, Punjaruk W, Coyle B, Kerr I, Xipell E, Rodriguez M, Gonzalez-Huarriz M, Tunon MT, Zazpe I, Tejada-Solis S, Diez-Valle R, Fueyo J, Gomez-Manzano C, Alonso MM, Pastakia D, McCully C, Murphy R, Bacher J, Thomas M, Steffen-Smith E, Saleem K, Waldbridge S, Widemann B, Warren K, Miele E, Buttarelli F, Arcella A, Begalli F, Po A, Baldi C, Carissimo G, Antonelli M, Donofrio V, Morra I, Nozza P, Gulino A, Giangaspero F, Ferretti E, Elens I, De Vleeschouwer S, Pauwels F, Van Gool S, Fritzell S, Eberstal S, Sanden E, Visse E, Darabi A, Siesjo P, McDonald P, Wrogemann J, Krawitz S, Del Bigio M, Eisenstat D, Wolff J, Kwiecien R, Pietsch T, Faldum A, Kortmann RD, Warmuth-Metz M, Rutkowski S, Slavc I, Kramm CM, Uparkar U, Geyer R, Ermoian R, Ellenbogen R, Leary S, Triscott J, Hu K, Fotovati A, Yip S, Kast R, Toyota B, Dunn S, Hegde M, Corder A, Chow K, Mukherjee M, Ashoori A, Brawley V, Heslop H, Gottschalk S, Yvon E, Ahmed N, Wong TT, Yang FY, Lu M, Liang HF, Wang HE, Liu RS, Teng MC, Yen CC, Agnihotri S, Ternamian C, Jones C, Zadeh G, Rutka J, Hawkins C, Filipek I, Drogosiewicz M, Perek-Polnik M, Swieszkowska E, Baginska BD, Jurkiewicz E, Perek D, Kuehn A, Falkenstein F, Wolff J, Kwiecien R, Pietsch T, Gnekow A, Kramm C, Brooks MD, Jackson E, Piwnica-Worms D, Mitra RD, Rubin JB, Liu XY, Korshunov A, Schwartzentruber J, Jones DTW, Pfaff E, Sturm D, Fontebasso AM, Quang DAK, Albrecht S, Kool M, Dong Z, Siegel P, Von Diemling A, Faury D, Tabori U, Lichter P, Plass C, Majewski J, Pfister SM, Jabado N, Lulla R, Echevarria M, Alden T, DiPatri A, Tomita T, Goldman S, Fangusaro J, Qaddoumi I, Lin T, Merchant TE, Kocak M, Panandiker AP, Armstrong GT, Wetmore C, Gajjar A, Broniscer A, Gielen GH, Muehlen AZ, Kramm C, Pietsch T, Hubert C, Ding Y, Toledo C, Paddison P, Olson J, Nandhabalan M, Bjerke L, Bax D, Carvalho D, Bajrami I, Ashworth A, Lord C, Hargrave D, Reis R, Workman P, Jones C, Little S, Popov S, Jury A, Burford A, Doey L, Al-Sarraj S, Jurgensmeier J, Jones C, Carvalho D, Bjerke L, Bax D, Chen L, Kozarewa I, Baker S, Grundy R, Ashworth A, Lord C, Hargrave D, Reis R, Jones C, Bjerke L, Perryman L, Burford A, Bax D, Jury A, Popov S, Box G, Raynaud F, Hargrave D, Eccles S, Jones C, Viana-Pereira M, Pereira M, Burford A, Jury A, Popov S, Perryman L, Bax D, Forshew T, Tatevossian R, Sheer D, Pimental J, Pires M, Reis R, Jones C, Sarkar C, Jha P, Patrick IRP, Somasundaram K, Pathak P, Sharma MC, Suri V, Suri A, Gerges N, Haque T, Nantel A, Faury D, Jabado N, Lee C, Fotovati A, Triscott J, Chen J, Venugopal C, Singhal A, Dunham C, Kerr J, Verreault M, Yip S, Wakimoto H, Jones C, Jayanthan A, Narendran A, Singh S, Dunn S, Giraud G, Holm S, Gustavsson B, Van Gool S, Kizyma R, Kizyma Z, Dvornyak L, Kotsay B, Epari S, Sharma P, Gurav M, Gupta T, Shetty P, Moiyadi A, Kane S, Jalali R. HIGH GRADE GLIOMAS. Neuro Oncol 2012; 14:i56-i68. [PMCID: PMC3483348 DOI: 10.1093/neuonc/nos102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
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Grossman CI, Forsyth A, Purcell DW, Allison S, Toledo C, Gordon CM. Advancing novel HIV prevention intervention research with MSM--meeting report. Public Health Rep 2011; 126:472-9. [PMID: 21800742 PMCID: PMC3115207 DOI: 10.1177/003335491112600404] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
HIV continues to exact an enormous toll on society and to disproportionately affect gay and bisexual men and other men who have sex with men (MSM). Innovative prevention interventions are needed to reverse this trend. In August 2009, the U.S. National Institute of Mental Health and the Centers for Disease Control and Prevention convened a meeting of scientists, community representatives, advocates, and federal partners to discuss innovative prevention-intervention science. The meeting was structured to maximize discussion of (1) healthy sex interventions, (2) community and structural interventions, (3) integrated biomedical and behavioral interventions, and (4) interventions to improve uptake of HIV testing. Presentations and discussion focused on research gaps in designing risk-reducing and sexual health-promoting interventions for MSM, including interventions to address mental health, substance use, disclosure, and stigma. This article summarizes the meeting proceedings, highlights key points, and outlines future directions.
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Affiliation(s)
- Cynthia I Grossman
- National Institutes of Health, National Institute of Mental Health, 6001 Executive Blvd., Room 6201, Bethesda, MD 20892, USA.
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