1
|
Nsanya MK, Abramson R, Kisigo GA, Hickner A, Nyanza EC, Peck RN, Kapiga SH. Hypertension among adolescents in sub-Saharan Africa: a systematic review. Front Cardiovasc Med 2023; 10:1251817. [PMID: 38155990 PMCID: PMC10754047 DOI: 10.3389/fcvm.2023.1251817] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Hypertension (HTN) among adolescents is common in high-income countries, and leads to increased premature cardiovascular diseases (CVD). In sub-Saharan Africa (SSA), the prevalence of HTN among adolescents, associated risk factors and CVD complications are not well-described. Such data is needed for planning public health programs to prevent premature CVD in SSA. Methods We systematically searched 5 databases (MEDLINE, Embase, Google Scholar, Web of Science, and African Index Medicus) from their establishment to December 2021. Key search terms were: adolescent, arterial hypertension, and names of the 48 countries in SSA. We used Covidence® to manage the search results. The review was registered in the Open Science Framework (OSF) https://osf.io/p5sbt/. Results We identified 4,008 articles out of which we screened 3,088 abstracts, and reviewed 583 full-text articles. We finally included 92 articles that were published between 1968 to December 2021. The majority were cross-sectional studies (80%) and conducted in school settings (78%). The risk of bias was low for 59 studies (64.1%), moderate for 29 studies (31.5%), and high for 4 studies (4.3%). Overall, the prevalence of HTN varied widely from 0.18% to 34.0% with a median (IQR) of 5.5% (3.1%, 11.1%). It was relatively higher in studies using automated blood pressure (BP) devices, and in studies defining HTN using thresholds based on percentile BP distribution for one's height, age, and sex. In addition, the prevalence of HTN was significantly higher in studies from Southern Africa region of SSA and positively correlated with the year of publication. Across studies, traditional risk factors such as age, sex, body mass index, and physical inactivity, were commonly found to be associated with HTN. In contrast, non-traditional risk factors related to poverty and tropical diseases were rarely assessed. Only three studies investigated the CVD complications related to HTN in the study population. Conclusion The prevalence of HTN among adolescents in SSA is high indicating that this is a major health problem. Data on non-traditional risk factors and complications are scarce. Longitudinal studies are needed to clearly define the rates, causes, and complications of HTN. Systematic Review Registration https://osf.io/p5sbt/, identifier (10.17605/OSF.IO/P5SBT).
Collapse
Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Rachel Abramson
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Godfrey A Kisigo
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andy Hickner
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Elias C Nyanza
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medicine - Cornell University, New York, NY, United States
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Saidi H Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Nsanya MK, Atchison CJ, Bottomley C, Doyle AM, Kapiga SH. Modern contraceptive use among sexually active women aged 15-19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey. BMJ Open 2019; 9:e030485. [PMID: 31467055 PMCID: PMC6720144 DOI: 10.1136/bmjopen-2019-030485] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe differences in modern contraceptive use among adolescent women aged 15-19 years according to their marital status and to determine factors associated with modern contraceptive use among sexually active women in this population. DESIGN Cross-sectional analysis of Adolescent 360 evaluation baseline survey. SETTING The 15 urban and semiurban wards of Ilemela district, Mwanza region, North-Western Tanzania. PARTICIPANTS Adolescent women aged 15-19 years who were living in the study site from August 2017 to February 2018 and who provided informed consent. Women were classified as married if they had a husband or were living as married. Unmarried women were classified as sexually active if they reported having sexual intercourse in the last 12 months. OUTCOME MEASURE Prevalence of modern contraceptive among adolescent women aged 15-19 years. RESULTS Data were available for 3511 women aged 15-19 years, of which 201 (5.7%) were married and 744 (22.5%) were unmarried-sexually active. We found strong evidence of differences in use of modern contraceptive methods according to marital status of adolescent women. Determinants of modern contraception use among unmarried-sexually active women were increasing age, increasing level of education, being in education, hearing of modern contraception from interpersonal sources or in the media in the last 12 months, perceiving partner and/or friends support for contraceptive use, as well as higher knowledge and self efficacy for contraception. CONCLUSIONS Sexual and reproductive health programmes aiming to increase uptake of modern contraceptives in this population of adolescent women should consider the importance of girl's education and social support for contraceptive use particularly among unmarried-sexually active women.
Collapse
Affiliation(s)
- Mussa Kelvin Nsanya
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Christina J Atchison
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Christian Bottomley
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Aoife Margaret Doyle
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Saidi H Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
3
|
Francis JM, Grosskurth H, Kapiga SH, Weiss HA, Mwashiuya J, Changalucha J. Ethanol Concentration of Traditional Alcoholic Beverages in Northern Tanzania. J Stud Alcohol Drugs 2017; 78:476-477. [PMID: 28499118 DOI: 10.15288/jsad.2017.78.476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joel M Francis
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Heiner Grosskurth
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania.,MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.,Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Saidi H Kapiga
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania.,MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.,Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Joseph Mwashiuya
- Tanzania Food and Drug Authority (TFDA), Dar es Salaam, Tanzania
| | - John Changalucha
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
| |
Collapse
|
4
|
Francis JM, Weiss HA, Helander A, Kapiga SH, Changalucha J, Grosskurth H. Comparison of self-reported alcohol use with the alcohol biomarker phosphatidylethanol among young people in northern Tanzania. Drug Alcohol Depend 2015; 156:289-296. [PMID: 26455816 DOI: 10.1016/j.drugalcdep.2015.09.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The one-month Time Line Follow Back calendar (TLFB) and the Alcohol Use Disorders Identification Test (AUDIT) are used to collect self-reported alcohol intake data. We compared these instruments with the alcohol biomarker phosphatidylethanol (PEth) among young-people in northern Tanzania. METHODS AUDIT and TLFB were applied in a cross-sectional study of 202 young people (18-24 years), who reported using alcohol during the past year (103 male casual labourers; 99 college students). We assayed whole blood for PEth 16:0/18:1, using liquid chromatography-tandem mass spectrometry. RESULTS For both self-report methods, alcohol consumption was high, particularly among men (e.g. a median of 54 drinks per month in labourers), and about half of male students (48%) reported hazardous or harmful levels of drinking (AUDIT ≥8). Almost half (49%) of participants were PEth-positive (median concentration 0.03μmol/L). There were significant positive correlations between reported total alcohol intake and PEth concentration in males (Spearman's correlation rs=0.65 in college students and rs=0.57 in casual labourers; p<0.001). Self-reported use in the past month was a sensitive marker of having a positive PEth result (≥0.01μmol/L) with 89% of those with a PEth positive result reporting alcohol use, and this was similar in all groups. The proportion of those with AUDIT scores ≥8 and AUDIT-C scores ≥6 among those with a high cut-off positive PEth result (≥0.30μmol/L) ranged between 94 and 100%. CONCLUSION TLFB and AUDIT are sensitive measures to detect heavy alcohol use among young-people in northern Tanzania. They can be used to identify young people who may benefit from alcohol-focused interventions.
Collapse
Affiliation(s)
- Joel M Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania.
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anders Helander
- Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden
| | - Saidi H Kapiga
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania; Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - John Changalucha
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Heiner Grosskurth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania; Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| |
Collapse
|
5
|
Francis JM, Weiss HA, Mshana G, Baisley K, Grosskurth H, Kapiga SH. The Epidemiology of Alcohol Use and Alcohol Use Disorders among Young People in Northern Tanzania. PLoS One 2015; 10:e0140041. [PMID: 26444441 PMCID: PMC4596556 DOI: 10.1371/journal.pone.0140041] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 02/03/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Alcohol use is a global public health problem, including as a risk factor for HIV infection, but few data are available on the epidemiology of alcohol use and alcohol use disorders (AUD) among young people in sub-Saharan Africa. METHODS We conducted a cross-sectional survey among 4 groups of young people aged 15-24 years old (secondary school students, college/university students, employees of local industries and casual labourers) in two regions (Kilimanjaro and Mwanza) of northern Tanzania. Using a multistage stratified random sampling strategy, we collected information on demographics, alcohol use, and behavioural factors. We screened severity of alcohol use using the Alcohol Use Disorder Identification Test (AUDIT) and estimated the quantity and frequency of alcohol consumption using the timeline-follow-back-calendar (TLFB) method. RESULTS A total of 1954 young people were surveyed. The prevalence of reported alcohol use was higher among males (47-70% ever users and 20-45% current users) than females (24-54% ever users and 12-47% current users). Prevalence of use was substantially higher in Kilimanjaro than Mwanza region. In both regions, participants reported high exposure to alcohol advertisements, and wide alcohol availability. College students reported the highest prevalence of current alcohol use (45% among males; 26% among females) and of heavy episodic drinking (71% among males; 27% among females) followed by casual labourers. Males were more likely to have AUD (an AUDIT score ≥8) than females, with 11-28% of males screening positive for AUD. Alcohol use was associated with male gender, being in a relationship, greater disposable income, non-Muslim religion and a higher number of sexual partners. CONCLUSIONS Alcohol use is a significant problem among young people in northern Tanzania. There is an urgent need to develop, pilot and deliver interventions to help young people delay initiation and reduce levels of harmful drinking, particularly among college students and casual labourers.
Collapse
Affiliation(s)
- Joel M. Francis
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
- * E-mail:
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gerry Mshana
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kathy Baisley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heiner Grosskurth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Saidi H. Kapiga
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mwanza Centre, National Institute for Medical Research, Mwanza, Tanzania
- Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| |
Collapse
|
6
|
Imade GE, Musa J, Sagay AS, Kapiga SH, Sankale JL, Idoko J, Kanki P. Association of Bacterial vaginosis and other Sexually Transmitted Infections with HIV among pregnant women in Nigeria. Afr J Med Med Sci 2014; 43:23-28. [PMID: 26681823 PMCID: PMC4679194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the association of Bacterial vaginosis (BV) and other sexually transmissible infections (STIs) with HIV prevalence among pregnant women in Jos, Nigeria. METHODS This was a cross- sectional study of pregnant women who participated in the Prevention of Mother-to-Child Transmission of HIV program of the AIDS Prevention Initiative in Nigeria, between April 2002 and July 2004, at the Jos University Teaching Hospital in Jos, Nigeria. Blood, high vaginal and endocervical samples were obtained for diagnosis of HIV, BV and other STIs. Data were analyzed for prevalence of HIV, BV and other STIs. Univariate and multivariate logistic regression models generated unadjusted and adjusted odds ratios (OR) as well as 95% confidence intervals (CI) of the association of BV and other STIs with HIV prevalence. P value <0.05 was considered statistically significant. RESULTS A total of 4,046 pregnant women were studied and 97.6% (3,950/4,046) had complete laboratory records for analysis. The prevalence of HIV was 8.2% (CI: 7.4-9.1); BV 11.9% (CI: 10.9-12.9); Candida 10.7% (CI: 9.7-11.7); mixed infection of BV and Candida 2.8% (CI: 2.3-3.4); Trichomonads 0.6% (CI: 0.3-0.8) and syphilis 0.35% (0.16-0.54). BV, Candida, mixed BV and Candida; and Trichomonads were independently associated with HIV infection [adjusted OR (95% CI), 2.9 (CI: 2.2-3.9); 2.0 (CI: 1.5-2.9); 3.4 (CI: 2.0-5.6), and 3.3 (CI: 1.1-9.7) respectively]. CONCLUSION HIV prevalence is higher among pregnant women who have BV, Candida and Trichomonads vaginal infections compared with women who have no evidence of infection. The practice of routine screening for BV and other STIs among pregnant women as a strategy for identifying women at risk for prevalent HIV infection should be sustained/ encouraged and the syndromic management of STIs should be integrated into all antenatal care management protocols in antenatal clinics in order to curb the epidemic of heterosexual HIV transmission.
Collapse
Affiliation(s)
- Godwin E. Imade
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Saidi H. Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA
| | - Jean-Louis Sankale
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston MA, USA
| | - John Idoko
- Department of Medicine, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Phyllis Kanki
- Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston MA, USA
| |
Collapse
|
7
|
Kiwelu IE, Novitsky V, Kituma E, Margolin L, Baca J, Manongi R, Sam N, Shao J, McLane MF, Kapiga SH, Essex M. HIV-1 pol diversity among female bar and hotel workers in Northern Tanzania. PLoS One 2014; 9:e102258. [PMID: 25003939 PMCID: PMC4087014 DOI: 10.1371/journal.pone.0102258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 03/27/2014] [Accepted: 06/16/2014] [Indexed: 11/18/2022] Open
Abstract
A national ART program was launched in Tanzania in October 2004. Due to the existence of multiple HIV-1 subtypes and recombinant viruses co-circulating in Tanzania, it is important to monitor rates of drug resistance. The present study determined the prevalence of HIV-1 drug resistance mutations among ART-naive female bar and hotel workers, a high-risk population for HIV-1 infection in Moshi, Tanzania. A partial HIV-1 pol gene was analyzed by single-genome amplification and sequencing in 45 subjects (622 pol sequences total; median number of sequences per subject, 13; IQR 5-20) in samples collected in 2005. The prevalence of HIV-1 subtypes A1, C, and D, and inter-subtype recombinant viruses, was 36%, 29%, 9% and 27%, respectively. Thirteen different recombination patterns included D/A1/D, C/A1, A1/C/A1, A1/U/A1, C/U/A1, C/A1, U/D/U, D/A1/D, A1/C, A1/C, A2/C/A2, CRF10_CD/C/CRF10_CD and CRF35_AD/A1/CRF35_AD. CRF35_AD was identified in Tanzania for the first time. All recombinant viruses in this study were unique, suggesting ongoing recombination processes among circulating HIV-1 variants. The prevalence of multiple infections in this population was 16% (n = 7). Primary HIV-1 drug resistance mutations to RT inhibitors were identified in three (7%) subjects (K65R plus Y181C; N60D; and V106M). In some subjects, polymorphisms were observed at the RT positions 41, 69, 75, 98, 101, 179, 190, and 215. Secondary mutations associated with NNRTIs were observed at the RT positions 90 (7%) and 138 (6%). In the protease gene, three subjects (7%) had M46I/L mutations. All subjects in this study had HIV-1 subtype-specific natural polymorphisms at positions 36, 69, 89 and 93 that are associated with drug resistance in HIV-1 subtype B. These results suggested that HIV-1 drug resistance mutations and natural polymorphisms existed in this population before the initiation of the national ART program. With increasing use of ARV, these results highlight the importance of drug resistance monitoring in Tanzania.
Collapse
Affiliation(s)
- Ireen E. Kiwelu
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Vladimir Novitsky
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Elimsaada Kituma
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - Lauren Margolin
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Jeannie Baca
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Rachel Manongi
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - Noel Sam
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - John Shao
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
| | - Mary F. McLane
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Saidi H. Kapiga
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - M. Essex
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
8
|
Francis JM, Grosskurth H, Changalucha J, Kapiga SH, Weiss HA. Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa. Trop Med Int Health 2014; 19:476-88. [PMID: 24479379 PMCID: PMC4065366 DOI: 10.1111/tmi.12267] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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] [Indexed: 11/29/2022]
Abstract
Objective Systematic review and meta-analysis of published studies of alcohol use among young people (age 15–24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. Methods Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I2 statistic (DerSimonian-Laird). Results We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20–58%], use in the last month 28% (IQR: 17–37%), use in the last year 26% (IQR: 22–32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3–36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79–85%) and female sex workers (66%; 95%CI: 58–74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63–75%). Conclusions Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population.
Collapse
Affiliation(s)
- Joel M Francis
- London School of Hygiene and Tropical Medicine, London, UK; National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | | | | | | | | |
Collapse
|
9
|
Njai HF, Ewings FM, Lyimo E, Foulongne V, Ngerageza D, Mongi A, Ssemwanga D, Andreasen A, Nyombi B, Ao T, Michael D, Urassa M, Todd J, Zaba B, Changalucha J, Hayes R, Kapiga SH. Deciphering the complex distribution of human immunodeficiency virus type 1 subtypes among different cohorts in Northern Tanzania. PLoS One 2013; 8:e81848. [PMID: 24349139 PMCID: PMC3859540 DOI: 10.1371/journal.pone.0081848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 04/08/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background Increased understanding of the genetic diversity of HIV-1 is challenging but important in the development of an effective vaccine. We aimed to describe the distribution of HIV-1 subtypes in northern Tanzania among women enrolled in studies preparing for HIV-1 prevention trials (hospitality facility-worker cohorts), and among men and women in an open cohort demographic surveillance system (Kisesa cohort). Methods The polymerase encompassing partial reverse transcriptase was sequenced and phylogenetic analysis performed and subtype determined. Questionnaires documented demographic data. We examined factors associated with subtype using multinomial logistic regression, adjusted for study, age, and sex. Results Among 140 individuals (125 women and 15 men), subtype A1 predominated (54, 39%), followed by C (46, 33%), D (25, 18%) and unique recombinant forms (URFs) (15, 11%). There was weak evidence to suggest different subtype frequencies by study (for example, 18% URFs in the Kisesa cohort versus 5–9% in the hospitality facility-worker cohorts; adjusted relative-risk ratio (aRR) = 2.35 [95% CI 0.59,9.32]; global p = 0.09). Compared to men, women were less likely to have subtype D versus A (aRR = 0.12 [95% CI 0.02,0.76]; global p = 0.05). There was a trend to suggest lower relative risk of subtype D compared to A with older age (aRR = 0.44 [95% CI 0.23,0.85] per 10 years; global p = 0.05). Conclusions We observed multiple subtypes, confirming the complex genetic diversity of HIV-1 strains circulating in northern Tanzania, and found some differences between cohorts and by age and sex. This has important implications for vaccine design and development, providing opportunity to determine vaccine efficacy in diverse HIV-1 strains.
Collapse
Affiliation(s)
- Harr F. Njai
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fiona M. Ewings
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eric Lyimo
- National Institute for Medical Research, Mwanza, Tanzania
| | - Vincent Foulongne
- Laboratoire de Virologie, University of Montpellier, Montpellier, France
| | | | - Aika Mongi
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Aura Andreasen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Tony Ao
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Denna Michael
- National Institute for Medical Research, Mwanza, Tanzania
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- National Institute for Medical Research, Mwanza, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Basia Zaba
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saidi H. Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| |
Collapse
|
10
|
Kiwelu IE, Novitsky V, Margolin L, Baca J, Manongi R, Sam N, Shao J, McLane MF, Kapiga SH, Essex M. Frequent intra-subtype recombination among HIV-1 circulating in Tanzania. PLoS One 2013; 8:e71131. [PMID: 23940702 PMCID: PMC3733632 DOI: 10.1371/journal.pone.0071131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/26/2013] [Indexed: 11/23/2022] Open
Abstract
The study estimated the prevalence of HIV-1 intra-subtype recombinant variants among female bar and hotel workers in Tanzania. While intra-subtype recombination occurs in HIV-1, it is generally underestimated. HIV-1 env gp120 V1-C5 quasispecies from 45 subjects were generated by single-genome amplification and sequencing (median (IQR) of 38 (28–50) sequences per subject). Recombination analysis was performed using seven methods implemented within the recombination detection program version 3, RDP3. HIV-1 sequences were considered recombinant if recombination signals were detected by at least three methods with p-values of ≤0.05 after Bonferroni correction for multiple comparisons. HIV-1 in 38 (84%) subjects showed evidence for intra-subtype recombination including 22 with HIV-1 subtype A1, 13 with HIV-1 subtype C, and 3 with HIV-1 subtype D. The distribution of intra-patient recombination breakpoints suggested ongoing recombination and showed selective enrichment of recombinant variants in 23 (60%) subjects. The number of subjects with evidence of intra-subtype recombination increased from 29 (69%) to 36 (82%) over one year of follow-up, although the increase did not reach statistical significance. Adjustment for intra-subtype recombination is important for the analysis of multiplicity of HIV infection. This is the first report of high prevalence of intra-subtype recombination in the HIV/AIDS epidemic in Tanzania, a region where multiple HIV-1 subtypes co-circulate. HIV-1 intra-subtype recombination increases viral diversity and presents additional challenges for HIV-1 vaccine design.
Collapse
Affiliation(s)
- Ireen E. Kiwelu
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Vladimir Novitsky
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Lauren Margolin
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Jeannie Baca
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Rachel Manongi
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - Noel Sam
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - John Shao
- Kilimanjaro Christian Medical Centre and College, Tumaini University, Moshi, Tanzania
| | - Mary F. McLane
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Saidi H. Kapiga
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | - M. Essex
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
11
|
Kapiga SH, Ewings FM, Ao T, Chilongani J, Mongi A, Baisley K, Francis S, Andreasen A, Hashim R, Watson-Jones D, Changalucha J, Hayes R. The epidemiology of HIV and HSV-2 infections among women participating in microbicide and vaccine feasibility studies in Northern Tanzania. PLoS One 2013; 8:e68825. [PMID: 23874780 PMCID: PMC3715536 DOI: 10.1371/journal.pone.0068825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 02/05/2013] [Accepted: 06/03/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To prepare for future HIV prevention trials, we conducted prospective cohort studies among women working in food and recreational facilities in northern Tanzania. We examined the prevalence and incidence of HIV and HSV-2, and associated risk factors. METHODS Women aged 18-44 years working in food and recreational facilities were screened to determine their eligibility for the studies. Between 2008-2010, HIV-negative women were enrolled and followed for 12 months. At enrolment and 3-monthly, we collected socio-demographic and behavioural data, and performed clinical examinations for collection of biological specimens that were tested for reproductive tract infections. Risk factors for HIV and HSV-2 incidence were investigated using Poisson regression models. RESULTS We screened 2,229 and enrolled 1,378 women. The median age was 27 years (interquartile range, IQR 22, 33), and median duration working at current facility was 2 years. The prevalences of HIV at screening and HSV-2 at enrolment were 16% and 67%, respectively. Attendance at the 12-month visit was 86%. HIV and HSV-2 incidence rates were 3.7 (95% confidence interval, CI: 2.8,5.1) and 28.6 (95% CI: 23.5,35.0)/100 person-years, respectively. Women who were separated, divorced, or widowed were at increased risk of HIV (adjusted incidence rate ratio, aRR = 6.63; 95% CI: 1.97,22.2) and HSV-2 (aRR = 2.00; 95% CI: 1.15,3.47) compared with married women. Women reporting ≥3 partners in the past 3 months were at higher HIV risk compared with women with 0-1 partner (aRR = 4.75; 95% CI: 2.10,10.8), while those who had reached secondary education or above were at lower risk of HSV-2 compared with women with incomplete primary education (aRR = 0.42; 95% CI: 0.22,0.82). CONCLUSIONS HIV and HSV-2 rates remain substantially higher in this cohort than in the general population, indicating urgent need for effective interventions. These studies demonstrate the feasibility of conducting trials to test new interventions in this highly-mobile population.
Collapse
Affiliation(s)
- Saidi H Kapiga
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kiwelu IE, Novitsky V, Margolin L, Baca J, Manongi R, Sam N, Shao J, MacLane MF, Kapiga SH, Essex M. Analysis of HIV-1 gp120 quasispecies suggests high prevalence of intra-subtype recombination. Retrovirology 2012. [PMCID: PMC3441973 DOI: 10.1186/1742-4690-9-s2-p146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
13
|
McLellan JS, Pancera M, Carrico C, Gorman J, Julien JP, Khayat R, Louder R, Pejchal R, Sastry M, Dai K, O'Dell S, Patel N, Shahzad-ul-Hussan S, Yang Y, Zhang B, Zhou T, Zhu J, Boyington JC, Chuang GY, Diwanji D, Georgiev I, Kwon YD, Lee D, Louder MK, Moquin S, Schmidt SD, Yang ZY, Bonsignori M, Crump JA, Kapiga SH, Sam NE, Haynes BF, Burton DR, Koff WC, Walker LM, Phogat S, Wyatt R, Orwenyo J, Wang LX, Arthos J, Bewley CA, Mascola JR, Nabel GJ, Schief WR, Ward AB, Wilson IA, Kwong PD. Structure of HIV-1 gp120 V1/V2 domain with broadly neutralizing antibody PG9. Nature 2011; 480:336-43. [PMID: 22113616 PMCID: PMC3406929 DOI: 10.1038/nature10696] [Citation(s) in RCA: 703] [Impact Index Per Article: 54.1] [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: 09/01/2011] [Accepted: 11/04/2011] [Indexed: 01/26/2023]
Abstract
Variable regions 1 and 2 (V1/V2) of human immunodeficiency virus-1 (HIV-1) gp120 envelope glycoprotein are critical for viral evasion of antibody neutralization, and are themselves protected by extraordinary sequence diversity and N-linked glycosylation. Human antibodies such as PG9 nonetheless engage V1/V2 and neutralize 80% of HIV-1 isolates. Here we report the structure of V1/V2 in complex with PG9. V1/V2 forms a four-stranded β-sheet domain, in which sequence diversity and glycosylation are largely segregated to strand-connecting loops. PG9 recognition involves electrostatic, sequence-independent and glycan interactions: the latter account for over half the interactive surface but are of sufficiently weak affinity to avoid autoreactivity. The structures of V1/V2-directed antibodies CH04 and PGT145 indicate that they share a common mode of glycan penetration by extended anionic loops. In addition to structurally defining V1/V2, the results thus identify a paradigm of antibody recognition for highly glycosylated antigens, which-with PG9-involves a site of vulnerability comprising just two glycans and a strand.
Collapse
Affiliation(s)
- Jason S McLellan
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Wu X, Zhou T, Zhu J, Zhang B, Georgiev I, Wang C, Chen X, Longo NS, Louder M, McKee K, O’Dell S, Perfetto S, Schmidt SD, Shi W, Wu L, Yang Y, Yang ZY, Yang Z, Zhang Z, Bonsignori M, Crump JA, Kapiga SH, Sam NE, Haynes BF, Simek M, Burton DR, Koff WC, Doria-Rose NA, Connors M, Mullikin JC, Nabel GJ, Roederer M, Shapiro L, Kwong PD, Mascola JR. Focused evolution of HIV-1 neutralizing antibodies revealed by structures and deep sequencing. Science 2011; 333:1593-602. [PMID: 21835983 PMCID: PMC3516815 DOI: 10.1126/science.1207532] [Citation(s) in RCA: 685] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Antibody VRC01 is a human immunoglobulin that neutralizes about 90% of HIV-1 isolates. To understand how such broadly neutralizing antibodies develop, we used x-ray crystallography and 454 pyrosequencing to characterize additional VRC01-like antibodies from HIV-1-infected individuals. Crystal structures revealed a convergent mode of binding for diverse antibodies to the same CD4-binding-site epitope. A functional genomics analysis of expressed heavy and light chains revealed common pathways of antibody-heavy chain maturation, confined to the IGHV1-2*02 lineage, involving dozens of somatic changes, and capable of pairing with different light chains. Broadly neutralizing HIV-1 immunity associated with VRC01-like antibodies thus involves the evolution of antibodies to a highly affinity-matured state required to recognize an invariant viral structure, with lineages defined from thousands of sequences providing a genetic roadmap of their development.
Collapse
MESH Headings
- AIDS Vaccines
- Amino Acid Sequence
- Antibodies, Neutralizing/chemistry
- Antibodies, Neutralizing/genetics
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/isolation & purification
- Antibody Affinity
- Antibody Specificity
- Base Sequence
- Binding Sites
- Binding Sites, Antibody
- CD4 Antigens/metabolism
- Complementarity Determining Regions/genetics
- Crystallography, X-Ray
- Epitopes
- Evolution, Molecular
- Genes, Immunoglobulin Heavy Chain
- HIV Antibodies/chemistry
- HIV Antibodies/genetics
- HIV Antibodies/immunology
- HIV Antibodies/isolation & purification
- HIV Envelope Protein gp120/chemistry
- HIV Envelope Protein gp120/immunology
- HIV Envelope Protein gp120/metabolism
- HIV Infections/immunology
- HIV-1/chemistry
- HIV-1/immunology
- High-Throughput Nucleotide Sequencing
- Humans
- Immunoglobulin Fab Fragments/chemistry
- Immunoglobulin Fab Fragments/immunology
- Immunoglobulin Heavy Chains/chemistry
- Immunoglobulin Heavy Chains/immunology
- Immunoglobulin J-Chains/genetics
- Immunoglobulin Light Chains/chemistry
- Immunoglobulin Light Chains/immunology
- Models, Molecular
- Molecular Sequence Data
- Mutation
- Sequence Analysis, DNA
Collapse
Affiliation(s)
- Xueling Wu
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tongqing Zhou
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jiang Zhu
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baoshan Zhang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ivelin Georgiev
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charlene Wang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xuejun Chen
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nancy S. Longo
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark Louder
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Krisha McKee
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sijy O’Dell
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephen Perfetto
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephen D. Schmidt
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Wei Shi
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lan Wu
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yongping Yang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zhi-Yong Yang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zhongjia Yang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zhenhai Zhang
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Biochemistry and Molecular Biophysics, Columbia University, New York, NY 10032, USA
| | - Mattia Bonsignori
- Duke Human Vaccine Institute, Duke University School of Medicine, and Duke University Medical Center, Durham, NC 27710, USA
| | - John A. Crump
- Division of Infectious Diseases and International Health, Department of Medicine, and Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
- Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
| | | | - Noel E. Sam
- Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Reproductive Health Programme, Moshi, Tanzania
| | - Barton F. Haynes
- Duke Human Vaccine Institute, Duke University School of Medicine, and Duke University Medical Center, Durham, NC 27710, USA
| | - Melissa Simek
- International AIDS Vaccine Initiative (IAVI), New York, NY 10038, USA
| | - Dennis R. Burton
- Department of Immunology and Microbial Science and IAVI Neutralizing Antibody Center, The Scripps Research Institute, La Jolla, CA 92037, USA
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Cambridge, MA 02129, USA
| | - Wayne C. Koff
- International AIDS Vaccine Initiative (IAVI), New York, NY 10038, USA
| | - Nicole A. Doria-Rose
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark Connors
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - James C. Mullikin
- NIH Intramural Sequencing Center (NISC), National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gary J. Nabel
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mario Roederer
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lawrence Shapiro
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Biochemistry and Molecular Biophysics, Columbia University, New York, NY 10032, USA
| | - Peter D. Kwong
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - John R. Mascola
- Vaccine Research Center, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
15
|
Baeten JM, Donnell D, Kapiga SH, Ronald A, John-Stewart G, Inambao M, Manongi R, Vwalika B, Celum C. Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples. AIDS 2010; 24:737-44. [PMID: 20042848 DOI: 10.1097/qad.0b013e32833616e0] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision. DESIGN/METHODS Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used. RESULTS A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07). CONCLUSION Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.
Collapse
|
16
|
Msisha WM, Kapiga SH, Earls F, Subramanian SV. Socioeconomic status and HIV seroprevalence in Tanzania: a counterintuitive relationship. Int J Epidemiol 2008; 37:1297-303. [PMID: 18820319 DOI: 10.1093/ije/dyn186] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the relationship between multiple dimensions of socioeconomic status (SES) and HIV seroprevalence in Tanzania. METHODS Using a large nationally representative sample of 7515 sexually active adults drawn from the 2003-04 Tanzania HIV/AIDS Indicator Survey, we analysed the relationship between multiple SES measures and HIV seroprevalence using weighted logistic regression models. RESULTS In adjusted models, individuals in the highest quintile of standard of living had increased odds ratio (OR) of being HIV-positive (male: OR 2.38, 95% CI 1.17-4.82; female: OR 3.74, 95% CI 2.16-6.49). Occupational status was differentially associated with HIV in men and women; women in professional jobs had higher OR of being HIV-positive (OR 1.54, 95% CI 1.02-2.38), whereas unemployed men had higher risk of being HIV-positive (OR 3.49, 95% CI 1.43-8.58). No marked association was found between increasing education and HIV seroprevalence for men (P = 0.83) and women (P = 0.87). CONCLUSION Contrary to the prevailing perception that low SES individuals tend to be more vulnerable to HIV-infection, we found a positive association between standard of living and HIV-infection. Strategies aimed at reducing HIV-infection needs to be cognizant of the complex social heterogeneity in the patterns of HIV-infection.
Collapse
Affiliation(s)
- Wezi M Msisha
- Europe and Central Asia Human Development Sector, The World Bank, Washington DC, USA
| | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES To examine the relationship between patterns of alcohol use and HIV infection and to assess the association between problem drinking and the prevalence of risk factors for HIV among a sample of high-risk African women. METHODS Baseline data were collected between 2002 and 2003 during enrollment of 1050 women in a prospective cohort study designed to assess risk factors for HIV. Information about demographic and employment characteristics, sexual behaviors, and drinking patterns were obtained by interviews. The CAGE questionnaire was used to assess problem drinking. The association between measures of alcohol use and HIV/STDs and sexual behaviors were summarized using odds ratios, adjusted odds ratios (AOR), and 95% confidence intervals (CI). RESULTS HIV prevalence was 19.0% (95% CI, 16.6%-21.4%). Overall 73.9% of the women drank alcohol whereas 34.6% were classified as problem drinkers. After adjusting for demographic and employment variables, drinkers were at increased risk to be HIV+ when compared with nondrinkers (AOR, 2.10; 95% CI, 1.29-3.42). Greater involvement with alcohol, as indicated by recency, frequency and quantity consumed, was associated with increased risk. Problem drinkers were at greater risk to be HIV+ than nonproblem drinkers (AOR, 1.79; 95% CI, 1.06-3.04 vs. AOR, 2.43; 95% CI, 1.45-4.06). Problem drinkers were also more likely to have engaged in several types of high-risk sexual behaviors and to have other STD infections including HSV-2. CONCLUSION Programs aiming at limiting alcohol use or promoting abstinence from alcohol might help to reduce high-risk behaviors and lower the burden of HIV/STDs in this population.
Collapse
|
18
|
Abstract
OBJECTIVE To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors. METHODS Nationally representative, cross-sectional data on 12,522 women and men aged 15-49 years from the 2003-2004 Tanzanian AIDS Indicator Survey. Three-level multilevel binary logistic regression models were specified to estimate the relative contribution of regions and neighborhoods to the variation in HIV seroprevalence. RESULTS Spatial distribution of individual correlates (and risk factors) of HIV do not explain the neighborhood and regional variation in HIV seroprevalence. Neighborhoods and regions accounted for approximately 14 and 6% of the total variation in HIV. HIV prevalence ranged from 1.8% (Kigoma) to 6.7% (Iringa) even after adjusting for the compositional make-up of these regions. An inverse association was observed between log odds of being HIV positive and neighborhood poverty [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09-0.61] and regional poverty (OR 0.97, 95% CI 0.95-0.99). CONCLUSION Our study provides evidence for independent contextual variations in HIV, above and beyond that which can be ascribed to geographical variations in individual-level correlates and risk factors. We emphasize the need to adopt both a group-based and a place-based approach, as opposed to the dominant high-risk group approach, for understanding the epidemiology of HIV as well as for developing HIV intervention activities.
Collapse
Affiliation(s)
- Wezi M Msisha
- Europe and Central Asia Human Development Sector, The World Bank, Washington, DC, USA
| | | | | | | |
Collapse
|
19
|
Kapiga SH, Sam NE, Bang H, Ni Q, Ao TTH, Kiwelu I, Chiduo S, Ndibe U, Seage G, Coplan P, Shao J, Rosenberg ZF, Essex M. The role of herpes simplex virus type 2 and other genital infections in the acquisition of HIV-1 among high-risk women in northern Tanzania. J Infect Dis 2007; 195:1260-9. [PMID: 17396994 DOI: 10.1086/513566] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Accepted: 11/10/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We examined the role of herpes simplex virus type 2 (HSV-2) and other genital infections on human immunodeficiency virus type 1 (HIV-1) incidence in a cohort study conducted between 2002 and 2005 among female bar/hotel workers in Moshi, Tanzania. METHODS At baseline and every 3 months thereafter, participants were interviewed, and blood and genital samples were collected. Predictors of HIV-1 incidence were evaluated using a Cox proportional hazards regression model. RESULTS Of 845 women who were HIV-1 seronegative at baseline, 689 (81.5%) were monitored in the study for a total of 698.6 person-years at risk (PYARs). The overall HIV-1 incidence was 4.6/100 PYARs (95% confidence interval [CI], 3.0-6.2/100 PYARs), and condom use was very low. After adjustment for other risk factors, the risk of HIV-1 was increased among women with HSV-2 at baseline (hazard ratio [HR], 4.3 [95% CI, 1.5-12.4]) and in those who acquired HSV-2 during the study period (HR, 5.5 [95% CI, 1.2-25.4]). Other independent predictors of HIV-1 were baseline chlamydial infection (HR, 5.2), bacterial vaginosis (HR, 2.1), and the occurrence of genital ulcers (HR, 2.7). CONCLUSION HSV-2 and other genital infections were the most important risk factors for HIV-1. Control of these infections could help to reduce HIV-1 incidence in this population.
Collapse
Affiliation(s)
- Saidi H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Larsen U, Mlay J, Aboud S, Ballard R, Sam NE, Shao JF, Kapiga SH. Design of a community-based study of sexually transmitted infections/HIV and infertility in an urban area of northern Tanzania. Sex Transm Dis 2007; 34:20-4. [PMID: 16691158 DOI: 10.1097/01.olq.0000218878.29220.8e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to describe the design of a community-based study of sexually transmitted infections (STIs)/HIV and infertility in northern Tanzania. STUDY DESIGN Households were selected using a 2-stage sampling design. Eligible women and their partners were interviewed before samples were collected for STIs/HIV detection. Posttest counseling and treatment for STIs and infertility were provided. RESULTS A total of 2019 women and 794 male partners were interviewed. Over 70% of interviewed women and men provided blood and urine samples. Individuals providing blood and urine samples had high-risk profiles for STIs/HIV when compared with others who did not provide these samples. Although the study results may be affected by selection bias, risk factors for STIs/HIV were similar to those in other studies supporting the generalizability of the findings. CONCLUSIONS It is feasible to conduct a community-based survey, including collection of biomarkers and measurement of infertility, in this urban setting.
Collapse
Affiliation(s)
- Ulla Larsen
- Department of Sociology, University of Maryland, College Park, Maryland 20742, USA.
| | | | | | | | | | | | | |
Collapse
|
21
|
Klinger EV, Kapiga SH, Sam NE, Aboud S, Chen CY, Ballard RC, Larsen U. A Community-based study of risk factors for Trichomonas vaginalis infection among women and their male partners in Moshi urban district, northern Tanzania. Sex Transm Dis 2007; 33:712-8. [PMID: 16755271 DOI: 10.1097/01.olq.0000222667.42207.08] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine predictors of Trichomonas vaginalis among women and their partners in Moshi, Tanzania. STUDY DESIGN Women (N = 1440) and their partners (N = 588) were interviewed and specimens for detection of T. vaginalis and sexually transmitted infections (STIs) were collected. RESULTS Prevalence of T. vaginalis was 10.7% in women and 6.3% in men. Having a partner with T. vaginalis was the strongest risk factor in women (adjusted odds ratio [OR], 19.44; 95% confidence interval [CI], 7.84-48.25) and men (adjusted OR, 19.01; 95% CI, 6.8-52.40). Risk of T. vaginalis infection was increased in subjects with less education. Other risk factors in women were daily alcohol consumption, being separated, reporting infertility problems, having a partner who had children with other women, and other STIs; and in men, the risk factor was having no income. T. vaginalis was not associated with HIV-1 in women and men. CONCLUSIONS Prevention of T. vaginalis and other STIs among couples is a major priority. Reduction of alcohol consumption in women is an important intervention.
Collapse
Affiliation(s)
- Elissa V Klinger
- Harvard School of Public Health, Department of Population and International Health, Boston, Massachusetts 02115, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Kapiga SH, Sam NE, Mlay J, Aboud S, Ballard RC, Shao JF, Larsen U. The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care 2006; 18:379-87. [PMID: 16809117 DOI: 10.1080/09540120500465012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [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] [Indexed: 10/24/2022]
Abstract
We conducted a community-based study to determine the predictors of HIV-1 among women aged 20-44 years (N = 1,418) and their regular male partners (N = 566) from randomly selected households in Moshi, Tanzania. The weighted prevalence of HIV-1 was 10.3% in women and 7% in men. The highest risk of HIV-1 was in subjects whose partners were HIV-1 seropositive in both women (adjusted odds ratio (AOR) = 26.63; 95% confidence interval (CI): 10.74-66.02) and men (AOR = 22.25; 95%CI: 7.06-70.15). Herpes simplex virus type 2 (HSV-2) and Mycoplasma genitalium were also significantly associated with HIV-1. Women with male partners >or=12 years older than themselves had increased risk of HIV-1 (AOR = 1.99; 95%CI: 1.01-7.85). Other predictors of HIV-1 were history of infertility and the number of sex partners in the last three years in women and the age at time of circumcision and history of past sexually transmitted diseases (STDs) in male partners. These findings show that HIV-1/STDs were major public health problems among women and their long-term partners in this population. HIV-1 prevention efforts should include promotion of couple's HIV-1 counseling and testing services, control of HSV-2, promotion of safer sexual practices and strategies to reduce the age difference between women and their partners.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Tassiopoulos KK, Seage GR, Sam NE, Ao TTH, Masenga EJ, Hughes MD, Kapiga SH. Sexual behavior, psychosocial and knowledge differences between consistent, inconsistent and non-users of condoms: a study of female bar and hotel workers in Moshi, Tanzania. AIDS Behav 2006; 10:405-13. [PMID: 16752083 DOI: 10.1007/s10461-006-9112-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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] [Indexed: 11/30/2022]
Abstract
Understanding psychosocial, sexual behavior and knowledge differences between never, inconsistent and consistent condom users can improve interventions to increase condom use in resource-poor countries, but they have not been adequately studied. We examined these differences in a cohort of 961 female hotel and bar workers in Moshi, Tanzania. Forty-nine percent of women reported no condom use; 39% reported inconsistent use, and 12% reported consistent use. Women with multiple sexual partners in the past five years were less likely to be consistent rather than inconsistent users as were women who had ever exchanged sex for gifts or money. Inconsistent users had higher condom knowledge and higher perceived acceptability of condom use than did never users, but they did not differ from consistent users by these factors. There are important differences between women by level of condom use. These findings can help inform interventions to increase condom use.
Collapse
Affiliation(s)
- Katherine K Tassiopoulos
- Department of Epidemiology, Harvard School of Public Health, Kresge Building, Room 816, 677 Huntington Avenue, Boston, MA 02115, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Ao TTH, Sam NE, Masenga EJ, Seage GR, Kapiga SH. Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2. Sex Transm Dis 2006; 33:163-9. [PMID: 16505740 DOI: 10.1097/01.olq.0000187204.57006.b3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOALS We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania. STUDY DESIGN Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection. RESULTS The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife. CONCLUSIONS These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.
Collapse
Affiliation(s)
- Trong T H Ao
- Department of Epidemiology, University of Washington, Seattle, 98145, USA.
| | | | | | | | | |
Collapse
|
25
|
Villamor E, Kapiga SH, Fawzi WW. Vitamin A Serostatus and Heterosexual Transmission of HIV: Case-Control Study in Tanzania and Review of the Evidence. INT J VITAM NUTR RES 2006; 76:81-5. [PMID: 16941419 DOI: 10.1024/0300-9831.76.2.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Results from a randomized clinical trial suggested that vitamin A/beta-carotene supplementation to HIV-1-infected women during pregnancy and lactation may increase the risk of vertical transmission. Limited information is available on the potential role of vitamin A on heterosexual HIV transmission. This is a relevant question in many resource-limited settings where both vitamin A deficiency and HIV infection are highly prevalent. We conducted a case-control study (34 cases and 38 controls) nested within a cohort of HIV-negative women attending family planning clinics in Tanzania, to examine whether low serum concentrations at baseline were associated with the risk of seroconversion. There was not a significant association (OR = 2.14, 95% C I = 0.54, 8.45). In light of these and previous results, we conclude that there is not enough evidence yet to suggest a causal association between vitamin A and heterosexual transmission.
Collapse
Affiliation(s)
- Eduardo Villamor
- Department of Nutrition, Harvard School of Public Health, Boston, 02115, USA.
| | | | | |
Collapse
|
26
|
Sagay AS, Kapiga SH, Imade GE, Sankale JL, Idoko J, Kanki P. HIV infection among pregnant women in Nigeria. Int J Gynaecol Obstet 2005; 90:61-7. [PMID: 15907849 DOI: 10.1016/j.ijgo.2005.03.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 03/24/2005] [Accepted: 03/30/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine risk factors for HIV among pregnant women (N = 2657) receiving antenatal services in Jos, Plateau state, Nigeria. METHODS Information about potential risk factors was obtained at interview. Biological samples were collected for detection of HIV and other sexually transmitted infections (STIs). RESULTS The prevalence of HIV was 8.2%. Women aged 20-29 years had more than 4-fold increased risk of HIV. Women of Catholic (adjusted odds ratio (AOR) = 1.72, 95% CI = 1.01-2.95) and Pentecostal (AOR = 2.57, 95% CI = 1.46-4.52) denominations were more likely to be HIV-infected when compared to Moslem women. The risk of HIV was also increased among women with multiple marriages and in women married to a banker/accountant. Other predictors of HIV were having a husband with other partners, perceived risk of HIV, STIs, candidiasis and bacterial vaginosis. CONCLUSIONS Development of effective interventions, including behavioral change, expansion of perinatal HIV prevention services and STI control, should be given the highest priority.
Collapse
Affiliation(s)
- A S Sagay
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
OBJECTIVE To determine risk factors for bacterial vaginosis (BV) among women working in the bars and hotels in Moshi, Northern Tanzania. RESULTS Severe disturbances of vaginal flora or BV were detected in 70/268 (26.1%) women (95% confidence interval (CI): 20.8%-31.4%). In multivariate analyses, religion was the only socio-demographic characteristic that remained significantly associated with BV. Other independent predictors of BV were Trichomonas vaginalis (adjusted odds ratio (OR)=2.7, 95% CI: 1.4-5.3), Chlamydia trachomatis (adjusted OR=3.5, 95% CI: 1.2-10.6), syphilis (adjusted OR=7.1, 95% CI: 41.1-4.7) and herpes simplex virus type 2 (HSV-2) infection (adjusted OR=1.8, 95% CI: 1.0-3.3). CONCLUSION Bacterial vaginosis (BV) was the common cause of genital symptoms in the study population. Since sexually transmitted diseases (STDs) were strongly associated with BV, control of STDs and BV should be given the highest priority in this population.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Population and International Health, Harvard School of Public Health, 665 Huntington Avenue, Bldg 1 Room 1105, Boston, MA 02115, USA
| | | | | | | | | |
Collapse
|
28
|
Schmid GP, Buvé A, Mugyenyi P, Garnett GP, Hayes RJ, Williams BG, Calleja JG, De Cock KM, Whitworth JA, Kapiga SH, Ghys PD, Hankins C, Zaba B, Heimer R, Boerma JT. Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet 2004; 363:482-8. [PMID: 14962531 DOI: 10.1016/s0140-6736(04)15497-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
During the past year, a group has argued that unsafe injections are a major if not the main mode of HIV-1 transmission in sub-Saharan Africa. We review the main arguments used to question the epidemiological interpretations on the lead role of unsafe sex in HIV-1 transmission, and conclude there is no compelling evidence that unsafe injections are a predominant mode of HIV-1 transmission in sub-Saharan Africa. Conversely, though there is a clear need to eliminate all unsafe injections, epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV-1 in the region. Increased efforts are needed to reduce sexual transmission of HIV-1.
Collapse
|
29
|
Abstract
OBJECTIVE To determine factors associated with male condom use in Tanzania. METHODS Data from the 1996 Tanzania Demographic and Health Survey (TDHS) was used. In this survey, a national representative sample of sexually active men (N=1898) and women (N=7027) were interviewed to obtain information about potential predictors of sexual practices and condom use. RESULTS Two hundred and ninety (4.1%) women and 288 (15.2%) men had used condoms during their last sexual encounter. Men aged 20-24 years and women aged 15-19 years reported the highest rate of condom use. In both men and women, condom use increased with increasing level of education. Residents of large urban centers were more likely to have used condoms among both women [adjusted OR=1.8, 95% CI=1.2-2.8] and men (adjusted O=2.0, 95% CI=1.3-3.1). Condom use was significantly increased among women (adjusted OR=6.2, 95% CI=4.4-8.8) and men [adjusted OR-5.9, 95% CI=3.2-8.8) practising high-risk sexual behaviour. Similarly, condom use was significantly increased among men who were never married and in those who had ever tested for AIDS. CONCLUSIONS Condom promotion activities have been less successful in Tanzania. Additional efforts to increase condom acceptability and use are urgently needed.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA
| | | |
Collapse
|
30
|
Kapiga SH, Sam NE, Shao JF, Masenga EJ, Renjifo B, Kiwelu IE, Manongi R, Fawzi WW, Essex M. Herpes simplex virus type 2 infection among bar and hotel workers in northern Tanzania: prevalence and risk factors. Sex Transm Dis 2003; 30:187-92. [PMID: 12616132 DOI: 10.1097/00007435-200303000-00001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Type-specific serological tests have allowed for a better understanding of the epidemiology of herpes simplex virus type 2 (HSV-2) infection in Africa. GOAL The goal was to determine risk factors for HSV-2 among bar and hotel workers in Moshi, Tanzania. STUDY DESIGN A cross-sectional study was conducted involving 515 workers in randomly selected bars and hotels in Moshi. RESULTS The seroprevalence of HSV-2 was 43.5%. Women were more likely to be HSV-2-seropositive than men (age-adjusted OR = 3.8; 95% CI = 2.5-5.8). In multivariate analyses, age was positively associated with HSV-2 in both women and men. HIV-1-seropositive women had a significantly increased risk of HSV-2 infection (adjusted OR = 2.8; 95% CI = 1.5-5.1). Other predictors of HSV-2 were religion and sexual behavior for women and level of education, frequency of alcohol use, and concurrent partners for men. CONCLUSION The most common genital infection was that with HSV-2. Control of HSV-2 might be an important strategy for HIV-1 infection prevention in this population.
Collapse
Affiliation(s)
- Saidi H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were significantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventions in Tanzania.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
| | | |
Collapse
|
32
|
Kapiga SH, Bang H, Spiegelman D, Msamanga GI, Coley J, Hunter DJ, Fawzi WW. Correlates of plasma HIV-1 RNA viral load among HIV-1-seropositive women in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2002; 30:316-23. [PMID: 12131569 DOI: 10.1097/00126334-200207010-00008] [Citation(s) in RCA: 22] [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] [Indexed: 11/27/2022]
Abstract
This study was conducted to determine the predictors of plasma HIV-1 RNA viral load in HIV-1-positive pregnant women (N = 151) participating in a clinical trial in Tanzania. Viral load was measured at randomization, delivery, and approximately 7 months after delivery. The median viral load was 20,400 copies/mL at baseline, 20,216 copies/mL at delivery, and 19,100 copies/mL 7 months after delivery. The absolute CD4+ lymphocyte count had a strong negative correlation with HIV-1 RNA viral load at baseline (r = -.38), time of delivery (r = -.36), and 7 months after delivery (r = -.53). The association between CD4+ lymphocyte count and HIV-1 RNA viral load was modified by the per capita daily food expenditure in the household, although the difference in viral load became small as the food expenditure in the household increased and was marginally significant at the 75th percentile of the per capita food expenditure. The presence of malaria parasites at baseline was associated with an approximate 116% higher viral load at the three evaluation points (p =.007). Although the long-term effects of malaria on viral load are unknown, prevention of malaria among people living with HIV-1 should be given the highest priority.
Collapse
Affiliation(s)
- Saidi H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | |
Collapse
|
33
|
Kapiga SH, Sam NE, Shao JF, Renjifo B, Masenga EJ, Kiwelu IE, Manongi R, Fawzi W, Essex M. HIV-1 epidemic among female bar and hotel workers in northern Tanzania: risk factors and opportunities for prevention. J Acquir Immune Defic Syndr 2002; 29:409-17. [PMID: 11917247 DOI: 10.1097/00126334-200204010-00013] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted this study to determine the prevalence and risk factors for HIV-1 infection among women (N = 312) who were working in the bars and hotels in Moshi, a town in northern Tanzania. Study subjects were interviewed to obtain information about HIV-1 risk factors and examined to collect samples for the diagnosis of sexually transmitted diseases (STDs). The prevalence of HIV-1 was 26.3% (95% confidence interval [CI], 21.4%-31.2%). In multivariate analyses, the risk of HIV-1 increased with increasing age (p value, test for linear trend <.001) and the number of sexual partners during the last 5 years (p value, test for linear trend <.03). Other significant predictors were having a male partner with other sexual partners (Adjusted odds ratio [AOR], 1.92; 95% CI, 1.03-3.60), and consuming alcohol >2 days per week (AOR, 2.56; 95% CI, 1.12-5.88). The risk of HIV-1 was also significantly increased in women with bacterial vaginosis (AOR, 2.37; 95% CI, 1.09-5.13) and in study subjects with herpes simplex virus (HSV)-2 antibodies (AOR, 2.48; 95% CI, 1.24-4.98). These results indicate that women working in these settings were at increased risk of HIV-1. Programs aiming at promoting safer sexual practices and control of other STDs are urgently needed in this population. Such programs should address the underlying conditions that facilitate risk behaviors and create obstacles for these women who wish to protect themselves against HIV-1.
Collapse
Affiliation(s)
- Saidi H Kapiga
- Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Urassa WK, Kapiga SH, Msamanga GI, Antelman G, Coley J, Fawzi WW. Risk Factors for Syphilis among HIV-1 Infected Pregnant Women in Dar Es Salaam, Tanzania. Afr J Reprod Health 2001. [DOI: 10.2307/3583323] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
35
|
Urassa WK, Kapiga SH, Msamanga GI, Antelman G, Coley J, Fawzi WW. Risk factors for syphilis among HIV-1 infected pregnant women in Dar es Salaam, Tanzania. Afr J Reprod Health 2001; 5:54-62. [PMID: 12471929] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
This study was conducted to determine the risk factors for recent (active) syphilis among HIV-1 seropositive pregnant women (N = 1058) in Dar es Salaam, Tanzania, Recruitment of study participants (N = 1058) was done between April 1995 and June 1997 at four main prenatal clinics in Dar es Salaam city. Study subjects were interviewed to obtain information about potential risk factors, and blood and genital specimens were collected for detection of syphilis and other genital infections. The prevalence of active syphilis was 5.9%. After adjusting for other risk factors, women without their own source of income had a 50% lower risk of syphilis (OR = 0.5, 95% CI: 0.3-0.9). The risk of active syphilis was significantly increased among women with genital ulceration on examination (OR = 8.4, 95% CI: 1.5-47.7), and in those with trichomoniasis (OR = 2.2, 95% CI: 1.2-3.8). HIV-related immunodeficiency was not associated with increased risk of syphilis. These results show that syphilis and other genital infections are a major problem among HIV infected women. Prevention of syphilis and other genital infections is urgently needed in this population.
Collapse
Affiliation(s)
- W K Urassa
- Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | |
Collapse
|
36
|
Kapiga SH, Mwakagile D, Spiegelman D, Msamanga GI, Hunter D, Fawzi WW. Predictors of CD4+ lymphocyte count among HIV-seropositive and HIV-seronegative pregnant women in Dar es Salaam, Tanzania. East Afr Med J 2000; 77:206-11. [PMID: 12858905 DOI: 10.4314/eamj.v77i4.46622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the predictors of CD4+ lymphocyte count among pregnant women in Dar es Salaam, Tanzania. METHODS Between 04/1995 and 03/1997, HIV-seropositive (n=1,027) and HIV-seronegative (n=280) pregnant women were interviewed to obtain socio-demographic characteristics. Later, blood samples was collected for determination of T-lymphocyte subsets and other haematological indices. RESULTS CD4+ lymphocyte count was significantly higher among HIV-seronegative women (mean=770 cells/mm3, standard deviation (SD)=232 cells/mm3) than HIV-seropositive women (mean=422 cells/mm3, SD=205 cells/mm3). Most HIV-seropositive women were asymptomatic, in WHO clinical stage 1 (84.3%). Among HIV-seropositive women, total white blood count (WBC) and erythrocyte sedimentation rate (ESR) remained significantly correlated with CD4+ after adjusting for other predictors in multivariate analyses. For women of average age 25 years, the CD4+ lymphocyte count increased by about 16 cells/mm3 for each increment of 1000 WBC cells/mm3, while each 10 mm/hr increase in ESR was associated with a reduction of CD4+ lymphocyte count of about 8 cells/mm3. CONCLUSION These results show that simple and inexpensive haematological indices cannot be recommended for use as alternative measures of HIV-related immunosuppression in this population of mainly asymptomatic women.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | |
Collapse
|
37
|
Kapiga SH, Lyamuya EF, Vuylsteke B, Spiegelman D, Larsen U, Hunter DJ. Risk Factors for HIV-1 Seroprevalence among Family Planning Clients in Dar es Salaam, Tanzania. Afr J Reprod Health 2000. [DOI: 10.2307/3583246] [Citation(s) in RCA: 3] [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: 11/10/2022]
|
38
|
Kapiga SH, Lyamuya EF, Vuylsteke B, Spiegelman D, Larsen U, Hunter DJ. Risk factors for HIV-1 seroprevalence among family planning clients in Dar es Salaam, Tanzania. Afr J Reprod Health 2000; 4:88-99. [PMID: 11000712] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Between March and September of 1995, women receiving family planning (FP) services in three large clinics in Dar es Salaam, Tanzania were invited to participate in a cross-sectional study. Consenting women were interviewed to obtain information about HIV risk factors, and blood for HIV testing was collected. The prevalence of HIV was 16.9% (95% CI: 14.4%-19.3%). The risk of HIV increased significantly with age. Compared with married women, the risk of HIV was significantly higher among cohabiting women (age-adjusted OR = 2.3; 95% CI = 1.5-3.5) and among women who were single, divorced or widowed (age-adjusted OR = 2.3; 95% CI = 1.2-4.4). The risk of HIV was also significantly higher among hotel workers (age-adjusted OR = 4.3; 95% CI = 1.4-12.9). Women with laboratory evidence of sexually transmitted diseases were at increased risk of HIV. This study shows that HIV is a major public health problem among FP clients in Tanzania. Innovative HIV interventions are needed to reduce further spread of HIV infection.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
| | | | | | | | | | | |
Collapse
|
39
|
Kapiga SH, Msamanga GI, Spiegelman D, Mwakyoma H, Fawzi WW, Hunter DJ. Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam, Tanzania. Int J Gynaecol Obstet 1999; 67:87-94. [PMID: 10636052 DOI: 10.1016/s0020-7292(99)00125-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Dar es Salaam, Tanzania. METHODS Between July 1996 and December 1997 we interviewed 691 HIV-infected women to obtain information about risk factors for SIL. Cervical smears and samples for lymphocyte subsets and sexually transmitted diseases (STD) diagnosis were collected. RESULTS The prevalence of SIL was 2.9% (20/686) (95% CI = 1.7-4.2%). Eleven women had low-grade SIL while nine women had high-grade SIL. The number of lifetime sexual partners and live births was associated with a marginally non-significant increased risk of SIL. The risk of SIL was significantly increased among women with CD4+ cell count < 200/mm3 (multivariate odds ratio (OR) = 6.15, 95% CI = 1.19-41.37) and decreased by 68% for each 5-cm increase in mid-upper arm circumference (multivariate OR = 0.32, 95% CI = 0.10-0.93). CONCLUSIONS HIV-related immunosuppression and wasting and long-term sexual behavior were the major determinants of SIL in this population. Federation of Gynecology and Obstetrics.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | | | |
Collapse
|
40
|
Kapiga SH, Vuylsteke B, Lyamuya EF, Dallabetta G, Laga M. Evaluation of sexually transmitted diseases diagnostic algorithms among family planning clients in Dar es Salaam, Tanzania. Sex Transm Infect 1998; 74 Suppl 1:S132-8. [PMID: 10023364] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES To determine the prevalence of sexually transmitted diseases (STDs) and to assess the validity of STD screening approaches among family planning clients in Dar es Salaam, Tanzania. METHODS Between March and September 1995, information about sociodemographic characteristics, contraceptive use, sexual behaviour, and medical history was obtained from consenting women (n = 908). After interview, blood and genital specimens were collected for diagnosis of STDs and HIV. Based on the information obtained at interview and clinical examination, STD diagnostic algorithms were developed and validated. RESULTS The prevalence of STDs was HIV (16.9%), gonococcal and/or chlamydial cervicitis (8.2%), and Trichomonas vaginalis and/or Candida albicans (27.2%). The risk of cervicitis was increased among unmarried women and among women with a husband < or = 25 years of age and women having more than one sex partners in the past 3 months or a new sex partner during the past month. Most women with cervicitis (62.2%) and vaginitis (67.6%) were asymptomatic. A screening strategy for cervicitis based on symptoms had a sensitivity of 29.7%, a specificity of 84.1%, and a positive predictive value (PPV) of 15.9%. The corresponding figures for an algorithm based on clinical signs were 20.3%, 90.2%, and 15.6%. The sensitivity of a simple risk assessment algorithm ranged from 20.3% to 73%. An approach based on both risk assessment (risk score > or = 1) and clinical signs (cervical mucopus and friability) had a sensitivity of 37.8%, a specificity of 87.5%, and a PPV of 21.4%. A syndromic approach for vaginitis resulted in a higher sensitivity than the approach based on the type of vaginal discharge. CONCLUSION Although there is no single screening strategy for cervicitis which can be advocated for large scale application, risk assessment might be the only cost effective strategy for identifying women with cervicitis in family planning clinics in Tanzania.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVES To determine the risk factors for HIV seroconversion and assess the association between contraceptive use and HIV infection among women attending three large family planning clinics in Dar es Salaam, Tanzania. DESIGN Prospective cohort study. METHODS Between 1992 and 1995, 2471 HIV-negative women were followed prospectively. Information about sociodemographic characteristics, sexual behavior, contraceptive use and other risk factors was collected at recruitment and updated at follow-up visits. At the end of the study, specimens were collected for HIV testing and laboratory diagnosis of sexually transmitted diseases. RESULTS The overall HIV incidence was 3.4 per 100 person-years [95% confidence interval (Cl), 2.6-4.1]. The risk of HIV seroconversion decreased with increasing age (P=0.04, test for trend). Women reporting three or more sex partners during the follow-up period had the highest risk of HIV [age-adjusted relative risk (RR), 4.89; 95% Cl, 2.61-9.17]. Having an uncircumcised husband was associated with a significantly increased risk of HIV (age-adjusted RR, 3.60; 95% Cl, 1.12-11.59). The risk of HIV was also significantly increased among women with gonorrhoea (age-adjusted RR, 3.51; 95% Cl, 1.60-7.71) and candidiasis at baseline (age-adjusted RR, 1.98; 95% Cl, 1.17-3.33) and among women reporting alcohol consumption during the follow-up period. After controlling for other risk factors, the risk of HIV infection amongst users of oral contraceptive, intrauterine device and injectable contraceptive was not significantly increased. Similarly, there was no significant trend associated with increasing duration of use of any of these contraceptive methods. CONCLUSION These findings confirm that a large number of new HIV infections continue to occur in this population. Reassuringly, no significant association was observed between HIV and use of specific contraceptive methods. Interventions to reduce further spread of HIV are still urgently needed.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
| | | | | | | |
Collapse
|
42
|
Gertig DM, Kapiga SH, Shao JF, Hunter DJ. Risk factors for sexually transmitted diseases among women attending family planning clinics in Dar-es-Salaam, Tanzania. Genitourin Med 1997; 73:39-43. [PMID: 9155554 PMCID: PMC1195758 DOI: 10.1136/sti.73.1.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/04/2023]
Abstract
BACKGROUND Identification of risk factors for sexually transmitted diseases (STDs) assists in development of treatment algorithms, which are potentially important components of STD control when microbiologic facilities are limited. METHODS A cross-sectional study was performed to assess STD and HIV risk factors of 2285 women attending three family planning clinics in Dar-es-Salaam, Tanzania during 1991-92. Women were interviewed and examined for signs of STDs. Specimens were taken for laboratory diagnosis of HIV, other sexually transmitted organisms, and Candida albicans. RESULTS The prevalence of gonorrhoea was found to be 4.2%, prevalence of trichomoniasis was 14.3%, and positive syphilis serology was found in 2.5% of women. Unmarried women were at increased risk of trichomoniasis (age-adjusted OR = 1.48 95% CI [1.12, 1.95]), gonorrhoea (age-adjusted OR = 1.81 95% CI [1.14, 2.86]) and syphilis (age-adjusted OR 1.5 [0.84, 2.68]). An increasing number of sexual partners in the past five years was associated with an increased risk of all STDs. Current use of the oral contraceptive pill was positively associated with gonorrhoea, multivariate OR = 1.75 95% CI [1.05, 2.93]. The prevalence of candidiasis was 11.5% and was not associated with any of the demographic or behavioural risk factors examined. Clinical diagnostic algorithms for STDs in this study population had relatively low sensitivity and low positive predictive value. CONCLUSION Being unmarried and having a higher number of sexual partners were consistently associated with each STD, while the associations for other risk factors varied between STDs, emphasising the complexity of STD distribution. Further development of diagnostic algorithms and other methods for screening women for STDs are needed to reduce the impact of STDs and HIV in developing countries.
Collapse
Affiliation(s)
- D M Gertig
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachussetts 02115, USA
| | | | | | | |
Collapse
|
43
|
Kapiga SH. Determinants of multiple sexual partners and condom use among sexually active Tanzanians. East Afr Med J 1996; 73:435-42. [PMID: 8918004] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper is based on the analyses of data collected in the Tanzania Demographic and Health Survey (TDHS). The TDHS national sample was obtained by using 1988 population census list of enumeration areas. Information about sexual behaviour and condom use was obtained from sexually active women (N = 4620) and men (N = 1440) reporting sexual activity during the period of four weeks preceding the survey. Univariate and multivariate (using logistic regression model) analyses were done to identify predictors of condom use and highrisk sexual behaviour. About 6% of women and 31% of men reported to have more than one sexual partner during the study period. Compared to respondents married once and in monogamous union, the tendency to have multiple partners was increased among never married women [OR 10.9, 95% CI (7.1-16.9)] and men [2.6 (1 7-3.9)], formerly married women [11.5 (7.3-17.9)], and among men in monogamous marriage reporting more than one marriage [12.4 (8.3-18.4)]. Occupation, residence, ever use of contraceptives, and AIDS knowledge were not associated with history of multiple sexual partners. Only 134 (9.3%) men and 173 (3.7%) women reported to have used condoms during the study period. After adjusting for other predictors of condom use, respondents reporting multiple sexual partners were more likely to have used condom among both women [3.4 (2.2-5.4)] and men [3.3 (2.3-6.0)]. Condom use was common in urban areas than rural areas and among unmarried respondents. These results show that high-risk sexual behaviour is common among men. Condom use was very low indicating that efforts to promote condom use has been less successful in Tanzania. More efforts are needed to promote safer sexual practices and condom use in Tanzania.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatlatics, Munimbill University College of Health Sciences, Dar es Saiaam, Tanzania
| |
Collapse
|
44
|
Abstract
Reducing the number of sex partners and using condoms are the major means for individuals to protect themselves from STDs and AIDS in sub-Saharan Africa. To identify predictors of having only one sex partner in the last year and to assess knowledge and use of condoms among women of reproductive age in Dar-es-Salaam, Tanzania, we interviewed 2285 women at 3 representative family planning clinics between February 1991 and June 1992. After interview, blood and genital specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). Although knowledge of sexual transmission of AIDS was very high, less than a half of the respondents (42.8%) mentioned use of condoms as an AIDS preventive measure. Younger and more educated women were more likely to mention use of condoms for AIDS prevention, however only 4.6% of women interviewed were regular users of condoms, while 19.8% were occasional users. The majority of women who had never used a condom (57.5%) reported not using condoms because 'men did not like them'. Condom use was positively associated with increasing level of education and increasing number of sexual partners. 14.8% of women reported having more than one sex partner in the last year; this behaviour was more likely among cohabiting women (increased by 210%); HIV-positives (increased by 120%); and among women with STDs (increased by 50%).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- S H Kapiga
- University of Dar-es-Salaam, Department of Epidemology and Biostatistics, Mukimbili University College of Health Sciences, Tanzania
| | | | | | | |
Collapse
|
45
|
Kapiga SH, Shao JF, Lwihula GK, Hunter DJ. Risk factors for HIV infection among women in Dar-es-Salaam, Tanzania. J Acquir Immune Defic Syndr (1988) 1994; 7:301-9. [PMID: 8106970] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To identify risk factors for HIV infection among women not known to be members of high-risk groups in Dar-es-Salaam, Tanzania, and assess associations between contraceptive use and HIV infection, we conducted a cross-sectional case-control study at three representative family planning clinics. Between February 1991 and June 1992, we enrolled 2,285 women; women were interviewed using a structured questionnaire, and specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). The overall HIV prevalence was 11.5% (95% CI: 10.2-12.8). Other prevalent STDs included gonorrhea (4.2%), trichomoniasis (14.3%), candidiasis (11.5%), and syphilis (2.5%). HIV seroprevalence was significantly lower among younger women and women in nonpolygamous marriages. HIV risk increased with both women's education and male partner's education. Number of sex partners in the last 5 years was positively associated with HIV risk; however, among HIV-seropositive women, the median number of sexual partners was only two. For married women with only a single partner, their risk increased significantly if their husbands had other partners. The risk of HIV infection was higher among subjects with STDs, although only significantly so for gonorrhea (OR 1.95, 95% CI: 1.10-3.45). After controlling for known and potential risk factors, the risk of HIV infection was significantly increased among women who had ever used an intrauterine device (IUD) (OR 2.50, 95% CI: 1.35-4.64). Use of other contraceptives, including oral contraceptives, was not significantly associated with HIV infection. Our findings confirm that HIV and STDs are a major public health problem among women in Dar-es-Salaam.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- S H Kapiga
- Muhimbili University College of Health Sciences, University of Dar-es-Salaam, Tanzania
| | | | | | | |
Collapse
|
46
|
Kapiga SH, Hunter DJ, Nachtigal G. Reproductive knowledge, and contraceptive awareness and practice among secondary school pupils in Bagamoyo and Dar-es-Salaam, Tanzania. Cent Afr J Med 1992; 38:375-80. [PMID: 1298567] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Reproductive knowledge, and contraceptive awareness and practice were assessed among secondary school pupils in Bagamoyo and Dar-es-Salaam, Tanzania. Four classes from four government secondary schools were randomly selected within strata of year of schooling, and students were interviewed using a structured questionnaire. All 490 pupils in selected classes participated in the study. Of 481 respondents with complete data, 315 (65.5 pc) were males and 166 (34.5 pc) were females; 256 (53.2 pc) were from Dar-es-Salaam while 225 (46.8 pc) were from Bagamoyo. Two hundred and ninety three (60.9 pc) respondents reported they were sexually active. However, only 77 (17.0 pc) pupils knew the "safe period" within the menstrual cycle and 329 (68.4 pc) pupils were able to spontaneously mention at least one method of contraception. Less contraceptive awareness was noted among respondents below 18 years of age particularly among females in both study areas. Only 45 (15.4 pc) pupils had ever used a contraceptive method. Despite a reasonable level of awareness and a positive attitude towards contraception, only a small proportion of sexually active pupils had ever used contraceptives. More research is required to identify the barriers to contraceptive use in the presence of knowledge.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Epidemiology and Biostatistics, University of Dar-es-Salaam, Tanzania
| | | | | |
Collapse
|
47
|
Justesen A, Kapiga SH, van Asten HA. Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania. Stud Fam Plann 1992; 23:325-9. [PMID: 1475800] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es Salaam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life.) A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies--precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics.
Collapse
Affiliation(s)
- A Justesen
- Department of Obstetrics and Gynaecology, Muhimbili Medical Centre, University of Dar es Salaam, Tanzania
| | | | | |
Collapse
|
48
|
|
49
|
Abstract
We assessed knowledge of AIDS among pupils in selected schools in Tanzania in August 1989. Four hundred and eight-one pupils from four randomly selected secondary schools, two from Dar-Es-Salaam (a city) and two from Bagamoyo (a semi-rural town), were interviewed using a structured questionnaire. Of these, 476 (99.0%) had heard of AIDS, and 447 (92.9%) were able to mention spontaneously at least one sexually transmitted disease (STD), of whom 374 (83.7%) mentioned AIDS. Knowledge was found to increase with age and tended to be higher among women in Dar-Es-Salaam than in Bagamoyo. These data suggest that communication channels directed at women in rural areas should be strengthened. While knowledge of sexual transmission of HIV was generally high, and prevalence of reported misconceptions about modes of transmission was very low, knowledge of non-sexual means of transmission (transfusions, injections, vertical) was lacking. Although 80% of pupils mentioned reduction of number of sexual partners as a means of AIDS prevention, only 22% mentioned condom use, and less than 5% reported that they had ever used a condom. Future research should concentrate on means of promoting sexual behavior change, the ultimate aim of any AIDS prevention strategy.
Collapse
Affiliation(s)
- S H Kapiga
- Department of Community Health, University of Dar-Es-Salaam, Tanzania
| | | | | |
Collapse
|