Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author



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Abstract: This paper examines men's condom use at last higher-risk sex (i.e., nonmarital, noncohabiting partner) in five sub-Saharan countries: Burkina Faso, Cameroon, Kenya, Tanzania, and Zambia. The two most recent Demographic and Health Surveys (DHS) in each country are analyzed to show trends in various indicators. Condom use is an important way to prevent the transmission of HIV, the virus that causes AIDS. Encouragingly, use of condoms has increased substantially in Burkina Faso, Cameroon, and Tanzania, with smaller increases in Kenya and Zambia. At the same time, levels of higher-risk sex have declined in four of the five countries, although use of a condom at last higher-risk sex remains below 50 percent in Kenya and Zambia. Multivariate analysis shows that higher education is a consistently strong, positive predictor of condom use at last higher-risk sex, whereas higher wealth status is not significant in most surveys. Knowledge that use of condoms can reduce the risk of HIV transmission is a consistently strong, positive predictor of condom use, but urban-rural residence and region are significant only in some surveys. Comparing the two most recent DHS surveys in each of the five countries, there are no clear patterns of change in the predictive strength of explanatory variables. However, there is evidence of widening gaps in condom use by level of education in Cameroon and by urban-rural residence in Kenya. One important policy finding that emerged from this study is that low wealth status is not a barrier to condom use in most countries, but lack of education is. (author's)
Language: English
Keywords: BURKINA FASO | CAMEROON | KENYA | TANZANIA | ZAMBIA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | MULTIVARIATE ANALYSIS | MEN | CONDOM USE | RISK BEHAVIOR | EDUCATIONAL STATUS | DEVELOPING COUNTRIES | AFRICA, WESTERN | AFRICA, SUB SAHARAN | AFRICA | AFRICA, EASTERN | AFRICA, SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | DATA ANALYSIS | RESEARCH METHODOLOGY | RISK REDUCTION BEHAVIOR | BEHAVIOR | SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS

Document Number: 326392

Does cotrioxazole prophylaxis for the prevention of HIV-associated opportunistic infections select for resistant pathogens in Kenyan adults?
Author: Hamel MJ, Greene C, Chiller T, Ouma P, Polyak C, Otieno K, Williamson J,

Shi YP, Feikin DR, Marston B, Brooks JT, Poe A, Zhou Z


Source: Am J Trop Med Hyg. 2008 Sep;79(3):320-30.
Abstract: We assessed the effect of daily cotrimoxazole, essential for HIV care, on

development of antifolate-resistant Plasmodium falciparum, naso-pharyngeal

Streptococcus pneumoniae (pneumococcus), and commensal Escherichia coli.

HIV-positive subjects with CD4 cell count < 350 cells/muL (lower-CD4; N = 692)

received cotrimoxazole; HIV-positive with CD4 cell count > or = 350 cells/muL

(higher-CD4; N = 336) and HIV-negative subjects (N = 132) received multivitamins.

Specimens were collected at baseline, 2 weeks, monthly, and at sick visits during

6 months of follow-up to compare changes in resistance, with higher-CD4 as

referent. P. falciparum parasitemia incidence density was 16 and 156/100

person-years in lower-CD4 and higher-CD4, respectively (adjusted rate ratio [ARR] = 0.11; 95% confidence interval [CI] = 0.06-0.15; P < 0.001) and 97/100

person-years in HIV-negative subjects (ARR = 0.62; 95% CI = 0.44-0.86; P = 005).

Incidence density of triple and quintuple dihydrofol reductase/dihydropteroate-synthetase mutations was 90% reduced in lower-CD4 compared with referent. Overall, cotrimoxazole non-susceptibility was high among isolated pneumococcus (92%) and E. coli (76%) and increased significantly in lower-CD4 subjects by Week 2 (P < 0.005). Daily cotrimoxazole prevented malaria and reduced incidence of antifolate-resistant P. falciparum but

contributed to increased pneumococcus and commensal Escherichia coli resistance.
Language: English
Keywords: |AIDS-RELATED OPPORTUNISTIC INFECTIONS|PREVENTION & CONTROL|ADOLESCENT|ADULT|AGED|ANIMALS|ANTI-BACTERIAL AGENTS/PHARMACOLOGY|ANTI-INFECTIVE GENTS/ADMINISTRATION & DOSAGE THERAPEUTICUSE |ANTIMALARIALS/PHARMACOLOGY|COHORT STUDIES |DRUG RESISTANCE|ESCHERICHIA COLI/DRUG EFFECTS|FEMALE|HIV INFECTIONS|DRUG THERAPY|HUMANS|KENYA|MALARIA, ALCIPARUM/PARASITOLOGY/PREVENTION & CONTROL |MALE|MIDDLE AGED|PLASMODIUM FALCIPARUM/DRUG EFFECTS|PROSPECTIVE STUDIES|STREPTOCOCCUS PNEUMONIAE|DRUG EFFECTS|TRIMETHOPRIM-SULFAMETHOXAZOLE COMBINATION/ADMINISTRATION & DOSAGE| THERAPEUTIC
HIV infection does not disproportionately affect the poorer in sub-Saharan Africa.
Author: Mishra V
Source: AIDS. 2007 Nov;21 Suppl 7:S17-28.
Language: English
Abstract: Background:

Wealthier populations do better than poorer ones on most measures of

health status, including nutrition, morbidity and mortality, and healthcare

utilization.


Objectives:

This study examines the association between household

wealth status and HIV serostatus to identify what characteristics and behaviours

are associated with HIV infection, and the role of confounding factors such as

place of residence and other risk factors.
Methods:

Data are from eight national surveys in sub-Saharan Africa (Kenya, Ghana, Burkina Faso, Cameroon, Tanzania, Lesotho, Malawi, and Uganda) conducted during 2003-2005. Dried blood spot samples were collected and tested for HIV, following internationally accepted ethical standards and laboratory procedures. The association between household wealth (measured by an index based on household ownership of durable assets and other amenities) and HIV serostatus is examined using both descriptive and multivariate statistical methods.


Results:

In all eight countries, adults in the wealthiest quintiles have a higher prevalence of HIV than those in the poorer quintiles. Prevalence increases monotonically with wealth in most cases. Similarly for cohabiting couples, the likelihood that one or both partners is HIV infected increases with wealth. The positive association between wealth and HIV prevalence is only partly explained by an association of wealth with other underlying factors, such as place of residence and education, and by differences in sexual behaviour, such as multiple sex partners, condom use, and male circumcision.



Conclusion:

In sub-Saharan Africa, HIV prevalence does not exhibit the same

pattern of association with poverty as most other diseases. HIV programmes should also focus on the wealthier segments of the population.
Language: English
The impact of onset controllability on stigmatization and supportive

communication goals toward persons with HIV versus lung cancer: a comparison between Kenyan and U.S. participants.
Author: Miller AN, Fellows KL, Kizito MN
Source: Health Commun. 2007;22(3):207-19.
Abstact: This study examined the impact of controllability of onset (i.e., means of

transmission), disease type (HIV and lung cancer), and culture (Kenya and U.S.)



on stigmatizing attitudes and goals for supportive communication. Four hundred sixty-four Kenyan students and 526 American students, and 441 Kenyan nonstudents and 591 American nonstudents were randomly assigned to 1 of 12 hypothetical scenario conditions and asked to respond to questions regarding 3 different types of stigmatizing attitudes and 6 types of supportive communication goals with respect to the character in the scenario. Means of transmission had a strong effect on the blame component of stigma, but none on cognitive attitudes and social interaction components. Similarly, although an effect for means of transmission emerged on intention to provide "recognize own responsibility" and "see others' blame" types of support, no effect was evident for most other supportive interaction goals. Although effects for culture were small, Kenyan participants, student and nonstudent alike, were not as quick as American participants to adopt goals of communicating blame in any direction. Implications for measurement of stigma in future research are discussed.
Language: English
Keywords: |ADOLESCENT |ADULT |AGED |AGED, 80 AND OVER|ATTITUDE TO HEALTH| CROSS-CULTURAL COMPARISON| EDUCATIONAL STATUS |FEMALE |HIINFECTIONS|EPIDEMIOLOGY|ETIOLOGY|PSYCHOLOGY |HEALTH BEHAVIOR|HUMANS |INTERNAL-EXTERNAL CONTROL|KENYA|EPIDEMIOLOGY| LUNG NEOPLASMS/EPIDEMIOLOGY/ETIOLOGY|PSYCHOLOGY

| MALE| MIDDLE AGED| PRECIPITATING FACTORS|PREJUDICE |QUESTIONNAIRES|SOCIAL SUPPORT |STEREOTYPING |STUDENTS|PSYCHOLOGY |UNITED STATES/EPIDEMIOLOGY| UNIVERSITIES

Education and nutritional status of orphans and children of HIV-infected parents in Kenya.
Author: Mishra V, Arnold F, Otieno F, Cross A, Hong R
Source: AIDS Educ Prev. 2007 Oct;19(5):383-95.
Abstract: We examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. We analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate logistic regression. Results indicate that orphans, fostered children, and children of HIV-infected parents are significantly less likely to attend school than non-orphaned/non-fostered children of HIV-negative parents. Children of HIV-infected parents are more likely to be underweight and wasted, and less likely to receive medical care for ARI and diarrhea. Children of HIV-negative single mothers are also disadvantaged on most indicators. The findings highlight the need to expand child welfare programs to include not only orphans but also fostered children, children of single mothers, and children of HIV-infected parents, who tend to be equally, if not more, disadvantaged.
Language: English
Keywords: |ADOLESCENT|ADULT|CHILDCHILD WELFARE/*STATISTICS & NUMERICAL DATA|CHILD OF IMPAIRED ARENTS/EDUCATION/*STATISTICS & NUMERICAL DATA

|CHILD, ORPHANED/EDUCATION/*STATISTICS & NUMERICAL DATA|CHILD, PRESCHOOL|EDUCATIONAL STATUS|FAMILY CHARACTERISTICS|FEMALE|FOSTER HOME CARE

|HIV INFECTIONS|HEALTH STATUS DISPARITIES|HUMANS|INFANT|INFANT, NEWBORN

|KENYA/EPIDEMIOLOGY|LOGISTIC MODELS|MALE|MIDDLE AGED|MULTIVARIATE ANALYSIS|NUTRITIONAL STATUS|VULNERABLE POPULATIONS

Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan Africa.
Author: Bakayev V,Velayati AA, Bahadori M, Tabatabaei SJ, Alaei A, Farahbood A, Masjedi MR
Source: Arch Iran Med. 2007 Oct;10(4):486-97.
Abstract: Background:

The pandemic of HIV/AIDS in sub-Saharan Africa and the rise of epidemics in Asia to the previously unforeseen level are likely to have global social, economic, and political impacts. In this emergency, it is vital to reappraise the weight of powerful religious and cultural factors in spreading the disease. The role of Islam in shaping values, norms, and public policies in North African states is to be appreciated for the lowest HIV prevalence in their populations. Yet, the place of religion in prevention of the disease diffusion is not fully understood nor worldwide acknowledged by the primary decision makers.

Another topic, which has received little attention to date, despite the abundance

of literature concerning the unfortunate Africa's anti-AIDS campaign, is an issue

of colonial past.
Methods:

To better comprehend the share of both traits in

diverse spread of HIV in sub-Saharan Africa, we studied the correlation between

Muslim and Christian proportions in the state's population and HIV rate.


Results:

By this method, Muslim percentage came out as a potential predictor of HIV

prevalence in a given state. In another approach, most subcontinental countries

were clustered by colocalization and similarity in their leading religion,

colonial past, and HIV seroprevalence starting from barely noticeable (0.6 - 1.2%, for Mauritania, Senegal, Somalia, and Niger) and low levels (1.9 - 4.8%, for Mali, Eritrea, Djibouti, Guinea, Guinea-Bissau, Burkina-Faso, and Chad) for Muslim populated past possessions of France and Italy, in the northern part of the subcontinent. Former territories of France, Belgium, Portugal, and the UK

formed two other groups of the countries nearing the equator with Catholic

prevailing (Democratic Republic of Congo, Republic of Congo, Rwanda, Gabon, and Burundi) or mixed populations comprising Christian, Muslim, and indigenous believers (Benin, Ghana, Uganda, Togo, Angola, Nigeria, Liberia, Kenya, Cameroon, Cote d'Ivoire, and Sierra-Leone), which covered the HIV prevalence range from 1.9% to 7%. Albeit being traced by origin to the central part of the continent, HIV has reached the highest rates in the South, particularly Malawi (14.2%), Zambia (16.5%), South Africa (21.5%), Zimbabwe (24.6%), Lesotho (28.9%), Botswana (37.3%), and Swaziland (38.8%)-all former British colonies with dominating Christian population.
Conclusion:

In the group ranking list, a distinct North to

South oriented incline in HIV rates related to prevailing religion and previous

colonial history of the country was found, endorsing the preventive role of the

Islam against rising HIV and the increased vulnerability to menace in states with

particular colonial record.


Language: English
Keywords: |ACQUIRED IMMUNODEFICIENCY SYNDROME| EPIDEMIOLOGY| ETHNOLOGY| VIROLOGY|ADOLESCENT|ADULT|AFRICA SOUTH OF THE SAHARA/EPIDEMIOLOGY|CULTURE|FEMALE |GEOGRAPHY |HIV/GENETICS|HUMANS|MALE|PREVALENCE|RELIGION

|RISK FACTORS|SEXUAL BEHAVIOR|VIRAL LOAD

High prevalence of HIV infection among rural tea plantation residents in Kericho, Kenya.
Author: Foglia G, Sateren WB, Renzullo PO, Bautista CT, Langat L
Source: Epidemiol Infect. 2008 May;136(5):694-702. Epub 2007 Jun 29.
Abstract: Human immunodeficiency virus type 1 (HIV-1) epidemiology among residents of a rural agricultural plantation in Kericho, Kenya was studied. HIV-1 prevalence was 14.3%, and was higher among women (19.1%) than men (11.3%). Risk factors associated with HIV-1 for men were age (>or=25 years), marital history (one or more marriages), age difference from current spouse (>or=5 years), Luo ethnicity, sexually transmitted infection (STI) symptoms in the past 6 months, circumcision (protective), and sexual activity (>or=7 years). Among women, risk factors associated with HIV-1 were age (25-29 years, >or=35 years), marital history (one or more marriages), age difference from current spouse (>or=10 years), Luo ethnicity, STI symptoms in the past 6 months, and a STI history in the past 5years. Most participants (96%) expressed a willingness to participate in a future HIV vaccine study. These findings will facilitate targeted intervention and prevention measures for HIV-1 infection in Kericho.
Language: English
Keywords: |ADOLESCENT|ADULT|AGE FACTORS|ETHNIC GROUPS |FEMALE|HIV INFECTIONS |EPIDEMIOLOGY |VIROLOGY|HIV-1 |ISOLATION & PURIFICATION|HUMANS |KENYA |EPIDEMIOLOGY|MALE|MIDDLE AGED|PREVALENCE

|RISK FACTORS|RURAL POPULATION|SEX FACTORS

The protective effect of circumcision on HIV incidence in rural low-risk men circumcised predominantly by traditional circumcisers in Kenya: two-year follow-up of the Kericho HIV Cohort Study.
Author: Shaffer DN, Bautista CT, Sateren WB, Sawe FK, Kiplangat SC, Miruka AO, Renzullo PO, Scott PT, Robb ML, Michael NL, Birx DL
Source: J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):371-9.
Abstract: Background:

Three randomized controlled trials (RCTs) have demonstrated that male

circumcision prevents female-to-male HIV transmission in sub-Saharan Africa. Data from prospective cohort studies are helpful in considering generalizability of

RCT results to populations with unique epidemiologic/cultural characteristics.



Methods:

Prospective observational cohort sub-analysis. A total of 1378 men were

evaluated after 2 years of follow-up. Baseline sociodemographic and

behavioral/HIV risk characteristics were compared between 270 uncircumcised and 1108 circumcised men. HIV incidence rates (per 100 person-years) were calculated, and Cox proportional hazards regression analyses estimated hazard rate ratios (HRs).


Results:

Of the men included in this study, 80.4% were circumcised; 73.9% were circumcised by traditional circumcisers. Circumcision was associated with tribal affiliation, high school education, fewer marriages, and smaller age difference between spouses (P < 0.05). After 2 years of follow-up, there were 30 HIV incident cases (17 in circumcised and 13 in uncircumcised men). Two-year HIV incidence rates were 0.79 (95% confidence interval [CI]: 0.46 to 1.25) for circumcised men and 2.48 (95% CI: 1.33 to 4.21) for uncircumcised men

corresponding to a HR = 0.31 (95% CI: 0.15 to 0.64). In one model controlling for

sociodemographic factors, the HR increased and became non-significant (HR = 0.55; 95% CI: 0.20 to 1.49). CONCLUSIONS: Circumcision by traditional circumcisers offers protection from HIV infection in adult men in rural Kenya. Data from well-designed prospective cohort studies in populations with unique cultural characteristics can supplement RCT data in recommending public health policy.


Language: English
Keywords: |ADOLESCENT| ADULT| CHILD|CIRCUMCISION, MALE/STATISTICS & NUMERICAL DATA| COHORT STUDIES| HIV INFECTIONS |EPIDEMIOLOGY/*PREVENTION & CONTROL/VIROLOGY|HIV-1|HUMANS|INCIDENCE|KENYA/EPIDEMIOLOGY| MALE |MEDICINE, AFRICAN TRADITIONAL|RISK FACTORS|RURAL POPULATION

|SEXUAL BEHAVIOR

Antiretroviral durability and tolerability in HIV-infected adults living in urban Kenya.
Author: Hawkins C, Achenbach C, Fryda W, Ngare D, Murphy R
Source: J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):304-10.
Abstract: Background:

Insufficient data exist on the durability and tolerability of

first-line antiretroviral therapy (ART) regimens provided by HIV treatment

programs implemented in developing countries.


Methods:

Longitudinal observation of clinical, immunologic, and treatment parameters of all HIV-infected adult patients initiated on ART was performed at Saint Mary's Mission Hospital in Nairobi, Kenya from September 2004 until August 2006.


Results:

A total of 1286 patients were analyzed (59.1% female). Initial ART regimens were primarily stavudine, lamivudine, and nevirapine (62.1%). Median ART duration was 350 days (11.6 months). Significant improvements in clinical and immunologic status were noted after 12 months of therapy. ART switches occurred in 701 (54.5%) patients. The cumulative incidence of ART switch at 12 months was 78.4%. Concurrent ART-related toxicities (40.6%) and tuberculosis treatment interactions (28.1%) were the most frequent reasons for ART switch. Baseline AIDS symptoms (hazard rate [HR]=1.59, 95% confidence interval [CI]: 1.28 to 1.98; P<0.01) and a CD4 count

Conclusions:

Excellent clinical and immunologic responses to ART were observed in

this urban Kenyan population; however, frequent switches in ART among medication classes because of toxicity or drug interactions may limit the durability of these responses.
Language: English
Keywords: |ADOLESCENT |ADULT |AGED|ANTI-RETROVIRAL AGENTS |ADVERSE EFFECTS |THERAPEUTIC USE|CD4 LYMPHOCYTE COUNT|DEVELOPING COUNTRIES|DRUG THERAPY, COMBINATION |EXANTHEMA|CHEMICALLY INDUCED|PREVENTION & CONTROL |FEMALE|GOVERNMENT PROGRAMS|TRENDS|HIV INFECTIONS |DRUG THERAPY|IMMUNOLOGY|PREVENTION & CONTROL |HUMANS |KENYA|EPIDEMIOLOGY|MALE |MIDDLE AGED|PATIENT COMPLIANCE|PERIPHERAL NERVOUS SYSTEM DISEASES|CHEMICALLY INDUCED|PREVENTION & CONTROL |PROBABILITY|SENTINEL SURVEILLANCE |TREATMENT OUTCOME |URBAN POPULATION

Understanding the differences between contrasting HIV epidemics in east and west Africa: results from a simulation model of the Four Cities Study.
Author: Orroth KK, Freeman EE, Bakker R, Buve A, Glynn JR, Boily MC, White RG, Habbema JD, Hayes RJ
Source: Sex Transm Infect. 2007 Aug;83 Suppl 1:i5-16. Epub 2007 Apr 3.
Abstract: Objective:

To determine if the differences in risk behaviours, the proportions of

males circumcised and prevalences of sexually transmitted infections (STIs)

observed in two African cities with low prevalence of HIV (Cotonou, Benin, and

Yaounde, Cameroon) and two cities with high prevalence (Kisumu, Kenya, and Ndola, Zambia) could explain the contrasting HIV epidemics in the four cities.
Methods:

An individual-based stochastic model, STDSIM, was fitted to the demographic,

behavioural and epidemiological characteristics of the four urban study

populations based on data from the Four Cities Study and other relevant sources.

Model parameters pertaining to STI and HIV natural history and transmission were held constant across the four populations. The probabilities of HIV, syphilis and chancroid acquisition were assumed to be doubled among uncircumcised males. A priori plausible ranges for model inputs and outputs were defined and sexual behaviour characteristics, including those pertaining to commercial sex workers (CSWs) and their clients, which were allowed to vary across the sites, were identified based on comparisons of the empirical data from the four sites. The proportions of males circumcised in the model, 100% in Cotonou and Yaounde, 25%in Kisumu and 10% in Ndola, were similar to those observed. A sensitivity analysis was conducted to assess how changes in critical parameters may affect the model fit.
Results:

Population characteristics observed from the study that

were replicated in the model included younger ages at sexual debut and marriage in east Africa compared with west Africa and higher numbers of casual partners in the past 12 months in Yaounde than in the other three sites. The patterns in prevalence of STIs in females in the general population and CSWs were well fitted. HIV prevalence by age and sex and time trends in prevalence in the model were consistent with study data with the highest simulated prevalences in Kisumu and Ndola, intermediate in Yaounde and lowest in Cotonou. The sensitivity analysis suggested that the effect of circumcision on the development of the HIV epidemics may have been mediated indirectly by its effect on ulcerative STI.
Conclusions:

The contrasting HIV epidemics in east and west Africa could be

replicated in our model by assuming that male circumcision reduced susceptibility to HIV, syphilis and chancroid. Varying rates of male circumcision may have played an important role in explaining the strikingly different HIV epidemics observed in different parts of sub-Saharan Africa.
Language: English
Keywords: |ADOLESCENT| ADULT|AFRICA, EASTERN |EPIDEMIOLOGY |AFRICA, WESTERN |EPIDEMIOLOGY|CIRCUMCISION, MALE |STATISTICS & NUMERICAL DATA|DISEASE OUTBREAKS |STATISTICS & NUMERICAL DATA|FEMALE|HIV INFECTIONS |EPIDEMIOLOGY|HUMANS|MALE|PREVALENCE|RISK FACTORS|RISK-TAKING|SENSITIVITY AND SPECIFICITY|SEXUAL BEHAVIOR|STATISTICS & NUMERICAL DATA|SEXUALLY TRANSMITTED DISEASES|EPIDEMIOLOGY|TRANSMISSION



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