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Bangladesh moves from being a low-prevalence nation for HIV to one with a concentrated epidemic in injecting drug users

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INTERNATIONAL JOURNAL OF std & aids 2008年第5期19卷 327-331页

作者： Azim, T. Rahman, M. Alam, M. S. Chowdhury, I. A. Khan, R. Reza, M. Rahman, M. Chowdhury, E. I. Hanifuddin, M. Rahman, A. S. M. M. Int Ctr Diarrhoeal Dis Res HIV AIDS Programme Dhaka 1212 Bangladesh Inst Epidemiol Dis Control & Res Dhaka Bangladesh Minist Hlth & Family Welf Natl AIDS Comm Directorate Gen Hlth Serv Dhaka Bangladesh Minist Hlth & Family Welf Natl AIDS STD Programme Directorate Gen Hlth Serv Dhaka Bangladesh

Bangladesh has been conducting annual serological surveillance for HIV and syphilis since 1998 among most at-risk populations including sex workers, males having sex with males, injecting drug users (IDUs) and heroin smokers. During the seventh round conducted between January and June 2006, 10,368 people were sampled and the overall HIV prevalence was 0.9%. The highest HIV rate was recorded in male IDUs from the capital city Dhaka (7%), and the rates have risen significantly over the rounds (P < 0.001). In Dhaka, most of the HIV-positive IDUs (10.5%) were localized in one neighbourhood, while in the remaining neighbourhoods 1% were positive (P < 0.001). In all other groups, HIV prevalence was < 1%. Active syphilis rates were highest in female IDUs (9.9%) followed by female street-based sex workers (8.6%). However, rates in female sex workers in Dhaka declined significantly over the years (P < 0.001). Bangladesh has to act urgently to prevent escalation of the epidemic.

关键词： HIV syphilis injecting drug users sex workers Bangladesh

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Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities

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DRUG AND ALCOHOL DEPENDENCE 2008年第1-2期95卷 45-53页

作者： Parry, Charles Petersen, Petal Dewing, Sarah Carney, Tara Needle, Richard Kroeger, Karen Treger, Latasha MRC Alcohol & Drug Abuse Res Unit ZA-7505 Tygerberg South Africa Univ Stellenbosch Dept Psychiat ZA-7505 Tygerberg South Africa US Ctr Dis Control & Prevent Global Programme AIDS Natl Ctr HIV STD & TB Prevent Atlanta GA 30333 USA US Ctr Dis Control & Prevent Global Programme AIDS ZA-0001 Pretoria South Africa

The current assessment was undertaken to examine the link between drug use and sexual risk behavior among men who have sex with men (MSM) in locations known to have high prevalence rates of drug use and sexual risk behavior in Cape Town, Durban and Pretoria, South Africa. Street intercepts and purposive snowball sampling were used to recruit drug-using MSM. A rapid assessment was undertaken which included observation, mapping, key informant interviews and focus group interviews with MSM. Drug using key informants were tested for HIV. The use of drugs like crack cocaine, cannabis and methamphetamine to specifically facilitate sexual encounters was evident. Drugs led to inconsistent condom use and other high-risk sexual activities despite HIV risk knowledge being high. Many injecting drug-using MSM shared needles and reused equipment. Among MSM who agreed to HIV testing, one-third tested positive. Views about drug and HIV treatment and preventive services and their efficacy were mixed. Various barriers to accessing services were highlighted including homosexual stigmatization and availability of drugs in treatment facilities. Recommendations include addressing the gap between HIV-risk knowledge and practice, extending VCT services for MSM, increasing the visibility of drug abuse services within communities, addressing concerns about drug availability in treatment centers as well as reintegration issues and the need for after-care services, reducing stigmatization in drug and HIV services for MSM and finally, strengthening the link between drug treatment services and HIV prevention by integrating HIV/drug-related risks into HIV prevention efforts and HIV risks into drug use prevention efforts. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

关键词： HIV/aids men who have sex with men injecting drug users risk behavior South Africa rapid assessment

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Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya

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BMC PEDIATRICS 2008年第1期8卷 52-52页

作者： Van Winghem, Joelle Telfer, Barbara Reid, Tony Ouko, Judith Mutunga, Angela Jama, Zaina Vakil, Shobha Med Sans Frontieres Nairobi Kenya Med Sans Frontieres Ctr Operat Res Brussels Belgium Natl AIDS & STD Control Programme NASCOP Minist Hlth Govt Kenya ART Program Nairobi Kenya

Background: To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya. Methods: We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/aids. Results: This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective;for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95% CI 93.16-96.74) at 12 months after the time of initiation of HAART. Conclusion: Our model of pediatric HIV/aids care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings.

关键词： Human Immunodeficiency Virus Human Immunodeficiency Virus Testing Treatment Literacy Human Immunodeficiency Virus Status Human Immunodeficiency Virus Care

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Condom Use Among Sexually Active Kenyan Female Adolescents at Risk for HIV-1 Infection

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aids AND BEHAVIOR 2008年第6期12卷 923-929页

作者： Cherutich, Peter Brentlinger, Paula Nduati, Ruth Kiarie, James N. Farquhar, Carey Minist Hlth Kenya Natl AIDS STD Control Programme Nairobi Kenya Univ Washington Dept Hlth Serv Seattle WA 98195 USA Univ Washington Dept Epidemiol Seattle WA 98195 USA Univ Nairobi Dept Paediat Nairobi Kenya Univ Nairobi Dept Obstet & Gynaecol Nairobi Kenya Univ Washington Dept Med Seattle WA USA

High rates of unintended pregnancy and HIV infection occur in sub-Saharan Africa yet few Kenyan studies have defined correlates of condom use in sexually active female adolescents. Female adolescents receiving reproductive health care and aged 15-19 were interviewed. The prevalence of ever-use of condom was 21.4% and 52 (7.3%) subjects were infected with HIV-1. Older age, higher levels of education, ever-use of hormonal contraceptives and higher numbers of sexual partners, non-consensual sex and exchange of sex for favours, were independent correlates of condom use. Condom use should be promoted in this population. Further exploration is needed on the developmental and contextual factors predisposing female adolescents to increased risk of HIV.

关键词： Condom Female adolescents Kenya

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HIV infection and multidrug-resistant tuberculosis - The perfect storm

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JOURNAL OF INFECTIOUS DISEASES 2007年第Supplement_1期196卷 S86-S107页

作者： Wells, Charles D. Cegielski, J. Peter Nelson, Lisa J. Laserson, Kayla F. Holtz, Timothy H. Finlay, Alyssa Castro, Kenneth G. Weyer, Karin Ctr Dis Control & Prevent Natl Ctr HIV STD & TB Prevent Div TB Eliminat Int Res & Program Branch Atlanta GA 30333 USA CDC Global Programme AIDS Maputo Mozambique CDC Res Ctr Kenya Med Res Inst Kisumu Kenya MRC Pretoria South Africa

Background. Multidrug-resistant (MDR) tuberculosis (TB) has emerged as a global epidemic, with similar to 425,000 new cases estimated to occur annually. The global human immunodeficiency virus (HIV) infection epidemic has caused explosive increases in TB incidence and may be contributing to increases in MDR-TB prevalence. Methods. We reviewed published studies and available surveillance data evaluating links between HIV infection and MDR-TB to quantify convergence of these 2 epidemics, evaluate the consequences, and determine essential steps to address these epidemics. Results. Institutional outbreaks of MDR-TB have primarily affected HIV-infected persons. Delayed diagnosis, inadequate initial treatment, and prolonged infectiousness led to extraordinary attack rates and case-fatality rates among HIV-infected persons. Whether this sequence occurs in communities is less clear. MDR-TB appears not to cause infection or disease more readily than drug-susceptible TB in HIV-infected persons. HIV infection may lead to malabsorption of anti-TB drugs and acquired rifamycin resistance. HIV-infected patients with MDR-TB have unacceptably high mortality;both antiretroviral and antimycobacterial treatment are necessary. Simultaneous treatment requires 6-10 different drugs. In HIV-prevalent countries, TB programs struggle with increased caseloads, which increase the risk of acquired MDR-TB. Surveillance data suggest that HIV infection and MDR-TB may converge in several countries. Conclusions. Institutional outbreaks, overwhelmed public health programs, and complex clinical management issues may contribute to the convergence of the MDR-TB and HIV infection epidemics. To forestall disastrous consequences, infection control, rapid case detection, effective treatment, and expanded program capacity are needed urgently.

关键词： MULTIDRUG-resistant tuberculosis HIV infections EPIDEMICS HIV-positive persons MALABSORPTION syndromes ANTIRETROVIRAL agents ANTIBACTERIAL agents HEALTH promotion QUANTITATIVE research

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Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

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PUBLIC HEALTH REPORTS 2006年第6期121卷 695-702页

作者： Seguy, Nicole Hladik, Wolfgang Munyisia, Esther Bolu, Omotayo Marum, Larry H. Diaz, Theresa CDC Global Programme AIDS Natl Ctr HIV STD & TB Prevent Atlanta GA 30333 USA Natl AIDS & STI Control Program Nairobi Kenya Ctr Dis Control & Prevent Global AIDS Program Natl Ctr HIV STD & TB Prevent Nairobi Kenya

Objective. In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. Methods. UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. Results. Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted;for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. Conclusion. Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.

关键词： MATERNAL-fetal exchange aids transmission HIV-positive women INFECTIOUS disease transmission

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Adherence to antiretroviral therapy in a home-based aids care programme in rural Uganda

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LANCET 2006年第9547期368卷 1587-1594页

作者： Weidle, Paul J. Wamai, Nafuna Solberg, Peter Liechty, Cheryl Sendagala, Sam Were, Willy Mermin, Jonathan Buchacz, Kate Behumbiize, Prosper Ransom, Ray L. Bunnell, Rebecca Ctr Dis Control & Prevent Epidemiol Branch Div HIV AIDS Prevent Natl Ctr HIV STD & TB Prevent Atlanta GA 30333 USA Global Programme AIDS Ctr Dis Control & Prevent Uganda Entebbe Uganda Univ Calif San Francisco San Francisco CA 94143 USA

Background Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based aids care programme that provides the therapy and other aids care, prevention, and support services in rural Uganda. Methods HIV-infected individuals with advanced HIV disease or a CD4-cell count of less than 250 cells per mu L were eligible for antiretroviral therapy. Adherence interventions included group education, personal adherence plans developed with trained counsellors, a medicine companion, and weekly home delivery of antiretroviral therapy by trained lay field officers. We analysed factors associated with pill count adherence (PCA) of less than 95%, medication possession ratio (MPR) of less than 95%, and HIV viral load of 1000 copies per mL or more at 6 months (second quarter) and 12 months (fourth quarter) of follow-up. Findings 987 adults who had received no previous antiretroviral therapy (median CD4-cell count 124 cells per mu L, median viral load 217 000 copies per mL) were enrolled between July, 2003, and May, 2004. PICA of less than 95% was calculated for 0.7-2.6% of participants in any quarter and MPR of less than 95% for 3.3-11.1%. Viral load was below 1000 copies per mL for 894 (98%) of 913 participants in the second quarter and for 860 (96%) of 894 of participants in the fourth quarter. In separate multivariate models, viral load of at least 1000 copies per mL was associated with both PICA below 95% (second quarter odds ratio 10.6 [95% CI 2.45-45.7];fourth quarter 14.5 [2.51-83.6]) and MPR less than 95% (second quarter 9.44 [3.40-26.2];fourth quarter 10.5 [4.22-25.9]). Interpretation Good adherence and response to antiretroviral therapy can be achieved in a home-based aids care programme in a resource-limited rural Afr

关键词： Acquired Immunodeficiency Syndrome Anti-Retroviral Agents Home Care Services 获得性免疫缺陷综合征家庭医疗保健服务病人依从农村人口 home delivery HIV Infections Anti-Retroviral Agents Home Care Services Quarter Acquired Immunodeficiency Syndrome Highly Active Antiretroviral Therapy

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Effectiveness of community-based outreach in preventing HIV/aids among injecting drug users

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INTERNATIONAL JOURNAL OF DRUG POLICY 2005年第Sup1期16卷 S45-S57页

作者： Needle, RH Burrows, D Friedman, SR Dorabjee, J Touzé, G Badrieva, L Grund, JPC Kumar, MS Nigro, L Manning, G Latkin, C Ctr Dis Control & Prevent Natl Ctr HIV STD & TB Prevent Global Programme AIDS Atlanta GA 30333 USA AIDS Projects Management Grp Sydney NSW 2000 Australia Natl Dev & Res Inst Inc New York NY 10010 USA Macfarlane Burnet Inst Med Res & Publ Hlth Ctr Harm Reduct Fairfield Vic 3078 Australia Intercambios Asociac Civil RA-1046 Buenos Aires DF Argentina Project Renewal Kazan 420097 Russia Addict Res Ctr CVO NL-3531 JX Utrecht Netherlands Sahai Trust Madras 600017 Tamil Nadu India Univ Catania Infect Dis Unit I-95125 Catania Italy Community REACH Pact Washington DC 20036 USA Johns Hopkins Bloomberg Sch Publ Hlth Baltimore MD USA

This paper focuses on the evidence for the effectiveness of community-based outreach intervention as one component of a comprehensive HIV prevention model for preventing HIV infection in injecting drug user (IDU) Populations. Three empirical questions guided the review of the evidence. This article includes primarily published literature on community-based outreach derived mostly from developing countries but also unpublished literature. Wherever possible, evidence from multi-country, multi-site studies or meta-analytical studies is included. More than 40 published studies reveal that injecting drug users (IDUs), who are reached by community-based outreach and provided with access to risk reduction services, report reducing HIV risk behaviours. The strength of the evidence was assessed using Hill's criteria, which permit a review of multiple studies with different designs. Using the criteria, it is possible to infer causation about the evidence of effectiveness of the intervention. The evidence for the effectiveness of a community-based outreach strategy is strong. Despite evidence from 20 years of evaluation studies of the effectiveness of community-based outreach, a huge gap exists in most countries between the number of IDUs who want or could benefit from outreach services and the number of IDUs who actually receive them. Findings from evaluation studies on the effectiveness of community-based outreach must be made accessible, disseminated globally and provided to policy- and decision-makers to persuade them to take action and implement scaled-up prevention programmes. This requires ongoing advocacy and constant strengthening of the evidence base. Plans are needed to link evidence-based findings with technical assistance as well as training to enhance the capacity of regions and countries to introduce, scale up and sustain HIV prevention outreach to IDUs as part of a comprehensive HIM prevention strategy. (c) 2005 Elsevier B.V. All rights reserved.

关键词： HIV/aids injection drug users evidence-based prevention community-based outreach risk reduction

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Does increased general schooling protect against HIV infection?: A study in four African cities

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TROPICAL MEDICINE & INTERNATIONAL HEALTH 2004年第1期9卷 4-14页

作者： Glynn, JR Caraël, M Buvé, A Anagonou, S Zekeng, L Kahindo, M Musonda, R Univ London London Sch Hyg & Trop Med Infect Dis Epidemiol Unit London WC1E 7HT England UNAIDS CH-1211 Geneva 27 Switzerland Inst Trop Med B-2000 Antwerp Belgium SIDA Programme Lutte Contre Cotonou 04378 Benin Minist Publ Hlth Yaounde Cameroon Natl AIDS STD Control Programme Nairobi Kenya Trop Dis Res Ctr Ndola Zambia

BACKGROUND The association between educational attainment and risk of HIV infection varies between populations and over time. Earlier studies in sub-Saharan Africa have found that those with more education are at increased risk of HIV infection. METHODS We investigated the associations between general schooling and both HIV and herpes simplex-2 (HSV-2) infection using data from the multicentre study on factors determining the differential spread of HIV in four African cities. Cross-sectional general population studies were conducted in 1997-1998 in Cotonou (Benin), Yaounde (Cameroon), Kisumu (Kenya), and Ndola (Zambia), including about 2000 adults in each city. RESULTS There was no association between schooling and HIV infection in men or women in Kisumu or Ndola. Women in Yaounde and men in Cotonou, with more schooling, were less likely to be HIV positive. These associations persisted after adjusting for sociodemographic factors. Similar trends in men in Yaounde and women in Cotonou were not statistically significant. Increased schooling was associated with significantly decreased risk of HSV-2 infection in women in Kisumu and Ndola and men in Cotonou. In all the cities those with more education tended to report less risky sexual behaviour. CONCLUSIONS There was no evidence of an increased risk of HIV infection associated with education as seen in earlier studies. In each city there was some evidence of lower HIV or HSV-2 infection rates and less risky sexual behaviour associated with increased education levels. The most educated may be responding more readily to health education programmes. The challenge is to extend this to the rest of the population.

关键词： HIV schooling education risk factors herpes simplex-2 sexual behaviour Africa

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Assessing the cost and willingness to pay for voluntary HIV counselling and testing in Kenya

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HEALTH POLICY AND PLANNING 2002年第2期17卷 187-195页

作者： Forsythe, S Arthur, G Ngatia, G Mutemi, R Odhiambo, J Gilks, C Futures Grp Int POLICY Project Planning & Finance HIV AIDS Act Washington DC 20036 USA Univ Liverpool Liverpool Sch Trop Med DFID Knowledge Programme HIV AIDS STI Liverpool L3 5QA Merseyside England HIV AIDS Prevent & Care Project Nairobi Kenya Kenya Govt Med Res Ctr Nairobi Kenya Natl AIDS STD Control Programme Nairobi Kenya

Objective: Voluntary counselling and testing (VCT) should be an important component in a country's HIV/aids prevention and care strategy. However, the high cost of VCT raises concerns about the affordability of VCT in low-income countries. This study was designed to assess the costs of VCT and to identify potential ways of introducing VCT more affordably. Methodology: An economic evaluation was performed of VCT services in two rural health centres in Thika District and an urban health centre in Nairobi, Kenya. A contingent valuation study was also performed among VCT clients. Estimates were developed regarding the national cost of offering VCT services in Kenya. Results: VCT added US$6800 per year to the average cost of providing services at each of these three health centres. The evaluation revealed that the incremental cost, from the government's perspective, of adding VCT is approximately $16 per client. The estimated incremental cost per client is significantly less than a previous cost estimate in Kenya which estimated a cost per client of $26. The difference in cost estimates is in part attributable to the emphasis of this project on integrating VCT services into existing health centres, rather than creating stand-alone sites. The cost of VCT services might be further reduced to as little as $8 per client if a government health worker could perform the counselling. A contingent valuation study indicated that most VCT clients would be willing to pay at least $2 for the service. However, if the full cost of the service were charged to the client, less than 5% of clients indicated they were willing and able to pay for the service. Conclusions: Integrating services into existing health centres can significantly reduce the cost of VCT. Additional cost reductions may be feasible if health centre staff are hired to perform the counselling. Furthermore, it appears that some level of cost recovery from VCT clients is feasible and can contribute to sustainability, altho

关键词： health care health economics HIV Africa prevention education

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