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Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya

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JOURNAL OF SUBSTANCE ABUSE TREATMENT 2022年 134卷 108587-108587页

作者： Mbogo, Loice W. Sambai, Betsy Guthrie, Brandon L. Bukusi, David Chohan, Bhavna Macharia, Paul Dunbar, Matt Juma, Emily Sinkele, William Gitau, Esther Tseng, Ashley S. Bosire, Rose Masyuko, Sarah Musyoki, Helgar Temu, Tecla M. Herbeck, Joshua Farquhar, Carey Monroe-Wise, Aliza Ludwig-Barron, Natasha T. Univ Washington Sch Publ Hlth Dept Epidemiol UW Box 351619 Seattle WA 98195 USA Univ Washington Sch Publ Hlth Dept Global Hlth UW Box 351620 Seattle WA 98195 USA Univ Washington Global Assistance Program Kenya Box 20723-00202 Nairobi Kenya Univ Washington Dept Med Div Allergy & Infect Dis Box 356423 Seattle WA 98195 USA Kenyatta Natl Hosp HTC & HIV Care Box 20723-00202 Nairobi Kenya Support Addict Prevent & Treatment Afr SAPTA Box 21761-00505 Nairobi Kenya Natl AIDS & STI Control Programme NASCOP Kenyatta Minist Hlth Box 19362-00202 Nairobi Kenya Kenya Med Res Inst KEMRI Ctr Clin Res Box 54840-00200 Nairobi Kenya

Background: HIV prevalence among people who inject drugs (PWID) in Kenya is estimated to be 18% compared to 4.5% in the general population. Studies from high-income countries have demonstrated that methadone use is associated with increased uptake of antiretroviral therapy (ART) and higher rates of viral suppression among PWID with HIV. However, it is unclear whether methadone use has the same effect among African PWID living with HIV. Methods: We performed a cross-sectional study to evaluate associations between methadone program partici-pation and ART uptake and viral suppression (HIV RNA viral load < 1000 copies/ml) among PWID with HIV in Kenya. Participants were recruited from needle and syringe programs and methadone clinics, interviewed on site, and samples were obtained and assayed for HIV viral loads. Univariate and multiple logistic regression were used to determine associations. Results: Among 679 participants, median age was 37 years, 48% were female, and 24% were in a methadone program. We observed higher proportions of ART use (96% vs. 87%, p = 0.001) and HIV viral suppression (78% vs. 65%, p = 0.012) among PWID on methadone compared to those not on methadone treatment. PWID who were not participating in a methadone program were 3-fold more likely to be off ART and approximately twice as likely to be viremic compared to those in methadone programs (adjusted odds ratio [aOR] = 3.35, 95% confidence interval [CI]: 1.35-8.35 and aOR = 1.90, 95% CI: 1.03-3.52, respectively). Conclusions: In this study, Kenyan PWID living with HIV participating in a methadone treatment program were more likely to be on ART and to have achieved viral suppression. Scale-up of methadone programs may have a positive impact on HIV epidemic control for this key population.

关键词： Methadone Antiretroviral therapy Viral suppression Kenya

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The complex challenges of HIV vaccine development require renewed and expanded global commitment

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LANCET 2020年第10221期395卷 384-388页

作者： Bekker, Linda-Gail Tatoud, Roger Dabis, Francois Feinberg, Mark Kaleebu, Pontiano Marovich, Mary Ndung'u, Thumbi Russell, Nina Johnson, Jeremiah Luba, Maureen Fauci, Anthony S. Morris, Lynn Pantaleo, Giuseppe Buchbinder, Susan Gray, Glenda Vekemans, Johan Kim, Jerome H. Levy, Yves Corey, Lawrence Shattock, Robin Makanga, Michael Williamson, Carolyn Dieffenbach, Carl Goodenow, Maureen M. Shao, Yiming Staprans, Silvija Warren, Mitchell Johnston, Margaret I. Univ Cape Town Desmond Tutu HIV Ctr ZA-7925 Cape Town South Africa Univ Cape Town Div Med Virol Fac Hlth Sci Cape Town South Africa San Francisco Dept Publ Hlth Bridge HIV San Francisco CA USA Fred Hutchinson Canc Res Ctr 1124 Columbia St Seattle WA 98104 USA Rech Nord & Sud Sida HIV Hepatites Paris France NIAID 9000 Rockville Pike Bethesda MD 20892 USA Int AIDS Vaccine Initiat New York NY USA NIH Off AIDS Res Bldg 10 Bethesda MD 20892 USA South African Med Res Council Cape Town South Africa Treatment Act Grp New York NY USA Uganda Virus Res Inst MRC Entebbe Uganda London Sch Hyg & Trop Med Uganda Res Unit Entebbe Uganda Int Vaccine Inst Seoul South Korea Vaccine Res Inst Creteil France Univ Paris Est Creteil INSERM U955 Creteil France AIDS Vaccine Advocacy Coalit New York NY USA European & Dev Countries Clin Trials Partnership The Hague Netherlands Natl Hlth Lab Serv Natl Inst Communicable Dis Johannesburg South Africa Univ KwaZulu Natal Ctr AIDS Program Res South Africa Durban South Africa Univ KwaZulu Natal Africa Hlth Res Inst HIV Pathogenesis Programme Durban South Africa Univ Witwatersrand Fac Hlth Sci MRC Antibody Immun Res Unit Johannesburg South Africa Univ Lausanne Serv Immunol & Allergy Univ Lausanne Hosp Lausanne Switzerland Univ Lausanne Swiss Vaccine Res Inst Univ Lausanne Hosp Lausanne Switzerland Bill & Melinda Gates Fdn Seattle WA USA Chinese Ctr Dis Control & Prevent State Key Lab Infect Dis Prevent & Control Natl Ctr AIDS STD Control & Prevent Collaborat Innovat Ctr Diag & Treatment Infect Di Beijing Peoples R China Imperial Coll London Dept Med London England Int AIDS Soc Geneva Switzerland WHO Geneva Switzerland

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Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya

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AJAR-AFRICAN JOURNAL OF aids RESEARCH 2018年第2期17卷 99-108页

作者： Prakash, Ravi Bhattacharjee, Parinita Blanchard, Andrea Musyoki, Helgar Anthony, John Kimani, Joshua Gakii, Gloria Sirengo, Martin Muraguri, Nicholas Mziray, Elizabeth Kasonde, Lombe Blanchard, James Isac, Shajy Moses, Stephen KHPT Bangalore Karnataka India Univ Manitoba Dept Community Hlth Sci Winnipeg MB Canada Minist Hlth Natl AIDS & STI Control Programme NASCOP Nairobi Kenya PHDA Nairobi Kenya Minist Hlth Nairobi Kenya World Bank 1818 H St NW Washington DC 20433 USA

While Kenya has had a long-standing national HIV-prevention programme, evidence on the level of exposure to its interventions and related effects on behavioural changes among female sex workers (FSWs) is limited. Using cross-sectional behavioural data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW programme exposure levels and behavioural outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorised programme exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention programme, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive programme exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57;95% CI: 1.08-2.31) and seeking treatment for STIs (AOR: 3.37;95% CI: 1.63-7.02) compared to FSWs with no or moderate exposure. Intensive programme exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63;95% CI: 1.19-2.24), reporting of violence to police (AOR: 2.45;95% CI: 1.03-5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63;95% CI: 0.94-2.82). Although HIV prevention programmes in Kenya have been underway for over a decade, programme efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified programme exposure (intervention depth) to enhance gains in behavioural change among FSWs and preventing the burden of HIV infection among them.

关键词： behaviour change condom use empowerment programme exposure violence

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Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination

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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 2018年第2期47卷 550-560页

作者： Lim, Aaron G. Qureshi, Huma Mahmood, Hassan Hamid, Saeed Davies, Charlotte F. Trickey, Adam Glass, Nancy Saeed, Quaid Fraser, Hannah Walker, Josephine G. Mukandavire, Christinah Hickman, Matthew Martin, Natasha K. May, Margaret T. Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol Avon England Pakistan Hlth Res Council Islamabad Pakistan Ctr Dis Control & Prevent TEPHINET Atlanta GA USA Aga Khan Univ Karachi Pakistan Ctr Dis Control & Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Natl AIDS Control Programme Islamabad Pakistan Univ Calif San Diego Dept Med Div Global Publ Hlth San Diego CA 92103 USA

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently similar to 150 000 treated annually) during 2016-30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan's HCV burden will increase markedly.

关键词： Mathematical model direct-acting antivirals prevention incidence mortality LMIC

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Human papillomavirus (HPV) associated oral cavity and oropharyngeal cancers: Cross-sectional follow-up study in South Asian country, Sri Lanka

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ANNALS OF ONCOLOGY 2018年 29卷 104-104页

作者： Alahakoon, P. K. D. P. P. Perera, K. A. Pannala, W. S. Natl Canc Inst Clin Oncol Colombo Sri Lanka Natl STD AIDS Control Programme Clin Res Colombo Sri Lanka

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Modelling the cost of hepatitis C virus transmission in Pakistan

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JOURNAL OF HEPATOLOGY 2020年 73卷 S791-S791页

作者： Lim, Aaron G. Walker, Josephine Mafirakureva, Nyashadzaishe Khalid, Gul Ghuttai Qureshi, Huma Mahmood, Hassan Trickey, Adam Fraser, Hannah Aslam, Khawar Falq, Gregoire Fortas, Camille Zahid, Hassaan Naveed, Ammara Auat, Rosa Saeed, Quaid Davies, Charlotte Mukandavire, Christinah Glass, Nancy Maman, David Martin, Natasha Hickman, Matthew May, Margaret Hamid, Saeed Sadiq Loarec, Anne Averhoff, Francisco Vickerman, Peter Univ Bristol Bristol Med Sch Populat Hlth Sci Bristol Avon England Univ Sheffield Hlth Econ & Decis Sci Sheffield S Yorkshire England Med San Frontieres Brussels Belgium Doctors Plaza Karachi Pakistan Pakistan Hlth Res Council Islamabad Pakistan World Hlth Org Islamabad Pakistan Med San Frontieres Epictr Paris France Inst Pasteur Paris France Pakistan Kidney & Liver Inst & Res Ctr Dept Gastroenterol & Hepatol Lahore Pakistan Natl AIDS Control Programme Islamabad Pakistan Imperial Coll London Dept Infect Dis Epidemiol London England US Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Calif San Diego Dept Med Div Infect Dis & Global Publ Hlth San Diego CA 92103 USA Aga Khan Univ Karachi Pakistan

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Building the Framework for Standardized Clinical Laboratory Reporting of Next-generation Sequencing Data for Resistance-associated Mutations in Mycobacterium tuberculosis Complex

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CLINICAL INFECTIOUS DISEASES 2019年第9期69卷 1634-1640页

作者： Tornheim, Jeffrey A. Starks, Angela M. Rodwell, Timothy C. Gardy, Jennifer L. Walker, Timothy M. Cirillo, Daniela M. Jayashankar, Lakshmi Miotto, Paolo Zignol, Matteo Schito, Marco Johns Hopkins Univ Sch Med Div Infect Dis Baltimore MD 21205 USA Ctr Dis Control & Prevent Div TB Eliminat Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Fdn Innovat New Diagnost Geneva Switzerland Univ Calif San Diego Div Pulm Crit Care & Sleep Med La Jolla CA 92093 USA Univ British Columbia Sch Populat & Publ Hlth Vancouver BC Canada British Columbia Ctr Dis Control Clin Prevent Serv Vancouver BC Canada Univ Oxford Nuffield Dept Med Oxford England IRCCS San Raffaele Sci Inst Milan Italy NIAID Columbus Technol Inc US Natl Inst Hlth 9000 Rockville Pike Bethesda MD 20892 USA WHO Global TB Programme Geneva Switzerland Crit Path Inst Crit Path TB Drug Regimens Tucson AZ 85718 USA

Tuberculosis is the primary infectious disease killer worldwide, with a growing threat from multidrug-resistant cases. Unfortunately, classic growth-based phenotypic drug susceptibility testing (DST) remains difficult, costly, and time consuming, while current rapid molecular testing options are limited by the diversity of antimicrobial-resistant genotypes that can be detected at once. Next-generation sequencing (NGS) offers the opportunity for rapid, comprehensive DST without the time or cost burden of phenotypic tests and can provide useful information for global surveillance. As access to NGS expands, it will be important to ensure that results are communicated clearly, consistent, comparable between laboratories, and associated with clear guidance on clinical interpretation of results. In this viewpoint article, we summarize 2 expert workshops regarding a standardized report format, focusing on relevant variables, terminology, and required minimal elements for clinical and laboratory reports with a proposed standardized template for clinical reporting NGS results for Mycobacterium tuberculosis.

关键词： tuberculosis next-generation sequencing reporting standardization interpretation

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Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women

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NATURE MEDICINE 2018年第4期24卷 491-+页

作者： McKinnon, Lyle R. Liebenberg, Lenine J. Yende-Zuma, Nonhlanhla Archary, Derseree Ngcapu, Sinaye Sivro, Aida Nagelkerke, Nico Lerma, Jose Gerardo Garcia Kashuba, Angela D. Masson, Lindi Mansoor, Leila E. Karim, Quarraisha Abdool Karim, Salim S. Abdool Passmore, Jo-Ann S. Ctr AIDS Programme Res South Africa CAPRISA Durban South Africa Univ Manitoba Dept Med Microbiol Winnipeg MB Canada Univ KwaZulu Natal Dept Med Microbiol Durban South Africa Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ North Carolina Chapel Hill Eschelman Sch Pharm Chapel Hill NC USA Univ Cape Town Inst Infect Dis & Mol Med IDM Cape Town South Africa Columbia Univ Dept Epidemiol New York NY USA Natl Hlth Lab Serv Cape Town South Africa

Several clinical trials have demonstrated that antiretroviral (ARV) drugs taken as pre-exposure prophylaxis (PrEP) can prevent HIV infection1, with the magnitude of protection ranging from -49 to 86% (refs. 2-11). Although these divergent outcomes are thought to be due primarily to differences in product adherence(12), biological factors likely contribute(13). Despite selective recruitment of higher-risk participants for prevention trials, HIV risk is heterogeneous even within higher-risk groups(14-16). To determine whether this heterogeneity could influence patient outcomes following PrEP, we undertook a post hoc prospective analysis of results from the CAPRISA 004 trial for 1% tenofovir gel (n = 774 patients), one of the first trials to demonstrate protection against HIV infection. Concentrations of nine proinflammatory cytokines were measured in cervicovaginal lavages at >2,000 visits, and a graduated cytokine score was used to define genital inflammation. In women without genital inflammation, tenofovir was 57% protective against HIV (95% confidence interval (CI): 7-80%) but was 3% protective (95% CI: -104-54%) if genital inflammation was present. Among women who highly adhered to the gel, tenofovir protection was 75% (95% CI: 25-92%) in women without inflammation compared to -10% (95% CI: -184-57%) in women with inflammation. Immunological predictors of HIV risk may modify the effectiveness of tools for HIV prevention;reducing genital inflammation in women may augment HIV prevention efforts.

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Assisted HIV partner services training in three sub-Saharan African countries: facilitators and barriers to sustainable approaches

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JOURNAL OF THE INTERNATIONAL aids SOCIETY 2019年第S3期22卷 e25307页

作者： Han, Hannah Myers, Serene Khan, Eveline Mboh Masyukoi, Sarah J. Paredes, Zulmira Chimoun, Francois T. Mudender, Florindo Wamuti, Beatrice M. Nambu, Winifred Kemunto, Emily Mugambi, Mary Kariithi, Edward Golden, Matthew R. Tih, Pius M. Welty, Thomas Farquhar, Carey Univ Washington Dept Global Hlth Seattle WA 98195 USA I TECH Seattle WA USA Cameroon Baptist Convent Hlth Serv AIDS Care & Prevent Program Bamenda Cameroon Minist Hlth Natl AIDS & STI Control Programme Nairobi Kenya I TECH Maputo Mozambique PATH Kisumu Kenya Univ Washington Dept Epidemiol Seattle WA 98195 USA Univ Washington Dept Med Seattle WA USA Publ Hlth Seattle & King Cty HIV STD Program Seattle WA USA

Introduction: Healthcare worker training is essential to successful implementation of assisted partner services (aPS), which aims to improve HIV testing and linkage-to-care outcomes for previously unidentified HIV-positive individuals. Cameroon, Kenya and Mozambique are three African countries that have implemented aPS programmes and are working to bring those programmes to scale. In this paper, we present and compare different aPS training strategies implemented by these three countries, and discuss facilitators and barriers associated with implementation of aPS training in sub-Saharan Africa. Discussion: aPS training programmes in Cameroon, Kenya and Mozambique share the following components: the development of comprehensive and interactive training curricula, recruitment of qualified trainees and trainers with intimate knowledge of the community served, continuous training, and rigorous monitoring and evaluation activities. Cameroon and Kenya were able to engage various stakeholders early on, establishing multilateral coalitions that facilitated attainment of long-term buy-in from the local governments. Ministries of Health and various implementing partners are often included in strategic planning and delivery of training curricula to ensure sustainability of the training programmes. Kenya and Mozambique have integrated aPS training into the national HTS guidelines, which are being rolled out nationwide by the Ministries of Health and implementing partners. Continual revision of training curricula to reflect the country context, as well as ongoing monitoring and evaluation, have also been identified as key facilitators to sustain aPS training programmes. Some of the barriers to scale-up and sustainability of aPS training include limited funding and resources for training and scale-up and shortage of aPS providers to facilitate on-the-job mentorship. Conclusions: These three programmes demonstrate that aPS training can be implemented and scaled up in sub-Saharan A

关键词： partner services HIV/aids training strategies facilitators and barriers sustainability sub-Saharan Africa

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Ecologies of security: On the everyday security tactics of female sex workers in Nairobi, Kenya

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GLOBAL PUBLIC HEALTH 2018年第12期13卷 1767-1780页

作者： Lorway, Robert Lazarus, Lisa Chevrier, Claudyne Khan, Shamshad Musyoki, Helgar K. Mathenge, John Mwangi, Peninah Macharia, Pascal Bhattacharjee, Parinita Isac, Shajy Kimani, Joshua Gaaki, Gloria Becker, Marissa Moses, Stephen Blanchard, James Univ Manitoba Dept Community Hlth Sci Ctr Global Publ Hlth Winnipeg MB Canada Univ Texas San Antonio Dept Commun San Antonio TX USA Minist Hlth Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Hlth Opt Young Men HIV AIDS & STIs HOYMAS Nairobi Kenya Kenya Sex Workers Alliance KESWA Nairobi Kenya BHESP Nairobi Kenya Univ Manitoba Key Populat Tech Support Unit TSU Nairobi Kenya Karnataka Hlth Promot Trust Bengaluru Karnataka India Univ Nairobi Dept Med Microbiol Nairobi Kenya Partners Hlth & Dev SWOP Nairobi Kenya

This paper highlights important environmental dimensions of HIV vulnerability by describing how the sex trade operates in Nairobi, Kenya. Although sex workers there encounter various forms of violence and harassment, as do sex workers globally, we highlight how they do not merely fall victim to a set of environmental risks but also act upon their social environment, thereby remaking it, as they strive to protect their health and financial interests. In so doing, we illustrate the mutual constitution of 'agency' and 'structure' in social network formations that take shape in everyday lived spaces. Our findings point to the need to expand the focus of interventions to consider local ecologies of security in order to place the local knowledges, tactics, and capacities that communities might already possess on centre stage in interventions. Planning, implementing, and monitoring interventions with a consideration of these ecologies would tie interventions not only to the risk reduction goals of global public health policy, but also to the very real and grounded financial priorities of what it means to try to safely earn a living through sex work.

关键词： Kenya female sex work HIV security affect

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