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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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Social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda

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INTERNATIONAL JOURNAL OF std & aids 2003年第3期14卷 218-223页

作者： Jacobs, B Kambugu, FSK Whitworth, JAG Ochwo, M Pool, R Lwanga, A Tifft, S Lule, J Cutler, JR Medical Research Council Programme on AIDS Uganda Virus Research Institute Entebbe Uganda STD/AIDS Control Programme Ministry of Health and Mulago Hospital Kampala Uganda Commercial Market Strategies Project Kampala Uganda The Futures Group International Kampala Uganda National Drug Authority and Clinical Epidemiology Unit Makerere University Medical School Kampala Uganda USAID Uganda PO Box 7856 Kampala Uganda

We implemented social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda, and studied its feasibility, acceptability and effectiveness as a possible means to treat stds and thereby prevent HIV. Clear Seven was distributed at private health care outlets in three rural districts and two divisions of the capital. Comparisons were made with a pre-intervention period in the same sites plus one additional rural district. There were almost universally positive attitudes to Clear Seven. Cure rate (84% versus 47%), treatment compliance (93% versus 87%), and condom use during treatment (36% versus 18%) were significantly higher among Clear Seven users (n=422) than controls (n=405). Partner referral was similar but fewer Clear Seven partners were symptomatic when seeking treatment. Distribution of socially marketed pre-packaged treatment for male urethritis should be expanded in sub-Saharan Africa. Consideration should be given to developing similar kits for women.

关键词： Africa std HIV health care delivery prevention of sexual transmission

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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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Misidentification of Onchocerca volvulus as guinea worm

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ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2001年第8期95卷 821-826页

作者： Eberhard, ML Melemoko, G Zee, AK Weisskopf, MG Ruiz-Tiben, E Ctr Dis Control & Prevent Div Parasit Dis Atlanta GA 30341 USA Minist Hlth Guinea Worm Eradicat Programme Bangui Cent Afr Republ Natl Ctr HIV STD & TB Prevent Div HIV AIDS Prevent Atlanta GA 30329 USA Ctr Dis Control & Prevent Epidem Intelligence Serv Epidemiol Program Off Atlanta GA 30333 USA Emory Univ Carter Ctr Global 2000 Program Atlanta GA 30307 USA

Over the past 10 years, the status of human infection with guinea worm (Dracunculus medinensis) in the Central African Republic (CAR) has been difficult to ascertain. It is unclear if indigenous cases are occurring and whether cases are migrating into the CAR from surrounding countries. A team of investigators visited the CAR in July-August 2000, to attempt to ascertain the presence of indigenous transmission. No cases of true guinea-worm infection (i.e. dracunculiasis) were detected, but three cases of human infection with Onchocerca volvulus, each of which had been misidentified as dracunculiasis, were detected. The unusual presentation of skin blisters and extraction of an intact female O. volvulus are described. As a result of this investigation, and the confusion of onchocerciasis being misidentified as dracunculiasis, the presence of endemic transmission of guinea worm in the CAR remains in question.

关键词： COMMUNICABLE diseases -- Transmission ONCHOCERCA volvulus

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HIV/aids in Sri Lanka: The Problem and the Response

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Journal of Health Management 2000年第2期2.0卷 175-183页

作者： Abeyewickreme, Iyanthi National STD/AIDS Control Programme Colombo P.O. Box 567 Sri Lanka

Sri Lanka is considered a low-prevalence country with an estimated adult HIV prevalence of 0.07 per cent. The predominant mode of HIV transmission is through unsafe heterosexual sex. Vulnerable groups include young people, internally displaced persons and migrants from rural to urban centres. Urbanisation and temporary migration out of the country constitute other factors of HIV transmission. The national response to HIV has included targeting education programmes to young people and vulnerable groups, early treatment of sexually-transmitted diseases, blood safety and improving the provision of care. Multisectoral collaboration, ensuring access to condoms and voluntary counselling and testing besides IEC activities integrated with health services remain important priorities for the future. © 2000, Sage Publications. All rights reserved.

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Health care systems in transition III. Sri Lanka, Part II. The current status of HIV-aids in Sri Lanka

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JOURNAL OF PUBLIC HEALTH MEDICINE 2000年第1期22卷 21-24页

作者： Abeyewickreme, I de Silva, K Natl STD AIDS Control Programme Colombo Sri Lanka Off WHO Representat Colombo 7 Sri Lanka

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Amplification with molecular beacon primers and reverse line blotting for the detection and typing of human papillomaviruses

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JOURNAL OF VIROLOGICAL METHODS 2000年第1-2期89卷 29-37页

作者： Jordens, JZ Lanham, S Pickett, MA Amarasekara, S Abeywickrema, I Watt, PJ Univ Southampton Dept Mol Med Southampton SO16 6YD Hants England John Radcliffe Hosp Publ Hlth Lab Oxford OX3 9DU England Natl STD AIDS Control Programme Colombo Sri Lanka

A novel method for the detection and typing of human papillomavirus (HPV) was developed using molecular beacon primers. The method is based on the use of HPV-specific primers containing a hairpin loop structure in which fluorescent donor and quencher groups are held in close proximity such that fluorescence is quenched. Amplification of the target sequence results in the opening of the loop and the resulting fluorescence can be detected on a sequence detector system (SDS) 7700 (Applied Biosystems), as used for TaqMan(TM) assays. Fluorescent amplicons were identified on the SDS 7700 and then typed by a single hybridisation with specific probes immobilised in lines on a nylon membrane and detected on a fluorescent scanner. This novel beacon primer method compared well with conventional PCR for cervical scrape specimens. The combination of the beacon primer method and reverse line blotting should enable large-scale population studies of HPV infection. (C) 2000 Elsevier Science B.V. All rights reserved.

关键词： human papillomavirus line blotting molecular beacon primer sequence detector system

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