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Brouwer, C. N. M., C. L. Lok, I. Wolffers, and S. Sebagalls. "Psychosocial and economic aspects of HIV/AIDS and counselling of caretakers of HIV-infected children in Uganda." AIDS Care 12, no. 5 (October 2000): 535–40. http://dx.doi.org/10.1080/095401200750003725.
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Odwee, Ambrose, Keneth Iceland Kasozi, Christine Amongi Acup, Patrick Kyamanywa, Robinson Ssebuufu, Richard Obura, Jude B Agaba, et al. "Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda." African Health Sciences 20, no. 1 (April 20, 2020): 122–31. http://dx.doi.org/10.4314/ahs.v20i1.17.
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Background: Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients.
Methods: A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors.
Results: The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 – 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with op- portunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition.
Discussion: In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities.
Conclusion: Malnutrition is a threat in HIV adult patients in rural communities of Uganda.
Keywords: Malnutrition; HIV adult patients; Bushenyi district; Uganda.
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Kiyingi, Joshua, Proscovia Nabunya, Ozge Sensoy Bahar, Larissa Jennings Mayo-Wilson, Yesim Tozan, Josephine Nabayinda, Flavia Namuwonge, et al. "Prevalence and predictors of HIV and sexually transmitted infections among vulnerable women engaged in sex work: Findings from the Kyaterekera Project in Southern Uganda." PLOS ONE 17, no. 9 (September 29, 2022): e0273238. http://dx.doi.org/10.1371/journal.pone.0273238.
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Introduction Women engaged in sex work (WESW) have an elevated risk of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Estimates are three times higher than the general population. Understanding the predictors of HIV and STI among WESW is crucial in developing more focused HIV and STI prevention interventions among this population. The study examined the prevalence and predictors of HIV and STI among WESW in the Southern part of Uganda. Methodology Baseline data from the Kyaterekera study involving 542 WESW (ages 18–55) recruited from 19 HIV hotspots in the greater Masaka region in Uganda was utilized. HIV and STI prevalence was estimated using blood and vaginal fluid samples bioassay. Hierarchical regression models were used to determine the predictors of HIV and STI among WESW. Results Of the total sample, 41% (n = 220) were found to be HIV positive; and 10.5% (n = 57) tested positive for at least one of the three STI (Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis) regardless of their HIV status. Older age (b = 0.09, 95%CI = 0.06, 0.13, p≤0.001), lower levels of education (b = -0.79, 95%CI = -1.46, -0.11, p≤0.05), fewer numbers of children in the household (b = -0.18, 95%CI = -0.36, -0.01), p≤0.05), location (i.e., fishing village (b = 0.51, 95%CI = 0.16, 0.85, p≤0.01) or small town (b = -0.60, 95%CI = -0.92, -0.28, p≤0.001)), drug use (b = 0.58, 95%CI = 0.076, 1.08, p≤0.05) and financial self-efficacy (b = 0.05, 95%CI = -0.10, 0.00, p≤0.05), were associated with the risk of HIV infections among WESW. Domestic violence attitudes (b = -0.24, 95%CI = -0.42, -0.07, p≤0.01) and financial distress (b = -0.07, 95%CI = -0.14, -0.004, p≤0.05) were associated with the risk of STI infection among WESW. Conclusion Study findings show a high prevalence of HIV among WESW compared to the general women population. Individual and family level, behavioural and economic factors were associated with increased HIV and STI infection among WESW. Therefore, there is a need for WESW focused HIV and STI risk reduction and economic empowerment interventions to reduce these burdens.
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Bloch, Sonja C. M., Louise J. Jackson, Emma Frew, and Jonathan D. C. Ross. "Assessing the costs and outcomes of control programmes for sexually transmitted infections: a systematic review of economic evaluations." Sexually Transmitted Infections 97, no. 5 (March 2, 2021): 334–44. http://dx.doi.org/10.1136/sextrans-2020-054873.
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ObjectiveTo identify economic evaluations of interventions to control STIs and HIV targeting young people, and to assess how costs and outcomes are measured in these studies.DesignSystematic review.Data sourcesSeven databases were searched (Medline (Ovid), EMBASE (Ovid), Web of Science, PsycINFO, NHS Economic Evaluation Database, NHS Health Technology Assessment and Database of Abstracts of Reviews of Effects) from January 1999 to April 2019. Key search terms were STIs (chlamydia, gonorrhoea, syphilis) and HIV, cost benefit, cost utility, economic evaluation, public health, screening, testing and control.Review methodsStudies were included that measured costs and outcomes to inform an economic evaluation of any programme to control STIs and HIV targeting individuals predominantly below 30 years of age at risk of, or affected by, one or multiple STIs and/or HIV in Organisation for Economic Co-operation and Development countries. Data were extracted and tabulated and included study results and characteristics of economic evaluations. Study quality was assessed using the Philips and BMJ checklists. Results were synthesised narratively.Results9530 records were screened and categorised. Of these, 31 were included for data extraction and critical appraisal. The majority of studies assessed the cost-effectiveness or cost-utility of screening interventions for chlamydia from a provider perspective. The main outcome measures were major outcomes averted and quality-adjusted life years. Studies evaluated direct medical costs, for example, programme costs and 11 included indirect costs, such as productivity losses. The study designs were predominantly model-based with significant heterogeneity between the models.Discussion/ConclusionNone of the economic evaluations encompassed aspects of equity or context, which are highly relevant to sexual health decision-makers. The review demonstrated heterogeneity in approaches to evaluate costs and outcomes for STI/HIV control programmes. The low quality of available studies along with the limited focus, that is, almost all studies relate to chlamydia, highlight the need for high-quality economic evaluations to inform the commissioning of sexual health services.
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Yaung Kwee, Yaung Kwee, and Alfinda Novi Kristanti and Mochamad Zakki Fahmi Alfinda Novi Kristanti and Mochamad Zakki Fahmi. "Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review." Journal of the chemical society of pakistan 43, no. 3 (2021): 361. http://dx.doi.org/10.52568/000570/jcsp/43.03.2021.
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Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.
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Yaung Kwee, Yaung Kwee, and Alfinda Novi Kristanti and Mochamad Zakki Fahmi Alfinda Novi Kristanti and Mochamad Zakki Fahmi. "Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review." Journal of the chemical society of pakistan 43, no. 3 (2021): 361. http://dx.doi.org/10.52568/000570.
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Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.
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Peprah, Emmanuel, Elisabet Caler, Anya Snyder, and Fassil Ketema. "Deconstructing Syndemics: The Many Layers of Clustering Multi-Comorbidities in People Living with HIV." International Journal of Environmental Research and Public Health 17, no. 13 (June 30, 2020): 4704. http://dx.doi.org/10.3390/ijerph17134704.
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The HIV epidemic has dramatically changed over the past 30 years; there are now fewer newly infected people (especially children), fewer AIDS-related deaths, and more people with HIV (PWH) receiving treatment. However, the HIV epidemic is far from over. Despite the tremendous advances in anti-retroviral therapies (ART) and the implementation of ART regimens, HIV incidence (number of new infections over a defined period of time) and prevalence (the burden of HIV infection) in certain regions of the world and socio-economic groups are still on the rise. HIV continues to disproportionally affect highly marginalized populations that constitute higher-risk and stigmatized groups, underserved and/or neglected populations. In addition, it is not uncommon for PWH to suffer enhanced debilitating conditions resulting from the synergistic interactions of both communicable diseases (CDs) and non-communicable diseases (NCDs). While research utilizing only a comorbidities framework has advanced our understanding of the biological settings of the co-occurring conditions from a molecular and mechanistic view, harmful interactions between comorbidities are often overlooked, particularly under adverse socio-economical and behavioral circumstances, likely prompting disease clustering in PWH. Synergistic epidemics (syndemics) research aims to capture these understudied interactions: the mainly non-biological aspects that are central to interpret disease clustering in the comorbidities/multi-morbidities only framework. Connecting population-level clustering of social and health problems through syndemic interventions has proved to be a critical knowledge gap that will need to be addressed in order to improve prevention and care strategies and bring us a step closer to ending the HIV epidemic.
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Kamitani, Emiko, Adebukola H. Johnson, Megan Wichser, Yuko Mizuno, Julia B. DeLuca, and Darrel H. Higa. "Mapping the study topics and characteristics of HIV pre-exposure prophylaxis research literature: a protocol for a scoping review." BMJ Open 9, no. 5 (May 2019): e024212. http://dx.doi.org/10.1136/bmjopen-2018-024212.
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IntroductionThe research literature addressing pre-exposure prophylaxis (PrEP) has increased considerably over the last decade. To better understand the research areas and explore research gaps, we will conduct a scoping review to map study topics and describe study characteristics and populations in publications focused on PrEP. The purpose of this protocol is to describe planned methods for the scoping review.Methods and analysisWe will implement a comprehensive systematic literature search to identify PrEP citations in the United States Centres for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database that is unique and extensively focuses on HIV/sexually transmitted infections/hepatitis. We will screen and include studies that are (1) focused on HIV PrEP, (2) primary research with human participants and (3) published in English. Two reviewers will independently abstract data on authors’ names, study years, countries, population characteristics and design. To describe and summarise study topics, we will use 19 codes and five categories that were developed from a preliminary study. The five categories arecategory 1: potential PrEP user/prescriber(behaviours/issues for potential PrEP takers/healthcare professionals),category 2: considerations while on PrEP(experiences of and problems related to staying on or prescribing PrEP),category 3: PrEP efficacy and safety(biomedical aspects and medication efficacy),category 4: methods of and experiences with PrEP clinical trials(possesses/experiences of clinical trials) andcategory 5: cost-effectiveness or economic evaluation(cost studies). Data will be analysed with descriptive statistics.Ethics and disseminationThe findings will be presented at HIV-related conferences and published in peer-review journals.
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Fish, Douglas N. "Prophylaxis of HIV Infection following Occupational Exposure." Annals of Pharmacotherapy 27, no. 10 (October 1993): 1243–56. http://dx.doi.org/10.1177/106002809302701015.
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OBJECTIVE: To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis. DATA SOURCES: English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis. STUDY SELECTION: Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included. DATA EXTRACTION: In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed. DATA SYNTHESIS: Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain. CONCLUSIONS: Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.
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Gorantla, Misha, and Nagaraj Kondagunta. "Clinico demographic profile of newly diagnosed HIV sero positive patients attending an ART centre: a cross sectional study." International Journal Of Community Medicine And Public Health 4, no. 8 (July 22, 2017): 2895. http://dx.doi.org/10.18203/2394-6040.ijcmph20173342.
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Background: India faces a high burden of HIV. An understanding of the determinants of this disease is of vital importance in curtailing this epidemic. The objective was to study the clinico-demographic profile of the study subject.Methods: This is a cross sectional study done on 142 patients which includes all newly diagnosed (diagnosed on or after 1st January 2012), sero positive, adult patients, enrolled at ART centre, Nalgonda and started on treatment during the months of December 2012, January 2013, February 2013. A pre designed, pre tested questionnaire was used. Data regarding their demographic characteristics and various clinical aspects was obtained. Results: Out of a total of 142 study subjects, majority (78.88%) belonged to economically productive age group (16-45 years). Married individuals constituted a majority (79.57%). A majority of the subjects were skilled laborers, belonged to lower middle class of BG Prasad classification, hailed from rural areas and belonged to nuclear families. Very few had high educational attainment. A majority (95.78%) reported not using condoms during their last sexual act and 9.16% subjects reported being previously diagnosed with an STD. Most common presenting complaint was fever and most common opportunistic infections were candidiasis and tuberculosis. Majority were found to belong to stage 1 HIV. Participants were mostly underweight and had severe anaemia. Majority had CD4 count between 201- 350 cells/mm3. Conclusions: Interventions targeting improvement in socio economic status, education levels, nutritional status as well as awareness about condom use must be built into the national HIV programme.
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Puplampu, Adikwor Ewoenam, Seth Afagbedzi, Samuel Dery, Dzifa Adimle Puplampu, and Chris Guure. "Determinants of Higher-Risk Sexual Behavior in Some Selected African Countries." Scientifica 2021 (September 3, 2021): 1–13. http://dx.doi.org/10.1155/2021/8089293.
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Background. Although higher-risk sexual behavior (H-RSB) is a major contributor to the rapid rising rate of new HIV infections, there exists paucity of comprehensive evidence across the sub-Saharan African region. The purpose of this study was to determine the prevalence of H-RSB and its determinants across sub-Saharan Africa to inform policy. Method. Data were obtained from the Demographic and Health Survey (DHS) of ten sub-Saharan African (SSA) countries with their three most current DHS surveys from 2000 to 2016. Only participants who ever had sexual encounters in their lifetime were included in the study. Weighted adjusted Cox regression with robust variance and constant time was used to investigate disparities of H-RSB among the ten SSA countries. Relationships between sociodemographic, socioeconomic, knowledge, mass media, and H-RSB were investigated. Results. The trend and prevalence of higher-risk sexual behavior show that Lesotho experienced a decreasing trend of the prevalence of H-RSB from 8.92 in period one to 6.42 in period three. Ghana experienced a marginal increase from 6.22 in period one to 6.76 in period two and then to 6.43 in the third period. However, Malawi, Zambia, and Zimbabwe obtained a marginal increasing trend in the prevalence of H-RSB from period one to three: 2.75 to 3.74, 4.33 to 6.24, and 6.11 to 7.99, respectively. Meanwhile, the prevalence of H-RSB in Namibia and Uganda decreased in period two to 1.84 and 5.76 but increased in period three to 2.01 and 6.83, respectively. Generally, determinants of H-RSB among the countries include age, sex, religious affiliation, marital status, educational level, employment status, economic status, age at first sex, and status of circumcision. Conclusion. Trend of relatively high prevalence of H-RSB has been found across majority of the countries with key sociodemographic factors influencing H-RSB. Therefore, different targeted interventional approaches are needed in all the countries to help reduce H-RSB and the overall HIV incidence. If issues regarding sexual behavior and sexual health are not addressed adequately, H-RSB can negate all the appreciable efforts aimed at ending the HIV pandemic by 2030.
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MacCarthy, Sarah, Max Izenberg, Joanna L. Barreras, Ron A. Brooks, Ana Gonzalez, and Sebastian Linnemayr. "Rapid mixed-methods assessment of COVID-19 impact on Latinx sexual minority men and Latinx transgender women." PLOS ONE 15, no. 12 (December 31, 2020): e0244421. http://dx.doi.org/10.1371/journal.pone.0244421.
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We conducted a rapid, mixed-methods assessment to understand how COVID-19 affected Latinx sexual minority men (LSMM) and transgender women (LTGW). Using a computer-assisted telephone interviewing software, one interviewer called 52 participants (randomly sampled from a larger HIV prevention pilot study aiming to increase HIV knowledge and testing frequency; n = 36 LSMM and n = 16 LTGW) between 04/27/20-05/18/20. We quantified core domains using the Epidemic-Pandemic Impacts Inventory scale and provided important context through open-ended qualitative questions assessing: 1) COVID-19 infection history and experiences with quarantine; 2) Health and healthcare access; 3) Employment and economic impact of COVID-19. Participants reported increases in physical conflict or verbal arguments with a partner (13.5%) or other adult(s) (19.2%) due to stressors associated with the safer-at-home order. Participants also reported increased alcohol consumption (23.1%), problems with sleep (67.3%) and mental health (78.4%). Further, disruptions in access to Pre-Exposure Prophylaxis or PrEP–a daily pill to prevent HIV–occurred (33.3% of 18 participants who reported being on PrEP). Many said they received less medical attention than usual (34.6%), and LTGW reported delays in critical gender-affirming hormones/procedures. Half of the participants lost their jobs (50.0%); many undocumented participants relayed additional financial concerns because they did not qualify for financial assistance. Though no COVID-19 infections were noted, COVID-19 dramatically impacted other aspects of health and overall wellbeing of LSMM and LTGW. Public health responses should address the stressors faced by LSMM and LTGW during the COVID-19 pandemic and the impact on wellbeing.
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Seguin, Maureen, Catherine Dodds, Esther Mugweni, Lisa McDaid, Paul Flowers, Sonali Wayal, Ella Zomer, et al. "Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study." Health Technology Assessment 22, no. 22 (April 2018): 1–158. http://dx.doi.org/10.3310/hta22220.
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Background Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. Objectives To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). Design A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. Setting Twelve general practices and three community settings in London. Main outcome measure HIV SSK return rate. Results Stage 1 – the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 – of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. Limitations Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. Conclusions Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. Future work Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. Study registration This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. Funding The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.
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Nakalega, Rita, Carolyne Akello, Brenda Gati, Clemensia Nakabiito, Monica Nolan, Betty Kamira, Juliane Etima, et al. "Ethical considerations for involving adolescents in biomedical HIV prevention research." BMC Medical Ethics 22, no. 1 (September 23, 2021). http://dx.doi.org/10.1186/s12910-021-00695-3.
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Abstract Background Involvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda. Methods From August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions. Results Most community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention. Conclusions Stakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining adolescents in HIV clinical trials and identifying practical strategies to ensure high ethical standards during trial implementation.
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Joss, Jennifer L., Heather L. Pearcey, and Tara V. Postnikoff. "The Syphilis and HIV Connection: A Model in defense of an Anthropology of Sexually Transmitted Infections." NEXUS: The Canadian Student Journal of Anthropology 15, no. 1 (January 1, 2001). http://dx.doi.org/10.15173/nexus.v15i1.177.
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This paper was initiated as an effort to improve our understanding of health-seeking behaviour in individuals with sexually transmitted infections. It quickly became apparent that the social, cultural, economic, biological and political issues that influence health-seeking behaviour in individuals with sexually transmitted infections greatly differed from those who have or had other diseases. Through a critique of the most current model describing sexually transmitted infection health-seeking behaviour developed by Aral and Wasserheit (1999), this paper presents a focused argument for an anthropology of sexually transmitted infections. The Aral and Wasserheit (1999) model fails to significantly describe the health-seeking behaviour of individuals infected with more than one sexually transmitted infection simultaneously. By examining aspects of pathocenosis and epidemiological synergy, it was found that the complex interactions between syphilis and HIV/AIDS changes the way we should study health-seeking behaviour for individuals with sexually transmitted infections in general. Therefore, while examining the syphilis/HIV paradigm, it became clear that an anthropology of sexually transmitted infections is in fact necessary.
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Ssekamatte, Tonny, John Bosco Isunju, Muyanga Naume, Esther Buregyeya, Richard K. Mugambe, Rhoda K. Wanyenze, and Justine N. Bukenya. "Barriers to access and utilisation of HIV/STIs prevention and care services among trans-women sex workers in the greater Kampala metropolitan area, Uganda." BMC Infectious Diseases 20, no. 1 (December 2020). http://dx.doi.org/10.1186/s12879-020-05649-5.
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Abstract Background Trans-women sex workers bear the greatest brunt of HIV and other sexually transmitted infections (STI). Trans-women are 49 times more at risk of HIV infections compared to the general population. However, they remain underserved and continue to grapple with access to and utilisation of HIV/STI prevention services. This study explored barriers to access and utilisation of HIV/STI prevention services and associated coping mechanisms. Methods This exploratory qualitative study was conducted among trans-women sex workers in the Greater Kampala Metropolitan area, Uganda. A total of 22 in-depth interviews, 6 key informant interviews and 9 focus group discussions were conducted to obtain data on barriers to access and utilisation of HIV and other STI prevention and care services, and coping strategies of trans-women sex workers. Data were analysed through thematic analysis using a hybrid of inductive and deductive approaches. Results Individual level barriers to access and utilisation of HIV/STI prevention and care services included internalised stigma and low socio-economic status. Healthcare system barriers included social exclusion and lack of recognition by other key population groups; stigmatisation by some healthcare providers; breach of confidentiality by some healthcare providers; limited hours of operation of some key population-friendly healthcare facilities; discrimination by straight patients and healthcare providers; stockout of STI drugs; inadequate access to well-equipped treatment centres and high cost of drugs. At community level, transphobia hindered access and utilisation of HIV/STI prevention and care services. The coping strategies included use of substitutes such as lotions, avocado or yoghurt to cope with a lack of lubricants. Herbs were used as substitutes for STI drugs, while psychoactive substances were used to cope with stigma and discrimination, and changing the dress code to hide their preferred gender identity. Conclusions Individual, community and healthcare system barriers hindered access and utilisation of HIV/STI prevention and care services among the trans-women sex workers. There is a need to create an enabling environment in order to enhance access to and utilisation of HIV/STI prevention and care services for trans-women sex workers through sensitisation of healthcare providers, other key population groups and the community at large on the transgender identity.
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Nuwamanya, Elly, Robinah Nalwanga, Afra Nuwasiima, Janet U. Babigumira, Francis T. Asiimwe, Joseph B. Babigumira, and Vitalis P. Ngambouk. "Effectiveness of a mobile phone application to increase access to sexual and reproductive health information, goods, and services among university students in Uganda: a randomized controlled trial." Contraception and Reproductive Medicine 5, no. 1 (October 31, 2020). http://dx.doi.org/10.1186/s40834-020-00134-5.
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Abstract Background University students are one of the most vulnerable groups to sexual reproductive health [SRH] threats like sexually transmitted infections [STIs], unwanted pregnancies, and unsafe abortions and often have limited access to SRH information, goods, and services. This study assessed the effectiveness of using a mobile phone application (APP) to increase access to SRH information, goods, and services among university students in Uganda. Methods Using data from a double-blinded randomized controlled trial, participants were randomly assigned to both the intervention (APP) and control (standard of care) arms. We executed descriptive analyses for baseline demographic characteristics by intervention, difference in difference (DID), and quantile regression analyses for both primary and secondary outcomes. Results The median age of participants was 21 years of age, and the majority were female (over 60%), unemployed (over 85%) and Christian (90%). Over 50% were resident in off-campus hostels and in a relationship. Between baseline and end-line, there was a significant increase in SRH knowledge score (DID = 2, P < 0.001), contraceptive use (DID = 6.6%, P < 0.001), HIV Voluntary testing and counselling (DID = 17.2%, P < 0.001), STI diagnosis and treatment (DID = 12.9%, P < 0.001), and condom use at last sex (DID = 4%,P = 0.02) among students who used the APP. There was a significant 0.98 unit increase in knowledge score (adjusted coefficient = 0.98, P < 0.001), a significant 1.6-fold increase in odds of contraceptive use (adjusted coefficient = 1.6, P = 0.04), a significant 3.5-fold increase in HIV VCT (adjusted coefficient = 3.5, P < 0.001), and a significant 2-fold increase in odds of STI testing and treatment (adjusted coefficient = 1.9, P < 0.001) after adjusting for demographic characteristics among APP users compared to the control group. Conclusion A mobile phone application increased sexual and reproductive health information (knowledge score), access to goods (contraceptives), and services (HIV voluntary testing and counseling and sexually transmitted infection diagnosis and management) among sexually active university students in Uganda. Further technical development, including the refinement of youth-friendly attributes, extending access to the app with other platforms besides android which was pilot tested, as well as further research into potential economic impact and paths to sustainability, is needed before the app is deployed to the general youth population in Uganda and other low-income settings. Trial registration MUREC1/7 No. 07/05–18. Registered on June 29, 2018.
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Maqbool, Mudasir, Misba Khan, Maqsood Mohammad, Miracle Ayomikun Adesina, and Ginenus Fekadu. "AWARENESS ABOUT REPRODUCTIVE HEALTH IN ADOLESCENTS AND YOUTH: A REVIEW." Journal of Applied Pharmaceutical Sciences and Research, October 27, 2019, 1–5. http://dx.doi.org/10.31069/japsr.v2i3.1.
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Reproductive health is a relatively new concept that recognizes that especially a young girl has special reproductive health needs before, during and beyond the childbearing age. It also lays emphasis on the fact that health (more importantly reproductive health) of the present generation has an everlasting effect on the overall health of the next generation and that both are of crucial importance for socio-economic development. Reproductive health need of young people especially for young girls and women includes needs for reproductive health care, family planning, HIV/AIDS information, safer sex, unwanted pregnancy, early pregnancy, sexually transmitted diseases (STDs), safe abortion and safe motherhood. Recently a number of programs for school going adolescent in India have focused on information, education, and communication with a limited focus on the provision of clinical and counseling services on reproductive health. Educational programs can increase awareness about reproductive health but this awareness may not always translate into appropriate help-seeking behavior by adolescents. The limited knowledge about reproductive health issues makes young girls vulnerable to various diseases and infections including HIV/AIDS/STDs, substance abuse, sexual violence, and exploitation. In this paper, we would briefly focus on various aspects of reproductive health.
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Kansiime, Catherine, Laura Hytti, Kate Andrews Nelson, Belen Torondel, Suzanna C. Francis, Clare Tanton, Giulia Greco, et al. "Menstrual health interventions, schooling, and mental health problems among Ugandan students (MENISCUS): study protocol for a school-based cluster-randomised trial." Trials 23, no. 1 (September 7, 2022). http://dx.doi.org/10.1186/s13063-022-06672-4.
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Abstract Background Menstrual health is an increasingly recognised public health issue, defined as complete physical, mental, and social well-being in relation to the menstrual cycle. The MENISCUS trial aims to assess whether a multi-component intervention addressing physical and emotional aspects of menstrual health improves educational attainment, mental health problems, menstrual management, self-efficacy, and quality of life among girls in secondary school in Uganda. Methods The study is a parallel-arm cluster-randomised controlled trial with 60 schools (clusters) in Wakiso and Kalungu districts, with a mixed-methods process evaluation to assess intervention fidelity and acceptability and economic and policy analyses. The schools will be randomised 1:1 to immediate intervention or to optimised usual care with delayed intervention delivery. The intervention includes creation of a Menstrual Health Action Group at schools and NGO-led training of trainers on puberty education, development of a drama skit, delivery of a menstrual health kit including reusable pads and menstrual cups, access to pain management strategies including analgesics, and basic improvements to school water, sanitation, and hygiene facilities. Baseline data will be collected from secondary 2 students in 2022 (median age ~15.5 years), with endline after 1 year of intervention delivery (~3600 females and a random sample of ~900 males). The primary outcomes assessed in girls are (i) examination performance based on the Mathematics, English, and Biology curriculum taught during the intervention delivery (independently assessed by the Uganda National Examinations Board) and (ii) mental health problems using the Total Difficulties Scale of the Strengths and Difficulties 25-item questionnaire. Secondary outcomes are menstrual knowledge and attitudes in girls and boys and, in girls only, menstrual practices, self-efficacy in managing menstruation, quality of life and happiness, prevalence of urogenital infections, school and class attendance using a self-completed menstrual daily diary, and confidence in maths and science. Discussion The trial is innovative in evaluating a multi-component school-based menstrual health intervention addressing both physical and emotional aspects of menstrual health and using a “training of trainers” model designed to be sustainable within schools. If found to be cost-effective and acceptable, the intervention will have the potential for national and regional scale-up. Trial registration ISRCTN 45461276. Registered on 16 September 2021
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Giuliani, Giuseppe, Giovanni Ricevuti, Antonio Galoforo, and Marianno Franzini. "Microbiological aspects of ozone: bactericidal activity and antibiotic/antimicrobial resistance in bacterial strains treated with ozone." Ozone Therapy 3, no. 3 (December 18, 2018). http://dx.doi.org/10.4081/ozone.2018.7971.
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Antimicrobial resistance is one of the most complex global health challenges today. The world has long ignored warnings that antibiotics and other medicines are losing their effectiveness after decades of overuse and misuse in human medicine, animal health and agriculture. Common illnesses like pneumonia, postoperative infections, diarrhoeal and sexually transmitted diseases, as well as the world’s largest infectious disease killers – tuberculosis (TB), HIV and malaria – are increasingly becoming untreatable because of the emergence and spread of drug resistance. Worsening antimicrobial resistance could have serious public health, economic and social implications. The threat of antimicrobial resistance is also becoming a key consideration for programmes addressing maternal and child health, sexual and reproductive health, foodborne diseases, water and sanitation, and infection prevention and control. Although the 21st century is being shaped by technology and innovation, humans could soon find themselves in an era where simple infections once again kill millions every year. The past three years have seen unprecedented global political momentum to address antimicrobial resistance: in 2015, governments adopted a global action plan at the World Health Assembly and in 2016 passed a political declaration at the United Nations General Assembly. Antimicrobial resistance has made it onto the agendas of the G7 and G20 groups and is a core component of the Global Health Security Agenda. WHO is working closely with the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health in leading global efforts against antimicrobial resistance and ensuring that the necessary momentum is consolidated and sustained. These efforts are guided by an ad-hoc interagency coordination group established in 2017. A global development and stewardship framework to combat antimicrobial resistance is being drafted to support the development of new antimicrobial medicines, diagnostics, vaccines and other tools. One of the gravest global concerns about antimicrobial resistance currently is that antibiotic resistance has emerged in so many pathogens, including TB. In 2016, at the high-level meeting of the UN General Assembly on antimicrobial resistance, Heads of State directed an unprecedented level of attention to curbing the spread of infections that are resistant to antimicrobial medicines. They reaffirmed their commitment to stopping the misuse of antimicrobial medicines in human health, animal health and agriculture, and recognized the need for stronger systems to monitor drug-resistant infections and the amounts of antimicrobials used in humans and animals. In the wake of the increasing global awareness of the need for new antibiotics, Member States highlighted market failures, and called for new incentives for investment in research and development of new, effective and affordable medicines, rapid diagnostic tests, and other important therapies to replace those that are losing their effectiveness. In response to this and in line with the Global Action Plan on Antimicrobial Resistance to support the identification of pathogens of greatest concern, WHO developed a priority list of antibiotic resistant bacteria to underpin renewed efforts for the research and development of new antibiotics. The only possible defence against the threat of antimicrobial resistance and the (very real) possibility of a post-antibiotic era is a global and coordinated effort by all stakeholders to support other important therapies such as the Oxygen-Ozone (O2O3) therapy. As a result, the scope and focus of the work underlying this dissertation was to study the application of O2O3 therapy towards several resistant bacteria. Moreover, we evaluated three different framework for gut bacteria, skin and soft tissue infections and mucosal infections.