Susceptibility to measles, mumps, and rubella in newly arrived adult immigrants and refugees.

BACKGROUND: Despite effective vaccination programs for measles, mumps, and rubella in the United States and Canada, outbreaks continue to occur in susceptible subgroups, such as foreign-born persons. OBJECTIVE: To determine the susceptibility of newly arrived immigrants and refugees to measles, mumps, and rubella. DESIGN: Seroprevalence study. SETTING: Two hospitals and three community clinics in Montreal, Quebec, Canada. PATIENTS: 1480 adult immigrants and refugees who were recruited from October 2002 to December 2004. MEASUREMENTS: Sociodemographic and clinical data and serology for measles, mumps, and rubella. RESULTS: Thirty-six percent (range, 22% to 54%) of the study population was nonimmune to at least 1 of the 3 diseases. This proportion varied by age, sex, and region of origin. In multivariate analysis and after adjustment for region of origin, age, and socioeconomic factors, immigrant women had higher odds (odds ratio, 2.1) of being immune to measles (95% CI, 1.2 to 3.8) and an odds ratio of 1.7 of being nonimmune to rubella (CI, 1.2 to 2.6) compared with immigrant men. LIMITATIONS: The results from the community-based convenience sample of immigrants may not be generalizable to all immigrant populations. CONCLUSIONS: Many new immigrants and refugees, particularly women, are susceptible to measles, mumps, or rubella and may benefit from targeted vaccination programs.

A Randomized Switch From Nevirapine-Based Antiretroviral Therapy to Single Tablet Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate in Virologically Suppressed Human Immunodeficiency Virus-1-Infected Rwandans.

Background. Many human immunodeficiency virus (HIV)-infected patients remain on nevirapine-based antiretroviral therapy (ART) despite safety and efficacy concerns. Switching to a rilpivirine-based regimen is an alternative, but there is little experience with rilpivirine in sub-Saharan Africa where induction of rilpivirine metabolism by nevirapine, HIV subtype, and dietary differences could potentially impact efficacy. Methods. We conducted an open-label noninferiority study of virologically suppressed (HIV-1 ribonucleic acid [RNA] < 50 copies/mL) HIV-1-infected Rwandan adults taking nevirapine plus 2 nucleos(t)ide reverse-transcriptase inhibitors. One hundred fifty participants were randomized 2:1 to switch to coformulated rilpivirine-emtricitabine-tenofovir disoproxil fumarate (referenced as the Switch Arm) or continue current therapy. The primary efficacy endpoint was HIV-1 RNA < 200 copies/mL at week 24 assessed by the US Food and Drug Administration Snapshot algorithm with a noninferiority margin of 12%. Results. Between April and September 2014, 184 patients were screened, and 150 patients were enrolled; 99 patients switched to rilpivirine-emtricitabine-tenofovir, and 51 patients continued their nevirapine-based ART. The mean age was 42 years and 43% of participants were women. At week 24, virologic suppression (HIV-1 RNA level <200 copies/mL) was maintained in 93% and 92% in the Switch Arm versus the continuation arm, respectively. The Switch Arm was noninferior to continued nevirapine-based ART (efficacy difference 0.8%; 95% confidence interval, -7.5% to +12.0%). Both regimens were generally safe and well tolerated, although 2 deaths, neither attributed to study medications, occurred in participants in the Switch Arm. Conclusions. A switch from nevirapine-based ART to rilpivirine-emtricitabine-tenofovir disoproxil fumarate had similar virologic efficacy to continued nevirapine-based ART after 24 weeks with few adverse events.

Treating psychological trauma among Rwandan orphans is associated with a reduction in HIV risk-taking behaviors: A pilot study.

The nongovernmental organization, Uyisenga N'Manzi (UNM), provides Rwandan orphans of genocide and HIV/AIDS with education, social, and mental health services. Many orphans in UNM report symptoms of psychological trauma. The primary study objective was to evaluate a multidisciplinary program integrating HIV prevention with an existing package of mental health services. We randomly selected 120 orphans between ages 15-25 years served by UNM and evaluated sexually-transmitted infections, HIV risk-taking behaviors and knowledge, and mental health at baseline, 5, 9, and 12 months. Increased trauma symptoms at baseline were associated with poorer coping skills and social functioning, and increased psychological distress and HIV risk-taking behavior. Following the 12-month intervention, trauma symptoms declined significantly, with those accessing counseling services showing greatest improvement. Orphans with the highest trauma scores benefited most from the intervention. In this at-risk population, addressing mental health issues in the context of HIV prevention is critical.