RESUMEN
BACKGROUND: Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. METHODS: With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. RESULTS: One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. CONCLUSIONS: The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.
Asunto(s)
Bisexualidad/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Infecciones por Chlamydia/epidemiología , Víctimas de Crimen/estadística & datos numéricos , Estudios Transversales , Gonorrea/epidemiología , Personas con Mala Vivienda/estadística & datos numéricos , Humanos , Jamaica/epidemiología , Masculino , Prevalencia , Factores de Riesgo , Asunción de Riesgos , Enfermedades de Transmisión Sexual/epidemiología , Factores Socioeconómicos , Sífilis/epidemiología , Tricomoniasis/epidemiología , Sexo Inseguro , Poblaciones Vulnerables , Adulto JovenRESUMEN
Locally conducted research has played a critical role in guiding the response to the human immunodeficiency virus (HIV) epidemic in Jamaica. Active HIV/AIDS case-based surveillance and serosurveys helped to define the acquired immunodeficiency syndrome (AIDS) epidemic in Jamaica and identify those who were most at risk. Studies among sexually transmitted infection (STI) clinic attendees ident fled genital ulcers and syphilis as risk factors for HIV infection and were suggestive of other risk factors. Given the synergistic role of HI V and other STI, an integrated approach was taken to HIV/STI control and the STI services were strengthened based on research. Studies were conducted among sex-workers (SW), men who have sex with men, persons who go to sites to meet new sex partners, prisoners and others most at risk in order to understand risk factors and better guide the HIV/STI response. National population based surveys were conducted periodically to monitor knowledge, attitudes, beliefs as well as sexual behaviour and condom use. The research contributed greatly to Jamaica's comprehensive HIV/STI control programme that has been effective in slowing the HIV epidemic, reducing HlVprevalence among SW and STI clinic attendees, preventing mother-to-child transmission, reducing syphilis rates and mitigating the impact of HIV on the population.
Asunto(s)
Infecciones por VIH/terapia , Adulto , Brotes de Enfermedades , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Jamaica/epidemiología , Masculino , Vigilancia de la Población , PrevalenciaRESUMEN
The goal of this study is to describe the establishment of an HIV testing and treatment programme in the Jamaican correctional system and to estimate the prevalence of HIV/sexually transmitted disease (STD) among adult incarcerated men in this country. A demonstration project was implemented by the Jamaican Department of Correctional Services and Ministry of Health in the nation's largest correctional centre. All inmates were offered HIV and syphilis testing, and a subset was offered chlamydia, gonorrhoea and trichomoniasis testing. Cross-sectional data from the project were reviewed to determine the prevalence and correlates of HIV/STD. HIV test acceptance was 63% for voluntary testers (n = 1200). The prevalence of HIV was 3.3% (95% confidence interval [CI] 2.33-4.64) (n = 1017) and the prevalence syphilis was 0.7% (95% CI 0.29-1.49) (n = 967). Among the subset tested (n = 396) the prevalence of chlamydia was 2.5% (95% CI 1.22-4.49) and for trichomoniasis it was 1.8% (95% CI 0.01-3.60), but no cases of gonorrhoea were detected (n = 396). The prevalence of HIV was significantly higher at 25% (95% CI 13.64-39.60) for persons located in a separate section where individuals labelled as men who have sex with men (MSM) are separated. HIV/STD testing is important and feasible in Jamaica. A special focus should be placed on providing services to inmates labelled as MSM. Other Caribbean nations may also benefit from similar programmes.
Asunto(s)
Programas de Gobierno/organización & administración , Infecciones por VIH/epidemiología , Prisioneros , Enfermedades de Transmisión Sexual/epidemiología , Adulto , Estudios de Factibilidad , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Homosexualidad Masculina , Humanos , Jamaica/epidemiología , Masculino , Prevalencia , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/terapiaRESUMEN
OBJECTIVE: To describe the attitudes of Sexually Transmitted Infection (STI) clinic attendees towards male circumcision. DESIGN AND METHODS: A convenience sample of attendees at the main STI clinic in Kingston was interviewed using a structured questionnaire in June 2008. RESULTS: One-hundred men and 98 women were interviewed. Over 90% of the men were not circumcised. Although 60% of men and 67% of women reported that they had heard of circumcision, the research nurse assessed that 28% of men and 40% of women actually understood what circumcision was. When asked about the benefits of circumcision, 32% of men and 41.8% of women said that circumcision makes it easier to clean the penis while 13% of men and 20.4% of women said that circumcision lessens the likelihood of STI. Twenty-two per cent of men and 13.3% of women said that the foreskin offers protection while 18% of men and 10.2% of women said that the penis looks more attractive when uncircumcised. When informed that research showed that circumcision reduced the risk of HIV 35% of men said that they were willing to be circumcised and 67.3% of women said that they would encourage their spouse to be circumcised (p < 0.001) while 54% of men and 72.4% of women said that they would circumcise their sons (p = 0.057). CONCLUSION: Knowledge of circumcision and its benefits were limited among STI clinic attendees. Significantly more women than men were in favour of circumcision when informed that it reduced the risk of HIV infection.
Asunto(s)
Circuncisión Masculina/psicología , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Adulto , Distribución de Chi-Cuadrado , Femenino , Infecciones por VIH/transmisión , Humanos , Jamaica/epidemiología , Masculino , Enfermedades de Transmisión Sexual/transmisión , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To delineate changes in the epidemiology of HIV including morbidity and mortality patterns based on three key time points in Jamaica's HIV response. METHOD: Surveillance data from Jamaica's HIV/AIDS Tracking system (HATS) were analysed and distribution of cases by age, gender sexual practice, risk factors and clinical features were determined for three time periods (1988-1994: formal establishment of HIV surveillance at the national level, 1995-2003: introduction of HAART globally; 2004-June 2008: introduction of HAART and HIV rapid testing in Jamaica). Factors that predicted late stage diagnosis (AIDS or AIDS death) were also determined RESULTS: 22 603 persons with HIV were reported to the Ministry of Health, Jamaica, between 1988 and June 2008. Between the first and last time blocks, the modal age category remained constant (25-49 years) and the proportion of women reported with HIV non-AIDS increased from 32.5% to 61.4% (p < 0.001). However the male:female ratio for persons reported with AIDS remained at 1.3:1 between 1995 and 2008. Although heterosexual transmission was the most frequent mode of transmission in each time period, sexual behaviour was consistently under-reported (4769 persons or 21% of all cases ever reported). Late stage diagnosis (AIDS or AIDS death) decreased significantly between the first and last time blocks (16% decline, p < 0.0001) with men, older persons and persons with unknown risk history being more likely to be diagnosed at AIDS or AIDS death. CONCLUSION: HIV testing and treatment programmes have improved timely diagnosis and reduced morbidity associated with HIV infection in Jamaica. However new strategies must be developed to target men and older persons who are often diagnosed at a late stage of disease. Surveillance systems must be strengthened to improve understanding of persons reported with unknown risk behaviours and unknown sexual practices.
Asunto(s)
Infecciones por VIH/epidemiología , Vigilancia de la Población , Adolescente , Adulto , Factores de Edad , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SocioeconómicosRESUMEN
The subtypes of the human immunodeficiency virus - type 1 (HIV-1) strains from 54 HIV-1 - infected persons including 44 strains which were typed previously by heteroduplex mobility assay (HMA) were determined by DNA sequencing and phylogenetic analysis. Of 54 HIV- infected persons, 92.5% were infected with HIV-1 subtype B and 7.5% with other HIV-1 subtypes including subtypes D (3.7%), A (1.9%) and J (1.9%). In the phylogenetic analysis, the subtype A virus found in the sample clustered with subtype A reference strains and a circulating recombinant form (CRF) reference strain which originates in Central Africa and is circulating in Cuba indicating a close relationship between these viruses. There was 86% concordance between HMA and DNA sequencing in assigning subtype B viruses. For the non-B subtype viruses, there was less concordance between the two methods (67%). The results confirm the predominance of HIV-1 subtype B strains and the high genetic diversity of HIV-1 strains in circulation in Jamaica. The efficacies and some limitations of the HMA as a method of HIV-1 subtyping also were noted. It is important that the HIV/AIDS epidemic in Jamaica be monitored meticulously for possible expansions in non-B subtypes and the emergence of inter-subtype recombinant forms. We recommend that the more expensive DNA sequencing and phylogenetic analysis, including HIV-1 genotyping for antiretroviral drug resistance testing, be used as an adjunct to the more cost-effective HMA to track the HIV/AIDS epidemic in Jamaica.
Asunto(s)
ADN Viral/química , Variación Genética , Infecciones por VIH/virología , VIH-1/genética , VIH-1/clasificación , Análisis Heterodúplex , Humanos , Jamaica , Filogenia , Reproducibilidad de los Resultados , Análisis de Secuencia de ADN , Productos del Gen env del Virus de la Inmunodeficiencia Humana/genética , Productos del Gen gag del Virus de la Inmunodeficiencia Humana/genéticaRESUMEN
OBJECTIVE: To describe the design, methods and baseline findings of a multi-level prevention intervention to increase consistent condom use among persons at public social sites in Kingston, Jamaica, who have new or concurrent sexual partnerships. METHODS: A two-arm randomized controlled trial (RCT) of 147 sites where persons meet new sex partners. Sites were identified by community informants as places where people meet new sexual partners, which include bars, street locations, bus stops, malls and others. Sites were sorted into 50 clusters based on geographic proximity and type of site and randomized to receive a multi-level site-based intervention or not. Intervention components include on-site HIV testing, condom promotion and peer education. Effectiveness of the intervention will be measured by comparing the proportion of persons with new or multiple partners in the past year who report recent inconsistent condom use at intervention vs. control sites. RESULTS: Baseline surveys were conducted at 66 intervention (711 men, 845 women) and 65 control sites (654 men, 738 women). Characteristics of intervention and control sites as well as the characteristics of patrons at these sites were similar. The outcome variable was balanced with approximately 30% of men and 25% of women at intervention and control sites reporting a new partner or more than one partner in the past year and recent inconsistent condom use. CONCLUSIONS: The baseline findings confirm that the population is an appropriate target group for HIV prevention and that randomization will provide the means to estimate programme effectiveness.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Promoción de la Salud/métodos , Sexo Seguro , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Incidencia , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Proyectos de Investigación , Conducta SexualAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Terapia Antirretroviral Altamente Activa/métodos , Congresos como Asunto , Erradicación de la Enfermedad , Epidemias , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , HumanosRESUMEN
The HIV prevalence in the Caribbean is estimated at 1.0% (0.9% - 2%) with 230,000 persons living with HIV/AIDS. HIV rates vary among countries with the Bahamas, Guyana, Haiti and Trinidad and Tobago having HIV rates of 2% or above while Cuba's rate is less than 0.2%. However throughout the Caribbean, HIV rates are significantly higher among those groups most at risk such as commercial sex workers, men who have sex with men and crack/cocaine users. The Caribbean Community (CARICOM) Heads of Governments declared AIDS to be a regional priority in 2001. The Pan Caribbean AIDS Partnership (PANCAP) was formed to lead the regional response to the HIV epidemic. National HIV Programmes have made definite progress in providing ARV treatment to persons with HIV/AIDS and reducing death rates due to AIDS, decreasing HIV mother-to-child transmission and providing a range ofHIVprevention programmes. However HIV stigma remains strong in the Caribbean and sexual and cultural practices put many youth, women and men at risk of HIV The Caribbean has set itself the goal of achieving universal access to HIV prevention, treatment and care. Several challenges need to be addressed. These include reducing HIV stigma, strengthening national responses, scaling-up better quality prevention programmes with greater involvement of vulnerable populations, more supportive HIV policies and wider access to ARV treatment with better adherence. In addition, there needs to be improved coordination among PANCAP partners at the regional level and within countries.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Política de Salud , Accesibilidad a los Servicios de Salud , Cobertura Universal del Seguro de Salud , Región del Caribe/epidemiología , Brotes de Enfermedades , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Prevalencia , Desarrollo de Programa , Salud Pública , Factores de RiesgoRESUMEN
OBJECTIVE: Paediatric HIV is a leading cause of morbidity and mortality worldwide. We describe HIV-related mortality in a cohort of HIV-infected Jamaican children and identified factors which influenced survival. METHODS: A retrospective descriptive study was conducted for the period March 2003 - December 2005 at Cornwall Regional Hospital, Montego Bay, Jamaica. We summarized demographic and clinical data of deceased and living perinatally HIV-infected children and identified factors that influenced survival of rapid and slow progressors. Rapid progressors are HIV-infected children identified clinically before age 2 years and slow progressors after age 2 years. RESULTS: There were 9 (180%) HIV/AIDS-related deaths among 50 HIV-infected children of whom 23 (46%) were males and 21 (43%) were AIDS orphans. Five children (10%0) received ARV prophylaxis, 31 (62%) were breastfed and 39 (78%) received HAART Surviving children displayed primarily non-AIDS defining illnesses (pneumonia and sepsis) but there was no difference in AIDS-defining illnesses among living and deceased children. The median age at diagnosis was 26 months (range 3-121; IQR 10, 54). The median age at death was 30 months (range 7-122 months; IQR 17, 118). Both surviving and deceased children presented with primarily moderate symptoms at diagnosis (21, 42%) and death (7, 78%). In rapid progressors, 19 of 20 (95%) on HAART remained alive and all 4 (100%) who did not receive HAART died. The mortality rate in children on HAART was 30.78 per 100 person years and 48 per 100 person years in children not receiving HAART. CONCLUSIONS: HAART is the only factor identified which prolonged survival for HIV-infected children who are rapid progressors, have AIDS-defining illnesses and are orphans.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/mortalidad , Terapia Antirretroviral Altamente Activa , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Jamaica/epidemiología , Masculino , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND AND PURPOSE: Highly active antiretroviral therapy (HAART) has improved morbidity and mortality and quality of life, revitalized communities and transformed the perception of HIV/AIDS from being a "death sentence" to a chronic illness. Strict and sustained adherence to medication is essential long-term viral suppression. In April 2005, an Adherence Support Programme was introduced to Jamaica's HIV Programme, whereby Persons Living with HIV/AIDS (PLWHA) who had achieved high levels of adherence were trained to provide support to other PLWHA in order to increase their adherence to HAART regimens. METHODS: A cross-sectional survey of 116 individuals with advanced HIV and on HAART was performed in June and July 2006. RESULTS: Many participants were unemployed, poor persons with limited education. Based on self-report of seven-day adherence, 54.8% of persons were 95-100% adherent, 37.5% were 80-94% adherent and 7.7% were < 80% adherent. Having interacted with an adherence counsellor was not associated with adherence levels. Factors associated with nonadherence were: being away from home (38%), sleeping through dose-time (37%), forgetfulness (37%) and running out of pills (31%). Having no food (26.9%), not wanting to be seen taking medication (200%) and intolerable side effects (18.8%) were also reasons given. Only 44% of persons used aids to remind them of dose times. CONCLUSION: Adherence in this study group is low and may have worsened since 2005. More emphasis must be placed on preparing adults to start HAART The use of pillboxes and other reminders such as alarm clocks and cell phones must be reinforced.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Estudios Transversales , Recolección de Datos , Femenino , Infecciones por VIH/epidemiología , Humanos , Jamaica/epidemiología , Masculino , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Jamaica has a well-established, comprehensive National Human Immunodeficiency Virus (HIV) programme that has slowed the HIV epidemic and mitigated its impact. Adult HIV prevalence has been stable at approximately 1.5% since 1996. HIV rates are high among those most at risk such as sex-workers (9%) and men who have sex with men [MSM] (31.8%). Risk behaviour among adults with AIDS includes multiple sexual partners (80%), a history of a sexually transmitted infection [STI] (51.1%), commercial sex (23.9%) and crack/cocaine (8.0%). Approximately 20% of all reported AIDS cases, mainly women, give no history of any of the usual risk factors for HIV infection. The national programme is based in the Ministry of Health. Since 1988, Jamaica has had a national plan to guide its HIV response. A National AIDS Committee was established in 1988 to lead the multi-sectoral response. Prevention approaches have included information, education and communication campaigns, condom promotion, sexually transmitted infections (STI) control, targeted interventions, cultural approaches, outreach and peer education, workplace programmes and HIV counselling and testing. Concerted efforts have been made to reduce HIV stigma and discrimination. Antiretroviral therapy (ARV) was introduced for prevention of mother-to-child transmission in 2001 and a public access treatment programme introduced in 2004. A national HIV/AIDS Policy was adopted unanimously in parliament in 2005. The National Strategic plan 2007-2012 commits Jamaica to achieving universal access to HIVprevention, treatment and care. Awareness of HIV and how to prevent it is near universal though belief in myths remains strong. The condom market has increased from approximately 2.5 million in 1985 to 12 million in 2006 while condom use has grown significantly with nearly 75% of men and 65% of women reporting condom use at last sex with a non-regular partner The proportion of women 15-24 years reporting ever having a HIV test increased from 29.8% in 2004 to 48.9% in 2008. HIV transmission from mother-to-child has declined from 25% prior to 2000 to less than 8% in 2007. As of September 2008, 4450 persons or an estimated 68.5% of persons with advanced HIV and AIDS have been placed on ARV treatment resulting in a significant decline in mortality and morbidity due to HIV
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adulto , Actitud Frente a la Salud , Comorbilidad , Brotes de Enfermedades , Femenino , Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud , Humanos , Jamaica/epidemiología , Masculino , Prevalencia , Asunción de Riesgos , Conducta Sexual , Sífilis/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Paediatric HIV/AIDS remains a significant challenge in developing countries. We describe the effectiveness of interventions in HIV-infected children attending Paediatric Infectious Diseases Clinics in Jamaica. METHODS: One hundred and ninety-seven HIV-infected children were followed prospectively in multicentre ambulatory clinics between September 1, 2002 and August 31, 2005, in the Kingston Paediatric and Perinatal HIV/AIDS Programme, Jamaica, and their outcomes described. RESULTS: Median follow-up was 23 child-months (interquartile range [IQR] 12-31) with 12 children (6.0%) lost to follow-up and deaths (n=13) occurred at 4.64 per 100 child-years of follow-up. Median age was 5.0 years (IQR 2.2-8.1) and 32.1% had Centers for Disease Control and Prevention (CDC) category C disease at enrollment; 62% were ever on antiretroviral therapy (ART) with median duration of 15.4 months (IQR 5.5-25.5); 85% initiated ART with zidovudine/lamivudine/nevirapine. Mean weight-for-height 0.13 +/- 1.02 (mean difference -1.71 [95% Confidence interval (CI) -2.73, -0.69]; p = 0.001) and body mass index-for-age 0.05 +/- 1.11 (mean difference -1.11, [CI -1.79, -0.43]; p = 0.002); z scores increased after 24 months on ART; however, children remained stunted. Reductions in the incidence of hospitalizations (mean diff 30.95, [CI 3.12, 58.78]; p = 0.03) and in episodes of pneumonia, culture-positive sepsis and tuberculosis occurred in those on ART. CONCLUSIONS: A successfully implemented ambulatory model for paediatric HIV care in Jamaica has improved the quality of life and survival of HIV-infected children.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Calidad de Vida , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/administración & dosificación , Niño , Preescolar , Intervalos de Confianza , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Lactante , Jamaica/epidemiología , Masculino , Estudios Prospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To characterize the clinicopathological manifestations and outcomes of a cohort of HIV-infected Jamaican adolescents. METHODS: This is a retrospective cohort study to determine demographic, clinical, immunological characteristics, antiretroviral uptake and mortality in 94 adolescents aged 10-19 years followed in the Kingston Paediatric and Perinatal HIV/AIDS Programme (KPAIDS) between September 2002 and May 2007. Parametric and non-parametric tests are used to compare variables. RESULTS: The median age at initial presentation was 10.0 years (interquartile range (IQR) 7.0-12.0 years), 54.3% (51) were female (p = 0.024), transmission was primarily mother-to-child (70, 73.4%), with 87% (61) of the latter presenting as slow progressors. Sexual transmission accounted for 19.1% and there was significant female predominance (n=15; p = 0.024). At most recent visit, perinatally infected adolescents were more likely (p < 0.0001) to reside with a non-parent (n=42) than a biological parent (n=19) and most had Centers for Disease Control and Prevention (CDC) category C (35/50%) disease, whereas the majority of non-perinatally infected children were classified CDC category A. Mean z scores for height-for-age was -1.47 +/- 1.21 (n=77), weight-for-age -1.06 +/- 1.44 (n=80) and BMI-for-age -0.34 +/- 1.21 (n=76) respectively; females (n=41) were taller than males (n=36) at their current height (p = 0.031). Lymphadenopathy (82%), dermatitis (72.0%), hepatomegaly (48%) and parotitis (48%) were the most common clinical manifestations, with significant predilection for lymphadenopathy (p < or = 0.0001), dermatitis (p = 0.010), splenomegaly (p = 0.008), hepatomegaly (p = 0.001) and parotitis (p = 0.007) among perinatally infected children. Median baseline CD4+ cell count was 256.0/microL (IQR 71.0 - 478.0 cells/microL); median most recent CD4+ cell count was 521/microL (IQR 271.0 - 911.0 cells/microL). Seventy-six per cent (n=71) were initiated with highly active antiretroviral therapy (HAART) and 62 (87.3%) were currently receiving first-line therapy. Six behaviourally infected females became pregnant, resulting in five live births. There were seven deaths (7.4%). CONCLUSION: This study comprehensively characterizes HIV infection among perinatally infected teens with predominantly slow-progressor disease and an increasing population of sexually-infected adolescents. As the cohort transitions to adulthood, adolescent developmental, mental health and life planning issues must be urgently addressed.
Asunto(s)
Infecciones por VIH/patología , Complicaciones Infecciosas del Embarazo/patología , Enfermedades Virales de Transmisión Sexual/patología , Adaptación Psicológica , Adolescente , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Niño , Estudios de Cohortes , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Humanos , Jamaica/epidemiología , Masculino , Educación del Paciente como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/psicología , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Virales de Transmisión Sexual/epidemiología , Enfermedades Virales de Transmisión Sexual/psicología , Adulto JovenRESUMEN
The immune reconstitution inflammatory syndrome (IRIS) is a recognized complication associated with opportunistic infections occurring in HIV-infected individuals after the initiation of highly active antiretroviral therapy (HAART). We report on three HIV-infected infants with rapid progressor HIV disease who present with IRIS due to the BCG vaccine and occurring 3-6 weeks after initiation of HAART
Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Fármacos Anti-VIH/efectos adversos , Vacuna BCG/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Linfadenitis/inducido químicamente , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Vacuna BCG/inmunología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/transmisión , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/etiología , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Jamaica , Linfadenitis/microbiología , MasculinoRESUMEN
BACKGROUND: Paediatric and Perinatal HIV/AIDS remain significant health challenges in the Caribbean where the HIV seroprevalence is second only to Sub-Saharan Africa. METHOD: We describe a collaborative approach to the prevention, treatment and care ofHIVin pregnant women, infants and children in Jamaica. A team of academic and government healthcare personnel collaborated to address the paediatric and perinatal HIV epidemic in Greater Kingston as a model for Jamaica (population 2.6 million, HIV seroprevalence 1.5%). A five-point plan was utilized and included leadership and training, preventing mother-to-child transmission (pMTCT), treatment and care of women, infants and children, outcomes-based research and local, regional and international outreach. RESULTS: A core group of paediatric/perinatal HIV professionals were trained, including paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data managers, information technology personnel and students to serve Greater Kingston (birth cohort 20,000). During September 2002 to August 2007, over 69 793 pregnant women presented for antenatal care. During these five years, significant improvements occurred in uptake of voluntary counselling (40% to 91%) and HIV-testing (53% to 102%). Eight hundred and eighty-three women tested HIV-positive with seroprevalence rates of 1-2% each year The use of modified short course zidovudine or nevirapine in the first three years significantly reduced mother-to-child transmission (MTCT) of HIV from 29% to 6% (RR 0.27; 95%0 CI--0.10, 0.68). During 2005 to 2007 using maternal highly active antiretroviral therapy (HAART) with zidovudine and lamivudine with either nevirapine, nelfinavir or lopinavir/ritonavir and infant zidovudine and nevirapine, MTCT was further reduced to an estimated 1.6% in Greater Kingston and 4.75% islandwide. In five years, we evaluated 1570 children in four-weekly paediatric infectious diseases clinics in Kingston, St Andrew and St Catherine and in six rural outreach sites throughout Jamaica; 24% (377) had HIV/AIDS and 76% (1193) were HIV-exposed. Among the infected children, 79% (299 of 377) initiated HAART resulting in reduced HIV-attributable childhood morbidity and mortality islandwide. An outcomes-based research programme was successfully implemented. CONCLUSION: Working collaboratively, our mission of pMTCT of HIV and improving the quality of life for families living and affected by HIV/AIDS in Jamaica is being achieved.
Asunto(s)
Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Desarrollo de Programa , Salud Pública , Fármacos Anti-VIH/uso terapéutico , Región del Caribe/epidemiología , Niño , Protección a la Infancia , Preescolar , Intervalos de Confianza , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Bienestar del Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Cooperación Internacional , Jamaica/epidemiología , Pediatría , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Estudios SeroepidemiológicosRESUMEN
The aim of this investigation was to characterize the pattern of cervical myoelectrical activity (EMG) in the sheep, during the periovulatory period, after synchronization of oestrus with progestagen and eCG. EMG was measured with a computerised modular system in five ewes previously fitted with a pair of monopolar Teflon needle electrodes in the muscle layers of the cervix. Each ewe was submitted to oestrus synchronization treatment with intravaginal progestagen sponge during 12 days, and the administration of 500 IU of eCG at the withdrawal of sponge. EMG was recorded in each animal during 19 h, starting 44 h after withdrawal of sponge. The number and duration of events were determined every hour during the experiment. Two distinct event durations were identified: one lasting less than 200 s and another lasting between 300 and 500 s. The two types of events analysed (less than 200 s and lasting between 300 and 500 s) had a similar pattern during the period of observation although they were not in synchrony. For events lasting less than 200 s, activity increased between 48 and 50 h after sponge withdrawal, with the peak of activity being observed between 51 and 53 h. For events of 300-500 s duration, the peak of activity was observed between 48 and 50h after sponge withdrawal and activity was maintained until 51-53 h. The increase in cervical motility observed in progestagen-eCG treated ewes is in keeping with the increase in cervical activity observed by others in natural cycling animals, and suggests that exogenous hormones used in synchronization protocols had no deleterious action on cervical motility during periovulatory period. The enhanced activity of cervical muscle layer found around the time of mating and/or AI suggests it may play an important role as a regulatory mechanism of sperm transport. Taking advantage of the cervical responsiveness to various drugs, experimental modulation of cervical activity could be used to facilitate cervical sperm transport and consequent improve of fertility after cervical AI.
Asunto(s)
Cuello del Útero/fisiología , Estro/fisiología , Progestinas/administración & dosificación , Ovinos/fisiología , Transporte Espermático/fisiología , Animales , Gonadotropina Coriónica/administración & dosificación , Electromiografía , Electrofisiología , Sincronización del Estro , Femenino , Acetato de Fluorogestona/administración & dosificación , Caballos , CinéticaRESUMEN
Critical donor selection and testing increases the safety of blood transfusion by excluding donors at risk of transmitting infections. This study investigated the seroprevalence of and risk factors for sexually transmitted infections (STIs) among accepted and deferred blood donors in Jamaica. A total of 1015 blood donors consisting of 794 (78%) accepted donors and 221 (22%) deferred donors presenting at the Central Blood Bank, Jamaica, over a six-month period, were recruited for this study. A standardized questionnaire was administered to each participant and a sample of blood obtained for detection of hepatitis B surface antigen, antibodies to Treponema pallidum, human immunodeficiency virus (HIV) and human T-cell lymphotrophic virus type-1 (HTLV-1). Deferred donors were three times more likely to be seropositive for STI than accepted donors (16.3% vs 5.2%, OR 3.57, 95% CI 2.16 - 5.90, p < 0.0001). Males had significant association between STI seropositivity and having fathered children with two or more women (p = 0.0085), unprotected sexual intercourse with several persons (p = 0.0326), and history of genital herpes (p = 0.0121). Significant risk factors identified among females were unprotected sex with several partners (p = 0.0385); having more than ten lifetime partners (p = 0.0105); and use of depoprovera (p = 0.0028). This study confirms higher rates of STI among deferred blood donors and supports the donor deferral system in Jamaica.
Asunto(s)
Donantes de Sangre , Selección de Donante , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Análisis de Varianza , Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Transfusión Sanguínea , Femenino , VIH/aislamiento & purificación , Antígenos de Superficie de la Hepatitis B/sangre , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estudios Seroepidemiológicos , Enfermedades de Transmisión Sexual/sangre , Enfermedades de Transmisión Sexual/terapia , Treponema pallidum/aislamiento & purificaciónRESUMEN
The purpose of this study was to assess the prevalence of high risk health behaviours among adult Jamaicans aged 15-49 years in 2000, and to compare the results with the 1993 survey. A nationally representative sample of 2013 persons aged 15-74 years was surveyed in 2000 using cluster sampling in the Jamaica Healthy Lifestyle Survey (Wilks et al, unpublished). Interviewer administered questionnaires and anthropometrical measurements were done. Data for a sub-sample of adults aged 15-49 years were analyzed The sub-sample included 1401 persons (473 men and 928 women). Significantly more men (18.6%) than women (4.3%) reported never having had a blood pressure check (p = 0.0001). Approximately one-third of the women reported that they had never had a Pap smear (36.0%) or a breast examination (31.2%). Current cigarette smoking was reported in 28.6% of men and 7.7% of women (OR 3.73 CI 2.71, 5.15), while 49.0% of men and 15.0% of women ever smoked marijuana (OR 3.28 CI 2.56, 4.20). Significantly more men (28.0%) than women (11.7%) reported ever having a sexually transmitted disease (OR 2.93 CI 2.16, 3.97); having more than one sexual partner in the past year (49.1% vs 11.4%, OR 4.31 CI 3.22, 5.76) and usually using a condom during sexual intercourse (55.3% vs 40.5%, OR 1.3 CI 1.11, 1.68). Between 1993 and 2000, significant trends include: more persons reported having a blood pressure check, a reduction in multiple sexual partners, increased condom use at last sex (women), reduced crack/cocaine use (males) and increased marijuana smoking. Although there were some significant positive lifestyle trends between 1993 and 2000, high risk behaviours remain common among Jamaican adults. Comprehensive health promotion programmes are needed to address these risk behaviours.
Asunto(s)
Conductas Relacionadas con la Salud , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Jamaica/epidemiología , Estilo de Vida , Masculino , Fumar Marihuana/epidemiología , Persona de Mediana Edad , Asunción de Riesgos , Enfermedades de Transmisión Sexual/epidemiología , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0%); one (0.8%) isolate each of subtypes C, D and E was found and 7 (4.9%) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.