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1.
J Clin Virol ; 141: 104898, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34174711

RESUMEN

BACKGROUND: HIV rapid diagnostic test (RDT) algorithms have been successfully employed worldwide to accelerate critically important HIV testing. Deviations from the algorithm and processing errors have been associated with inaccurate algorithm results. Positive RDT algorithm results should be confirmed prior to HIV clinic enrollment, but compliance varies. We sought to retest HIV status of patients in three West African military HIV clinics. SETTING: Military HIV clinics in Lome, Togo; Freetown, Sierra Leone; and Monrovia, Liberia METHODS: Patients coming for routine HIV clinic visits were approached for enrollment. Consenting participants completed a 15-minute questionnaire and provided blood samples for both national and WHO-recommended HIV RDT algorithms, and HIV ELISA (plus HIV PCR if HIV ELISA negative). RESULTS: In total, 817 participants provided data: 374 in Togo, 360 in Sierra Leone, and 83 in Liberia. One participant from Liberia was HIV-negative (although follow-up testing was positive). Two of 807 participants on antiretroviral treatment (ART) had inconclusive algorithms, while 2 of 10 participants not on ART had algorithms, for 4 total based on the WHO-approved algorithm. Using the national algorithms, only 3 were inconclusive. A substantial proportion of the cohort had taken ART for over 6 years (25-46%, depending on the site). CONCLUSION: HIV RDT retesting in three military HIV clinics did not uncover significant numbers of misclassified HIV patients. There was no significant difference between national and WHO-recommended RDT algorithms, although the study was underpowered to detect a difference. Antiretroviral treatment was not associated with increased rates of inconclusive RDT algorithm results.


Asunto(s)
Infecciones por VIH , Personal Militar , Algoritmos , Antirretrovirales/uso terapéutico , Pruebas Diagnósticas de Rutina , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Sensibilidad y Especificidad
2.
AIDS Behav ; 22(9): 2851-2860, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29869734

RESUMEN

Substance abuse is a public health priority in the context of the HIV epidemic, especially in military communities. This cross-sectional study quantified alcohol and cannabis use in the Malawi Defence Force and investigated its associations with condom use, transactional sex, multiple sexual partners, and sexual violence. Participants were 944 male and female service members ≥ 18 years old. Data were collected in 2013 using a computer-assisted self-interview. Twenty-four percent of men and women screened positive for hazardous and harmful drinking [Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8]. About 6% reported using cannabis in the past year and 10% reported using cannabis prior to 1 year ago. Multivariable models found elevated adjusted odds of transactional sex and multiple sexual partners for men with an AUDIT score ≥ 8, and men who reported ever using cannabis. The adjusted odds of experiencing sexual violence were also elevated for men who reported ever using cannabis. These findings add to the growing concern that substance use may perpetuate the HIV epidemic in Sub-Saharan Africa by increasing risky sexual behaviors. A comprehensive military HIV prevention response should include substance use education and appropriate care and treatment for individuals screening positive for hazardous and harmful drinking.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Cannabis , Uso de la Marihuana/epidemiología , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Malaui/epidemiología , Masculino , Asunción de Riesgos , Violencia/estadística & datos numéricos
3.
Curr HIV Res ; 15(2): 82-89, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28521715

RESUMEN

BACKGROUND: Characterizing HIV infection and associated risk behaviors within military populations is critical for understanding the epidemic and informing prevention activities. However, the prevalence of HIV and related risk behaviors is often unknown. Further, militaries may not have the systems in place or the staff expertise to conduct HIV surveillance and risk behavior studies. METHODS: The Department of Defense HIV/AIDS Prevention Program (DHAPP), funded by the President's Emergency Plan for AIDS Relief and the US Department of Defense, provides technical assistance, management and administrative support for HIV/AIDS prevention, care and treatment for approximately 65 partner militaries. Collaborating with partner militaries in conducting Seroprevalence and Behavioral Epidemiology Risk Surveys (SABERS) and using the data to monitor the epidemic and inform activities is a key component of DHAPP. CONCLUSION: This paper describes the methodology used to plan, adapt, implement and report SABERS studies.


Asunto(s)
Seroprevalencia de VIH , Personal Militar , Asunción de Riesgos , Humanos , Medición de Riesgo , Estados Unidos/epidemiología
4.
Sex Transm Infect ; 91(8): 581-8, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26586849

RESUMEN

OBJECTIVES: Sexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. METHODS: Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. RESULTS: Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). CONCLUSIONS: Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.


Asunto(s)
Condones/estadística & datos numéricos , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales/psicología , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Adulto , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Prevalencia , Asunción de Riesgos , Conducta Sexual/psicología , Enfermedades de Transmisión Sexual/transmisión , Estados Unidos/epidemiología
5.
AIDS ; 17(17): 2521-7, 2003 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-14600525

RESUMEN

OBJECTIVE: To describe the demographics, risk behaviors, and HIV-1 subtypes in a large cohort of recently HIV-infected military personnel. DESIGN: Descriptive, cross-sectional study. METHODS: US military personnel with recent HIV seroconversion from six medical referral centers were enrolled with a self-administered questionnaire, CD4 cell counts, syphilis and hepatitis B serologies, plasma viral RNA levels, and HIV-1 subtype nucleic acid sequencing. RESULTS: Between February 1997 and May 2000, 520 patients were enrolled. Most [488 (94.3%)] were infected with HIV-1 subtype B. The most prevalent non-B subtype was a circulating recombinant form (CRF01_AE) [17 (61%)]; however, two pure subtypes (C and D), as well as CRF02_AG, CRF09_cpx and a BE recombinant were identified. The likely area of HIV-1 acquisition was the United States for 70% of the volunteers. At least three non-B subtype infections (two subtype C, one subtype CRF01_AE) were apparently acquired domestically. Risk behaviors and comorbid sexually transmitted diseases were reported during the seroconversion period. Volunteers with non-B subtype HIV infection were more likely to report heterosexual contacts [92% vs. 39%; odds ratio (OR), 10.0], including contacts with commercial sex workers (41% vs. 13%; OR, 4.9). The Roche Amplicor version 1.0 assay was less sensitive for non-B subtype infections than the Roche Amplicor version 1.5 assay. CONCLUSION: There is a high prevalence and diversity of non-B HIV subtypes in this large cohort. Efficient diagnosis of acute primary HIV-1 infection was identified as a goal for prevention programs. Modifiable risk behaviors and target populations for intervention were identified.


Asunto(s)
Infecciones por VIH/virología , VIH-1/clasificación , Personal Militar , Asunción de Riesgos , Adolescente , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/psicología , Prevalencia , Conducta Sexual/psicología , Estados Unidos/epidemiología
6.
Mil Med ; 167(6): 496-500, 2002 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12099086

RESUMEN

OBJECTIVE: To examine risk factors of sexually transmitted diseases (STDs) in a non-clinic-based sample of young male military personnel. METHODS: A total of 1,028 enlisted U.S. Marines completed a self-report survey querying sexual behaviors in the previous 3 months and provided urine specimens for STD screening by nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Risk for STDs was assessed using a composite Sexual Risk Index. Recent STD infection was defined as a positive result on urine-based screening for chlamydial and/or gonococcal infection and/or a history of STDs in the past 3 months. RESULTS: Recent STDs were identified in 76 men (7.4%): 42 (4.1%) were diagnosed with a chlamydial infection with no gonorrhea found, and 34 (3.3%) reported a history of STDs. Men with the highest score on the Sexual Risk Index were 2.6 times more likely to have a current STD compared with those at lowest risk (odds ratio = 2.6, confidence interval = 1.01, 6.2). CONCLUSIONS: Use of a composite measure of risk can identify the most significant factors associated with recent STDs in young military men. Such an index may be useful to target STD screening for those at greatest risk for STDs.


Asunto(s)
Personal Militar/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Humanos , Masculino , Análisis Multivariante , Prevalencia , Factores de Riesgo , Conducta Sexual , Encuestas y Cuestionarios , Estados Unidos/epidemiología
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