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1.
Epidemiol Infect ; 150: e72, 2022 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-35403594

RESUMO

In April 2020, Belgium experienced high numbers of fatal COVID-19 cases among nursing home (NH) residents. In response, a mass testing campaign was organised testing all NH residents and staff. We analysed the data of Flemish NHs to identify institutional factors associated with increased SARS-CoV-2 infection rates among NH residents. Cross-sectional study was conducted between 8 April and 15 May 2020. Data collected included demographics, group category (i.e. staff or resident), symptom status and test result. We retrieved additional data: number of beds and staff, type of beds (level of dependency of residents) and ownership (public, private for profit/non-profit institutions). Risk factor analysis was performed using negative binomial regression. In total, 695 NHs were included, 282 (41%) had at least one resident tested positive. Higher infection rate among residents was associated with a higher fraction of RVT beds, generally occupied by more dependent residents (incidence rate ratio (IRR) 1.97; 95% CI 1.00-3.86) and higher staff infection rate (IRR 1.89; 95% CI 1.68-2.12). No relationship was found between other investigated NH characteristics and infection rate among residents. Staff-resident interactions are key in SARS-CoV-2 transmission dynamics. Vaccination, regular staff testing, assessment of infection prevention and control strategies in all NHs are needed to face future SARS-CoV-2 epidemics in these settings.


Assuntos
COVID-19 , Bélgica/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Humanos , Casas de Saúde , Pandemias , SARS-CoV-2
2.
Neth J Med ; 76(8): 374-378, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30362948

RESUMO

BACKGROUND: The evidence that HIV treatment as prevention (TasP) and HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV transmission is overwhelming. But as PrEP and TasP can lead to increased sexual mixing between HIV positive and negative men who have sex with men (MSM), sexually transmitted infections such as acute hepatitis C (HCV), which were thought to be limited to HIV-infected MSM, could become more frequent in HIV uninfected MSM as well. The objective of this study was to describe a series of cases of sexually transmitted HCV infections in HIV-uninfected MSM in the Netherlands and Belgium. METHODS: Through the Dutch Acute HCV in HIV Study (a Dutch-Belgian prospective multicentre study on the treatment of acute HCV infection, NCT02600325) and the Be-PrEP-ared study (a PrEP project in Antwerp, EudraCT2015-000054-37) several acute HCV infections were detected in HIV-negative men. RESULTS: A newly acquired HCV infection was diagnosed in ten HIV-negative MSM. HCV was diagnosed at a sexually transmitted infection (STI) clinic (n = 2), by their general practitioner (n = 2), by their HIV physician (n = 1) or at a PrEP clinic (n = 5). Ten patients reported unprotected anal intercourse and four had a concomitant STI at the time of HCV diagnosis. Six patients reported using drugs during sex. CONCLUSIONS: Our observation calls for a larger nationwide epidemiological study on the prevalence, incidence and risk factors of HCV infection in HIV-uninfected MSM. In the changing landscape of TasP and PrEP, reliable and up-to-date epidemiological data on HCV among HIV-uninfected MSM are needed and will help in developing evidence-based testing policies.


Assuntos
Soronegatividade para HIV , Hepatite C/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Doença Aguda , Adulto , Bélgica/epidemiologia , Ensaios Clínicos como Assunto , HIV , Hepacivirus , Hepatite C/imunologia , Hepatite C/virologia , Humanos , Masculino , Países Baixos/epidemiologia , Estudos Prospectivos , Fatores de Risco , Comportamento Sexual , Doenças Virais Sexualmente Transmissíveis/imunologia , Doenças Virais Sexualmente Transmissíveis/virologia , Sexo sem Proteção
3.
Euro Surveill ; 16(28)2011 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-21794222

RESUMO

This venue-based, cross-sectional study reports on human immunodeficiency virus (HIV) prevalence and behaviour of 649 men who have sex with men (MSM) in Antwerp and Ghent, Flanders, Belgium, from October 2009 to March 2010. Using time-location sampling, we found that HIV prevalence in MSM who attended different types of venue ranged from a high of 14.5% (95% CI: 8.9­20.1; n=22 in cruising venues to 4.9% (95% CI: 1.9­7.9; n=10) in more general gay venues to 1.4% (95% CI: 0.0­3.6; n=3) at younger MSM venues. Of those who tested HIV positive (n=35, five were unaware of their HIV status or self-reported as being HIV negative. One in five respondents were of non-Belgian nationality. The results showed relatively high rates of testing for HIV (52.2%; 95 % CI: 47.8­56.2; n=288) and other sexually transmitted infections (STIs) (57.4%; 95% CI: 52.6­62.0; n=248) in the last 12 months. A majority of the men (n=233) used condoms consistently during their last anal sexual contact with a casual partner; however, HIV-positive men who were aware of their serostatus (n=30) reported less condom use with casual partners. This is the first such study in Belgium and the results constitute the evidence base for local, targeted interventions. Furthermore, our findings underscore the need for European cross-border cooperation to prevent HIV infection and other STIs among MSM.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Parceiros Sexuais , Adolescente , Adulto , Fatores Etários , Idoso , Bélgica/epidemiologia , Preservativos/estatística & dados numéricos , Estudos Transversais , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Características de Residência , Trabalho Sexual , Meio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
4.
Trop Med Int Health ; 9(5): 638-43, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15117310

RESUMO

OBJECTIVES: To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers. METHODS: A cross-sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems. RESULTS: Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less. Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider-client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them. CONCLUSIONS: The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.


Assuntos
Qualidade da Assistência à Saúde , Trabalho Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Venereologia/normas , Assistência Ambulatorial/normas , Competência Clínica/normas , Côte d'Ivoire , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Humanos
5.
Sex Transm Infect ; 79(5): 393-8, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14573835

RESUMO

OBJECTIVES: DNA amplification techniques have become widely used for the diagnosis of sexually transmitted infections. For the detection of Trichomonas vaginalis, PCR techniques are not yet widely used despite the publication of several assays. The sensitivity and specificity of five independent primer sets were determined on self collected vaginal specimens obtained from female commercial sex workers. METHODS: Self collected specimens were obtained from symptomatic and asymptomatic women attending a female sex workers clinic in Abidjan, Côte d'Ivoire. Two vaginal specimens were collected, the first one was processed for culture and the second was processed for PCR analysis. PCR techniques for trichomonads were performed, using the primers as reported by Riley (TVA5/TVA6), Kengne (TVK3/TVK7), Madico (BTUB 9/BTUB 2), Shiao (IP1/IP2), and Mayta (TV1/TV2). An EIA amplicon detection method was designed for each of the primer sets. RESULTS: True positive specimens were defined as culture positive and/or two positive PCR results with EIA amplicon detection in any combination. According to this definition a prevalence of 20% was obtained compared to 7% obtained by culture. The PCR primer set TVK3/TVK7 gave the highest sensitivity (89.2%). Poor sensitivities were obtained with the primer sets TV1/TV2 (60.2%) and TVA5/TVA6 (63.9%). PCR showed a sensitivity improvement of 2.4% up to 12% when EIA was used for amplicon detection. CONCLUSIONS: Overall, the sensitivities of the different PCR assays resulting from this study were lower than those previously described. These findings could be the result of the nature of the specimen population and suggests a strain variability.


Assuntos
Parasitologia/métodos , Reação em Cadeia da Polimerase/normas , Vaginite por Trichomonas/diagnóstico , Animais , Eletroforese em Gel de Ágar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Parasitologia/normas , Controle de Qualidade , Autocuidado , Sensibilidade e Especificidade , Trabalho Sexual , Manejo de Espécimes , Trichomonas vaginalis/isolamento & purificação , Vagina/parasitologia , Esfregaço Vaginal/métodos , Esfregaço Vaginal/normas
6.
J Agric Food Chem ; 51(5): 1260-4, 2003 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-12590465

RESUMO

Jojoba seed meal shows appetite-suppressing activity due to the presence of simmondsin. This pharmacological activity disappears with treatment of the meal with sodium hydroxide. To elucidate this mechanism of inactivation, the reaction of simmondsin in 1 N NaOH at 20 degrees C was monitored as a function of time. The end products of the reaction as well as intermediates were isolated and identified. The half-life of simmondsin was approximately 60 min with d-glucose and 2-hydroxy-3-methoxyphenylacetonitrile as reaction end products. The reaction mechanism could be elucidated by the isolation of isosimmondsin and a simmondsin lactone derivative. Those compounds were isolated and purified by a combination of column chromatography and HPLC and identified mainly by HRMS and NMR spectroscopy.


Assuntos
Acetonitrilas/química , Cicloexanos , Glucosídeos/química , Magnoliopsida/química , Sementes/química , Hidróxido de Sódio/farmacologia , Cromatografia Líquida de Alta Pressão , Estabilidade de Medicamentos , Glucose/análise , Glucose/química , Meia-Vida , Concentração de Íons de Hidrogênio , Espectroscopia de Ressonância Magnética , Metilação
7.
Trop Med Int Health ; 6(12): 971-9, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11737832

RESUMO

OBJECTIVES: To estimate the proportion of symptomatic patients with a bacterial sexually transmitted infection (STI) cured by primary health care services in Mwanza Region, Tanzania, and to compare the cure rate achieved by health centres before and after the introduction of improved STI treatment services. METHODS: A model was used that describes the different hurdles patients with an STI take before they can be considered cured by the health services. The values for the input parameters for the model were taken from different studies. Data from an intervention trial as well as from a population-based study on male urethritis were used to estimate the proportion of symptomatic patients with an STI who seek care from a health centre. An observational study in four health centres where improved STI treatment services had been introduced provided estimates of the proportions of patients with an STI correctly diagnosed and treated. Patients who returned to the health centres after 1 week were interviewed about compliance. An estimate of the efficacy of treatments prescribed for STIs in health centres before the introduction of improved STI services was obtained from a study on prescription patterns for genital discharge syndrome (GDS) and genital ulcer disease (GUD). RESULTS: It was estimated that in the catchment area of health centres offering improved STI services, 51-72% of patients with STI symptoms sought care from those health centres. About 76-85% of cases were correctly diagnosed, and of these 69-80% received efficacious treatment. Compliance with full treatment was estimated at 84%. The estimated overall cure rate achieved by the health centres offering improved STI services ranged between 23 and 41%. The proportion of symptomatic STI patients who attended a health centre before improved STI services were introduced was estimated at 39%. The estimated efficacy of the treatments prescribed was 28%. The overall cure rate achieved by these health centres was less than 10%. CONCLUSIONS: When assessing the performance of STI case detection and management all steps have to be taken into account that are taken by patients with an STI before they can be considered cured by the health services. The intervention to improve STI services in Mwanza Region has resulted in an improvement of the cure rate of STIs achieved by primary health care centres.


Assuntos
Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/tratamento farmacológico , Adolescente , Adulto , Assistência Ambulatorial , Antibacterianos/uso terapêutico , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Tanzânia , Resultado do Tratamento
8.
AIDS ; 15 Suppl 4: S109-16, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11686459

RESUMO

OBJECTIVE: To describe the distribution of HIV-1 subtypes in two cities with high HIV prevalence (Kisumu, Kenya and Ndola, Zambia) and two with relatively low prevalence (Cotonou, Benin and Yaoundé, Cameroon), and to examine whether the differences in prevalence of HIV infection could be due to the predominance within the infected populations of subtypes with differing efficiency of heterosexual transmission. METHODS: For around 100 randomly selected HIV-positive sera from the general population and 60 from sex workers in each city, the HIV-1 subtype was determined in the envfragment. For between 19 and 52 of the sera from the general population and 20-32 sera from sex workers, the subtype was also determined in the gag fragment. RESULTS: Over 70% of infections in Cotonou, Yaoundé and Kisumu were with subtype A (by env). However, around one-half of subtype A infections in Cotonou and Yaoundé were found to be the circulating recombinant form CRF02_AG when the gag fragment was also examined. A large number of different HIV strains were found in Yaoundé, including some belonging to group O. Over 20% of infections in Kisumu and around 10% in Yaoundé were with isolated intersubtype recombinant forms. All but a few infections in Ndola were with subtype C and no recombinants were found. CONCLUSIONS: The pattern of distribution of subtypes that we found does not suggest that differences in circulating subtypes play a major role in explaining the differences in prevalence of HIV-1 infection between the four cities. The emergence and spread of recombinants requires close surveillance to adapt testing strategies if needed, to inform vaccine development and to ascertain their role in the future spread of HIV.


Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , HIV-1/classificação , HIV-1/genética , População Urbana , Adolescente , Adulto , África Subsaariana/epidemiologia , Feminino , Produtos do Gene env/genética , Produtos do Gene gag/genética , Infecções por HIV/transmissão , Infecções por HIV/virologia , Análise Heteroduplex , Heterossexualidade , Humanos , Masculino , Prevalência , Trabalho Sexual
10.
AIDS ; 15 Suppl 4: S5-14, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11686465

RESUMO

OBJECTIVE: The objective of this study was to explore whether the differences in rate of spread of HIV in different regions in sub-Saharan Africa could be explained by differences in sexual behaviour and/or factors influencing the probability of HIV transmission during sexual intercourse. METHODS: A cross-sectional, population-based study was conducted in two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia) and two cities with a relatively low HIV prevalence (Cotonou in Benin and Yaoundé in Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population. Consenting men and women were interviewed and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection and trichomoniasis (the latter for women only). In addition, a survey was conducted on a random sample of 300 sex workers in each city. The research instruments, including the questionnaires and the laboratory procedures, were standardized to permit comparison of results. RESULTS: The numbers of men interviewed were 1021 in Cotonou, 973 in Yaoundé, 829 in Kisumu, and 720 in Ndola. The corresponding figures for women were 1095, 1116, 1060 and 1130. In Yaoundé, Kisumu and Ndola, the response rates for men were lower than for women due to failure to make contact with eligible men. The proportion of eligible women who were interviewed was 86% in Yaoundé, and 89% in Kisumu and Ndola. In Yaoundé, 76% of eligible men were interviewed, along with 82% in Kisumu and 75% in Ndola. The prevalence of HIV infection in men was 3.3% in Cotonou, 4.1% in Yaoundé, 19.8% in Kisumu and 23.2% in Ndola. For women, the respective figures were 3.4, 7.8, 30.1 and 31.9%. The prevalence of HIV infection among women aged 15-19 years was 23.0% in Kisumu and 15.4% in Ndola. Among women in Kisumu who had their sexual debut 5 years before the interview, the prevalence of HIV infection was 46%; in Ndola, it was 59%. Among sex workers, the prevalence of HIV infection was 57.5% in Cotonou, 34.4% in Yaoundé, 74.7% in Kisumu and 68.7% in Ndola. CONCLUSIONS: The HIV prevalence rates in the general population confirmed our preliminary assessment of the level of HIV infection in the four cities, which was based on estimates of HIV prevalence from sentinel surveillance among pregnant women. The very high prevalence of HIV infection among young women in Kisumu and Ndola calls for urgent intervention.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Adolescente , Adulto , África Subsaariana/epidemiologia , Estudos Transversais , Feminino , Anticorpos Anti-HIV/sangue , HIV-1/imunologia , Heterossexualidade , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Trabalho Sexual , Comportamento Sexual , Infecções Sexualmente Transmissíveis/diagnóstico , Inquéritos e Questionários
11.
AIDS ; 15 Suppl 4: S79-88, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11686469

RESUMO

OBJECTIVES: To compare the epidemiology of gonorrhoea, chlamydial infection and syphilis in four cities in sub-Saharan Africa; two with a high prevalence of HIV infection (Kisumu, Kenya and Ndola, Zambia), and two with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon). DESIGN: Cross-sectional study, using standardized methods, including a standardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa. METHODS: In each city, a random sample of about 2000 adults aged 15-49 years was taken. Consenting men and women were interviewed about their socio-demographic characteristics and their sexual behaviour, and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection, and (women only) Trichomonas vaginalis infection. Risk factor analyses were carried out for chlamydial infection and syphilis seroreactivity. RESULTS: The prevalence of gonorrhoea ranged between 0% in men in Kisumu and 2.7% in women in Yaoundé. Men and women in Yaoundé had the highest prevalence of chlamydial infection (5.9 and 9.4%, respectively). In the other cities, the prevalence of chlamydial infection ranged between 1.3% in women in Cotonou and 4.5% in women in Kisumu. In Ndola, the prevalence of syphilis seroreactivity was over 10% in both men and women; it was around 6% in Yaoundé, 3-4% in Kisumu, and 1-2% in Cotonou. Chlamydial infection was associated with rate of partner change for both men and women, and with young age for women. At the population level, the prevalence of chlamydial infection correlated well with reported rates of partner change. Positive syphilis serology was associated with rate of partner change and with HSV-2 infection. The latter association could be due to biological interaction between syphilis and HSV-2 or to residual confounding by sexual behaviour. At the population level, there was no correlation between prevalence of syphilis seroreactivity and reported rates of partner change. CONCLUSION: Differences in prevalence of chlamydial infection could be explained by differences in reported sexual behaviour, but the variations in prevalence of syphilis seroreactivity remained unexplained. More research is needed to better understand the epidemiology of sexually transmitted infections in Africa.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Sífilis/epidemiologia , Adolescente , Adulto , África Subsaariana/epidemiologia , Anticorpos Antibacterianos/sangue , Chlamydia trachomatis/isolamento & purificação , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae , Prevalência , Fatores de Risco , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação , População Urbana
12.
AIDS ; 15 Suppl 4: S89-96, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11686470

RESUMO

OBJECTIVES: To describe the epidemiology of Trichomonas vaginalis infection and its association with HIV infection, in women in four African cities with different levels of HIV infection. DESIGN: Cross-sectional study, using standardized methods, including a standardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa: two with a high prevalence of HIV infection (Kisumu, Kenya and Ndola, Zambia), and two with a relatively low prevalence of HIV (Cotonou, Benin and Yaoundé, Cameroon). METHODS: In each city, a random sample of about 2000 adults aged 15-49 years was taken. Consenting men and women were interviewed about their socio-demographic characteristics and their sexual behaviour, and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection, and (women only) T. vaginalis infection. Risk factor analyses were carried out for trichomoniasis for each city separately. Multivariate analysis, however, was only possible for Yaoundé, Kisumu and Ndola. RESULTS: The prevalence of trichomoniasis was significantly higher in the high HIV prevalence cities (29.3% in Kisumu and 34.3% in Ndola) than in Cotonou (3.2%) and Yaoundé (17.6%). Risk of trichomoniasis was increased in women who reported more lifetime sex partners. HIV infection was an independent risk factor for trichomonas infection in Yaoundé [adjusted odds ratio (OR) = 1.8, 95% confidence interval (CI) = 0.9-3.7] and Kisumu (adjusted OR = 1.7, 95% CI = 1.1-2.7), but not in Ndola. A striking finding was the high prevalence (40%) of trichomonas infection in women in Ndola who denied that they had ever had sex. CONCLUSION: Trichomoniasis may have played a role in the spread of HIV in sub-Saharan Africa and may be one of the factors explaining the differences in levels of HIV infection between different regions in Africa. The differences in prevalence of trichomoniasis between the four cities remain unexplained, but we lack data on the epidemiology of trichomoniasis in men. More research is required on the interaction between trichomoniasis and HIV infection, the epidemiology of trichomoniasis in men, and trichomonas infections in women who deny sexual activity.


Assuntos
Vaginite por Trichomonas/epidemiologia , Trichomonas vaginalis , Adolescente , Adulto , África Subsaariana/epidemiologia , Animais , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Distribuição Aleatória , Fatores de Risco , Comportamento Sexual , Inquéritos e Questionários , Vaginite por Trichomonas/parasitologia
13.
AIDS ; 15 Suppl 4: S97-108, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11686471

RESUMO

OBJECTIVES: To estimate age- and sex-specific herpes simplex virus type-2 (HSV-2) prevalence in urban African adult populations and to identify factors associated with infection. DESIGN AND METHODS: Cross-sectional, population-based samples of about 2000 adults interviewed in each of the following cities: Cotonou, Benin; Yaoundé, Cameroon; Kisumu, Kenya and Ndola, Zambia. Consenting study participants were tested for HIV, HSV-2 and other sexually transmitted infections. RESULTS: HSV-2 prevalence was over 50% among women and over 25% among men in Yaoundé, Kisumu and Ndola, with notably high rates of infection among young women in Kisumu and Ndola (39% and 23%, respectively, among women aged 15-19 years). The prevalence in Cotonou was lower (30% in women and 12% in men). Multivariate analysis showed that HSV-2 prevalence was significantly associated with older age, ever being married, and number of lifetime sexual partners, in almost all cities and both sexes. There was also a strong, consistent association with HIV infection. Among women, the adjusted odds ratios for the association between HSV-2 and HIV infections ranged from 4.0 [95% confidence interval (CI) = 2.0-8.0] in Kisumu to 5.5 (95% CI = 1.7-18) in Yaoundé, and those among men ranged from 4.6 (95% CI = 2.7-7.7) in Ndola to 7.9 (95% CI = 4.1-15) in Kisumu. CONCLUSIONS: HSV-2 infection is highly prevalent in these populations, even at young ages, and is strongly associated with HIV at an individual level. At a population level, HSV-2 prevalence was highest in Kisumu and Ndola, the cities with the highest HIV rates, although rates were also high among women in Yaoundé, where there are high rates of partner change but relatively little HIV infection. The high prevalence of both infections among young people underlines the need for education and counselling among adolescents.


Assuntos
Infecções por HIV/complicações , Herpes Genital/epidemiologia , População Urbana , Adolescente , Adulto , África Subsaariana/epidemiologia , Distribuição por Idade , Anticorpos Antivirais/sangue , Estudos Transversais , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/epidemiologia , HIV-1/imunologia , Herpes Genital/transmissão , Herpes Genital/virologia , Herpesvirus Humano 2/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Distribuição por Sexo , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/epidemiologia
14.
Sex Transm Infect ; 77(5): 351-2, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11588281

RESUMO

OBJECTIVES: To describe health seeking behaviour of female sex workers in Abidjan, Côte d'Ivoire. METHODS: A population based survey among a representative sample of 500 female sex workers and six focus group discussions. RESULTS: The sites of first encounter for care for the last STI episode included a public hospital or health centre (28%), a private clinic (16%), a confidential clinic (13%), a pharmacy (13%), and the informal sector (23%). The agreement between preferred and actual services used was weak (kappa 0.16). CONCLUSIONS: Sex workers expressed interest in seeking STI care in a wide range of public and private healthcare facilities. Those services should be upgraded to better respond to their sexual health needs.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/terapia , Adulto , África Ocidental , Feminino , Grupos Focais , Humanos , Vigilância da População/métodos
15.
AIDS ; 15(11): 1421-31, 2001 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-11504964

RESUMO

OBJECTIVE: To compare the seroincidence of HIV infection among female sex workers in Abidjan, Côte d'Ivoire before and during an intervention study to control sexually transmitted diseases (STD) and to study the effect of two STD diagnosis and treatment strategies on the prevalence of STD and on the seroincidence of HIV infection. METHOD: A screening facility for STD and HIV had been available since October 1992 for female sex workers. From June 1994, women who were HIV seronegative or HIV-2 positive during the screening could enroll in the intervention study in which participants reported once a month to a confidential clinic where they received health education, condoms and STD treatment if indicated. Women in the study were randomized either to a basic STD diagnosis and treatment strategy, which included a gynecologic examination when symptomatic, or to an intensive strategy that included a gynecologic examination regardless of symptoms. An outcome assessment every 6 months included a gynecologic examination, HIV serology and laboratory tests for STD. RESULTS: Of 542 women enrolled in the study, 225 (42%) had at least one outcome assessment. The HIV-1 seroincidence rate during the intervention study was significantly lower than before the study (6.5 versus 16.3 per 100 person-years; P = 0.02). During the study, the HIV-1 seroincidence rate was slightly lower in the intensive than in the basic strategy (5.3 versus 7.6 per 100 person-years; P = 0.5). CONCLUSION: National AIDS control programs should consider adopting as policy the type of integrated approach used in this intervention study for HIV prevention in female sex workers.


Assuntos
Infecções por HIV/prevenção & controle , HIV-1 , HIV-2 , Trabalho Sexual , Adulto , Preservativos , Côte d'Ivoire/epidemiologia , Estudos Transversais , Coleta de Dados , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Incidência , Análise Multivariada , Distribuição Aleatória , Sexo Seguro , Educação Sexual
16.
Sex Transm Dis ; 28(9): 539-45, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11518873

RESUMO

BACKGROUND: Plasmid-mediated and chromosomal-mediated resistance of Neisseria gonorrhoeae to penicillin, tetracycline, thiamphenicol, and trimethoprim-sulfamethoxazole has spread dramatically in Africa. Monitoring of antimicrobial susceptibility is a key element in the control of sexually transmitted diseases. GOAL: To document antimicrobial susceptibilities of gonococci isolated during the past 15 years in Kigali, Rwanda. STUDY DESIGN: Minimal inhibitory concentrations of recently collected gonococcal isolates of eight antimicrobials were determined. The results were compared with data collected for isolates obtained since 1986. RESULTS: In 1986, 35% of the gonococcal isolates were penicillinase-producing N gonorrhoeae. Tetracycline-resistant N gonorrhoeae appeared in 1989. The prevalence of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae increased significantly to 70.5% and 89.2%, respectively. Chromosomal resistance to penicillin, tetracycline, and thiamphenicol increased temporarily, then decreased significantly. Chromosomal resistance to trimethoprim-sulfamethoxazole appeared in 1988 and increased to 21.6%. All the isolates were susceptible to ceftriaxone, ciprofloxacin, spectinomycin, and kanamycin. CONCLUSIONS: This study illustrated the rapidly increasing frequencies of penicillinase-producing N gonorrhoeae and tetracycline-resistant N gonorrhoeae. Chromosomal resistance to thiamphenicol and trimethoprim-sulfamethoxazole excludes these drugs as alternative treatment. Programs for antimicrobial susceptibility surveillance of N gonorrhoeae should urgently be established in Africa.


Assuntos
Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , Resistência Microbiana a Medicamentos/genética , Humanos , Testes de Sensibilidade Microbiana/métodos , Neisseria gonorrhoeae/isolamento & purificação , Resistência às Penicilinas , Ruanda/epidemiologia , Vigilância de Evento Sentinela
18.
Int J STD AIDS ; 12(5): 299-301, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11368802

RESUMO

The aim of this study was to evaluate the performance of rapid plasma reagin (RPR) testing using expired and adversely stored antigen reagent. The sensitivity of RPR using antigen stored at 36 degrees C was compared at 3-monthly intervals with RPR using fresh antigen on 116 sera reactive by RPR and by Treponema pallidum particle agglutination (TPPA). After multiple phases of freezing and thawing, 8.3% of initial RPR reactive sera seroreverted. After storage at 36 degrees C for one year and 24 weeks after expiration the overall sensitivity of the adversely stored antigen was 93.8% compared with fresh antigen; the sensitivity was 100% for sera with RPR titres > or = 1:4 and 85.4% for sera with RPR titres of 1:1 and 1:2. The high stability of the reagent may increase the feasibility of the RPR test for use in poorly-equipped healthcare centres in developing countries.


Assuntos
Anticorpos Antibacterianos/imunologia , Cardiolipinas/imunologia , Indicadores e Reagentes/normas , Reaginas/imunologia , Sífilis/diagnóstico , Anticorpos Antibacterianos/sangue , Humanos , Reaginas/sangue , Sífilis/imunologia , Fatores de Tempo , Treponema pallidum/imunologia
19.
J Clin Microbiol ; 39(6): 2280-2, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11376070

RESUMO

The AMPLICOR PCR was used to detect Neisseria gonorrhoeae in endocervical specimens. A 16S rRNA PCR performed on N. gonorrhoeae-positive samples showed sensitivities of 73.2, 64.3, and 94.4% for samples treated directly with AMPLICOR lysis buffer, samples suspended in 2-sucrose phosphate, and samples suspended in diluted phosphate-buffered saline, respectively.


Assuntos
Colo do Útero/microbiologia , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , RNA Ribossômico 16S/genética , Feminino , Gonorreia/microbiologia , Humanos , Neisseria gonorrhoeae/genética , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Manejo de Espécimes/métodos
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