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1.
Open Forum Infect Dis ; 6(9): ofz328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31660406

RESUMO

Background: The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods: The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post-ART initiation. The vaginal microbiome was characterized by 16S rRNA gene-based sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA). Results: Five vaginal CSTs were identified, which varied significantly by bacterial load (P < .01): CST-1 was characterized by Lactobacillus iners, CST-2 by Gardnerella, CST-3 by Gardnerella and Prevotella, CST-4 by Lactobacillus crispatus, and CST-5 was highly diverse. Vaginal microbiome composition also did not change significantly after ART initiation (P = .985). Immune reconstitution after ART initiation did not affect vaginal microbiome CST assignment (P = .722) or individual-level changes in bacterial load (log response ratio [interquartile range], -0.50 [-2.75 to 0.38] vs -0.29 [-2.03 to 1.42]; P = .40). Conclusions: The vaginal microbiome of HIV-infected women was not affected by the initiation of ART or immune reconstitution in this observational study. Further research is needed to explore the long-term effects of ART treatment on the vaginal microbiome.

3.
Infect Dis (Lond) ; 51(1): 56-61, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30317905

RESUMO

BACKGROUND: The role of the anti-HIV neutralizing antibody response in protecting against HIV superinfection, and changes in neutralizing antibody potency and breadth after HIV superinfection have not been fully elucidated. This study examined the rate of HIV superinfection in men who have sex with men (MSM) also diagnosed with syphilis in Denmark, and the anti-HIV neutralizing antibody response in men who became superinfected. MATERIALS AND METHODS: MSM enrolled in the Danish HIV cohort who acquired syphilis were examined longitudinally for HIV superinfection using a validated next-generation sequencing assay. HIV superinfection cases were matched 3:1 to controls, and neutralizing antibody responses before (cases/controls) and after (cases) HIV superinfection were determined using a 20-pseudovirus panel. RESULTS: Four cases of HIV superinfection were identified from 95 MSM screened for a rate of HIV superinfection of 1.56/100 pys (95% CI = 0.43-4.01). Prior to HIV superinfection neutralizing antibody responses were low in breadth and potency, and did not differ between cases and controls (p = 1.0). In cases, neutralizing antibody responses increased modestly after HIV superinfection. CONCLUSIONS: These data support the theory that the natural neutralizing antibody response to HIV infection may not be the controlling factor in protecting against a subsequent HIV challenge.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Anti-HIV/sangue , Infecções por HIV/imunologia , HIV/imunologia , Homossexualidade Masculina , Dinamarca , HIV/classificação , HIV/genética , Infecções por HIV/virologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Superinfecção/imunologia , Superinfecção/virologia , Sífilis/complicações
4.
AIDS Res Hum Retroviruses ; 34(12): 1013-1016, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30215267

RESUMO

The limiting antigen (LAg)-avidity assay is a serologic assay used for cross-sectional HIV incidence testing. We compared the results obtained with the LAg-avidity assay using dried blood spot (DBS) samples stored at room temperature (18°C-25°C) or stored frozen at -80°C with results obtained from matched plasma samples. Matched DBS and plasma samples (306 paired samples) were collected in the HIV Prevention Trials Network (HPTN) 068 trial in South Africa (2012-2014). The DBS were stored at room temperature before testing. Matched DBS and plasma samples (100 paired samples) from the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA) were collected in 2016 and were stored at -80°C. All DBS testing was performed in 2017. Differences in normalized optical density (ODn) were compared between matched DBS and plasma samples. For DBS samples stored at room temperature (HPTN 068), the average difference in ODn values for plasma versus DBS was 1.49 (95% confidence intervals [CI]: 1.36-1.62). In contrast, when DBS samples were stored at -80°C (CEPHIA), the average difference in ODn values for plasma versus DBS was -0.22 (95% CI: -0.32 to -0.13). DBS samples stored at room temperature should not be used for cross-sectional HIV incidence testing with the LAg-avidity assay.


Assuntos
Teste em Amostras de Sangue Seco , Infecções por HIV/epidemiologia , Soroprevalência de HIV , Manejo de Espécimes/métodos , Temperatura Ambiente , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Adulto Jovem
5.
Clin Infect Dis ; 66(suppl_3): S213-S220, 2018 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-29617776

RESUMO

Background: The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Methods: Quantitative surveys were conducted among male adolescents aged 10-19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization-recommended HIV minimum package and the US President's Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Results: Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15-19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10-14 years; adjusted ß, 0.17; 95% confidence interval [CI], .12-.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16-2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30-4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Conclusions: Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents.


Assuntos
Circuncisão Masculina/psicologia , Aconselhamento/estatística & dados numéricos , Aconselhamento/normas , Assistência à Saúde/normas , Infecções por HIV/prevenção & controle , Adolescente , Criança , Preservativos , HIV/isolamento & purificação , Infecções por HIV/transmissão , Humanos , Masculino , Doenças Sexualmente Transmissíveis/prevenção & controle , África do Sul , Inquéritos e Questionários , Adulto Jovem
6.
Clin Infect Dis ; 66(suppl_3): S221-S228, 2018 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-29617781

RESUMO

Background: Little is known regarding the impact of counseling delivered during voluntary medical male circumcision (VMMC) services on adolescents' human immunodeficiency virus (HIV) knowledge, VMMC knowledge, or post-VMMC preventive sexual intentions. This study assessed the effect of counseling on knowledge and intentions. Methods: Surveys were conducted with 1293 adolescent clients in 3 countries (South Africa, n = 299; Tanzania, n = 498; Zimbabwe, n = 496). Adolescents were assessed on HIV and VMMC knowledge-based items before receiving VMMC preprocedure counseling and at a follow-up survey approximately 10 days postprocedure. Sexually active adolescents were asked about their sexual intentions in the follow-up survey. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by modified Poisson regression models with generalized estimating equations and robust variance estimators. Results: Regarding post-VMMC HIV prevention knowledge, older adolescents were significantly more likely than younger adolescents to know that a male should use condoms (age 10-14 years, 41.1%; 15-19 years, 84.2%; aPR, 1.38 [95% CI, 1.19-1.60]), have fewer sex partners (age 10-14 years, 8.1%; age 15-19 years, 24.5%; aPR, 2.10 [95% CI, 1.30-3.39]), and be faithful to one partner (age 10-14 years, 5.7%; age 15-19 years, 23.2%; aPR, 2.79 [95% CI, 1.97-3.97]) to further protect himself from HIV. Older adolescents demonstrated greater improvement in knowledge in most categories, differences that were significant for questions regarding number of sex partners (aPR, 2.01 [95% CI, 1.18-3.44]) and faithfulness to one partner post-VMMC (aPR, 3.28 [95% CI, 2.22-4.86]). However, prevention knowledge levels overall and HIV risk reduction sexual intentions among sexually active adolescents were notably low, especially given that adolescents had been counseled only 7-10 days prior. Conclusions: Adolescent VMMC counseling needs to be improved to increase knowledge and postprocedure preventive sexual intentions.


Assuntos
Circuncisão Masculina/psicologia , Aconselhamento , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Adolescente , Preservativos , Infecções por HIV/transmissão , Humanos , Masculino , Análise de Regressão , Comportamento de Redução do Risco , Comportamento Sexual , Parceiros Sexuais , África do Sul , Tanzânia , Zimbábue
7.
J Infect Dis ; 218(1): 109-113, 2018 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-29584878

RESUMO

In the United States, human papillomavirus (HPV) vaccination has been recommended for females since 2006 and males since 2011. We assessed temporal trends in HPV vaccine coverage (defined as receipt of ≥1 dose) among 9-26-year-old participants in the 2011-2016 National Health and Nutrition Examination Surveys. While coverage increased overall, from 37.7% to 45.7%, among females (adjusted prevalence difference [aPD], 7.1%; 95% confidence interval [CI], .1%-13.7%), there was no change among female adolescents aged 9-17 years. For males, coverage increased overall, from 7.8% to 27.4% (aPD, 18.8%; 95% CI, 14.1%-23.5%), and among every stratum of age, race/ethnicity, health insurance status, poverty level, and immigration status (P ≤ .05). The increase in HPV vaccine coverage observed among males is encouraging, but coverage remains below national targets for both males and females.


Assuntos
Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
8.
Clin Infect Dis ; 67(2): 211-217, 2018 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-29554238

RESUMO

Background: The epidemiology of Trichomonas vaginalis (TV) infection in the United States is poorly defined. Methods: Males and females aged 18-59 years who participated in the 2013-2014 National Health and Nutrition Examination Survey and provided a urine specimen were tested for TV infection (n = 4057). Participants were also examined for Chlamydia trachomatis (CT) infection, genital human papillomavirus (HPV) infection, and herpes simplex virus type 2 serostatus. Weighted adjusted prevalence ratios (aPRs) were estimated by multivariable Poisson regression. Results: TV infection prevalence was 0.5% and 1.8% among males and females, respectively. TV infection prevalence was 4.2% among black males, 8.9% among black females, and 0.03% and 0.8%, respectively, among males and females of other races/ethnicities. TV infection prevalence (aPR [95% confidence interval]) was positively associated with female sex (6.1 [3.3-11.3]), black race (vs other races/ethnicities; 7.9 [3.9-16.1]), older age (vs 18-24 years; 3.0 [1.2-7.1] for 25- to 39-year-olds and 3.5 [1.3-9.4] for 40- to 59-year-olds), having less than a high school education (vs completing high school or more; 2.0 [1.0-4.1]), being below the poverty level (vs at or above the poverty level; 4.0 [2.1-7.7]), and having ≥2 sexual partners in the past year (vs 0-1 sexual partners; 3.6 [2.0-6.6]). There were no TV and CT coinfections. Genital HPV detection was not independently associated with TV infection. Among persons aged 18-39 years, there was a significant racial disparity in all sexually transmitted infections examined, and this disparity was greatest for TV infection. Conclusions: There is a high and disproportionate burden of urinary TV infection in the adult civilian, noninstitutionalized black population in the United States that warrants intervention.


Assuntos
Doenças Sexualmente Transmissíveis/epidemiologia , Tricomoníase/epidemiologia , Tricomoníase/urina , Adolescente , Adulto , Afro-Americanos , Fatores Etários , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/urina , Feminino , Gonorreia/epidemiologia , Gonorreia/urina , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/urina , Prevalência , Fatores Raciais , Fatores Sexuais , Comportamento Sexual , Doenças Sexualmente Transmissíveis/parasitologia , Trichomonas vaginalis/isolamento & purificação , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Acquir Immune Defic Syndr ; 74 Suppl 1: S5-S14, 2017 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-27930606

RESUMO

BACKGROUND: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. CONCEPTUAL FRAMEWORK: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social-ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. DISCUSSION: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.


Assuntos
Antirretrovirais/uso terapêutico , Continuidade da Assistência ao Paciente , Infecções por HIV/prevenção & controle , Comunicação em Saúde , Aconselhamento , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde
10.
J Am Vet Med Assoc ; 243(7): 1042-8, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-24050573

RESUMO

OBJECTIVE: To determine the effect of an intervention (educational campaign) on hand hygiene (HH) and health-care workers' (HCWs') perceptions of HH. DESIGN: Prospective observational study and cross-sectional survey. SAMPLE: Observed opportunities for HH performed by HCWs before (n = 222) and after (249) intervention, measures of HH product usage, and surveys distributed to 300 HCWs. PROCEDURES: Data were collected by means of direct observation, measurement of HH product consumption, and surveys of HCWs. RESULTS: Adherence rates of HCWs for HH practices before and after the intervention were 27% (61/222 observations) and 29% (73/249 observations), respectively. Combined HH and glove use adherence rates before and after the intervention were 84% (186/222 observations) and 81% (201/249 observations), respectively. Before intervention, the highest combined HH and glove use adherence rate was detected for technicians (90% [57/63 observations]) and for opportunities after exposure to a patient's bodily fluids (100% [5/5 opportunities]). Rate of use of alcohol-based antimicrobial hand rubs (AHRs) and amount of HH products used did not significantly change during the study. Survey response rates were 41% (122) and 21% (62) before and after the intervention, respectively. Availability of AHRs and role modeling of HH (performance of HH each time it is warranted) were considered the factors most likely to increase HH adherence rates by survey respondents. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated the intervention did not increase HH adherence or use of AHRs. High rates of glove use before the start of the study may have been a confounding factor. Future educational campaigns should indicate that glove use should not supersede HH.


Assuntos
Desinfecção das Mãos/normas , Hospitais Veterinários/normas , Médicos Veterinários/normas , Técnicos em Manejo de Animais , Animais , Educação em Veterinária , Luvas Protetoras , Fidelidade a Diretrizes , Humanos , Estudantes
13.
Nurs Manag (Harrow) ; 14(4): 20-23, 2007 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-27732311

RESUMO

ACCORDING TO its own research in 2005, King's College Hospital NHS Foundation Trust is as good as, or better than, other teaching hospitals doing similar work, yet it experienced a 25 per cent chance of elective surgery cancellation after pre-admission.

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