HIV risk behaviors in sub-Saharan Africa and Northern Thailand: baseline behavioral data from Project Accept

BACKGROUND: Of 2.5 million new HIV infections worldwide in 2007, most occurred in sub-Saharan Africa and southeast Asia. We present the baseline data on HIV risk behaviors and HIV testing in sub-Saharan Africa and northern Thailand from Project Accept, a community-randomized controlled trial of community mobilization, mobile voluntary counseling and testing (VCT), and posttest support services. METHODS: A random household probability sample of individuals aged 18-32 years yielded a sample of 14,657, with response rates ranging from 84%-94% across the 5 sites (Thailand, Zimbabwe, Tanzania, and 2 in South Africa). Individuals completed an interviewer-administered survey on demographic characteristics, HIV risk behaviors, and history of VCT. RESULTS: In multivariate analysis, females, married individuals, less educated with 1 sexual partner in the past 6 months were more likely to have had unprotected intercourse in the previous 6 months. Rates of lifetime HIV testing ranged from 5.4% among males in Zimbabwe to 52.6% among females in Soweto. CONCLUSIONS: Significant risk of HIV acquisition in Project Accept communities exists despite 2 decades of prevention efforts. Low levels of recent HIV testing suggest that increasing awareness of HIV status through accessible VCT services may reduce HIV transmission.     

The HIV Epidemic in Eastern Europe and Central Asia

Eastern Europe and Central Asia represent one of the few regions globally where there is a continued increase in the incidence of HIV infection. For example, in Eastern Europe the rate of diagnosed cases of HIV infection per 100 000 population has increased from 11.7 in 2004 to 22.5 in 2011. Initially propelled by injection drug use, heterosexual transmission has now become a major driver of new infections in the region. Nonetheless substance use remains an important factor, with its control limited by challenges in scaling up harm reduction efforts. While most countries have implemented opioid substitution therapy programs, their scale remains very limited. Similarly, coverage of needles syringe programs across the region is variable. Complicating the control of HIV has been the emergence of non-injection drugs and inadequate access to antiretroviral therapy. In addition, structural barriers and stigma toward HIV infected people may contribute to the high proportion of late presentations for HIV care. Finally in the wake of the HIV epidemic, high rates of hepatitis C infection and tuberculosis have been noted.     

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

ObjectivesTo investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIV-positive and HIV-negative individuals.MethodsThis cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017.ResultsHIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06–7.17; aOR 1.89, 95% CI 1.54–2.34; aOR 0.60, 95% CI 0.44–0.80). In adjusted models, being in higher carotid intima–media thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78–1.00 mm: aOR 1.46, 95% CI 1.01–2.12; >1.00 mm: aOR 2.18, 95% CI 1.39–3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76–17.91; hypertension: aOR 12.62, 95% CI 3.60–44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41–2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIV-specific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17–2.22), with none for sinus tachycardia.ConclusionsHIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.     

HIV epidemic in Asia: optimizing and expanding vaccine development

The recent evidence in Thailand for protection from acquisition of HIV through vaccination in a mostly heterosexual population has generated considerable hope. Building upon these results and the analysis of the correlates of risk remains among the highest priorities. Improved vaccine concepts including heterologous prime-boost regimens, improved proteins with potent adjuvants and new vectors expressing mosaic antigens may soon enter clinical development to assess vaccine efficacy in men who have sex with men. Identifying heterosexual populations with sufficient HIV incidence for the conduct of efficacy trials represents perhaps the main challenge in Asia. Fostering translational research efforts in Asian countries may benefit from the development of master strategic plans and program management processes.     

Health GIS and HIV/AIDS studies: Perspective and retrospective

GIS (Geographic Information System) is a useful tool that aids and assists in health research, health education, planning, monitoring and evaluation of health programmes that are meant to control and eradicate certain life threatening diseases and epidemics. HIV/AIDS is one such epidemic that poses a serious challenge and threatens the overall human welfare. This communication is an attempt to link and understand the health scenario in a GIS context with emphasis on HIV/AIDS. Various GIS based functionalities for health studies and their scope in analyzing and controlling epidemiological diseases are explored. Overall scenario of the spread of HIV/AIDS around the world is presented along with the Indian perspective. Finally, we conclude with the general management problems, issues and challenges related to HIV/AIDS prevailing in India.     

Prevalence and associated factors of HIV-TB co-infection among HIV patients: a retrospective Study

BackgroundTB/HIV co-infection is a major public health problem in many parts of the world. But the prevalence of co-infection was varies among countries.This study was designed to assess prevalence of TB/HIV co-infection and to determine its factors.MethodsA retrospective study was done among HIV-positive patients at Hiwot Fana hospital from December, 2014 to 2018. The study participants were selected by simple random sampling. Patients with incomplete chart reviews were excluded and demographic, clinical and laboratory information were analyzed using SPSS and STATA. Uni-vitiate and bivariate logistic regressions were applied.ResultsFive hundred fourteen patients were enrolled in this study. Of these, 187(37.4%) had TB. Bivariate logistic analysis showed that HIV patients with regards to marital status[AOR = 2.6; 95%CI = 1.19–2.89], education status [AOR = 3.74; 95%CI = 2.47–5.66], weight less than 50kg [AOR = 2.54; 95% CI = 1.35 – 4.81], CD4 level < 200cells/mm³ [AOR = 4.57; 95%CI = 2.38– 6.86] and patient who were at WHO clinical stage III [AOR = 7.8; 95%CI = 5.15 – 8.55] were significantly associated with TB/HIV co-infection.ConclusionThe prevalence of TB among HIV patients was high and predicted by marital, education status, weight, CD4 cell count and WHO clinical stage III.