New Indicators for Delay in Initiation of Antiretroviral Treatment: Estimates for Cameroon

To propose two new indicators for monitoring access to antiretroviral treatment (ART) for human immunodeficiency virus (HIV); (i) the time from HIV seroconversion to ART initiation, and (ii) the time from ART eligibility to initiation, referred to as delay in ART initiation. To estimate values of these indicators in Cameroon.

We used linear regression to model the natural decline in CD4+ T-lymphocyte (CD4+ cell) numbers in HIV-infected individuals over time. The model was fitted using data from a cohort of 351 people in Côte d'Ivoire. We used the model to estimate the time from seroconversion to ART initiation and the delay in ART initiation in a representative sample of 4154 HIV-infected people who started ART in Cameroon between 2007 and 2010.

In Cameroon, the median CD4+ cell counts at ART initiation increased from 140 cells/μl (interquartile range, IQR: 66 to 210) in 2007-2009 to 163 cells/μl (IQR: 73 to 260) in 2010. The estimated average time from seroconversion to ART initiation decreased from 10.4 years (95% confidence interval, CI: 10.3 to 10.5) to 9.8 years (95% CI: 9.6 to 10.0). Delay in ART initiation increased from 3.4 years (95% CI: 3.1 to 3.7) to 5.8 years (95% CI: 5.6 to 6.2).

The estimated time to initiate ART and the delay in ART initiation indicate that progress in Cameroon is insufficient. These indicators should help monitor whether public health interventions to accelerate ART initiation are successful.

Full article at:  http://goo.gl/vVnwHK

By: Jacques DA Ndawinz a, Xavier Anglaret b, Eric Delaporte c, Sinata Koulla-Shiro d, Delphine Gabillard b, Albert Minga e, Dominique Costagliola a, Virginie Supervie a

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An Urgent Need for Integration of Family Planning Services into HIV Care: The High Burden of Unplanned Pregnancy, Termination of Pregnancy, and Limited Contraception Use among Female Sex Workers in Côte d'Ivoire

HIV infection and unintended pregnancy are occupational risks of commercial female sex work (FSW). The burden of unintended pregnancy among FSW including maternal and infant outcomes in the context of HIV is largely unknown.

From March to July 2014, 466 FSW were enrolled. Unintended pregnancy was common, and 64% of participants had ≥1 TOP. Half of FSW experiencing TOPs did so without a medical professional, resulting in frequent complications. Contraceptive use was lowest among younger FSW, and 37% of 20-24 year olds reported multiple TOPs. FSW with a TOP history reported 19% less consistent condom use with clients than women who never had a TOP (adjusted-prevalence ratio, 0.81; 95% confidence interval: 0.74 to 0.88), whereas use of reliable nonbarrier contraceptive methods was comparable between the groups. Although FSW were engaged in HIV testing and prevention services, only 59% of FSW had received HIV testing before childbirth during their last pregnancy, and 30% of HIV-infected FSW had lost ≥1 children.

Low contraceptive use and high burden of unintended pregnancy result in poor reproductive outcomes for FSW and avoidable mother-to-child HIV transmission risks. Integration of family planning and antenatal services into HIV prevention and care programs accessed by FSW could enhance reproductive outcomes and HIV prevention goals.

Below: The relationship between age, pregnancy history, and contraception use among female sex workers in Abidjan, Cote d’Ivoire, 2014 (n = 466). A, History of pregnancy and termination of pregnancy (TOP) across age categories. B, Use of barrier and nonbarrier contraception across age categories. Reliable nonbarrier contraception included injectable and oral contraceptive methods, implants, intrauterine devices and sterilization. Any reliable contraception included use of reliable nonbarrier methods listed above and/or consistent condom use with clients.

Via (PDF); http://ow.ly/d/3Kge 

By: Schwartz S1, Papworth E, Thiam-Niangoin M, Abo K, Drame F, Diouf D, Bamba A, Ezouatchi R, Tety J, Grover E, Baral S.

• 1*Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD; †Programme National de Lutte Contre le SIDA, Ministere de la Lutte Contre Le SIDA, Abidjan, Côte d'Ivoire; ‡Enda Santé, Dakar, Senegal; §Gaston Berger University, Department of Geography, School of Social Sciences, St. Louis, Senegal; and ‖Blety, Abidjan, Côte d'Ivoire.

Intimate Partner Violence & HIV in Ten Sub-Saharan African Countries: What Do the Demographic & Health Surveys Tell Us?

Below: Risk of HIV infection in women exposed to intimate partner violence

There were consistent and strong associations between HIV infection in women and physical violence, emotional violence, and male controlling behaviour (adjusted odds ratios ranged from 1·2 to 1·7; p values ranged from <0·0001 to 0·0058). The evidence for an association between sexual violence and HIV was weaker and only significant in the sample with women in their first union. The associations were dependent on the presence of controlling behaviour and a high regional HIV prevalence rate; when women were exposed to only physical, sexual, or emotional violence, and no controlling behaviour, or when HIV prevalence rates are lower than 5%, the adjusted odds ratios were, in general, close to 1 and insignificant.

The findings indicate that male controlling behaviour in its own right, or as an indicator of ongoing or severe violence, puts women at risk of HIV infection. HIV prevention interventions should focus on high-prevalence areas and men with controlling behaviour, in addition to violence.

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