Retrospective Analysis of Reproductive Health Indicators in the United Nations High Commissioner for Refugees Post-Emergency Camps 2007–2013

Background

The United Nations Refugee Agency’s Health Information System issues analytical reports on the current camp conditions and trends for priority reproductive health issues. The goal was to assess the status of reproductive health by analyzing seven indicators and comparing them to standards and host country estimates.

Methods

Data on seven indicators were extracted from the database during a seven-year period (2007 through 2013). A standardized country inclusion criterion was created based on the year of country implementation and the percentage of missing reports per camp and year. The unit of analysis was monthly camp reports by year within a country. To account for the lack of independence of monthly camp reports, the variance was computed using Taylor Series Linearization methods in SAS.

Results

Ten of the 23 eligible countries met the inclusion criterion. The mean camp maternal and neonatal mortality rates, except for two country years, were lower than the host country estimates for all countries and years. There was a significant increase in the percent of births attended by a skilled birth attendant (p < 0.0001), and 8 of 10 countries did not meet the standard of 100 % for all reporting years. The percent of births performed by Caesarian section (p < 0.001), were below the recommended minimum standard for nearly half of the countries every year. There was a significant increase in the percent of women screened for syphilis across years (p < 0.0001) and the percent of women who received post HIV exposure prophylaxis (p < 0.0001) and 10 % reached the standard for all reporting years, respectively.

Conclusion

Comprehensive, consistent and comparable statistics on reproductive health provides an opportunity to assess progress towards indicator standards. Despite some improvements over time, this analysis confirms that most countries did not meet standards and that there were differences in reproductive health indicators between countries and across years. Consequently, the HIS periodic monitoring of key reproductive health indicators at the camp level should continue. Data should be used to improve intervention strategies.

Below:  Proportion of women screened for syphilis annually by country. UNCHR target is 100 percent

Below:  Rate of condom distribution* in the population by year. *Figure depicts percentage (monthly rate*100)

Below:  Proportion of rape survivors who received post-exposure prophylaxis (PEP) within 72 h of an incident occurring. UNHCR target is 100 percent

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

By:  Jennifer Whitmill, Curtis Blanton, Sathyanarayanan Doraiswamy, Nadine Cornier, Marian Schilperood, Paul Spiegel, andBarbara Tomczyk

Rollins School of Public Health Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322 USA

Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA

Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA

United Nations High Commissioner for Refugees, Case Postale 2500 CH-1211, Genève 2, Dépôt Switzerland

Rollins School of Public Health Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322 USA

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The Danish PEP Registry: Experience with the Use of Post-Exposure Prophylaxis Following Blood Exposure to HIV from 1999-2012

BACKGROUND:

The risk of occupational exposures to blood cannot be eliminated completely and access to post-exposure prophylaxis (PEP) to prevent HIV transmission is important. However, PEP administration has been associated with frequent adverse effects, low compliance and difficulties to ensure a proper risk assessment. This nationwide study describes 14 years of experience with the use of PEP following blood exposure in Denmark.

METHODS:

A descriptive study of all PEP cases following non-sexual exposure to HIV in Denmark from 1999-2012.

RESULTS:

A total of 411 cases of PEP were described. There was a mean of 29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and then decreasing to 16 cases in 2012. Overall 67.2% of source patients were known to be HIV-positive at the time of PEP initiation, with no significant change over time. The median time to initiation of PEP was 2.5 h (0.15-28.5) following occupational exposure. Adverse effects were reported by 50.9% with no significant difference according to PEP regimen. In 85.1% of cases with available data, either a full course of PEP was completed or PEP was stopped because the source was tested HIV-negative. Only 6.6% stopped PEP early due to adverse effects.

CONCLUSIONS:

PEP in Denmark is generally prescribed according to the guidelines and the annual number of cases has declined since 2005. Adverse effects were common regardless of PEP regimens used and new drug regimens should be considered.

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By:   Lunding S1, Katzenstein TL2, Kronborg G3, Storgaard M4, Pedersen C5, Mørn B6, Lindberg JÅ7, Kronborg TM8, Jensen J9.

• 1a Department of Pulmonary and Infectious Diseases , Nordsjælland Hospital , Hillerød , Denmark.
• 2b Department of Infectious Diseases , Rigshospitalet , Copenhagen , Denmark.
• 3c Department of Infectious Diseases , Hvidovre Hospital , Hvidovre , Denmark.
• 4d Department of Infectious Diseases , Skejby Hospital , Århus , Denmark.
• 5e Department of Infectious Diseases , Odense Hospital , Odense , Denmark.
• 6f Department of Infectious Diseases , Ålborg Hospital , Ålborg , Denmark.
• 7g Department of Medicine , Herning Hospital , Herning , Denmark.
• 8h Medical Faculty, Copenhagen University , Copenhagen , Denmark.
• 9i Department of Medicine , Kolding Hospital , Kolding , Denmark.
• Infect Dis (Lond). 2016 Mar;48(3):195-200. doi: 10.3109/23744235.2015.1103896. Epub 2015 Nov 3.
• 
  

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Assessing the Feasibility of Police Initiation of HIV Post-Exposure Prophylaxis for Sexual Violence Survivors in Lusaka, Zambia

Globally, more than 1 in 3 women have experienced physical or sexual violence (SV) from intimate partners or SV from non-partners [1]. Furthermore, over 10% of all girls are estimated to have experienced a forced sexual act, with the highest rates of SV against girls found in sub-Saharan Africa [2].

Although public recognition of SV is growing in Zambia, reliable data on the nature and extent of such violence is limited. Approximately 20% of Zambian women aged 15 to 49 have experienced some form of sexual violence; however, this is likely underestimated due to underreporting [3]. Previous research in Zambia suggests that exposure to SV is equally pervasive among adolescent girls [4,5].

The risks associated with SV, especially among young women, are numerous. Immediate health consequences include unwanted pregnancy, physical trauma, mental distress and acquisition of HIV and other sexually-transmitted infections. The linkage between sexual and gender-based violence (SGBV) and risk of HIV has been well documented in Africa and is especially pronounced in countries with high HIV prevalence, such as Zambia [3,6-8].

Growing awareness of these negative consequences of SGBV led the Government of Zambia to develop a set of national guidelines for the management of SGBV, highlighting the need for a response system linking the health, police, and social services sectors. A critical component of this response is the prevention of HIV infection in SV survivors through the provision of preventive anti-retroviral therapy, or HIV post-exposure prophylaxis (PEP). The initial dose of PEP must be taken within 72 hours of exposure to HIV [9].

Given the time sensitivity of PEP and the fact that police and health services are often the first points of contact for SV survivors, strong coordination between these two sectors is central to the effective medical management of SV cases in Zambia [10]. Building on the results of previous research in Zambia, which demonstrated that trained Victim Support Unit (VSU) police officers could effectively administer the emergency contraception pill to SV survivors, the Population Council, Zambia Police Service, and Ministry of Health aimed to assess the feasibility of having trained VSU police officers safely and effectively provide a PEP starter dose to SV survivors with immediate referral to comprehensive medical services [10].

Below:  Police delivery of PEP (November 2012 - October 2013)

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

By:   Mary T Zama¹, Mardieh Dennis^1*, Jessica Price¹ and Stephanie M Topp²³

¹Population Council, Private Bag 319X, Ridgeway, Lusaka, Zambia

²Centre for Infectious Disease Research in Zambia, PO Box 34681, Lusaka, Zambia

³Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry Street, Alan Gilbert Building, Carlton 3010, VIC, Australia

  

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HIV-Related Stigma among Healthcare Providers in the Deep South

Stigma towards people living with HIV (PLWH) in healthcare settings is a barrier to optimal treatment. However, our understanding of attitudes towards PLWH from healthcare providers' perspective in the United States is limited and out-of-date. 

We assessed HIV-related stigma among healthcare staff in Alabama and Mississippi, using online questionnaires. Participants included 651 health workers (60 % White race; 83 % female). 

Multivariate regression suggests that several factors independently predict stigmatizing attitudes: Protestant compared to other religions, White race compared to other races, type of clinic (HIV/STI clinic), availability of post-exposure prophylaxis (yes: β = -0.107, p ≤ 0.05), and perceptions of policy enforcement (policies not enforced: β = 0.058, p = p ≤ 0.05). 

These findings may assist providers wishing to improve the quality care for PLWH. Enforcement of policies prohibiting discrimination may be a useful strategy for reducing HIV-related stigma among healthcare workers.

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By:   Stringer KL1, Turan B2, McCormick L3, Durojaiye M3, Nyblade L4, Kempf MC5,6, Lichtenstein B7, Turan JM3.

• 1Department of Sociology, College of Arts and Sciences, University of Alabama at Birmingham, HHB 460, 1720 2nd Ave South, Birmingham, AL, 35294-1152, USA. kristi.stringer.uab@gmail.com.
• 2Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
• 3Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
• 4RTI, International, Washington, DC, USA.
• 5Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
• 6Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
• 7Department of Criminal Justice, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA. 

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Six-Week Follow-Up After HIV-1 Exposure: A Position Statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). 

Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. 

Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. 

A follow-up period of 12 weeks is recommended after a possible exposure forHIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. 

If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.

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By:   Gaines H1,2,3, Albert J4,5,6, Axelsson M1, Berglund T1, Gisslén M6,7, Sönnerborg A3,5,6,8, Blaxhult A9, Bogdanovic G5, Brytting M1, Carlander C6,10, Flamholc L6,11, Follin P12, Haggar A13, Hagstam P14, Johansson M15, Navér L6,16,17, Persson Blom J18, Samuelson A5, Ström H13, Sundqvist M19, Svedhem Johansson V3, Tegmark Wisell K1, Tegnell A1, Thorstensson R1.

• 1 Public Health Agency of Sweden , Solna .
• 2 Unit of Infectious Diseases, Department of Medicine , Karolinska Institutet , Stockholm .
• 3 Department of Infectious Diseases , Karolinska University Hospital , Stockholm .
• 4 Department of Microbiology , Tumor and Cell Biology, Karolinska Institutet , Stockholm .
• 5 Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .
• 6 Swedish Reference Group for Antiviral Therapy , Stockholm .
• 7 Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Gothenburg .
• 8 Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet , Stockholm .
• 9 Department of Infectious Diseases , Södersjukhuset Venhälsan , Stockholm .
• 10 Clinic of Infectious Diseases, County Hospital of Västmanland , Västerås .
• 11 Department of Infectious Diseases , University of Lund, Skåne University Hospital , Malmö .
• 12 Department of Communicable Disease Control and Prevention , Region Västra Götaland , Gothenburg .
• 13 National Board of Health and Welfare , Stockholm .
• 14 Department of Communicable Disease Control and Prevention , Skåne , Malmö .
• 15 Department of Clinical Microbiology and Infectious Diseases , Kalmar County Hospital , Kalmar .
• 16 Department of Pediatrics , Karolinska University Hospital , Stockholm .
• 17 Department of Clinical Science , Intervention and Technology, Karolinska Institute , Stockholm .
• 18 Swedish Work Environment Authority , Stockholm , and.
• 19 Department of Laboratory Medicine , Clinical Microbiology, Örebro University Hospital , Örebro , Sweden. 

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Outcomes of a Postexposure Prophylaxis Program at the Korle-Bu Teaching Hospital in Ghana: A Retrospective Cohort Study

The risk for occupational exposure to HIV is a serious public health problem that is well characterized in the developed world, but less so in the developing countries such as Ghana. This study was undertaken to examine the characteristics of occupational exposure to HIV and the utilization of a risk assessment system (RAS)–based postexposure prophylaxis (PEP) among health care workers (HCWs) and health care students (HCSs) in the Korle-Bu Teaching Hospital (KBTH). 

During the study period (January 2005–December 2010), a total of 260 and 35 exposures were reported by HCWs and HCSs, respectively. Ward attendants reported the highest incidence rate of 6.46 of 100 person-years (P-Y). The incidence of high-risk exposures was 0.33 of 100 P-Y (n = 65); 60.0% occurred during a procedure of disposing of a needle and 24.6% during a cannula insertion. A total of 289 of the 295 individuals were administered PEP, of which 181 (62.6%) completed the 6-month follow-up testing schedule and none sero-converted. 

This shows that with a good RAS in place, it is possible to deploy an effective PEP program in a typical African teaching hospital like the KBTH in Accra, Ghana.

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By:   Raymond A. Tetteh, MSc, FPC Pharm1,2⇑, Edmund T. Nartey, MPhil3, Margaret Lartey, MB ChB, MPH, FWACP4, Aukje K. Mantel-Teeuwisse, PharmD, PhD1, Hubert G. M. Leufkens, PharmD, PhD1,5, Priscilla A. Nortey, PhD, FPC Pharm6 ,Alexander N. O. Dodoo, PhD, FPC Pharm3

1. ¹Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
2. ²Pharmacy Department, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
3. ³Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, Accra, Ghana
4. ⁴Department of Medicine, University of Ghana Medical School, Accra, Ghana
5. ⁵Medicines Evaluation Board, Utrecht, the Netherlands
6. ⁶Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana

1. Raymond A. Tetteh, Pharmacy Department, Korle-Bu Teaching Hospital, P.O. Box KB 77, Korle-Bu, Accra, Ghana. Email: r_niiatetteh@yahoo.com

 

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Post-Exposure Prophylaxis Use & Recurrent Exposure to HIV among Men Who Have Sex with Men Who Use Crystal Methamphetamine

BACKGROUND:

Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users.

METHODS:

Retrospective cohort study of all PEP prescriptions (N=1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once.

RESULTS:

Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64).

CONCLUSIONS:

While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

Full article at:  http://goo.gl/2ExGzK

By:  Oldenburg CE1, Jain S2, Mayer KH3, Mimiaga MJ4.

• 1Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; The Fenway Institute, Fenway Community Health, Boston, MA, United States. Electronic address: ceo242@mail.harvard.edu.
• 2The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.
• 3The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States.
• 4Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States. 

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