Field evaluation of Standard Diagnostics' Bioline HIV/Syphilis Duo test among female sex workers in Johannesburg, South Africa

BACKGROUND:

Point-of-care tests provide immediate results with the opportunity for same-day interventions with improved public health outcomes. A dual HIV/syphilis test enables early treatment of both diseases.

METHODS:

We conducted a field evaluation of the Standard Diagnostics' SD Bioline HIV/Syphilis Duo test (SD Bioline) among female sex workers. SD Bioline was conducted on finger-prick blood according to manufacturer's instructions and compared with (i) Genscreen HIV1/2 (third generation) and Vironostika Ag/Ab (fourth generation) assays for HIV, and (ii) Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) assays for syphilis. A negative TPPA test was considered negative, a TPPA-confirmed RPR titre ≤1:4 as past infection and a TPPA-confirmed RPR titre ≥1:8 as active syphilis. Sensitivity, specificity, positive and negative predictive values were calculated.

RESULTS:

Of 263 women recruited, 14 (5.3%) declined an HIV test. Among the remaining 249 women, 187 (75.1%) were HIV positive, 51 (20.5%) had syphilis antibodies with seven (2.8%) active infections. For HIV, the sensitivity and specificity were 98.9% (95% CI 95.8% to 99.8%) and 100% (95% CI 92.7% to 100%). For syphilis, the sensitivity and specificity were 66.7% (95% CI 52.0% to 78.9%) and 98.0% (95% CI 94.5% to 99.3%). Sera with high TPPA titres were more likely to test positive.

CONCLUSIONS:

In field conditions, while the SD Bioline test has high sensitivity and specificity for HIV and high specificity for syphilis, the test has lower sensitivity for syphilis than reported from laboratory evaluations. As the dual test detects only two thirds of syphilis cases, it should only be used in areas with weak screening programmes.

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By:  Black V1, Williams BG2, Maseko V3, Radebe F3, Rees HV2, Lewis DA4.

• 1Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
• 2Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
• 3Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.
• 4Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia. 
• Sex Transm Infect. 2016 May 6. pii: sextrans-2015-052474. doi: 10.1136/sextrans-2015-052474.

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Social Support, Sexual Violence, and Transactional Sex among Female Transnational Migrants to South Africa

OBJECTIVES:

To examine the relationship between sexual violence and transactional sex and assess the impact of social support on this relationship among female transnational migrants in Cape Town, South Africa.

METHODS:

In 2012 we administered a behavioral risk factor survey using respondent-driven sampling to transnational migrant women aged between 16 and 39 years, born outside South Africa, living in Cape Town, and speaking English, Shona, Swahili, Lingala, Kirundi, Kinyarwanda, French, or Somali.

RESULTS:

Controlling for study covariates, travel-phase sexual violence was positively associated with engagement in transactional sex (adjusted prevalence ratio [APR] = 1.38; 95% confidence interval [CI] = 1.07, 1.77), and social support was shown to be a protective factor (APR = 0.84; 95% CI = 0.75, 0.95). The interaction of experienced sexual violence during migration and social support score was APR = 0.85 (95% CI = 0.66, 1.10). In the stratified analysis, we found an increased risk of transactional sex among the low social support group (APR = 1.56; 95% CI = 1.22, 2.00). This relationship was not statistically significant among the moderate or high social support group (APR = 1.04; 95% CI = 0.58, 1.87).

CONCLUSIONS:

Programs designed to strengthen social support may reduce transactional sex among migrant women after they have settled in their receiving communities. 

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By:  Giorgio M1, Townsend L1, Zembe Y1, Guttmacher S1, Kapadia F1, Cheyip M1, Mathews C1.

• 1At the time of this study, Margaret Giorgio, Sally Guttmacher, and Farzana Kapadia were with the Department of Nutrition, New York University, New York, NY. Loraine Townsend, Yanga Zembe, and Catherine Mathews are with the Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. Mireille Cheyip is with the Centers for Disease Control and Prevention, Pretoria, South Africa. 
• Am J Public Health. 2016 Apr 14:e1-e7

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HIV Risk Behavior among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. 

This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. 

Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

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By:  Meade CS1,2, Lion RR3, Cordero DM3, Watt MH3, Joska JA4, Gouse H4, Burnhams W5.

• 1Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Box 90519, Durham, NC, 27708, USA. christina.meade@duke.edu.
• 2Duke Global Health Institute, Durham, NC, USA. christina.meade@duke.edu.
• 3Duke Global Health Institute, Durham, NC, USA.
• 4Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 5City Health, City of Cape Town, Cape Town, South Africa. 
• AIDS Behav. 2016 Feb 12.

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Combination Social Protection for Reducing HIV-Risk Behavior amongst Adolescents in South Africa

BACKGROUND:

Social protection (i.e. cash transfers, free schools, parental support) has potential for adolescent HIV-prevention. We aimed to identify which social protection interventions are most effective and whether combined social protection has greater effects in South Africa.

METHODS:

In this prospective longitudinal study, we interviewed 3516 adolescents aged 10-18 between 2009 and 2012. We sampled all homes with a resident adolescent in randomly-selected census areas in four urban and rural sites in two South African provinces. We measured household receipt of fourteen social protection interventions and incidence of HIV-risk behaviors. Using gender-disaggregated multivariate logistic regression and marginal-effects analyses, we assessed respective contributions of interventions and potential combination effects.

RESULTS:

Child-focused grants, free schooling, school feeding, teacher support, and parental monitoring were independently associated with reduced HIV-risk behavior incidence (OR 0.10-0.69). Strong effects of combination social protection were shown, with cumulative reductions in HIV-risk behaviors. For example, girls' predicted past-year incidence of economically-driven sex dropped from 11% with no interventions, to 2% amongst those with a child grant, free school and good parental monitoring. Similarly, girls' incidence of unprotected/casual sex or multiple-partners dropped from 15% with no interventions to 10% with either parental monitoring or school feeding, and to 7% with both interventions.

CONCLUSION:

In real-world, high-epidemic conditions, 'combination social protection' shows strong HIV-prevention effects for adolescents and may maximize prevention efforts.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Full PDF article at:  http://goo.gl/ojMVoi  Abstract:  http://goo.gl/fXkGhX

By:  Cluver LD1, Orkin MF, Yakubovich AR, Sherr L.

• 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK 2Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa 3DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa 4University College London, London, UK. 

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HIV Prevalence and Risk among People Who Inject Drugs in Five South African Cities

Highlights

• We conducted the largest cross-sectional HIV prevalence and risk survey among people who inject drugs in South Africa to date.
• We provide a description of participant demographics, drug using and sexual history and findings from bi-variate and multi-variate analysis for HIV infection.
• The study identified high-risk injecting and sexual practices among PWID in South Africa.
• We provide recommendations to inform future HIV prevention and treatment interventions for PWID in South Africa.

Abstract

Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data. We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants’ saliva and assessed drug-using and sexual practices by means of a questionnaire. 

We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females).

HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older , belonging to a racial group other than white, coming from Gauteng province, having ever worked as a sex worker and the presence of STI symptoms in the last 12 months. 

This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities.

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By:  Andrew Scheibe, David Makapela, Ben Brown, Monika dos Santos, Fabienne Hariga, Harsheth Virk, Linda-Gail Bekker, Olga Lyan, Nancy Fee, Margarete Molnar, Alina Bocai, Jason Eligh, Riku Lehtovuori

Affiliations

Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa

Correspondence

Corresponding author. 10 Upper Towers Road, Muizenberg, 7945, South Africa. +27 (0) 79 882 7726 (tel.).

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The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection among South African Young Women

BACKGROUND:

Alcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk.

METHODS:

In a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption.

RESULTS:

Visiting alcohol outlets was associated with having more sex partners, more unprotected sex acts, higher levels of transactional sex, and HSV-2 infection. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex.

CONCLUSIONS:

Frequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2.

Full article at:   http://goo.gl/y0VL6y

By:   Molly Rosenberg,^1,2,3,* Audrey Pettifor,^2,3,7 Annelies Van Rie,² Harsha Thirumurthy,^3,4 Michael Emch,^2,3,5 William C. Miller,^2,6 F. Xavier Gómez-Olivé,^7,12 Rhian Twine,⁷ James P. Hughes,⁸ Oliver Laeyendecker,^9,10 Amanda Selin,³ andKathleen Kahn^7,11,12

Michael Hoonbae Chung, Academic Editor

¹Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America

²Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

³Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁴Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁵Department of Geography, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁶Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America

⁷MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

⁸Department of Biostatistics, University of Washington, Seattle, Washington, United States of America

⁹Laboratory of Immunoregulation, NIAID, NIH, Baltimore, Maryland, United States of America

¹⁰Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America

¹¹Centre for Global Health Research, Umeå University, Umeå, Sweden

¹²INDEPTH Network, Accra, Ghana

University of Washington, UNITED STATES

PLoS One. 2015; 10(5): e0125510.

Published online 2015 May 8. doi:  10.1371/journal.pone.0125510

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Spatial Clustering of "Measured" & "Unmeasured" Risk Factors for HIV Infections in Hyper-Endemic Communities in Kwazulu-Natal, South Africa

Sub-Saharan Africa contains more than 60% of all HIV infections worldwide. HIV prevalence was currently estimated to be at least 15% in KwaZulu-Natal and the epidemic is described as hyper-endemic. 

Knowledge of spatial clustering of risk factors which are linked to new HIV infections is important for prioritizing areas to change the trajectory of the epidemic. Geoadditive models were used to investigate spatial characteristics of the risk factors from two clinical trial units (Umkomaas and Botha's Hill) in the province of KwaZulu-Natal, South Africa. 

Study population was a cohort of women who screened and enrolled in an HIV prevention biomedical intervention trial. The results suggest high HIV incidence rates (5.8 and 8 per 100 person-year). Considerable spatial variations in behavioural factors within a relatively small geographical region, low level of education, early age at sexual debut, higher number of sexual partners, not being married/cohabitating with a sexual partner and sexual activity in exchange for money, gift and drugs were all determined to be clustered in certain regions; they were accounted for 25% (Umkomaas) and 65% (Botha's Hill) of the excess new HIV infections in two clinical trial units. 

Results from our study highlighted existence of significant spatial heterogeneity in "measured" and "unmeasured" risk factors in a relatively small region. As the HIV funding has been declining, identifying, targeting and reaching the most-at-risk individuals will likely play a significant role in developing the most efficient and cost-effective prevention programmes and subsequently will change the trajectory of the epidemic.

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By:   Wand H1, Ramjee G2.

• 1 The Kirby Institute , Sydney , Australia.
• 2 HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa.

 

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Alcohol Use and Transactional Sex among Women in South Africa: Results from a Nationally Representative Survey

Background

Transactional sex is a risk factor for HIV infection. Alcohol use may increase the risk of transactional sex. No nationally-representative studies have examined the relationship between multiple dimensions of alcohol use and transactional sex in women in South Africa. The aim of the study was to examine the relationship between alcohol dependence, binge drinking and frequency of drinking in the past month and transactional sex in adult women in South Africa.

Methods

A cross-sectional study using multi-stage, cluster sampling collected data from a nationally representative sample of 5,969 women aged 16–55 years in 2012. The analysis conducted for this paper was restricted to women reporting sexual activity in the past 12 months (n = 3,594). Transactional sex was defined as having received money/gifts in exchange for sex with any sex partner in the past year. Alcohol use measures included: alcohol dependence (≥2 positive responses to the CAGE questionnaire); binge drinking (≥4 drinks for women on one occasion); and drinking frequency in the previous month. Logistic regression models were built to test the hypotheses that each dimension of alcohol use was associated with transactional sex.

Results

About 6.3% (n = 225) of sexually active women reported transactional sex. Almost a third (30.6%) of sexually active women had ever drunk alcohol, and 19.2% were current (past month) drinkers. Among lifetime drinkers, 28.0% were alcohol dependent and 56.6% were binge drinkers. Alcohol dependent women were twice as likely to report transactional sex (AOR 2.0, 95% CI 1.1–4.3, p<0.05) than those not alcohol dependent. Binge drinkers were 3.1 times more likely to have had transactional sex (95% CI 1.5–6.6, p<0.01) than non-binge drinkers. There was no significant relationship between frequency of drinking in the past month and transactional sex.

Conclusion

Alcohol dependency and binge drinking are significantly associated with transactional sex in South African women. HIV prevention programmes need to target these women, and address both their alcohol use, as well as the HIV risks associated with transactional sex.

Below:  The relationship between hazardous drinking and transactional sex based on the results of this study

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

By:   

Sarah Magni, Nicola Christofides, Renay Weiner

University of the Witwatersrand, Johannesburg, South Africa

Sarah Magni, Saul Johnson

Anansi Health Consulting, Johannesburg, South Africa

Renay Weiner

Soul City Institute for Health and Development Communication, Johannesburg, South Africa

 

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