Improving Adherence to Post-Cervical Biopsy Sexual Abstinence in Kenyan Female Sex Workers

PROBLEM:

Cervical biopsies offer a unique opportunity for studying local immune response. To investigate hormonally induced immune fluctuations in cervical tissues of Kenyan female sex workers, we improved biopsy sampling protocol safety. Here, we report on steps taken to minimize exposure to HIV following two cervical biopsies.

METHODS OF STUDY:

Women were asked to abstain from vaginal intercourse to limit HIV exposure during wound healing with financial compensation. A comprehension tool for informed consent, on-site detection of prostate-specific antigens indicating unprotected intercourse within 48 hr, and bi-weekly text message reminders were implemented.

RESULTS:

The implemented methods improved compliance with post-procedure abstinence by two times (P = 0.013). Fourteen days following a cervical biopsy, no sign of genital inflammation or change in HIV T-cell target proportion were observed.

CONCLUSIONS:

This study provides new tools for limiting HIV exposure in studies requiring biopsy sampling among women at risk of acquiring HIV.

Below:  Schematic representation of the study visits

Below:  PSA-semiquant cassette test serial dilutions to indicate PSA concentrations

Below:  Proportion of cervical HIV T-cell targets in HIV-uninfected and HIV-infected FSWs before and after biopsy sampling

Full article at:   http://goo.gl/tX6M5j

By: Lajoie J1,2,3, Boily-Larouche G1, Doering K1, Cheruiyot J4, Oyugi J1,3,4, Broliden K5, Kimani J1,3,4, Fowke KR1,2,3.

• 1Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.
• 2Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
• 3Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
• 4Kenya AIDS Control Program, Nairobi, Kenya.
• 5Department of Medicine Solna, Center for Molecular Medicine, Clinic of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
• Am J Reprod Immunol. 2016 May 24. doi: 10.1111/aji.12520. 

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A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. 

IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). 

Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. 

The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

Purchase full article at:   http://goo.gl/APdKtR

By:  Wilson KS1,2, Wanje G3, Yuhas K4, Simoni JM5, Masese L6, Vander Stoep A7, Jaoko W3, Hughes JP8, Richardson BA4,8, Scott McClelland R4,7,6,3.

• 1Department of Global Health, University of Washington, Seattle, 98104, USA. ksw@uw.edu.
• 2Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.
• 3Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 4Department of Global Health, University of Washington, Seattle, 98104, USA.
• 5Department of Psychology, University of Washington, Seattle, USA.
• 6Department of Medicine, University of Washington, Seattle, USA.
• 7Department of Epidemiology, University of Washington, Seattle, USA.
• 8Department of Biostatistics, University of Washington, Seattle, USA. 
• AIDS Behav. 2016 May 3. 

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Factors Related to Pregnancy among Female Sex Workers Living with HIV in the Dominican Republic

Female sex workers (FSWs) living with HIV are a vulnerable population for multiple health concerns and have been vastly understudied in public health literature. This study analyzes factors related to pregnancy among 268 FSWs living with HIV in the Dominican Republic. 

Results indicate that 

• 34% of participants had been pregnant since HIV diagnosis. 

Multivariate analysis revealed significant associations between 

• pregnancy after HIV diagnosis and ART interruption, 
• knowledge of mother-to-child transmission, 
• serostatus disclosure to a sex partner, 
• older age 
• and a more negative perception of their health provider. 

Results indicate noteworthy associations between having been pregnant and the health provider experience and ART interruption, indicating a significant need for further research on this population to ensure both maternal and child health.

Purchase full article at:   http://goo.gl/c9TS6h

By:  Cernigliaro D¹, Barrington C², Perez M³, Donastorg Y³, Kerrigan D⁴.

¹Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA. danacern@gmail.com.

²The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

³HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic.

⁴Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA.

AIDS Behav. 2016 May 4. [Epub ahead of print]

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A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya

We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. 

Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner ('index partner'). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. 

Recent IPV was associated with significantly higher risk of unprotected sex after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. 

Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.

Purchase full article at:   http://goo.gl/xqPyOl

By:  Wilson KS^1,2, Deya R³, Yuhas K³, Simoni J⁴, Vander Stoep A⁵, Shafi J^6,7, Jaoko W⁶, Hughes JP⁸, Richardson BA^3,8, McClelland RS^3,5,9,6.

Author information

¹Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA. ksw@uw.edu.

²Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.

³Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA.

⁴Department of Psychology, University of Washington, Seattle, USA.

⁵Department of Epidemiology, University of Washington, Seattle, USA.

⁶University of Nairobi, Nairobi, Kenya.

⁷Coast Province General Hospital, Mombasa, Kenya.

⁸Department of Biostatistics, University of Washington, Seattle, USA.

⁹Department of Medicine, University of Washington, Seattle, USA.

AIDS Behav. 2016 Apr 19. [Epub ahead of print]

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Perceived benefits and negative consequences of alcohol consumption in cving with HIV: A qualitative study

BACKGROUND:

Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.

METHODS:

Four focus groups, with a total of 24 adult women (96 % African-American, 88 % HIV-positive), were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.

RESULTS:

Regarding reasons for drinking, women described themes that included biological (addiction, to manage pain), psychological (coping, to escape bad experiences, to feel in control), and social (peer pressure, family). Themes related to consequences from alcohol included biological (damage to body, poor adherence to medications), psychological (risky or regrettable behavior, memory loss), and social (jail, loss of respect, poor choices). When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.

CONCLUSION:

Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection.

Full article at:   http://goo.gl/vA9COI

By:  Cook RL1, Cook CL2, Karki M3, Weber KM4, Thoma KA5, Loy CM6, Goparaju L7, Rahim-Williams B8.

• 1Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. cookrl@ufl.edu.
• 2Department of Family, Community, and Health System Science, University of Florida College of Nursing, PO Box 100197, Gainesville, FL, 32610-0197, USA.
• 3Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA.
• 4Cook County Health and Hospital System and Hektoen Institute of Medicine, 2225 W Harrison St, Chicago, IL, 60612, USA.
• 5Clinical Research Specialist, UF CARES, University of Florida Center for HIV/AIDS, Research, Education & Service, 653-1 West 8th Street, LRC 3rd Floor L-13, Jacksonville, FL, 32209, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
• 7Women's Interagency HIV Study (WIHS), Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 130, Washington DC, 20007, USA.
• 8Department of Public Health, Bethune-Cookman University, College of Health Sciences, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, Florida, 32114, USA. 
• BMC Public Health. 2016 Mar 15;16(1):263. doi: 10.1186/s12889-016-2928-x.

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Utilization of Alcohol Treatment among HIV-Positive Women with Hazardous Drinking

Highlights

• Less than one in five HIV+ women with hazardous drinking reported recent use of any alcohol treatment.
• Half of HIV+ women receiving any alcohol treatment reported receiving multiple treatment services among which Alcoholic Anonymous (AA) was the most common.
• A mixture of factors (income levels, social support, drinking levels, and drug use) was important in explaining utilization of alcohol treatment among HIV+ women with hazardous drinking.

Hazardous alcohol consumption has been frequently reported among women with HIV infection and is associated with a variety of negative health consequences. Treatments to reduce alcohol use may bring in health benefits. However, little is known regarding the utilization of alcohol treatment services among HIV+ women with hazardous drinking. Using data from the Women's Interagency HIV Study (WIHS), this study assessed utilization of any alcohol treatment in the past 6months and performed multivariable logistic regression to determine correlates of receipt of any alcohol treatment. 

Among 474 HIV+ women reporting recent hazardous drinking, less than one in five (19%) reported recent utilization of any alcohol treatment. Alcoholics Anonymous (AA) was the most commonly reported (12.9%), followed by inpatient detoxification (9.9%) and outpatient alcohol treatment program (7.0%). Half (51%) receiving any alcohol treatment reported utilization of multiple treatments. 

Multivariable analyses found alcohol treatment was more often utilized by those who had social support, fewer economic resources (income ≤$12,000 vs. >$12,000), higher levels of drinking (16-35 drinks/week vs. 12-15 drinks/week; 36+ drinks/week vs. 12-15 drinks/week), and those who reported any illicit drug use (OR=2.77, 95% CI=1.44 to 5.34). More efforts are needed to enhance the utilization of alcohol treatment. 

Our findings highlight the unique profile of those who utilized alcohol treatment. Such information is vital to improve treatment delivery to address unmet need in this particular population.

Purchase full article at:   http://goo.gl/IoaAIx

By:  Hu X1, Harman J2, Winterstein AG3, Zhong Y4, Wheeler AL5, Taylor TN6, Plankey M7, Rubtsova A8, Cropsey K9, Cohen MH10, Adimora AA11, Milam J12,Adedimeji A13, Cook RL14.

• 1Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: xingdi.hu@gmail.com.
• 2Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
• 3Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
• 4The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
• 5Department of Medicine, University of California, San Francisco and Department of Veterans Affairs Medical Center, San Francisco, CA, USA.
• 6College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
• 7Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, Washington, DC, USA.
• 8Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
• 9Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
• 10Department of Medicine, Stroger Hospital of Cook County Health and Hospital System and Rush University, Chicago, IL, USA.
• 11Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
• 12Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
• 13Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
• 14Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA.
• J Subst Abuse Treat. 2016 May;64:55-61. doi: 10.1016/j.jsat.2016.01.011. Epub 2016 Feb 15.

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A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening among Women with HIV

OBJECTIVE:

Women living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV.

MATERIALS AND METHODS:

This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer.

RESULTS:

A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer.

CONCLUSIONS:

The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.

Purchase full article at:   http://goo.gl/wwMV0l

By:  Murphy J1, Mark H, Anderson J, Farley J, Allen J.

• 1Department of Gynecology and Obstetrics, Johns Hopkins University School of Nursing and 
• 2Johns Hopkins School of Medicine, Baltimore, MD.
• J Low Genit Tract Dis. 2016 Apr;20(2):139-44. doi: 10.1097/LGT.0000000000000195. 

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Prevalence of Depressive Symptoms in Pregnant & Postnatal HIV-Positive Women in Ukraine

BACKGROUND:

Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.

METHODS:

Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher's exact test and χ(2) test for categorical variables.

RESULTS:

A quarter (27 % (49/180) antenatally and 25 % (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58 % (7/12) vs 25 % (42/167), being somewhat/terribly bothered by ART side effects (40 % (17/43) vs 23 % (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43 % (12/28) vs 23 % (25/110) with higher self-efficacy, p = 0.05). 

Postnatally, single mothers were more likely to screen positive (44 % (20/45) vs 21 % (18/84) of cohabiting and 19 % (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40 % (20/45) vs 18 % (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30 % (44/146) vs 14 % (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48 % (11/23) vs 27 % (10/37) fairly confident and 15 % (4/26) confident that they could do this). 

Of women who reported wanting help for their depressive symptoms, 82 % (37/45) postnatally but only 31 % (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.

CONCLUSIONS:

A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

Below:  Responses to three depression screening questions

Purchase full article at:   http://goo.gl/xNDFrB

By:  Bailey H1, Malyuta R2, Semenenko I2, Townsend CL3, Cortina-Borja M3, Thorne C3; Ukraine European Collaborative Study in EuroCoord.

• 1Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK. heather.bailey@ucl.ac.uk.
• 2Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
• 3UCL Institute of Child Health, University College London, London, UK.

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Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV among Infected Pregnant Women at the Yaounde Central Hospital

INTRODUCTION:

The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied.

AIM:

To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon).

METHODS:

A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014.

MAIN OUTCOME MEASURES:

Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs.

RESULTS:

Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (r_s = -0.217; P = .036).

CONCLUSION:

HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.

Full article at:   http://goo.gl/RE0oku

By:  Kuete M1, Yuan H2, He Q3, Tchoua Kemayou AL4, Ndognjem TP4, Yang F2, Hu Z2, Tian B2, Zhao K2, Zhang H2, Xiong C5.

• 1Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 2Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 4Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 5Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: clxiong951@sina.com. 
• Sex Med. 2016 Mar 19. pii: S2050-1161(16)00031-3. doi: 10.1016/j.esxm.2016.01.004.

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