Effectiveness of interventions to prevent mother-to-child transmission of HIV in Southern Ethiopia

Behailu Merdekios1, Adebola A Adedimeji2 1College of Medicine and Health Sciences, Arba Minch University, Ethiopia; 2Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, New York, USA Background: In Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT) of human immunodeficiency virus (HIV) is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women. Methods: A multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained. Results: Of the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1%) had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001) and voluntary counseling and testing for pregnant women (P < 0.05). Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination. Conclusion: In the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels. Keywords: human immunodeficiency virus, mother-to-child transmission, pregnant women, Ethiopi

‘They bring AIDS to us and say we give it to them’: Socio-structural context of female sex workers’ vulnerability to HIV infection in Ibadan Nigeria

The aim of the study was to examine and describe the individual and structural-environmental factors that shape the vulnerability of brothel-based female sex workers (FSWs) in Ibadan, southwest Nigeria to HIV infection. A descriptive qualitative research design was utilised to elicit data, using in-depth interviews and focus group discussions, from 60 randomly selected participants in four brothels. A thematic analysis of data was undertaken following transcription and validation of interviews. Five themes emerged from the data: (i) flawed knowledge and fatalistic attitudes; (ii) the psychosocial and economic context of sex work; (iii) religious beliefs, stigma and risk taking; (iv) barriers to HIV testing; and (v) legal and policy constraints to sex work. We describe the complex interaction between these themes and how they combine to increase the risk of HIV infection among FSWs. The impact of previous interventions to reduce the risk of HIV infection among FSWs has been limited by personal and structural factors; hence we recommend that new strategies that recognise the practical constraints to HIV prevention among FSWs are urgently needed to make the environment of commercial work safer for FSWs, their clients, and by extension the general population

HIV Risk Perception and Constraints to Protective Behaviour among Young Slum Dwellers in Ibadan, Nigeria

This study examined the relationship between HIV/AIDS risk perception and protective behaviour among sexually-active urban young slum dwellers in Ibadan, Nigeria. The multistage sampling techniques were used for selecting 1,600 respondents aged 15-24 years. Of these, 1,042 (65%) respondents who reported unprotected sex in the last three months were selected for analysis. Although the sexually-active respondents demonstrated basic knowledge of HIV/AIDS and high risk perception, risky behaviour was common and protective behaviour was poor. About 48% of 505 males and 12% of 537 females had multiple partners. Similarly, 29% of males and 38% of females were engaged in transactional sex. Only 14% of males and 5% of females used any form of protection, resulting in the high rates of sexually transmitted infections reported by 27% of males and 10% of females. Structural and environmental constraints were identified as barriers to adopting protective behaviour. Therefore, programme and policy interventions should be designed to address the peculiar circumstances of urban young slum dwellers to curtail the HIV epidemic

Traversing the cascade: urgent research priorities for implementing the 'treat all' strategy for children and adolescents living with HIV in sub-Saharan Africa

Children and adolescents living with HIV (CALHIV) in sub-Saharan Africa experience significant morbidity and alarmingly high mortality rates due to critical gaps in the HIV care cascade, including late diagnosis and initiation of treatment, as well as poor retention in care and adherence to treatment. Interventions to strengthen the adult HIV care cascade may not be as effective in improving the cascade for CALHIV, for whom specific strategies are needed. Particular attention needs to be paid to the contexts of sub-Saharan Africa, where more than 85% of the world's CALHIV live. Implementing the 'treat all' strategy in sub-Saharan Africa requires dedicated efforts to address the unique diagnosis and care needs of CALHIV, in order to improve paediatric and adolescent outcomes, prevent viral resistance and reduce the number of new HIV infections. We consider the UNAIDS 90-90-90 targets from the perspective of infants, children and adolescents, and discuss the key challenges, knowledge gaps and urgent research priorities for CALHIV in implementation of the 'treat all' strategy in sub-Saharan Africa

HIV Risk Perception and Constraints to Protective Behaviour Among Young Slum Dwellers in Ibadan, Nigeria

This study examined the relationship between HIV/AIDS risk perception and protective behaviour among sexually-active urban young slum dwellers in Ibadan, Nigeria. The multistage sampling tech\uadniques were used for selecting 1,600 respondents aged 15-24 years. Of these, 1,042 (65%) respond\uadents who reported unprotected sex in the last three months were selected for analysis. Although the sexually-active respondents demonstrated basic knowledge of HIV/AIDS and high risk perception, risky behaviour was common and protective behaviour was poor. About 48% of 505 males and 12% of 537 females had multiple partners. Similarly, 29% of males and 38% of females were engaged in transactional sex. Only 14% of males and 5% of females used any form of protection, resulting in the high rates of sexually transmitted infections reported by 27% of males and 10% of females. Structural and environmental constraints were identified as barriers to adopting protective behaviour. Therefore, programme and policy interventions should be designed to address the peculiar circum\uadstances of urban young slum dwellers to curtail the HIV epidemic

Characteristics of HIV-infected Children at Enrollment Into Care and at Antiretroviral Therapy Initiation in Central Africa

BACKGROUND: Despite the World Health Organization (WHO) regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART) in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described. MATERIALS AND METHODS: Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) pediatric cohort of 3,426 children (0-15 years) entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and weight-for-age Z score (WAZ), each at enrollment into HIV care and at ART initiation. Changes in the medians or proportions of each measure by year of enrollment and year of ART initiation were assessed to capture potential impacts of changing ART guidelines. RESULTS: Median age at care enrollment decreased from 77.2 months in 2004-05 to 30.3 months in 2012-13. The median age at ART initiation (n = 2058) decreased from 83.0 months in 2004-05 to 66.9 months in 2012-13. The proportion of childre

Expanding delivery of and access to evidence-based comprehensive HIV/SRH services among men who have sex with men (MSM) and transgender persons in Nigeria

The goals of this project were to: i) increase comprehensive HIV service delivery among MSM, transgender women, and their sexual partners, ii) build the capacity of a local NGO to function as a one-stop-shop for HIV and STI services, and iii) build evidence around the “hub and spokes” service delivery model, how to best reach transgender populations, and to pilot an intervention intended to promote mental health and reduce intersectional, internalized stigma experienced by sexual and gender minorities (both living with HIV and at risk of HIV acquisition). The project implemented a “hub and spokes” model of service provision of comprehensive HIV, sexual and reproductive health and support services to MSM and transgender women in Lagos. Key opinion leaders were essential in creating demand among their large social networks for services at the hub (a one-stop-shop facility) and public health facilities (spokes) that were trained to be a key-population friendly facility. Public health facilities can be capacitated to provide key population friendly services. The project also piloted a mental health promotion and stigma reduction intervention for MSM and transgender women, that addressed the mutiple stigmas experienced by sexual and gender minorities (i.e. intersectional stigma). The intervention determined that there is great need for and interest in such a stigma reduction intervention. The project also highlighted the need for more transgender-inclusive programming given the multiple levels of stigma that the community experiences. To reach more key populations, the hub and spokes model of service delivery should be expanded to other regions

Positive affect and its association with viral control among women with HIV infection.

We assessed the relationship between positive affect and viral suppression among women with HIV infection

Mevalonate pathway analysis of Saccharomyces cerevisiae during bioisoprene synthesis

Isoprene, synthesized through two complementary biosynthetic routes known as the mevalonate (MVA) pathway and the deoxy-xylulose phosphate pathway, is a valuable monomer that is used for rubber and several other chemical industries. Despite the recent interest in the industrial and biomedical applications of isoprene and its derivatives, the complexity of controlling its chemical synthesis due to the formation of greenhouse gases is a significant problem. To overcome the productivity and yield challenges, in addition to generating environmental and economic benefits, this study aimed to focus on the direct fermentation of cellulosic materials into bioisoprene. In this study, bioisoprene was synthesized via a biotransformation process through enzymatic hydrolysis of cassava peel using Aspergillus niger 11JK and Saccharomyces cerevisiae 19KB strain. The mevalonate (MVA) pathway (synthetic route) exploited during bioisoprene production by S. cerevisiae 19KB strain was investigated using the hydrolyzed cassava peel broth. The obtained crude extract was analyzed for bioisoprene yield and enzymatic activities using Gas chromatography. Furthermore, results of the size exclusion chromatography revealed the presence of polysaccharide hydrolyzing enzymes (e.g., amylase and cellulase), and mevalonate pathway enzymes, including isoprene synthase, mevalonate-5-diphosphate decarboxylase, and isopentyl phosphate kinase, in addition to isoprene, mevalonic acid (MVA), and its isomer dimethylallyl diphosphate (DMAPP). Based on the results obtained in this study, bioisoprene synthesis via direct fermentation of cheap and abundant carbon sources such as cassava peel using the S. cerevisiae 19KB strain will overcome the high production costs and low yield challenges of bioisoprene, thus generating significant environmental and economic benefits

Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS

Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes