Prevalences of sexually transmitted diseases.

<p>Prevalences of sexually transmitted diseases.</p

Evaluating HIV Prevention Programs: Herpes Simplex Virus Type 2 Antibodies as Biomarker for Sexual Risk Behavior in Young Adults in Resource-Poor Countries

<div><p>Background</p><p>Measuring effectiveness of HIV prevention interventions is challenged by bias when using self-reported knowledge, attitude or behavior change. HIV incidence is an objective marker to measure effectiveness of HIV prevention interventions, however, because new infection rates are relatively low, prevention studies require large sample sizes. Herpes simplex virus type 2 (HSV-2) is similarly transmitted and more prevalent and could thus serve as a proxy marker for sexual risk behavior and therefore HIV infection.</p><p>Methods</p><p>HSV-2 antibodies were assessed in a sub-study of 70,000 students participating in an education intervention in Western Province, Kenya. Feasibility of testing for HSV-2 antibodies was assessed comparing two methods using Fisher’s exact test. Three hundred and ninety four students (aged 18 to 22 years) were randomly chosen from the cohort and tested for HIV, <i>Chlamydia trachomatis</i>, <i>Neisseria gonorrhoeae</i>, and <i>Trichomonas vaginalis</i>. Out of these, 139 students were tested for HSV-2 with ELISA and surveyed for sexual risk behavior and 89 students were additionally tested for HSV-2 with a point-of-contact (POC) test.</p><p>Results</p><p>Prevalence rates were 0.5%, 1.8%, 0.3% and 2.3% for HIV, <i>Chlamydia trachomatis</i>, <i>Neisseria gonorrhoeae</i>, and <i>Trichomonas vaginalis</i>, respectively. Prevalence of HSV-2 antibodies was 3.4 % as measured by POC test (n=89) and 14.4 % by ELISA (n=139). Specificity of the POC test compared with ELISA was 100%, and the sensitivity only 23.1%. Associations between self-reported sexual behavior and HSV-2 serostatus could not be shown.</p><p>Conclusions</p><p>Associations between self-reported sexual risk behavior and HSV-2 serostatus could not be shown, probably due to social bias in interviews since its transmission is clearly linked. HSV-2 antibody testing is feasible in resource-poor settings and shows higher prevalence rates than other sexually transmitted diseases thus representing a potential biomarker for evaluation of HIV prevention interventions.</p></div

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi

<div><p>Background</p><p>Pediatric uptake and outcomes in antiretroviral treatment (ART) programmes have lagged behind adult programmes. We describe outcomes from a population-based pediatric ART cohort in rural southern Malawi.</p><p>Methods</p><p>Data were analyzed on children who initiated ART from October/2003 –September/2011. Demographics and diagnoses were described and survival analyses conducted to assess the impact of age, presenting features at enrolment, and drug selection.</p><p>Results</p><p>The cohort consisted of 2203 children <15 years of age. Age at entry was <1 year for 219 (10%), 1–1.9 years for 343 (16%), 2–4.9 years for 584 (27%), and 5–15 years for 1057 (48%) patients. Initial clinical diagnoses of tuberculosis and wasting were documented for 409 (19%) and 523 (24%) patients, respectively. Median follow-up time was 1.5 years (range 0–8 years), with 3900 patient-years of follow-up. Over the period of observation, 134 patients (6%) died, 1324 (60%) remained in the cohort, 345 (16%) transferred out, and 387 (18%) defaulted. Infants <1 year of age accounted for 19% of deaths, with a 2.7-fold adjusted mortality hazard ratio relative to 5–15 year olds; median time to death was also shorter for infants (60 days) than older children (108 days). Survival analysis demonstrated younger age at ART initiation, more advanced HIV stage, and presence of tuberculosis to each be associated with shorter survival time. Among children <5 years, severe wasting (weight-for-height z-score </p><p>Conclusions</p><p>Cumulative incidence of mortality was 5.2%, 7.1% and 7.7% after 1, 3, and 5 years, respectively, with disproportionate mortality in infants <1 year of age and those presenting with tuberculosis. These findings reinforce the urgent need for early diagnosis and treatment in this population, but also demonstrate that provision of pediatric care in a rural setting can yield outcomes comparable to more resourced urban settings of poor countries.</p></div

Estimated point-wise cumulative incidence (95% confidence interval) of death, transfer out of cohort, and defaulting, based on competing risk models.

<p>Estimated point-wise cumulative incidence (95% confidence interval) of death, transfer out of cohort, and defaulting, based on competing risk models.</p

Baseline characteristics of Z-OCS pediatric cohort.

<p>Baseline characteristics of Z-OCS pediatric cohort.</p

Predictors of survival in Z-OCS pediatric cohort.

<p>Predictors of survival in Z-OCS pediatric cohort.</p

Survival Outcomes in a Pediatric Antiretroviral Treatment Cohort in Southern Malawi - Fig 1

<p><b>Survival curves for the Z-OCS pediatric cohort (n = 2203) by (A) age at enrolment; (B) clinical stage at diagnosis; (C) clinical diagnosis of tuberculosis at enrolment; and (D) wasting (weight for-length/height <-3SD).</b> Survival analysis for wasting was restricted to patients <5 years of age.</p

Estimated cumulative incidence curves with mortality, transfer out of cohort, and default as competing events.

<p>Estimated cumulative incidence curves with mortality, transfer out of cohort, and default as competing events.</p

Risk Factors for Child Death.

1<p>HIV-exposed is considered those children with known exposure from birth (ie. mother was tested in ANC or on the labour ward).</p>2<p>Controlled for previous child death, birth weight, age.</p>3<p>Controlled for HIV-exposure, birthweight, age.</p>4<p>Controlled for HIV-exposure, previous child death, age.</p>5<p>Controlled for HIV-exposure, age (information not available for birthweight and previous child death for those mothers who had died).</p

Child Mortality amongst HIV-infected and HIV-uninfected mothers.

*<p>Amongst livebirths (excluding stillbirths).</p>***<p>Maternal age at time of study.</p