A Controlled Trial of Three Methods for Neonatal Circumcision in Lusaka, Zambia

Neonatal male circumcision (NMC) is not routinely practiced in Zambia, but it promising long-term HIV prevention strategy. We studied the feasibility and safety of three different NMC method

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence

Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection

Dolutegravir resistance in three pregnant and breastfeeding women in South Africa

Dolutegravir (DTG) has superior efficacy, safety, tolerability, and a better resistance profile compared with non-nucleoside reverse transcriptase inhibitors (NNRTI), making it the preferred antiretroviral therapy (ART) choice for adults and adolescents, including pregnant and breastfeeding women (PBFW)

A Controlled Trial of Three Methods for Neonatal Circumcision in Lusaka, Zambia

OBJECTIVE: Neonatal male circumcision (NMC) is not routinely practiced in Zambia, but it promising long-term HIV prevention strategy. We studied the feasibility and safety of three different NMC methods PATIENTS AND METHODS: We enrolled healthy newborns in a controlled trial of the Mogen, Gomco, and Plastibell devices. Doctors, nurses, and clinical officers were trained to perform Mogen, Gomco, and Plastibell techniques. Each provider performed at least 10 circumcisions using each device. Neonates were reviewed at one week and six weeks post circumcision for adverse events. RESULTS: Between October 2009 and March 2011, 17 providers (5 physicians, 9 nurse-midwives, and 3 clinical officers) without prior NMC experience were trained, and 640 circumcisions performed. The median infant birth weight was 3.2kg (IQR 2.9–3.5 kg) and median age at the time of procedure was 11 days (IQR:7–18 days); 149 babies (23.3%) were HIV-exposed. The overall adverse event rate was 4.9% (n=31/630), and the moderate-severe AE rate was 4.1% (n=26/630). Write in what this was. Rates did not significantly differ by method. Most providers (65%) preferred the Mogen clamp over the Gomco and Plastibell. CONCLUSIONS: Doctors, nurses, and clinical officers can be trained to safely provide NMC in a programmatic setting. The three studied techniques had comparable safety profiles. Mogen clamp was the preferred device for most providers