Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi

Background and Objectives:Integrating acute HIV-infection (AHI) testing into clinical settings is critical to prevent transmission, and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) clinics and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi.Methods:We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening.Results:Nearly two-thirds (62.8%, 9280/14,755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence = 0.64%)–a 0.9% case-identification increase. Prevalence was higher at STI [1.03% (44/4255)] than at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with HTC (153,125 copies/mL, P = 0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%).Conclusions:The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered

Randomized Controlled Pilot Study of Antiretrovirals and a Behavioral Intervention for Persons with Acute HIV Infection: Opportunity for Interrupting Transmission

Background. Persons with acute HIV infection (AHI) have heightened transmission risk. We evaluated potential transmission reduction using behavioral and biomedical interventions in a randomized controlled pilot study in Malawi. Methods. Persons were randomized 1:2:2 to standard counseling (SC), 5-session behavioral intervention (BI), or behavioral intervention plus 12 weeks of antiretrovirals (ARVs; BIA). All were followed for 26-52 weeks and, regardless of arm, referred for treatment according to Malawi-ARV guidelines. Participants were asked to refer partners for testing. Results. Among 46 persons (9 SC, 18 BI, 19 BIA), the average age was 28; 61% were male. The median viral load (VL) was 5.9 log copies/mL at enrollment. 67% (10/15) of BIA participants were suppressed (<1000 copies/mL) at week 12 vs 25% BI and 50% SC (P = .07). Although the mean number of reported condomless sexual acts in the past week decreased from baseline across all arms (1.5 vs 0.3 acts), 36% experienced incident sexually transmitted infection by 52 weeks (12% SC, 28% BI, 18% BIA). Forty-one percent (19/46) of participants referred partners (44% SC, 44% BI, 37% BIA); 15 of the partners were HIV-infected. Conclusions. Diagnosis of AHI facilitates behavioral and biomedical risk reduction strategies during a high-transmission period that begins years before people are typically identified and started on ARVs. Sexually transmitted infection incidence in this cohort suggests ongoing risk behaviors, reinforcing the importance of early intervention with ARVs to reduce transmission. Early diagnosis coupled with standard AHI counseling and early ARV referral quickly suppresses viremia, may effectively change behavior, and could have tremendous public health benefit in reducing onward transmission

KILchip v1.0: A Novel Plasmodium falciparum Merozoite Protein Microarray to Facilitate Malaria Vaccine Candidate Prioritization.

Passive transfer studies in humans clearly demonstrated the protective role of IgG antibodies against malaria. Identifying the precise parasite antigens that mediate immunity is essential for vaccine design, but has proved difficult. Completion of the Plasmodium falciparum genome revealed thousands of potential vaccine candidates, but a significant bottleneck remains in their validation and prioritization for further evaluation in clinical trials. Focusing initially on the Plasmodium falciparum merozoite proteome, we used peer-reviewed publications, multiple proteomic and bioinformatic approaches, to select and prioritize potential immune targets. We expressed 109 P. falciparum recombinant proteins, the majority of which were obtained using a mammalian expression system that has been shown to produce biologically functional extracellular proteins, and used them to create KILchip v1.0: a novel protein microarray to facilitate high-throughput multiplexed antibody detection from individual samples. The microarray assay was highly specific; antibodies against P. falciparum proteins were detected exclusively in sera from malaria-exposed but not malaria-naïve individuals. The intensity of antibody reactivity varied as expected from strong to weak across well-studied antigens such as AMA1 and RH5 (Kruskal-Wallis H test for trend: p < 0.0001). The inter-assay and intra-assay variability was minimal, with reproducible results obtained in re-assays using the same chip over a duration of 3 months. Antibodies quantified using the multiplexed format in KILchip v1.0 were highly correlated with those measured in the gold-standard monoplex ELISA [median (range) Spearman's R of 0.84 (0.65-0.95)]. KILchip v1.0 is a robust, scalable and adaptable protein microarray that has broad applicability to studies of naturally acquired immunity against malaria by providing a standardized tool for the detection of antibody correlates of protection. It will facilitate rapid high-throughput validation and prioritization of potential Plasmodium falciparum merozoite-stage antigens paving the way for urgently needed clinical trials for the next generation of malaria vaccines

KILchip v1.0: A Novel Plasmodium falciparum Merozoite Protein Microarray to Facilitate Malaria Vaccine Candidate Prioritization

Passive transfer studies in humans clearly demonstrated the protective role of IgG antibodies against malaria. Identifying the precise parasite antigens that mediate immunity is essential for vaccine design, but has proved difficult. Completion of the Plasmodium falciparum genome revealed thousands of potential vaccine candidates, but a significant bottleneck remains in their validation and prioritization for further evaluation in clinical trials. Focusing initially on the Plasmodium falciparum merozoite proteome, we used peer-reviewed publications, multiple proteomic and bioinformatic approaches, to select and prioritize potential immune targets. We expressed 109 P. falciparum recombinant proteins, the majority of which were obtained using a mammalian expression system that has been shown to produce biologically functional extracellular proteins, and used them to create KILchip v1.0: a novel protein microarray to facilitate high-throughput multiplexed antibody detection from individual samples.The microarray assay was highly specific; antibodies against P. falciparum proteins were detected exclusively in sera from malaria-exposed but not malaria-naïve individuals. The intensity of antibody reactivity varied as expected from strong to weak across well-studied antigens such as AMA1 and RH5 (Kruskal–Wallis H test for trend: p &lt; 0.0001). The inter-assay and intra-assay variability was minimal, with reproducible results obtained in re-assays using the same chip over a duration of 3 months. Antibodies quantified using the multiplexed format in KILchip v1.0 were highly correlated with those measured in the gold-standard monoplex ELISA [median (range) Spearman's R of 0.84 (0.65–0.95)]. KILchip v1.0 is a robust, scalable and adaptable protein microarray that has broad applicability to studies of naturally acquired immunity against malaria by providing a standardized tool for the detection of antibody correlates of protection. It will facilitate rapid high-throughput validation and prioritization of potential Plasmodium falciparum merozoite-stage antigens paving the way for urgently needed clinical trials for the next generation of malaria vaccines

Agricultural Information Worldwide, vol. 6, 2014

Agricultural Information Worldwide, Volume 6, 2014In this issue: FROM THE EDITOR’S DESK / Jim Morris-Knower (3); Conference Reflections / Antoinette Paris Greider (4). ARTICLES: Keynote Address: The State of Information Literacy Policy: A Global Priority / Sharon Weiner (5); Framing of Climate Change News in Four National Daily Newspapers in Southern Nigeria / Agwu Ekwe Agwu, Chiebonam Justina Amu (11); Access and Use of Information Communication Technologies by Women Staff of Public Extension Service in the North Central Zone of Nigeria / Agwu Ekwe Agwu, Elizabeth Ene Ogbonnah (18); Providing User Preferred Information Resources for a New Faculty of Agriculture, Nnamdi Azikiwe Univeristy, Awka, Nigeria / Chinwe V. Anunobi, Andrew U. Ogbonna (25); Diffusion of Scientific Knowledge in Agriculture: The Case for Africa / Shimelis Assefa, Daniel Gelaw Alemneh, Abebe Rorissa (34); The Use of Social Media in Agricultural Research Workflows in Ghana and Kenya / Justin Chisenga, Richard Kedemi, Joel Sam (48); Towards Mobile Agricultural Information Services in Zimbabwean Libraries: Challenges and Opportunities for Small Sacle Farmers in Utilizing ICTs for Sustainable Food Production / Collence Takaingenhamo Chisita, Thembani Malapela (58); Agriculture and Natural Resource Scientists' Biodiversity Information Needs: Barriers and Facilitators to Use and Access in the U.S. Southeast / Miriam L.E. Steiner Davis, Carol Tenopir, Suzie Allard (66); French Agricultural Research Institute Paves the Way to Open Access: Feedback from CIRAD / Marie-Claude Deboin, Cécile Fovet-Rabot (77); Exploring Relevance of Agro Input Dealers in Disseminating and Communicating of Soil Fertility Management Knowledge: The Case of Siaya and Trans Nzoia Counties, Kenya / T. B. Etyang, J. J. Okello, S. Zingore, P. F. Okoth, F. S. Mairura, A. Mureithi, B. S. Waswa (82); Plantwise Knowledge Bank: Building Sustainable Data and Information Processes to Support Plant Clinics in Kenya / Cambria Finegold, MaryLucy Oronje, Margo C. Leach, Teresia Karanja, Florence Chege, Shaun L.A. Hobbs (96); Innovation in Extension Services for Improved Farmer Access to Agricultural Information in Uganda / Patrick Kasangaki (102); Managing a Web Portal Adapting to New Technologies / Soonho Kim, Kathryn Pace Kincheloe, Yuan Gao, Valdete Berisha (107); Library Outreach to University Farm Staff / Emily MacKenzie, Natalie Waters (114); Enhancing Access to Research in Institutional Repositiories through API / Ryan Miller, Indira Yerramareddy (118); Building Capacity of Smallholder Farmers in Agribusiness and Entrepreneurship Skills in Northern Uganda / Basil Mugonola, Callistus Baliddawa (122); The Data Landscpe of the Coral Triangle / Jeanette Norris (127); Agricultural Information Access Among Smallholder Farmers: Comparative Assessment of Peri-Urban and Rural Settings in Kenya / Dorine Odongo (133); From Local to Global: Launching the New Rangelands West Portals and Database / Jeanne L. Pfander, Barbara S. Hutchinson, Valeria Pesce, Matt Rahr (138); Seed Village Programme: An Innovative Approach for Small Farmers / Dheeraj Singh, M. K. Chaudhary, M. L. Meena, M. M. Roy (143); Transformation of Indian Agricultural Libraries in a Digital and Collaborative Era: A Case Study / Neena Singh, Anil Chikate (147); Collaboration for Impact / Indira Yerramareddy, Luz Marina Alvaré, Katarlah Taylor (157