Direct Questioning of Genital Symptoms Increasing Opportunities for Identifying and Treating Sexually Transmitted Infections in Primary Health-care settings

We investigated the validity of self-reporting of genital symptoms amongst rural women attending primary health care clinics in rural KwaZulu-Natal. Random samples of 226 women were interviewed to measure self-reporting (unprompted), prompted and pelvic examination findings of genital symptoms. Against the presence of any STI self- reporting (unprompted) of symptoms had a sensitivity of 46.1%, specificity of 64.7%, positive predictive value (PPV) of 80.0% and negative predictive value (NPV) of 28.0% compared to prompted symptoms which had a sensitivity of 78.5%, specificity of 52.9%, PPV of 80.4% and NPV of 50.0%. The agreement between self- reporting (unprompted) and prompted symptoms was 0.54 (Kappa statistic). Our results suggest that in rural areas, by prompting women with a simple set of questions, the identification and treatment of STIs in this population would be enhanced, leading to better reproductive health outcomes including reduction of risk of infection with HIV. African Journal of Reproductive Health Vol. 10 (2) 2006: pp. 105-11

Stabilizing HIV prevalence masks high HIV incidence rates amongst rural and urban women in KwaZulu-Natal, South Africa

Background: In mature generalized human immunodeficiency virus (HIV) epidemics, as survival from accessing antiretroviral treatment (ART) increases, HIV prevalence data may be suboptimal and difficult to interpret without HIV incidence rates. Objective: To determine the HIV incidence rate among rural and urban women in KwaZulu-Natal, South Africa. Methods: We conducted a prospective cohort study from March 2004 to May 2007. Volunteers were recruited from a rural family-planning clinic and an urban clinic for sexually transmitted infections. Consenting, HIV-uninfected women aged 14-30 years were enrolled. Demographic, clinical, sexual and behavioural data were collected using standardized questionnaires with HIV risk reduction counselling and HIV testing. Pelvic examinations were completed at quarterly visits. Results: The HIV prevalence at screening was 35.7% [95% confidence interval (CI) 32.7-38.8] amongst rural women and 59.3% (95% CI 56.5-62.0) amongst urban women. A total of 594/2240 (26.5%) enrolled women contributed to 602 person-years (PYs) of follow-up. The median age was 22 years [inter-quartile range 18-23 years]. HIV incidence rate was 6.5/100 PY (95% CI 4.4-9.2) amongst rural women and 6.4/100 PY (95% CI 2.6-13.2) amongst urban women. HIV incidence rate of 17.2/100 PY (95% CI 2.1-62.2) was highest amongst urban women <20 years of age and 10.2/100 PY (95% CI 4.1-20.9) amongst rural women ≥25 years of age. Conclusion: HIV incidence rates are devastatingly high in young women in rural and urban KwaZulu-Natal, despite reports of stabilized HIV prevalence observed in current surveillance data. The diffuse nature of the HIV epidemic underscores the urgent need to enhance HIV prevention and treatment modalities

HIV-positive status disclosure in patients in care in rural South Africa: implications for scaling up treatment and prevention interventions.

CAPRISA, 2015Abstract available in pdf

Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Quality appraisal tool. (DOCX 20 kb

Challenges in HIV-prevention microbicide research.

E-Letter response to article Whither or wither microbicides? Science 2008; 321: 532-534.No abstract available

Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV

Abstract Background Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. Methods/Design As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). Discussion Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. Trial registration ClinicalTrials.gov registration # NCT0097269

Trends in Pretreatment HIV-1 Drug Resistance in Antiretroviral Therapy-naive Adults in South Africa, 2000–2016: A Pooled Sequence Analysis

Background: South Africa has the largest public antiretroviral therapy (ART) programme in the world. We assessed temporal trends in pretreatment HIV-1 drug resistance (PDR) in ART-naïve adults from South Africa. Methods: We included datasets from studies conducted between 2000 and 2016, with HIV-1 pol sequences from more than ten ART-naïve adults. We analysed sequences for the presence of 101 drug resistance mutations. We pooled sequences by sampling year and performed a sequence-level analysis using a generalized linear mixed model, including the dataset as a random effect. Findings: We identified 38 datasets, and retrieved 6880 HIV-1 pol sequences for analysis. The pooled annual prevalence of PDR remained below 5% until 2009, then increased to a peak of 11·9% (95% confidence interval (CI) 9·2-15·0) in 2015. The pooled annual prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) PDR remained below 5% until 2011, then increased to 10.0% (95% CI 8.4–11.8) by 2014. Between 2000 and 2016, there was a 1.18-fold (95% CI 1.13–1.23) annual increase in NNRTI PDR (p < 0.001), and a 1.10-fold (95% CI 1.05–1.16) annual increase in nucleoside reverse-transcriptase inhibitor PDR (p = 0.001). Interpretation: Increasing PDR in South Africa presents a threat to the efforts to end the HIV/AIDS epidemic. These findings support the recent decision to modify the standard first-line ART regimen, but also highlights the need for broader public health action to prevent the further emergence and transmission of drug-resistant HIV. Source of Funding: This research project was funded by the South African Medical Research Council (MRC) with funds from National Treasury under its Economic Competitiveness and Support Package. Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of CDC

High burden of human papillomavirus (HPV) infection among young women in KwaZulu-Natal, South Africa.

CAPRISA, 2016.Abstract available in PDF file

Anti-HIV-1 integrase potency of methylgallate from Alchornea cordifolia using in vitro and in silico approaches:

According to the 2018 report of the United Nations Programme on HIV/AIDS (UNAIDS), acquired immune deficiency syndrome (AIDS), a disease caused by the human immunodeficiency virus (HIV), remains a significant public health problem. The non-existence of a cure or effective vaccine for the disease and the associated emergence of resistant viral strains imply an urgent need for the discovery of novel anti-HIV drug candidates. The current study aimed to identify potential anti-retroviral compounds from Alchornea cordifolia