Regional Differences in Prevalence of HIV-1 Discordance in Africa and Enrollment of HIV-1 Discordant Couples into an HIV-1 Prevention Trial

Background: Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regional differences in HIV-1 discordance among African couples, has not previously been reported. Methodology/Principal Findings: The Partners in Prevention HSV-2/HIV-1 Transmission Trial (“Partners HSV-2 Study”), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 2007. Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8–31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r = 0.74, p = 0.09). Conclusions/Significance: HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Barriers to sexual and reproductive health programming for adolescents living with HIV in Uganda

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

Barriers, Sexual and reproductive health, Programming, Adolescents living with HIV, Uganda,

PreScreening Data and Other Characteristics of Partners HSV-2 Study Sites

*<p>2004 or 2005 census data.</p>**<p>From PEPFAR (http//<a href="http://www.pepfar.gov/" target="_blank">www.pepfar.gov/</a>): “National HIV-1 prevalence among adults aged 15–49” for each country listed.</p> ˆ<p>Clinical trial recruitment also extended to outlying districts with total population of 0.75–1.5 million persons.</p>#<p>Source of HIV-1 prevalence data: Kenya-reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-Kenyan1" target="_blank">[23]</a>; Uganda–reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-Ministry1" target="_blank">[7]</a>; Tanzania–reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-Kapiga1" target="_blank">[24]</a>; S. Africa–reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-Dorrington1" target="_blank">[25]</a>; Zambia–reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-Zambia1" target="_blank">[26]</a>; Botswana–reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001411#pone.0001411-UN2" target="_blank">[27]</a>.</p>&<p>-Total number of couples receiving HIV counseling and testing during previously defined recruitment periods: July 2005–April 2006 (Ndola and Kitwe, Zambia) and December 2006–April 2007 (all other Partners HSV-2 Study sites).</p>@<p>-NHRI calculated from PEPFAR data (http//<a href="http://www.pepfar.gov/" target="_blank">www.pepfar.gov/</a>) as: (“# individuals receiving counseling and testing in settings other than PMTCT in FY2006”+“# HIV-1 infected individuals receiving palliative care/basic health care and support in FY2006 (including HIV-1/TB)”)/“Adults and children (age 0–49) living with HIV-1 at the end of 2005”.</p