110 research outputs found
Migration intensity has no effect on peak HIV prevalence: An ecological study
Background: Correctly identifying the determinants of generalized HIV epidemics is crucial to bringing down ongoing high HIV incidence in these countries. High rates of migration are believed to be an important determinant of HIV prevalence. This study has two aims. Firstly, it evaluates the ecological association between levels of internal and international migration and national peak HIV prevalence using thirteen variables from a variety of sources to capture various aspects of internal and international migration intensity. Secondly, it examines the relationship between circular migration and HIV at an individual and population-level in South Africa.Methods: Linear regression was used to analyze the association between the various measures of migration intensity and peak national HIV prevalence for 141 countries and HIV prevalence by province and ethnic group in South Africa.Results: No evidence of a positive ecological association between national migration intensity and HIV prevalence was found. This remained the case when the analyses were limited to the countries of sub-Saharan Africa. On the whole, countries with generalized HIV epidemics had lower rates of internal and external migration. Likewise, no association was found between migration and HIV positivity at an individual or group-level in South Africa.Conclusion: These results do not support the thesis that migration measured at the country level plays a significant role in determining peak HIV prevalence
Age-Gaps in Sexual Partnerships: Seeing Beyond âSugar Daddiesâ
We examine for the first time age-mixing in sexual relationships in a population with very high HIV incidence and prevalence in rural South Africa. The highest levels of age assortativity (the pairing of like with like) were casual partnerships reported by men, the lowest levels were spousal relationships reported by women. Given the ageâsex distribution of HIV prevalence in this population, interventions to decrease age-gaps in spousal relationships may be effective in reducing HIV incidence
Redefining disease emergence to improve prioritization and macro-ecological analyses
AbstractMicrobial infections are as old as the hosts they sicken, but interest in the emergence of pathogens and the diseases they cause has been accelerating rapidly. The term âemerging infectious diseaseâ was coined in the mid-1900s to describe changes in disease dynamics in the modern era. Both the term and the phenomena it is meant to characterize have evolved and diversified over time, leading to inconsistencies and confusion. Here, we review the evolution of the term âemerging infectious diseaseâ (EID) in the literature as applied to human hosts. We examine the pathways (e.g., speciation or strain differentiation in the causative agent vs. rapid geographic expansion of an existing pathogen) by which diseases emerge. We propose a new framework for disease and pathogen emergence to improve prioritization. And we illustrate how the operational definition of an EID affects conclusions concerning the pathways by which diseases emerge and the ecological and socioeconomic drivers that elicit emergence. As EIDs appear to be increasing globally, and resources for science level off or decline, the research community is pushed to prioritize its focus on the most threatening diseases, riskiest potential pathogens, and the places they occur. The working definition of emerging infectious diseases and pathogens plays a crucial role in prioritization, but we argue that the current definitions may be impeding these efforts. We propose a new framework for classifying pathogens and diseases as âemergingâ that distinguishes EIDs from emerging pathogens and novel potential pathogens. We suggest prioritization of: 1) EIDs for adaptation and mitigation, 2) emerging pathogens for preventive measures, and 3) novel potential pathogens for intensive surveillance
Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT).
BACKGROUND: The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.
METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up intervals up to four years. The treatment effect for each outcome measure was determined at each follow-up period for the duration of symptoms for both groups.
RESULTS: At all follow-up intervals, the primary outcome measures were significantly worse in patients who had had symptoms for more than six months prior to treatment, regardless of whether the treatment was operative or nonoperative. When the values at the time of the four-year follow-up were compared with the baseline values, patients in the operative treatment group who had had symptoms for six months or less had a greater increase in the bodily pain domain of the Short Form-36 (SF-36) (mean change, 48.3 compared with 41.9; p \u3c 0.001), a greater increase in the physical function domain of the SF-36 (mean change, 47.7 compared with 41.2; p \u3c 0.001), and a greater decrease in the Oswestry Disability Index score (mean change, -41.1 compared with -34.6; p \u3c 0.001) as compared with those who had had symptoms for more than six months (with higher scores indicating less severe symptoms on the SF-36 and indicating more severe symptoms on the Oswestry Disability Index). When the values at the time of the four-year follow-up were compared with the baseline values, patients in the nonoperative treatment group who had had symptoms for six months or less had a greater increase in the bodily pain domain of the SF-36 (mean change, 31.8 compared with 21.4; p \u3c 0.001), a greater increase in the physical function domain of the SF-36 (mean change, 29.5 compared with 22.6; p = 0.015), and a greater decrease in the Oswestry Disability Index score (mean change, -24.9 compared with -18.5; p = 0.006) as compared with those who had had symptoms for more than six months. Differences in treatment effect between the two groups related to the duration of symptoms were not significant.
CONCLUSIONS: Increased symptom duration due to lumbar disc herniation is related to worse outcomes following both operative and nonoperative treatment. The relative increased benefit of surgery compared with nonoperative treatment was not dependent on the duration of the symptoms
Patient experiences following acute HIV infection diagnosis and counseling in South Africa
Individuals in the acute stage of HIV infection (AHI) have an elevated potential to transmit HIV and play a critical role in the growth of the epidemic. Routine identification and counseling of individuals during AHI could decrease transmission behavior during this key period. However, diagnosis of AHI may present challenges distinct from those experienced through diagnosis of established HIV infection. A study was conducted in a public youth clinic outside of Cape Town, South Africa, to identify and counsel individuals with acute stage HIV infection. In-depth interviews were conducted with patients following diagnosis. After counseling, patients were accepting of the testing regimen used to diagnose AHI. They used the knowledge of having been recently infected to identify the source of their infection, but did not retain or place importance on information regarding the increased ability to transmit HIV during the acute stage. Future interventions directed at the reduction of HIV transmission following diagnosis with AHI will need to find ways of making this information more salient, possibly through more culturally meaningful educational approaches
A Cross-Sectional Study to Assess HPV Knowledge and HPV Vaccine Acceptability in Mali
Despite a high prevalence of oncogenic human papilloma virus (HPV) infection and cervical cancer mortality, HPV vaccination is not currently available in Mali. Knowledge of HPV and cervical cancer in Mali, and thereby vaccine readiness, may be limited. Research staff visited homes in a radial pattern from a central location to recruit adolescent females and males aged 12â17 years and men and women aged â„18 years (N = 51) in a peri-urban village of Bamako, Mali. Participants took part in structured interviews assessing knowledge, attitudes, and practices related to HPV, cervical cancer, and HPV vaccination. We found low levels of HPV and cervical cancer knowledge. While only 2.0% of respondents knew that HPV is a sexually transmitted infection (STI), 100% said they would be willing to receive HPV vaccination and would like the HPV vaccine to be available in Mali. Moreover, 74.5% said they would vaccinate their child(ren) against HPV. Men were found to have significantly greater autonomy in the decision to vaccinate themselves than women and adolescents (p = 0.005), a potential barrier to be addressed by immunization campaigns. HPV vaccination would be highly acceptable if the vaccine became widely available in Bamako, Mali. This study demonstrates the need for a significant investment in health education if truly informed consent is to be obtained for HPV vaccination. Potential HPV vaccination campaigns should provide more information about HPV and the vaccine. Barriers to vaccination, including the significantly lower ability of the majority of the target population to autonomously decide to get vaccinated, must also be addressed in future HPV vaccine campaigns
The Empower Nudge lottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa
The objective of this study is to measure the preliminary efficacy of a pilot intervention,
grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective
modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually
transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18â40 years,
seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised
controlled trial to test a lottery incentive intervention designed to increase dual protection. At baseline, the
mean age of participants was 27 years; 82% of them were from South Africa; 58% self-identified as Black
African; average education completed was 11.7 years. At three months, assignment to the lottery intervention
was associated with higher odds of returning for study visits (OR: 6.0; 95%CI: 2.45 to 14.7, p < 0.01), higher
condom use (OR: 4.5; 95%CI: 1.43 to 14.1; p < 0.05), and higher use of dual protection (OR: 3.16; 95%CI: 1.01
to 9.9; p < 0.05). Only 60% of the study population returned after three months and only 38% returned after
six months. Women who receive post-abortion care represent a neglected population with an urgent need for
HIV and pregnancy prevention. Dual protection is a critically important strategy for this population.
Lottery-based behavioural economics strategies may offer possible ways to increase dual protection use in this
population. Further research with larger samples, longer exposure time, and more sites is needed to
establish fully powered efficacy of lottery incentives for dual protection; using objective verification for
monitoring
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