23 research outputs found
Modern Contraceptive and Dual Method Use among HIV-Infected Women in Lusaka, Zambia
HIV-infected women
in sub-Saharan Africa are at substantial risk of
unintended pregnancy and sexually transmitted
infections (STIs). Linkages between HIV and
reproductive health services are advocated. We
describe implementation of a reproductive health
counseling intervention in 16 HIV clinics in
Lusaka, Zambia. Between November 2009 and
November 2010, 18,407 women on antiretroviral
treatment (ART) were counseled. The median age
was 34.6 years (interquartile range (IQR):
29.9–39.7), and 60.1% of women were
married. The median CD4+ cell count
was 394 cells/uL (IQR: 256–558). Of
the women counseled, 10,904 (59.2%) reported
current modern contraceptive use. Among
contraceptive users, only 17.7% reported
dual method use. After counseling, 737 of 7,503
women not previously using modern contraception
desired family planning referrals, and 61.6%
of these women successfully accessed services
within 90 days. Unmet contraceptive need remains
high among HIV-infected women. Additional
efforts are needed to promote reproductive
health, particularly dual method
use
Genetic diversity fuels gene discovery for tobacco and alcohol use
Tobacco and alcohol use are heritable behaviours associated with 15% and 5.3% of worldwide deaths, respectively, due largely to broad increased risk for disease and injury(1-4). These substances are used across the globe, yet genome-wide association studies have focused largely on individuals of European ancestries(5). Here we leveraged global genetic diversity across 3.4 million individuals from four major clines of global ancestry (approximately 21% non-European) to power the discovery and fine-mapping of genomic loci associated with tobacco and alcohol use, to inform function of these loci via ancestry-aware transcriptome-wide association studies, and to evaluate the genetic architecture and predictive power of polygenic risk within and across populations. We found that increases in sample size and genetic diversity improved locus identification and fine-mapping resolution, and that a large majority of the 3,823 associated variants (from 2,143 loci) showed consistent effect sizes across ancestry dimensions. However, polygenic risk scores developed in one ancestry performed poorly in others, highlighting the continued need to increase sample sizes of diverse ancestries to realize any potential benefit of polygenic prediction.Peer reviewe
Participation in and Compliance with Public Voluntary Environmental Programs: An Evolutionary Approach
Multiancestry Genome-Wide Association Study of Lipid Levels Incorporating Gene-Alcohol Interactions
A person's lipid profile is influenced by genetic variants and alcohol consumption, but the contribution of interactions between these exposures has not been studied. We therefore incorporated gene-alcohol interactions into a multiancestry genome-wide association study of levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. We included 45 studies in stage 1 (genome-wide discovery) and 66 studies in stage 2 (focused follow-up), for a total of 394,584 individuals from 5 ancestry groups. Analyses covered the period July 2014-November 2017. Genetic main effects and interaction effects were jointly assessed by means of a 2-degrees-of-freedom (df) test, and a 1-df test was used to assess the interaction effects alone. Variants at 495 loci were at least suggestively associated (P <1 x 10(-6)) with lipid levels in stage 1 and were evaluated in stage 2, followed by combined analyses of stage 1 and stage 2. In the combined analysis of stages 1 and 2, a total of 147 independent loci were associated with lipid levels at P <5 x 10(-8) using 2-df tests, of which 18 were novel. No genome-wide-significant associations were found testing the interaction effect alone. The novel loci included several genes (proprotein convertase subtilisin/kexin type 5 (PCSK5), vascular endothelial growth factor B (VEGFB), and apolipoprotein B mRNA editing enzyme, catalytic polypeptide 1 (APOBEC1) complementation factor (A1CF)) that have a putative role in lipid metabolism on the basis of existing evidence from cellular and experimental models.Peer reviewe