HIV Prevention in Care and Treatment Settings: Baseline Risk Behaviors among HIV Patients in Kenya, Namibia, and Tanzania.

HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV) with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538). Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP). TRIAL REGISTRATION: ClinicalTrials.gov NCT01256463

Perceptions of food-insecure HIV-positive adults participating in a food supplementation program in central Kenya.

Malnutrition coexists with HIV in sub-Saharan Africa. Food supplementation is recommended for food-insecure, HIV-positive individuals. This study was part of a larger six-month food supplementation program for adults initiating antiretroviral therapy (ART) in central Kenya. We conducted 10 focus group interviews with program participants to examine the perceptions of participants regarding the food supplementation program. Focus group transcripts were analyzed for themes and six were identified. These were perception of food insecurity and the health of the participants, the benefits of participating, use of the food, coping strategies after the program ended, suggestions for improving the program, and sustainability of the benefits. Participants perceived that the food improved their health and ART adherence, and reduced stigma. The improvements were not always sustained. Sharing with people beyond the immediate family was very common, depleting the food available to the participants. Interventions with sustainable effects for food-insecure, HIV-positive individuals and their families are needed

Participant baseline HIV risk behaviors by country.

<p><u>Notes</u>. Percentages may not total to 100% due to rounding. The number of participants for individual variables may not sum to overall totals due to non-response from some participants.</p>*<p>F-statistics used to test for country differences.</p>a<p>Used a condom at every sexual encounter.</p>b<p>Includes antiretroviral medications and cotrimoxazole.</p>c<p>Among those not desiring pregnancy or partner pregnancy (males). Family planning methods include pill, injectable, IUD, implant, male and female sterilization.</p

Flow diagram of patient participants in a group-randomized trial of prevention with people living with HIV in HIV care and treatment clinics.

<p>Flow diagram of patient participants in a group-randomized trial of prevention with people living with HIV in HIV care and treatment clinics.</p

Sociodemographic and health characteristics of baseline PwP evaluation study participants.

<p><u>Notes</u>. Percentages may not total to 100% due to rounding. The number of participants for individual variables may not sum to overall totals due to non-response from some participants.</p>*<p>F-statistics used to test for country differences.</p>a<p>One Muslim observation was added per site in Namibia (6 total) to allow the model to converge.</p>b<p>Local currency was converted to US dollars (USD) for comparability.</p

Nitrogen availability and mycorrhizal colonization influence water use efficiency and carbon isotope patterns in Pinus sylvestris

Nitrogen availability and colonization by mycorrhizal fungi may influence plant budgets of water, carbon, and carbon isotopes (δ13C), but estimates of water use efficiency (WUE) derived from isotopic vs budgetary measurements are rarely compared. We assessed patterns of WUE, C allocation, and δ13C in cultures of nonmycorrhizal and ectomycorrhizal Pinus sylvestris at two N supply rates, 3% d−1 and 5% d−1. Mycorrhizal colonization increased δ13C at low N but not at high N. Relative to foliage, roots and mycorrhizal fungi were enriched in 13C 1.5 and 3, respectively. 13C fractionation during synthesis of transfer compounds of −1.5 could account for this progressive enrichment. Increasing N availability increased instantaneous WUE by 7% but decreased budget‐based WUE by 20%. WUE calculated isotopically was 10 times higher than budget‐based WUE. Plants in our system therefore transpired most water without concurrent photosynthesis. We conclude that WUE depends on N concentration and not on the rate of N supply. The proportion of transpiration uncoupled from photosynthesis may largely control WUE in well‐watered ecosystems, and this proportion depends on N concentration in the soil solution. Carbon isotopes only correlate with WUE above a critical concentration of available N. Thus, quantitatively interpreting δ13C patterns requires knowledge about coupling among C, N, and water in the plant–mycorrhizal–soil system