Endometrial Histopathology in Patients with Laparoscopic Proven Salpingitis and HIV-1 Infection

Study Objective. To identify sensitive and specific histological criteria for endometritis in women with laparoscopically-confirmed acute salpingitis. Methods. Women, age 18–40 years of age presenting with complaints of lower abdominal pain ≤2 weeks and no antibiotics use in past two weeks, were enrolled. They underwent clinical examination, screening for HIV; other sexually transmitted infections plus endometrial biopsy sampling for histopathology. Diagnostic laparoscopy confirmed the diagnosis of acute salpingitis. Controls were women undergoing tubal ligation and HIV-1 infected women asymptomatic for genital tract infection. Results. Of 125 women with laparoscopically-confirmed salpingitis, 38% were HIV-1 seropositive. Nineteen HIV-1 negative controls were recruited. For the diagnosis of endometritis, ≥1 plasma cells (PC) and ≥3 polymorphonuclear lymphocytes (PMN) per HPF in the endometrium had a sensitivity of 74% for HIV-1-seropositive, 63% for HIV-1-seronegative women with a specificity of 75% and positive predictive value of 85% regardless of HIV-1-infection for predicting moderate to severe salpingitis. For HIV-1-seronegative women with mild salpingitis, ≥1 PC and ≥3 PMN had a sensitivity of 16% and a PPV of 57%. Conclusion. Endometrial histology, did not perform well as a surrogate marker for moderate to severe salpingitis, and failed as a surrogate marker for mild salpingitis

The Association of HIV Counseling and Testing with HIV Risk Behaviors in a Random Population-based Survey in Kisumu, Kenya

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population

Association of Attitudes and Beliefs towards Antiretroviral Therapy with HIV-Seroprevalence in the General Population of Kisumu, Kenya

Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment.We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age.1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19).ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability

Foraging Fidelity as a Recipe for a Long Life: Foraging Strategy and Longevity in Male Southern Elephant Seals

Identifying individual factors affecting life-span has long been of interest for biologists and demographers: how do some individuals manage to dodge the forces of mortality when the vast majority does not? Answering this question is not straightforward, partly because of the arduous task of accurately estimating longevity in wild animals, and of the statistical difficulties in correlating time-varying ecological covariables with a single number (time-to-event). Here we investigated the relationship between foraging strategy and life-span in an elusive and large marine predator: the Southern Elephant Seal (Mirounga leonina). Using teeth recovered from dead males on îles Kerguelen, Southern Ocean, we first aged specimens. Then we used stable isotopic measurements of carbon () in dentin to study the effect of foraging location on individual life-span. Using a joint change-point/survival modelling approach which enabled us to describe the ontogenetic trajectory of foraging, we unveiled how a stable foraging strategy developed early in life positively covaried with longevity in male Southern Elephant Seals. Coupled with an appropriate statistical analysis, stable isotopes have the potential to tackle ecological questions of long standing interest but whose answer has been hampered by logistic constraints

Survival of Red Maasai, Dorper and crossbred lambs in the sub-humid tropics

The survival rates of Dorper, Red Maasai and crossbred lambs born over a period of 6 years at Diani Estate, Coast Province, Kenya were compared using the Cox mixed proportional hazards model with a random (frailty) term for sire. Of the 1785 lambs born, proportionately 0.44 died before they were 1 year old. Almost half of these deaths occurred before weaning; a third were associated with mis-mothering and a fifth with gastro-intestinal nematode parasite (endoparasite) infections. Half of the deaths post weaning were associated with endoparasite infections, predominantly Haemonchus contortus. The Red Maasai lambs had a lower risk of death than the Dorper lambs with a relative hazard of 0.27 pre-weaning and 0.25 post weaning. Other crosses and back crosses had relative hazards in between these values and 1; there was no evidence of heterosis. Survival rates were different among years and appeared to be associated to some degree with variations in rainfall. There were highly significant effects of both birth weight and weaning weight on survival. Body weight, together with packed red cell volume and faecal egg count, were also introduced into the proportional hazard model as time-varying covariates. All three variables had major influences on survival. The risk of death over the following month in animals individually treated with an anthelmintic drug pre weaning was reduced by 0.61 compared with those not treated. The sire frailty variance estimate was similar to its standard error pre-weaning but larger post weaning. When adjusted for lamb body weight the sire variance post weaning increased to three times its standard error

The shared frailty model and the power for heterogeneity tests in multicenter trials

Heterogeneity between centers in multicenter trials with time to event outcome can be modeled by the frailty proportional hazards model. The majority of the different approaches that have been used to fit frailty models assume either the gamma or the lognormal frailty density and are based on similar log likelihood expressions. These approaches are briefly reviewed and their specific features described; simulations further demonstrate that the different techniques lead to virtually the same estimates for the heterogeneity parameter. An important issue is the relationship between the size of a multicenter trial, in terms of number of centers and number of patients per center, and the bias and the spread of estimates of the heterogeneity parameter around its true value. Based on simulation results (restricted to constant hazard rate and the gamma frailty density), it becomes clear how the number of centers and the number of patients per center influence the quality of the estimates in the particular setting of breast cancer clinical trials. This insight is important in treatment outcome research, where one tries to relate differences with respect to clinical practice to differences in outcome in the various centers

Reducing Indoor Air Pollution through Participatory Development in Rural Kenya.”

ABSTRACT Objective: To evaluate effectiveness of smoke reduction interventions in rural homes. Methods: 24-hour kitchen respirable particles (kPM 3.5 ), kitchen CO (kCO), and personal CO (pCO) for the cook were assessed before and after interventions in Kajiado (n=25) and West Kenya (n=25). Women participated in developing interventions, including improved stoves (12), enlarged windows (all) and eaves (27), and hoods (17). Results: Pollution/exposure levels were high: mean 24h kPM 3.5 5,530 µg/m 3 (Kajiado), 1,710 µg/m 3 (West Kenya); 24h kCO 74.7 and 8.8 ppm respectively; 24h pCO 6.98 and 4.16 ppm respectively. Following interventions, there were marked reductions in all measures. For 15 homes receiving hoods, kPM 3.5 was reduced 75% (p=0.001), kCO by 77% (p=0.001) and pCO by 35% (p=0.011). Enlarged eaves and windows reduced kPM 3.5 by 62% (p=0.001) in West Kenya. Residents appreciated better lighting, ventilation and smoke reduction, although concerns about privacy required attention. Conclusion: This participatory approach achieved effective smoke reduction, and promoted interest in further development (155). INDEX TERMS Poor rural communities, Women and children, Indoor air pollution, Participatory technology development, Reduced exposure

The association of HIV counseling and testing with HIV risk behaviors in a random population-based survey in Kisumu, Kenya.

HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testing. Two-thirds of participants who tested HIV-positive in this study reported no prior HIV test. Women who had undergone recent testing were less likely to report high-risk behaviors than women who had never been tested; this was not seen among men. Although rates of HIV testing were higher than seen in previous studies, the majority of HIV-infected people were unaware of their status. Efforts should be made to increase HIV testing among this population