A Study of Individual Predictors of Maternal Self-Reported Unknown HIV Status in Kenya 2008

Objectives: To determine if maternal education and wealth status predicts maternal self-reported unknown HIV status among women in Kenya. Methods: Kenya Demographic Health Survey (KDHS) 2008 – 2009 was used to examine the association between unknown HIV status and education and wealth, controlling for age, place of residence, place of delivery, history of intimate violence, knowledge of prevention of mother to child transmission (PMTCT), and health decision-making. Results: 617 (21.8%) had unknown HIV status. Education was not associated with unknown HIV status. Only women in the richest wealth category reported less unknown HIV status. Home and private facility births, high PMTCT knowledge and antenatal care (ANC) visits significantly decreased likelihood of unknown HIV status in education and wealth status model. Rural residence significantly predicted unknown HIV status in education model. Conclusion: There is a need to improve PMTCT knowledge and services in rural areas, and to maximize counseling and testing through antenatal care visits.Master of Public Healt

Distribution of HPV genotypes in cervical intraepithelial lesions and cervical cancer in Tanzanian women

<p>Abstract</p> <p>Background</p> <p>Infection with human papillomavirus (HPV) is associated with uterine cervical intraepithelial neoplasia (CIN) and invasive cancers (ICC). Approximately 80% of ICC cases are diagnosed in under-developed countries. Vaccine development relies on knowledge of HPV genotypes characteristic of LSIL, HSIL and cancer; however, these genotypes remain poorly characterized in many African countries. To contribute to the characterization of HPV genotypes in Northeastern Tanzania, we recruited 215 women from the Reproductive Health Clinic at Kilimanjaro Christian Medical Centre. Cervical scrapes and biopsies were obtained for cytology and HPV DNA detection.</p> <p>Results</p> <p>79 out of 215 (36.7%) enrolled participants tested positive for HPV DNA, with a large proportion being multiple infections (74%). The prevalence of HPV infection increased with lesion grade (14% in controls, 67% in CIN1 cases and 88% in CIN2-3). Among ICC cases, 89% had detectable HPV. Overall, 31 HPV genotypes were detected; the three most common HPV genotypes among ICC were HPV16, 35 and 45. In addition to these genotypes, co-infection with HPV18, 31, 33, 52, 58, 68 and 82 was found in 91% of ICC. Among women with CIN2-3, HPV53, 58 and 84/83 were the most common. HPV35, 45, 53/58/59 were the most common among CIN1 cases.</p> <p>Conclusions</p> <p>In women with no evidence of cytological abnormalities, the most prevalent genotypes were HPV58 with HPV16, 35, 52, 66 and 73 occurring equally. Although numerical constraints limit inference, findings that 91% of ICC harbor only a small number of HPV genotypes suggests that prevention efforts including vaccine development or adjuvant screening should focus on these genotypes.</p

Associations Between Methylation of Paternally Expressed Gene 3 (PEG3), Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer.

Cytology-based screening for invasive cervical cancer (ICC) lacks sensitivity and specificity to discriminate between cervical intraepithelial neoplasia (CIN) likely to persist or progress from cases likely to resolve. Genome-wide approaches have been used to identify DNA methylation marks associated with CIN persistence or progression. However, associations between DNA methylation marks and CIN or ICC remain weak and inconsistent. Between 2008-2009, we conducted a hospital-based, case-control study among 213 Tanzania women with CIN 1/2/3 or ICC. We collected questionnaire data, biopsies, peripheral blood, cervical scrapes, Human papillomavirus (HPV) and HIV-1 infection status. We assessed PEG3 methylation status by bisulfite pyrosequencing. Multinomial logistic regression was used to estimate odds ratios (OR) and confidence intervals (CI 95%) for associations between PEG3 methylation status and CIN or ICC. After adjusting for age, gravidity, hormonal contraceptive use and HPV infection, a 5% increase in PEG3 DNA methylation was associated with increased risk for ICC (OR = 1.6; 95% CI 1.2-2.1). HPV infection was associated with a higher risk of CIN1-3 (OR = 15.7; 95% CI 5.7-48.6) and ICC (OR = 29.5, 95% CI 6.3-38.4). Infection with high risk HPV was correlated with mean PEG3 differentially methylated regions (DMRs) methylation (r = 0.34 p<0.0001), while the correlation with low risk HPV infection was weaker (r = 0.16 p = 0.047). Although small sample size limits inference, these data support that PEG3 methylation status has potential as a molecular target for inclusion in CIN screening to improve prediction of progression. Impact statement: We present the first evidence that aberrant methylation of the PEG3 DMR is an important co-factor in the development of Invasive cervical carcinoma (ICC), especially among women infected with high risk HPV. Our results show that a five percent increase in DNA methylation of PEG3 is associated with a 1.6-fold increase ICC risk. Suggesting PEG3 methylation status may be useful as a molecular marker for CIN screening to improve prediction of cases likely to progress

Incidence and recurrence risk of low birth weight in Northern Tanzania: A registry based study.

BackgroundLow birth weight (LBW) is an important indicator of newborn survival. It is associated with higher risk of morbidity, mortality and long-term health consequences. Little has been done on incidence and recurrence risk of LBW in developing countries including Tanzania. This study aimed to determine the incidence and recurrence risk of LBW among women who delivered at Kilimanjaro Christian Medical Center (KCMC), Tanzania.MethodsA hospital-based prospective cohort study was conducted using maternally-linked data from KCMC birth registry between 2000 and 2010. A total of 26,191 women delivered singleton live babies during the study period. Of these, 4,603 (17.6%) had subsequent pregnancies. The recurrence risk of LBW was estimated using a multivariable log-binomial regression model. A robust variance estimator was used to account for correlation between births of the same mother.ResultsThe incidence of LBW was 7.1%. The absolute recurrence risk of LBW was 28.1%. This corresponds to a relative risk (RR) of 5.08-fold, 95% CI 4.01-6.45). Antenatal care visits (ConclusionThe incidence of LBW and its recurrence was high in the study population. Women with previous history of LBW had higher risk of recurrent LBW in subsequent pregnancies. Identification of factors associated with LBW recurrence, proper post-partum care management to ensure Healthy Timing and Spacing of Pregnancy, Pre-conception care and close clinical follow-up during subsequent pregnancy may help reduce LBW recurrence

Adjusted odds ratios for the associations between mean DMR methylation for <i>PEG3</i>, HPV status and CIN and ICC.

*<p>Controlling for HIV-1 status, HPV positive status, age, and oral contraceptive (OC) use.</p><p>Per 5% methylation increase.</p

Distribution of participant characteristics by case-control status.

*<p>ICC/Cancer subtype: 45 patients had squamous cell carcinoma; 3 had adenosquamous carcinomas.</p><p>High Risk HPV- 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68.</p><p>Low/Other Risk HPV – 6,11, 26, 40, 42, 55, 61, 62, 69, 70, 72, 73, 81, 82, 83, 84.</p

Validation of the <i>PEG3</i> pyrosequencing assay.

<p>Defined mixtures (x-axis) of methylated and unmethylated DNAs were prepared and analyzed in quintuplicate by pyrosequencing (y-axis). The results shown represent the mean; error bars indicate standard deviations. The Pearson rho is 0.953 with a p-value of 0.004.</p

Correlation between High and Low Risk HPV status and methylation fraction means at differentially methylated region (DMRs) of <i>PEG3</i>.

<p>High Risk HPV - 16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68.</p><p>Low/Other Risk HPV – 6, 11, 26,40, 42, 55, 61, 62, 69, 70, 72, 73, 81, 82, 83, 84.</p

Book of Abstracts: 2019 Health Equity Summer Research Summit Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 18th, 2019

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