High-Risk Human Papillomavirus Is Associated with HIV Acquisition among South African Female Sex Workers

Background. Mounting evidence suggests an association between human papillomavirus (HPV) and HIV acquisition. This study aimed to explore this association among South African female sex workers (FSWs). Methods. We used data from 88 HIV-negative FSWs who participated in a vaginal gel (COL-1492) trial. Cervicovaginal rinse samples, obtained before HIV-seroconversion, were genotyped into high-risk (HR-) and low-risk (LR-) HPV. HIV-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) were estimated using Cox survival analysis. Results. HR- and LR-HPV prevalences were 70.5% (95% CI : 60.5–79.2) and 60.2% (95% CI : 49.9–70.0), respectively. Twenty-five women HIV seroconverted. Controlling for background characteristics and other sexually transmitted infections, HIV aHR increased by a factor of 1.7 (95% CI : 1.01–2.7, Plinear trend = 0.045) for an increase of one unit of the number of HR-HPV genotypes. Conclusions. HIV seroconversion among FSWs is associated with genital HR-HPV infection. Further investigation is warranted, including testing the possible protective effect of available HPV vaccines on HIV acquisition

Adult male circumcision as an intervention against HIV: An operational study of uptake in a South African community (ANRS 12126)

<p>Abstract</p> <p>Background</p> <p>To evaluate the knowledge, attitudes and beliefs about adult male circumcision (AMC), assess the association of AMC with HIV incidence and prevalence, and estimate AMC uptake in a Southern African community.</p> <p>Methods</p> <p>A cross-sectional biomedical survey (ANRS-12126) conducted in 2007-2008 among a random sample of 1198 men aged 15 to 49 from Orange Farm (South Africa). Face-to-face interviews were conducted by structured questionnaire. Recent HIV infections were evaluated using the BED incidence assay. Circumcision status was self-reported and clinically assessed. Adjusted HIV incidence rate ratios (aIRR) and prevalence ratios (aPR) were calculated using Poisson regression.</p> <p>Results</p> <p>The response rate was 73.9%. Most respondents agreed that circumcised men could become HIV infected and needed to use condoms, although 19.3% (95%CI: 17.1% to 21.6%) asserted that AMC protected fully against HIV. Among self-reported circumcised men, 44.9% (95%CI: 39.6% to 50.3%) had intact foreskins. Men without foreskins had lower HIV incidence and prevalence than men with foreskins (aIRR = 0.35; 95%CI: 0.14 to 0.88; aPR = 0.45, 95%CI: 0.26 to 0.79). No significant difference was found between self-reported circumcised men with foreskins and other uncircumcised men. Intention to undergo AMC was associated with ethnic group and partner and family support of AMC. Uptake of AMC was 58.8% (95%CI: 55.4% to 62.0%).</p> <p>Conclusions</p> <p>AMC uptake in this community is high but communication and counseling should emphasize what clinical AMC is and its effect on HIV acquisition. These findings suggest that AMC roll-out is promising but requires careful implementation strategies to be successful against the African HIV epidemic.</p

Guidance for health care worker surveys in humanitarian contexts in LMICs

Developed by the Social Sciences Analysis Cell (CASS) and the Research Roadmap to support those working with communities and healthcare workers in humanitarian and emergency contexts This document has been developed for response actors working in humanitarian contexts who seek rapid approaches to gathering evidence about the experience of healthcare workers, and the communities of which they are a part. Understanding healthcare worker experience is critical to inform and guide humanitarian programming and effective strategies to promote IPC, identify psychosocial support needs. This evidence also informs humanitarian programming that interacts with HCWs and facilities such as nutrition, health reinforcement, communication, SGBV and gender. In low- and middle-income countries (LMIC), healthcare workers (HCW) are often faced with limited resources, equipment, performance support and even formal training to provide the life-saving work expected of them. In humanitarian contexts1 , where human resources are also scarce, HCWs may comprise formally trained doctors, nurses, pharmacists, dentists, allied health professionals etc. as well as community members who perform formal health worker related duties with little or no trainingi . These HCWs frequently work in contexts of multiple public health crises, including COVID-19. Their work will be affected by availability of resources (limited supplies, materials), behaviour and emotion (fear), flows of (mis)information (e.g. understanding of expected infection prevention and control (IPC) measures) or services (healthcare policies, services and use). Multiple factors can therefore impact patients, HCWs and their families, not only in terms of risk of exposure to COVID-19, but secondary health, socio-economic and psycho-social risks, as well as constraints that interrupt or hinder healthcare provision such as physical distancing practices. The development and dissemination of training and guidance for HCWs is important for any new infectious disease outbreak. Equally, evaluation of their appropriateness and utility, their impacts on HCW performance and behaviour, and their effectiveness (perceived or measured against programmatic outcome indicators) is important to adapt and improve the appropriateness and effectiveness of resources for HCWs. We recommend HCW surveys are included as a critical component of research associated to humanitarian programming for communities and community health outcomes

A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project

Bertrand Auvert and colleagues describe the large-scale roll-out of adult male circumcision through a program in South Africa

How to improve outbreak response: a case study of integrated outbreak analytics from Ebola in Eastern Democratic Republic of the Congo.

The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018-2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d'Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity of the CASS was to conduct operational social science analyses that were useful to decision makers. This included ensuring that research questions were relevant, driven by epidemiological data from the field, that research could be conducted rapidly (ie, often within days), that findings were regularly and systematically presented to partners and that recommendations were co-developed with response actors. The implementation of the recommendations based on CASS analytics was also monitored over time, to measure their impact on response operations. This practice paper presents the CASS logic model, developed through a field-based externally led consultation, and documents key factors contributing to the usefulness and adaption of CASS and IOA to guide replication for future outbreaks

Généralisation de la circoncision comme méthode de prévention du VIH dans une communauté d'Afrique du Sud

The protective effect of male circumcision (MC) on HIV heterosexual acquisition among men was demonstrated in three randomized controlled trials conducted in Southern and Eastern Africa, and its roll-out has been recommended by the WHO and UNAIDS as an important complementary component of HIV prevention strategies in high incidence communities with low rates of MC. However, the scale-up of MC in communities where it is not a social norm raises several challenges in regards to its acceptability, its implementation, its uptake, and its impact on sexual behavior as well as knowledge, attitudes and practices about MC. The ANRS 12126 Bophelo Pele project was implemented following the international recommendations in the community of Orange Farm (South Africa), site of the first MC randomized controlled trial, and target community of this strategy. Research activities conducted to evaluate the project show that the roll-out of MC is acceptable and can be implemented quickly in limited resources settings according to international recommendations in a safe and cost-effective manner. MC uptake among uncircumcised men is satisfactory. In addition, three years after project implementation, no difference in sexual behavior between circumcised men and uncircumcised men and between female partners of circumcised and uncircumcised men was detected, although knowledge and attitudes about MC and its association with HIV could be improved. MC as an HIV prevention method in hyperendemic communities is a promising strategy which can have a considerable impact on the epidemic in Eastern and Southern Africa.L'effet protecteur de la circoncision masculine (CM) contre l'acquisition hétérosexuelle du VIH chez les hommes a été démontré dans trois essais contrôlés randomisés menés en Afrique australe et de l'Est, et sa généralisation a été recommandée par l’OMS et l’ONUSIDA comme une composante complémentaire importante des stratégies de prévention du VIH dans les pays à forte incidence du virus et bas taux de CM. Cependant, la généralisation de la CM dans les communautés ou elle n’est pas une norme sociale pose de nombreux défis en ce qui concerne son acceptabilité, son implémentation, son acceptation et son impact sur les comportements sexuels ainsi que sur les connaissances, attitudes et pratiques concernant la CM. Le projet ANRS 12126 Bophelo Pele a été implémenté à la suite des recommandations internationales dans la communauté d’Orange Farm, en Afrique du Sud, site du premier essai randomisé contrôlé sur la CM, et communauté cible de cette stratégie. Les activités de recherche menées au sein du projet prouvent que la généralisation de la CM est acceptable et réalisable rapidement dans une communauté à ressources limitées, selon les directives des instances internationales, de manière sure et coût-efficace. Son acceptation parmi les hommes non-circoncis est satisfaisante. De plus, trois ans après l’implémentation du projet, et bien que les connaissances envers la CM et son effet sur le risque du VIH restent à être améliorées, aucune différence de comportement sexuel n’a été décelée entre les hommes circoncis et les hommes non-circoncis ainsi qu’entre les partenaires des hommes circoncis et celles des hommes non-circoncis. La CM comme méthode de prévention du VIH dans les communautés hyperendémiques est donc une stratégie qui promet d’avoir un impact considérable sur l’épidémie en Afrique australe et de l’Est

Roll-out of male circumcision as an intervention against HIV in a South African community

L'effet protecteur de la circoncision masculine (CM) contre l'acquisition hétérosexuelle du VIH chez les hommes a été démontré dans trois essais contrôlés randomisés menés en Afrique australe et de l'Est, et sa généralisation a été recommandée par l’OMS et l’ONUSIDA comme une composante complémentaire importante des stratégies de prévention du VIH dans les pays à forte incidence du virus et bas taux de CM. Cependant, la généralisation de la CM dans les communautés ou elle n’est pas une norme sociale pose de nombreux défis en ce qui concerne son acceptabilité, son implémentation, son acceptation et son impact sur les comportements sexuels ainsi que sur les connaissances, attitudes et pratiques concernant la CM. Le projet ANRS 12126 Bophelo Pele a été implémenté à la suite des recommandations internationales dans la communauté d’Orange Farm, en Afrique du Sud, site du premier essai randomisé contrôlé sur la CM, et communauté cible de cette stratégie. Les activités de recherche menées au sein du projet prouvent que la généralisation de la CM est acceptable et réalisable rapidement dans une communauté à ressources limitées, selon les directives des instances internationales, de manière sure et coût-efficace. Son acceptation parmi les hommes non-circoncis est satisfaisante. De plus, trois ans après l’implémentation du projet, et bien que les connaissances envers la CM et son effet sur le risque du VIH restent à être améliorées, aucune différence de comportement sexuel n’a été décelée entre les hommes circoncis et les hommes non-circoncis ainsi qu’entre les partenaires des hommes circoncis et celles des hommes non-circoncis. La CM comme méthode de prévention du VIH dans les communautés hyperendémiques est donc une stratégie qui promet d’avoir un impact considérable sur l’épidémie en Afrique australe et de l’Est.The protective effect of male circumcision (MC) on HIV heterosexual acquisition among men was demonstrated in three randomized controlled trials conducted in Southern and Eastern Africa, and its roll-out has been recommended by the WHO and UNAIDS as an important complementary component of HIV prevention strategies in high incidence communities with low rates of MC. However, the scale-up of MC in communities where it is not a social norm raises several challenges in regards to its acceptability, its implementation, its uptake, and its impact on sexual behavior as well as knowledge, attitudes and practices about MC. The ANRS 12126 Bophelo Pele project was implemented following the international recommendations in the community of Orange Farm (South Africa), site of the first MC randomized controlled trial, and target community of this strategy. Research activities conducted to evaluate the project show that the roll-out of MC is acceptable and can be implemented quickly in limited resources settings according to international recommendations in a safe and cost-effective manner. MC uptake among uncircumcised men is satisfactory. In addition, three years after project implementation, no difference in sexual behavior between circumcised men and uncircumcised men and between female partners of circumcised and uncircumcised men was detected, although knowledge and attitudes about MC and its association with HIV could be improved. MC as an HIV prevention method in hyperendemic communities is a promising strategy which can have a considerable impact on the epidemic in Eastern and Southern Africa

Statistical power and estimation of incidence rate ratios obtained from BED incidence testing for evaluating HIV interventions among young people

CITATION: Auvert, B., Mahiane, G. S., Lissouba, P. & Moreau, T. 2011. Statistical power and estimation of incidence rate ratios obtained from BED incidence testing for evaluating HIV interventions among young people. PLoS ONE, 6(8): e21149, doi:10.1371/journal.pone.0021149.The original publication is available at http://journals.plos.org/plosoneBackground: The objectives of this study were to determine the capacity of BED incidence testing to a) estimate the effect of a HIV prevention intervention and b) provide adequate statistical power, when used among young people from sub-Saharan African settings with high HIV incidence rates. Methods: Firstly, after having elaborated plausible scenarios based on empirical data and the characteristics of the BED HIV-1 Capture EIA (BED) assay, we conducted statistical calculations to determine the BED theoretical power and HIV incidence rate ratio (IRR) associated with an intervention when using BED incidence testing. Secondly, we simulated a cross-sectional study conducted in a population among whom an HIV intervention was rolled out. Simulated data were analyzed using a log-linear Poisson model to recalculate the IRR and its confidence interval, and estimate the BED practical power. Calculations were conducted with and without corrections for misclassifications. Results: Calculations showed that BED incidence testing can yield a BED theoretical power of 75% or more of the power that can be obtained in a classical cohort study conducted over a duration equal to the BED window period. Statistical analyses using simulated populations showed that the effect of a prevention intervention can be estimated with precision using classical statistical analysis of BED incidence testing data, even with an imprecise knowledge of the characteristics of the BED assay. The BED practical power was lower but of the same magnitude as the BED theoretical power. Conclusions: BED incidence testing can be applied to reasonably small samples to achieve good statistical power when used among young people to estimate IRR. © 2011 Auvert et al.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0021149ArticlePublisher's versio