Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa

BACKGROUND: Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. METHODS: A cohort study that included HIV-uninfected pregnant women was performed. Lay community- based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition. RESULTS The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86). CONCLUSIONS: Maternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa

Prevalence and Risk Factors of Perineal Tears at the Limbe Regional Hospital, Cameroon Prospective

Background: Most of the studies on the prevalence and predisposing factors of perineal tears have been in developed countries. A few studies have been carried out in developing countries including Cameroon. The aim of this study is two fold: to 1) determine the prevalence and risk factors of perineal tear during vaginal delivery at the Limbe Regional Hospital, and 2) provide baseline data needed in auditing obstetric practice. Patients and Methods: This is a retrospective and prospective cross-sectional study. The retrospective data were obtained from the birth registers. Data was obtained for two consecutive years: 2011 and 2012, and included a total of 1336 birth records that were analysed to determine the prevalence and types of perineal tear and prevalence of episiotomies. The prospective study comprised a total of 200 women who gave birth at the LRH during the period January 21st through May 24th 2013. They were administered a structured questionnaire. The data for the prospective study was used to determine the predisposing factors of perineal tear. Data analysis was with Epi Info 7.0, and Microsoft Excel 2010 version. Statistical significance was set at P<0.05. Results: The average age of the participants was 25.8 (SD 5.0). The prevalence of perineal tear at the LRH was 19.2% and that of episiotomies was 2.3%. 13.1% of perineal tears were second-degree tears. Factors identified to be independently associated with perianal tears were: maternal age (25-40) (OR 2.6, 95% CI: 1.1-4.3;P=0.02), history of previous perineal tear (OR 3.4, 95% CI: 1.6-7.3;P<0.001), Antenatal care (ANC) visits (< 4) (OR 2.4, 95% CI: 1.26-4.53; P < 0.007), position of presenting part (occiputo-posterior) (OR 3.2, 95% CI: 1.6-6.12; P<0.001) and duration of second phase of labour (>30 minutes) (OR 3.2, 95% CI: 1.7-6.04; P<0.001). Conclusion: The prevalence of perineal tear was much higher than those of episiotomies in the LRH. Second-degree tears were more prevalent among the participants. Perineal outcomes at the LRH were excellent and should be maintained or improved

Metformin treatment reduces ovarian cytochrome P-450c17alpha response to human chorionic gonadotrophin in women with insulin resistance-related polycystic ovary syndrome.

It has recently been proposed that hyperinsulinaemic insulin resistance and increased ovarian cytochrome P-450c17alpha activity, two features of the polycystic ovary syndrome (PCOS), are pathogenetically linked. The aim of the present study was to test the hypothesis of the linkage between hyperinsulinaemia and supranormal activity of cytochrome P-450c17alpha using the human chorionic gonadotrophin (HCG) challenge, which is a more direct ovarian stimulus than gonadotrophin-releasing hormone (GnRH) in detecting modifications in ovarian steroidogenesis. Eleven women with insulin resistance-related PCOS were studied. HCG (10 000 IU) was given i.m., and blood samples were obtained 0, 8, 12, 16 and 24 h thereafter. Next day, metformin was given at a dose of 500 mg three times a day for 30-32 days, at which time the pretreatment study was repeated. Two women ovulated after metformin treatment. The administration of metformin was associated with a decrease in area under the curve for insulin during a 2h, 75g oral glucose tolerance test, in plasma free testosterone concentrations and an increase in plasma sex hormone binding globulin concentration. The plasma 17-hydroxyprogesterone response to HCG was significantly lower after metformin treatment. The present study gives a direct demonstration that metformin leads to a reduction in stimulated ovarian cytochrome P-450c17alpha activity in women with polycystic ovary syndrome