Impact of antiretroviral therapy on adult HIV prevalence in a low-income rural setting in Uganda: a longitudinal population-based study.

OBJECTIVE: To estimate the contribution to HIV prevalence of lives saved due to the introduction of antiretroviral therapy (ART) in rural Uganda in 2004. DESIGN: Open population-based cohort study. METHODS: An open general population cohort with annual demographic and HIV serostatus data is used to estimate annual HIV prevalence, HIV incidence, and mortality from 2000 to 2010. We calculated standardized mortality rates among HIV-positive adults and the expected number of deaths in the cohort if ART had not been available during 2004-2010, based on the average mortality rate in the 4 years (2000-2003) before ART introduction. RESULTS: During 2004-2010, the estimated prevalence increased by 29% from 6.9% to 8.9%. HIV incidence was 5.6 cases per 1000 person-years in 2004, falling to 3.9 cases per 1000 person-years in 2006, and slightly rising to 5.1 in 2010. There was an increase of 182 in the number of HIV-positive participants during that period, cumulatively 228 lives were saved due to ART. Expected lives saved due to ART accounted for an increasing proportion of the estimated HIV prevalence from 4.0% in 2004 to 29.4% in 2010. CONCLUSIONS: Expected lives saved due to ART largely accounted for the increased estimated HIV prevalence from 2004 to 2010. Because HIV prevalence survey results are important for planning, programming, and policy, their interpretation requires consideration of the increasing impact of ART in decreasing mortality

Sexual behaviour change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa

International audienceEditorial for sexual behaviour supplement

SciTokens: Capability-Based Secure Access to Remote Scientific Data

The management of security credentials (e.g., passwords, secret keys) for computational science workflows is a burden for scientists and information security officers. Problems with credentials (e.g., expiration, privilege mismatch) cause workflows to fail to fetch needed input data or store valuable scientific results, distracting scientists from their research by requiring them to diagnose the problems, re-run their computations, and wait longer for their results. In this paper, we introduce SciTokens, open source software to help scientists manage their security credentials more reliably and securely. We describe the SciTokens system architecture, design, and implementation addressing use cases from the Laser Interferometer Gravitational-Wave Observatory (LIGO) Scientific Collaboration and the Large Synoptic Survey Telescope (LSST) projects. We also present our integration with widely-used software that supports distributed scientific computing, including HTCondor, CVMFS, and XrootD. SciTokens uses IETF-standard OAuth tokens for capability-based secure access to remote scientific data. The access tokens convey the specific authorizations needed by the workflows, rather than general-purpose authentication impersonation credentials, to address the risks of scientific workflows running on distributed infrastructure including NSF resources (e.g., LIGO Data Grid, Open Science Grid, XSEDE) and public clouds (e.g., Amazon Web Services, Google Cloud, Microsoft Azure). By improving the interoperability and security of scientific workflows, SciTokens 1) enables use of distributed computing for scientific domains that require greater data protection and 2) enables use of more widely distributed computing resources by reducing the risk of credential abuse on remote systems.Comment: 8 pages, 6 figures, PEARC '18: Practice and Experience in Advanced Research Computing, July 22--26, 2018, Pittsburgh, PA, US

Susceptibility to intestinal infection and diarrhoea in Zambian adults in relation to HIV status and CD4 count.

BACKGROUND: The HIV epidemic in sub-Saharan Africa has had a major impact on infectious disease, and there is currently great interest in the impact of HIV on intestinal barrier function. A three year longitudinal cohort study in a shanty compound in Lusaka, Zambia, carried out before anti-retroviral therapy was widely available, was used to assess the impact of HIV on susceptibility to intestinal infectious disease. We measured the incidence and seasonality of intestinal infection and diarrhoea, aggregation of disease in susceptible individuals, clustering by co-habitation and genetic relatedness, and the disease-to-infection ratio. METHODS: Adults living in a small section of Misisi, Lusaka, were interviewed every two weeks to ascertain the incidence of diarrhoea. Monthly stool samples were analysed for selected pathogens. HIV status and CD4 count were determined annually. RESULTS: HIV seroprevalence was 31% and the prevalence of immunosuppression (CD4 count 200 cells/microL or less) was 10%. Diarrhoea incidence was 1.1 episodes per year and the Incidence Rate Ratio for HIV infection was 2.4 (95%CI 1.7-3.3; p < 0.001). The disease-to-infection ratio was increased at all stages of HIV infection. Aggregation of diarrhoea in susceptible individuals was observed irrespective of immunosuppression, but there was little evidence of clustering by co-habitation or genetic relatedness. There was no evidence of aggregation of asymptomatic infections. CONCLUSION: HIV has an impact on intestinal infection at all stages, with an increased disease-to-infection ratio. The aggregation of disease in susceptible individuals irrespective of CD4 count suggests that this phenomenon is not a function of cell mediated immunity