scholarly journals Behavioral effects of different contraceptive methods and HIV acquisition: an ancillary study of the ECHO randomized trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Mandisa Singata-Madliki ◽  
Theresa A. Lawrie ◽  
Yusentha Balakrishna ◽  
Florence Carayon-Lefebvre d’Hellencourt ◽  
G. Justus Hofmeyr
Keyword(s):  
Intrauterine Device ◽  
Research Unit ◽  
Coital Frequency ◽  
Ancillary Study ◽  
Menstrual Symptoms ◽  
Registration Number ◽  
Hiv Women ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
And Behavior

Abstract Background The ECHO trial randomised 7829 women to depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant (1:1:1) and found no clear difference in HIV incidence between these three groups. We have previously hypothesized that oligo-amenorrhoea induced by DMPA-IM may have a protective effect on HIV acquisition. The aim of this ancillary study was to assess the effects of DMPA-IM, the IUD and the LNG implant on menstrual symptoms and sexual behavior and to correlate these with HIV acquisition. Methods At the Effective Care Research Unit (ECRU) in South Africa, of 615 women already randomised to DMPA-IM, the copper IUD and the LNG implant (1:1:1) 552 agreed to participate. Participants completed a 28-day symptom and behavior diary following their one-month ECHO trial visit and returning it at their 3-month follow-up visit. HIV acquisition data were retrieved from ECHO trial records. Results Of 552 women enrolled on the ancillary study, 390 (70.6%) completed their daily diary; 130, 133, and 127 received DMPA-IM, IUD, and LNG implant, respectively. Thirty-three (5.9%) of these women acquired HIV. Women on the progestin-only contraceptives were more likely to experience amenorrhoea, as expected, and were less likely to have intra-menstrual coitus than IUD users (p < 0.001 for DMPA-IM vs IUD and p = 0.002 for implant vs IUD). Overall coital frequency was highest and condom usage lowest among DMPA-IM users. Intra-menstrual coitus correlated positively, and duration of menstruation correlated negatively, with HIV acquisition, although these effects were not statistically significant (p = 0.09 and p = 0.079, respectively). Conclusions Findings support the hypothesis that oligo-amenorrhoea and the associated reduced intra-menstrual coitus may mitigate the potential for an increased biological risk of HIV acquisition with DMPA-IM but more evidence is needed. Study registration number PACTR201706001651380

scholarly journals Behavioral Effects of Different Contraceptive Methods and HIV Acquisition: An Ancillary Study of the ECHO* Randomized Trial

2020 ◽  
Author(s):  
Mandisa Singata-Madliki ◽  
Theresa Lawrie ◽  
Yusentha Balakrishna ◽  
Florence Carayon-Lefebvre d’Hellencourt ◽  
George Justus Hofmeyr
Keyword(s):  
Intrauterine Device ◽  
Research Unit ◽  
Coital Frequency ◽  
Ancillary Study ◽  
Menstrual Symptoms ◽  
Registration Number ◽  
Hiv Women ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
And Behavior

Abstract BackgroundThe ECHO trial randomised 7829 women to depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant (1:1:1) and found no clear difference in HIV incidence between these three groups. We have previously hypothesized that oligo-amenorrhoea induced by DMPA-IM may have a protective effect on HIV acquisition. The aim of this ancillary study was to assess the effects of DMPA-IM, the IUD and the LNG implant on menstrual symptoms and sexual behavior and to correlate these with HIV acquisition.Methods At the Effective Care Research Unit (ECRU) in South Africa, women already randomised to DMPA-IM, the copper IUD and the LNG implant (1:1:1) were asked to participate. Participants completed a 28-day symptom and behavior diary following their one-month ECHO trial visit and returning it at their 3-month follow-up visit. HIV acquisition data were retrieved from ECHO trial records.ResultsOf 487 women enrolled on the ancillary study, 390 (80%) completed their daily diary; 130, 133, and 127 received DMPA-IM, IUD, and LNG implant, respectively. Thirty-three (8·4%) of these women acquired HIV. Women on the progestin-only contraceptives were more likely to experience amenorrhoea, as expected, and were less likely to have intra-menstrual coitus than IUD users (p < 0·001 for DMPA-IM vs IUD and P = 0·002 for implant vs IUD). Overall coital frequency was highest and condom usage lowest among DMPA-IM users. Intra-menstrual coitus correlated positively, and duration of menstruation correlated negatively, with HIV acquisition, although these effects were not statistically significant (p=0·09 and p=0·079, respectively).ConclusionsFindings support the hypothesis that oligo-amenorrhoea and the associated reduced intra-menstrual coitus may mitigate the potential for an increased biological risk of HIV acquisition with DMPA-IM but more evidence is needed. Study registration number: PACTR201706001651380

scholarly journals Copper intrauterine device use and HIV acquisition in women: a systematic review

2020 ◽  
Vol 46 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Philip C Hannaford ◽  
Angeline Ti ◽  
Tsungai Chipato ◽  
Kathryn M Curtis
Keyword(s):  
Observational Study ◽  
Hiv Risk ◽  
Intrauterine Device ◽  
Cochrane Library ◽  
Hiv Incidence ◽  
Increased Risk ◽  
Significant Difference ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Copper Intrauterine Device

ObjectivesTo review systematically copper intrauterine device (Cu-IUD) use and HIV acquisition in women.MethodsWe searched Pubmed, Embase and the Cochrane Library between database inception and 26 June 2019 for longitudinal studies comparing incident HIV infection among women using an unspecified IUD or Cu-IUD compared with non-hormonal or no contraceptive users, or hormonal contraceptive users. We extracted information from included studies, assessed study quality, and summarised study findings.ResultsFrom 2494 publications identified, seven met our inclusion criteria. One randomised controlled trial (RCT), judged “informative with few limitations”, found no statistically significant differences in HIV risk between users of the Cu-IUD and either intramuscular depot medroxyprogesterone acetate (DMPA-IM) or levonorgestrel implant. One observational study, deemed “informative but with important limitations”, found no statistically significant difference in HIV incidence among IUD users compared with women who had tubal ligation or who were not using any contraception. Another “informative but with important limitations” observational study found no difference in HIV incidence between Cu-IUD users and DMPA or norethisterone enanthate injectable, or implant users. An RCT considered “unlikely to inform the primary question” also found no difference in HIV risk between Cu-IUD and progestogen-only injectable users. Findings from the other three “unlikely to inform the primary question” cohort studies were consistent with the more robust studies suggesting no increased risk of HIV acquisition among Cu-IUD users.ConclusionThe collective evidence, including that from a large high-quality RCT, does not indicate an increased risk of HIV acquisition among users of Cu-IUDs.

scholarly journals Effects of injectable progestogen contraception versus the copper intrauterine device on HIV acquisition: sub-study of a pragmatic randomised controlled trial

2017 ◽  
Vol 43 (3) ◽  
pp. 175-180 ◽  
Author(s):  
G Justus Hofmeyr ◽  
Mandisa Singata-Madliki ◽  
Theresa A Lawrie ◽  
Eduardo Bergel ◽  
Marleen Temmerman
Keyword(s):  
Randomised Controlled Trial ◽  
South African ◽  
Pregnancy Termination ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Randomised Trial ◽  
Contraceptive Device ◽  
Increased Risk ◽  
Hiv Acquisition ◽  
Randomised Controlled

BackgroundEvidence from observational studies suggests an increased risk of HIV acquisition among women using depot medroxyprogesterone acetate (DMPA) contraception.MethodsWithin the context of a South African programme to increase women's access to the intrauterine contraceptive device (IUD), we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial (RCT) of the IUD versus injectable progestogen contraception (IPC) at two South African hospitals. The primary outcome was pregnancy; secondary outcomes included HIV acquisition. Consenting women attending termination of pregnancy services were randomised after pregnancy termination between July 2009 and November 2012. Condoms were promoted for the prevention of sexually transmitted infections. Voluntary HIV testing was offered at baseline and at 12 or more months later. Findings on HIV acquisition are reported in this article.ResultsHIV acquisition data were available for 1290 initially HIV-negative women who underwent a final study interview at a median of 20 months after randomisation to IPC or an IUD. Baseline group characteristics were comparable. In the IPC group, 545/656 (83%) of participants received DMPA, 96 (15%) received injectable norethisterone enanthate, 14 (2%) received the IUD and one received oral contraception. In the IUD group 609 (96%) received the IUD, 20 (3%) received IPC and 5 (1%) had missing data. According to intention-to-treat analysis, HIV acquisition occurred in 20/656 (3.0%) women in the IPC arm and 22/634 (3.5%) women in the IUD arm (IPC vs IUD, risk ratio 0.88; 95% confidence interval 0.48–1.59;p=0.7).ConclusionsThis sub-study was underpowered to rule out moderate differences in HIV risk, but confirms the feasibility of randomised trial methodology to address this question. Larger RCTs are needed to determine the relative risks of various contraceptive methods on HIV acquisition with greater precision.Trial registration numberPan African Clinical Trials Registry number PACTR201409000880157 (04-09-2014).

Genital Herpes in Human Immunodeficiency Virus Infected Patients

2021 ◽  
Vol 5 (8) ◽  
pp. 758-772
Author(s):  
Stella Sunur ◽  
Izazi Hari Purwoko ◽  
Yulia Farida Yahya ◽  
Raden Pamudji
Keyword(s):  
Genital Herpes ◽  
Clinical Manifestations ◽  
Symptomatic Treatment ◽  
Transmitted Infection ◽  
Sexual Transmitted Infection ◽  
Immunodeficiency Virus ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Common Infection

Genital herpes is a recurrent, lifelong sexual transmitted infection caused by HSV, especially type 2. Genital herpes is the most common infection in HIV patient. HSV-2 can increase the risk of HIV acquisition 2 to 3 times. Clinical manifestations of genital herpes can be different between HIV- infected and non-HIV patients. HIV-infected patients have a high risk of developing chronic and severe genital ulcers with atypical manifestation, prolonged healing, and resistant to treatment, depends on CD4 count. Genital herpes can be diagnosed based on history, clinical manifestation, laboratory and histopathologic examination. Management of genital herpes includes education and counseling patients and sexual partners, systemic antiviral, and symptomatic treatment.

Defining the PrEP care continuum among recently incarcerated men at high risk for HIV infection (Preprint)

2021 ◽  
Author(s):  
Matthew Murphy ◽  
Colette Sosnowy ◽  
Brooke Rogers ◽  
Siena Napoleon ◽  
Drew Galipeau ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
Hiv Infection ◽  
Care Continuum ◽  
Increased Risk ◽  
Biomedical Intervention ◽  
Prep Implementation ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Prospective Longitudinal

BACKGROUND HIV disproportionately impacts criminal justice (CJ)-involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in CJ-systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. OBJECTIVE This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. METHODS Men incarcerated in the Rhode Island Department of Corrections, a correctional system composed of all of the state's sentenced and awaiting trial population, are screened for HIV acquisition risk during the course of routine clinical care. Those identified at high risk for HIV acquisition are referred for evaluation for PrEP initiation and enrollment in this study. Individuals who express interest in initiating PrEP and consent to the study are then followed in a prospective longitudinal cohort. RESULTS The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to incarceration and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. CONCLUSIONS Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the CJ-context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic.

Enhancing Access to Safe and Secure Housing

2018 ◽  
pp. 105-142
Author(s):  
J Dickson-Gomez ◽  
K Quinn
Keyword(s):  
Treatment As Prevention ◽  
Structural Level ◽  
Housing Crisis ◽  
Response Options ◽  
Housing Status ◽  
Health Response ◽  
Persons Living With Hiv ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Living With Hiv

This chapter reviews the global pervasiveness of being homeless or unstably housed as an antecedent to risk of HIV acquisition and as a barrier to global efforts directed toward treatment as prevention. Emphasis on youth is provided, as they experience a vast disparity in this regard. Subsequently, this chapter addresses key structural-level intervention designed to provide stable living environments for persons living with HIV/AIDS. Several possible public health response options are provided, with an emphasis on feasibility and sustainability. Topics covered include the multidimensional definitions of housing status and stability, the global housing crisis and how it relates to HIV, structural interventions to address the link between housing and HIV, and future directions for research.

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