Self-reported reasons to screen for HIV and newly diagnosed HIV infections in clients of community based HIV/STI testing services in Germany, 01/2015-09/2017

Community-based sexual health services (SHS) are intended to improve access for people who may have difficulty attending traditional genitourinary medicine clinics. The objective of this study was to review uptake of sexually transmitted infection (STI) testing in an outreach clinic for those under 25 in an area where Black and minority ethnic groups comprise the majority of the local population. A retrospective case-notes review was undertaken of those attending. Standards were that Fraser guidelines should be completed in all under 16-year-old and all clients should be offered STI testing, HIV testing and contraception (if applicable) in accordance with local standards. One hundred and seventeen clients attended. Ten percent self-reported ethnicity was Asian. Thirty-six (31%) clients tested for chlamydia. Thirty (26%) had an HIV test. Five (14% of those tested) had a positive nucleic acid amplification test for chlamydia. Five (13%) of those requesting long term contraception had STI testing. This service has successfully improved access to STI screening. However, there may have been missed opportunities to offer tests in those requesting contraception. Under-representation of those of non-white ethnicity suggests access to SHS may be a particular problem and further work is required to improve the sexual health of the local community.

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Of ‘prostitutes’ and ‘AIDS people’: Feminization of HIV and AIDS in South-eastern Ghana

Contemporary Journal of African Studies ◽

10.4314/contjas.v3i2.1 ◽

2016 ◽

Vol 3 (2) ◽

pp. 1-38

Author(s):

Bright B. Drah

Keyword(s):

Social History ◽

Hiv Infections ◽

Hiv Prevalence ◽

Hiv And Aids ◽

Sub Saharan Africa ◽

Personal Factors ◽

Community Based ◽

Orphans And Vulnerable Children ◽

Historical Factors ◽

The Impact

In sub-Saharan Africa, more women than men live with HIV and women bear the largest proportion of the burden of care that is due to the epidemic. Only a few studies have documented the precise details of how women in countries with low HIV prevalence became the worst affected by the epidemic. In Ghana, the historical factors that account for high HIV infections among women and the emergence of women-led community-based HIV interventions have been less researched. This paper examines the historical (political-economic), cultural and personal factors that account for the high HIV prevalence in Manya Klo, the area worst impacted by HIV in Ghana. The paper presents the social history of the pandemic in Manya Klo and explains why Klo women are considered to be the sources of HIV in Ghana. It suggests that concentrating interventions on women helps to reduce the impact of HIV and inform national interventions. Women-focused interventions may, however, alienate other groups that can contribute to improving the lives of families affected by HIV. Therefore, women-focused interventions must be planned in a manner that engages multiple stakeholders.Keywords: Manya Krobo, queen mothers, female migration, female sex work, orphans and vulnerable children, community-based HIV initiatives

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Inequalities in women’s empowerment and prevalence of HIV in India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203380 ◽

2020 ◽

Vol 7 (8) ◽

pp. 3069

Author(s):

Shri Kant Singh ◽

Deepanjali Vishwakarma ◽

Bhawana Sharma ◽

Santosh Kumar Sharma

Keyword(s):

Gender Gap ◽

Hiv Infections ◽

Women's Empowerment ◽

Hiv Prevalence ◽

Women’S Empowerment ◽

Spousal Violence ◽

Sexual Rights ◽

Community Based ◽

Using Data ◽

Hiv Aids

Background: Over the years, there has been growing evidence of continuous narrowing gender gap in new HIV infections, despite stagnation in overall HIV prevalence in India. Among others, one of the reasons behind the exiting pattern in HIV/AIDS in the country is the poor status of women, lack of control over their sexuality and poor reproductive and sexual rights.Methods: This paper analyses the troika of women’s empowerment, spousal-violence, and HIV prevalence in India using data from two rounds (2005-2006 and 2015-2016) of Indian DHS having a community-based HIV testing.Results: Results corroborate the recent spurts in women’s empowerment in India, which cuts across socio-economic groups. It has positively influenced a decline in spousal-violence even in the lowest socio-economic strata despite significant inequality across states. HIV prevalence among women has not been changed over the last decade (0.22% to 0.23%) despite decreased adult HIV prevalence. Women having control over their sexuality is significantly less likely to have HIV infection. Relationship between marital control behavior of husband and HIV prevalence, which was significant in 2005-06 (OR=1.2, p<0.10), has emerged to be insignificant in 2015-16. This means that increasing women's empowerment has altered their HIV prevalence through increasing sexual-rights and reducing the intensity of marital control behavior.Conclusions: A combative relationship has been established between women’s empowerment and their risk of HIV/AIDS. The results have been consistently showing the variations of inequality in women’s empowerment across different states, consequently affecting the risk of HIV/AIDS. Ensuring sexual-rights of women should be the best strategy.

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Long Term Outcome of Lenalidomide-Dexamethasone (Rd) Vs Melphalan-Lenalidomide-Prednisone (MPR) Vs Cyclophosphamide-Prednisone-Lenalidomide (CPR) As Induction Followed By Lenalidomide-Prednisone (RP) Vs Lenalidomide (R) As Maintenance in a Community-Based Newly Diagnosed Myeloma Population: Updated Analysis of EMN01 Phase III Study

Blood ◽

10.1182/blood.v130.suppl_1.901.901 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 901-901

Author(s):

Sara Bringhen ◽

Massimo Offidani ◽

Pellegrino Musto ◽

Anna Marina Liberati ◽

Giulia Benevolo ◽

...

Keyword(s):

Board Of Directors ◽

Research Funding ◽

Phase Iii ◽

Cell Transplant ◽

Newly Diagnosed ◽

Community Based ◽

Advisory Committees ◽

Risk Of Death ◽

Grade 3 ◽

To Receive

Abstract Introduction : Rd and MPR showed to be effective combinations in elderly newly diagnosed multiple myeloma (NDMM) patients (pts). Cyclophosphamide is a less toxic alkylating alternative agent. EMN01 is the first trial to formally compare these three different Lenalidomide-based combinations. Maintenance with Lenalidomide has been recently approved in patients eligible for autologous stem cell transplant (ASCT). Few data are available about the best combination as maintenance in patients not eligible for ASCT. Methods : 662 pts with NDMM were randomized to receive 9 28-day cycles of Rd (lenalidomide 25 mg/day for 21 days; dexamethasone 40 mg on days 1,8,15 and 22 in pts 65-75 years old and 20 mg in those >75 years), MPR (lenalidomide 10 mg/day for 21 days; melphalan orally 0.18 mg/Kg for 4 days in pts 65-75 years old and 0.13 mg/Kg in >75 years pts; prednisone 1.5 mg/Kg for 4 days) or CPR (lenalidomide 25 mg/day for 21 days; cyclophosphamide orally 50 mg/day for 21 days in pts 65-75 years old and 50 mg every other day in >75 years pts; prednisone 25 mg every other day). After induction, pts were randomized to receive maintenance with lenalidomide alone (R; 10 mg/day for 21 days) or with prednisone (RP; R, 10 mg/day for 21 days and P, 25 mg every other day), until disease progression. Results : Pts characteristics were well balanced in all groups; 217 pts in Rd, 217 in MPR and 220 in CPR arms could be evaluated. After a median follow-up of 63.7 months, median PFS was 23.2 months in MPR, 18.9 months in CPR and 18.6 months in Rd (MPR vs CPR p=0.02; MPR vs Rd p=0.08). Median overall survival (OS) was 79.9 months in MPR, 69.4 months in CPR and 68.1 months in Rd (MPR vs CPR p=0.98; MPR vs Rd p=0.64). The most common grade ≥3 adverse event (AEs) was neutropenia: 64% in MPR, 29% in CPR and 25% in Rd pts (p<0.0001). Grade ≥3 non hematologic AEs were similar among arms. At the end of induction, 402 pts were eligible for maintenance, 198 in the RP and 204 in the R groups. PFS from start of maintenance was 22.2 months in the RP group and 17.6 in the R group, with 20% reduced the risk of death/progression for pts receiving RP maintenance (HR 0.81, p=0.07; Figure 1). A subgroup analysis was performed to determine the consistency of RP vs R treatment effect in different subgroups using interaction terms between treatment and cytogenetic abnormalities, ISS, age, sex, induction treatment and response before maintenance (Figure 1). No difference in OS was observed (HR 1.02, p=0.93) but the OS analysis was limited by the low number of events. Median duration of maintenance was 23.0 months in RP pts and 20.5 months in R pts, 14% and 13% of pts discontinued due to AEs, in RP and R groups, respectively. Conclusion : This phase III trial compared 2 different Lenalidomide-containing induction regimens and 2 different Lenalidomide-containing maintenance regimens in an elderly community-based NDMM population. MPR prolonged PFS by approximately 5 months, yet the higher incidence of hematologic toxicity should be carefully considered. The addition of low-dose prednisone to standard lenalidomide maintenance reduced the risk of death/progression by 20%, with a good safety profile. Updated results will be presented at the meeting. Disclosures Bringhen: Mundipharma: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria; Celgene: Honoraria; Bristol Myers Squibb: Honoraria; Karyipharm: Membership on an entity's Board of Directors or advisory committees. Offidani: celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Musto: Celgene: Honoraria; Janssen: Honoraria. Gaidano: Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Roche: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria. De Sabbata: Celgene: Membership on an entity's Board of Directors or advisory committees. Palumbo: Sanofi: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Binding Site: Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria, Research Funding; Genmab A/S: Consultancy, Honoraria, Research Funding; Janssen-Cilag: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau; Takeda: Consultancy, Employment, Equity Ownership, Honoraria, Research Funding. Hájek: Amgen, Takeda, BMS, Celgene, Novartis, Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Consultancy, Honoraria; Pharma MAR: Consultancy, Honoraria. Boccadoro: Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; AbbVie: Honoraria; Mundipharma: Research Funding; Sanofi: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding.

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The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain)

BMC Public Health ◽

10.1186/s12889-020-09603-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Cristina Agustí ◽

Núria Font-Casaseca ◽

Francesc Belvis ◽

Mireia Julià ◽

Núria Vives ◽

...

Keyword(s):

Spatial Distribution ◽

Hiv Infection ◽

Urban Areas ◽

Western Europe ◽

Hiv Infections ◽

National Registry ◽

Surveillance Data ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Incident Cases

Abstract Background Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. Methods Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012–2016) and associated risk factors at the small area level (ABS, acronym for “basic health area” in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. Results New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15–44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. Conclusions Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

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Late diagnosis of human immunodeficiency virus infections in high-risk groups in Karachi, Pakistan

International Journal of STD & AIDS ◽

10.1177/0956462418785264 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1400-1406

Author(s):

Zahra Hasan ◽

Sharaf Shah ◽

Rumina Hasan ◽

Shoaib Rao ◽

Manzoor Ahmed ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

High Risk ◽

Early Diagnosis ◽

Hiv Infection ◽

Hiv Infections ◽

Risk Groups ◽

Newly Diagnosed ◽

Immunodeficiency Virus ◽

Hiv 1

Human immunodeficiency virus (HIV) infection prevalence in Pakistan has been increasing in high-risk groups, including people who inject drugs (PWID) and transgender hijra sex workers (TG-HSWs) nationwide. Effective control of HIV requires early diagnosis of the infection. We investigated recency of HIV infections in newly-diagnosed cases in PWID and TG-HSWs. This was an observational study with convenience sampling. Overall, 210 HIV-positive subjects comprising an equal number of PWID and TG-HSWs were included. Antibody avidity was tested using the Maxim HIV-1 Limiting Antigen Avidity (LAg) EIA (Maxim Biomedical, Inc. Rockville, Maryland, USA). The mean age of study subjects was 29.5 years: PWID, 28.5 years and TG-HSWs, 30.4 years. Study subjects were married, 27%, or unmarried. Eighteen percent of individuals had recently-acquired HIV infections: 19% of PWID and 17% of TG-HSWs. Eighty-two percent of individuals had long-term HIV infections: 81% of PWID and 83% of TG-HSWs. This is the first study identification of recent HIV-1 infections in Pakistan. We show that most newly-diagnosed HIV patients in the high-risk groups studied had long-term infections. There is an urgent need for intervention in these groups to facilitate early diagnosis and treatment of HIV infection to reduce transmission in Pakistan.

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Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study

BMJ ◽

10.1136/bmj.m2724 ◽

2020 ◽

pp. m2724

Author(s):

Nicklas Vinter ◽

Qiuxi Huang ◽

Morten Fenger-Grøn ◽

Lars Frost ◽

Emelia J Benjamin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Time Varying ◽

Newly Diagnosed ◽

Survival Times ◽

Community Based ◽

Period 2 ◽

Hazard Ratios ◽

Time Period ◽

Heart Study ◽

All Cause Mortality

AbstractObjectiveTo assess temporal trends in the association between newly diagnosed atrial fibrillation and death.DesignCommunity based cohort study.SettingFramingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA.ParticipantsParticipants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period.Main outcome measuresThe main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods.Results5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from −2.9 years (95% confidence interval −3.2 to −2.5) in period 1, to −2.1 years (−2.4 to −1.8) in period 2, to −2.0 years (−2.3 to −1.7) in period 3 (Ptrend=0.03).ConclusionsNo evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.

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