Repeat voluntary HIV counseling and testing (VCT), sexual risk behavior and HIV incidence in Rakai, Uganda.
ABSTRACT We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.
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ABSTRACT: Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda. We used pre-existing clusters of communities randomised as part of a previous family planning trial in this cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group clusters (including two intervention groups from the original trial) received only standard of care HIV services. Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were self-reported experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with ClinicalTrials.gov, number NCT02050763. Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15-49 years. 5337 individuals (in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67-0·92) and sexual IPV (261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67-0·97). Incidence of emotional IPV did not differ (409 [20%] of 2039 vs 311 [18%] of 1737; 0·91, 0·79-1·04). SHARE had no effect on male-reported IPV perpetration. At follow-up 2 (after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 person-years in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46-0·97, p=0·0362). SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future work toward HIV prevention, treatment, and care, and SHARE's ecological approach could be adopted, at least partly, as a standard of care for other HIV programmes in sub-Saharan Africa. Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President's Emergency Plan for AIDS Relief, Fogarty International Center. Copyright © 2015 Wagman et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.11/2014; 3(1). DOI:10.1016/S2214-109X(14)70344-4
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ABSTRACT: Aim To present a systematic review that evaluates the contributions of the INDEPTH Network of health and demographic surveillance systems (HDSSs) to research efforts on prevention and treatment of HIV/AIDS in low- and middle-income countries. Methods Publication titles were sent to INDEPTH by member centres. These were uploaded onto the Zotero research tool from different databases (most from PubMed). We searched for publications using the keyword “HIV” and the publication date. The 540 relevant papers were all published in peer-reviewed English language journals between 1999 and 2012. For a paper to be included in this study it must have extensively tackled the issue of HIV (1), prevention (2) and challenges associated with the treatment. After a thorough review, 89 papers were finally selected. Results Consistent condom use has been found to be highly protective against HIV infection. Although women feel at risk of contracting HIV from their partners and many women knew about condoms, they were unable to use them due to the partner's refusal. Infection with STDs is associated with HIV infection, populations with high rates of STDs and high-risk sexual behaviour, interventions to treat STDs can help prevent HIV transmission. The study also found that mother-to-child transmission was 2.7 times higher in infants breastfed for more than six months than in those breastfed for less than six months. The study found that the most promising prevention intervention discovered so far is male circumcision. Conclusion INDEPTH member centres have tracked the course of the HIV/AIDS epidemic in sub-Saharan Africa. They have analysed how the virus is transmitted and how it impacts families, communities and economies. Prevention and treatment policies and technologies have also come under scrutiny, including prevention of mother-to-child transmission of HIV, male circumcision, behaviour change polices, antiretroviral treatment and other key interventions. The robust and extensive data HDSSs have generated provide critical insights to policy-makers as the epidemic moves into its fourth decade.07/2014; 14(1). DOI:10.1016/j.hivar.2014.06.004