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ABSTRACT: The importance of involving adolescents in HIV prevention trials has been recognized, but there have been few experiences reported from sub-Saharan Africa. We analyzed adult and adolescent data from a cohort study conducted to assess the feasibility of involving adolescents and adults in HIV vaccine-related studies.
Two hundred HIV-negative participants aged 16 to 40 years were enrolled, including 86 (43%) adolescents. At baseline, sexual risk behavior and willingness to participate (WTP) in future HIV vaccine trials questionnaires were administered. Three monthly HIV counseling, pregnancy, HIV and syphilis tests were performed. Risk questionnaires were repeated at 6 months and WTP at 12 months.
No significant difference in retention between adults (83%) and adolescents (87%) was noted (p = .58). Initially, more adults (40%) reported WTP compared to adolescents (13%) (p < .001). At the end of the study both groups reported higher levels of WTP; increasing to 40% among adolescents. HIV incidence during the study was 9.2 infections per 100 person-years (95% confidence interval [CI]: 4.4-19.2) among adolescents compared to 5.8 (95% CI 2.6-12.9) in adults (p = .42).
Retention of high-risk HIV-negative adolescents in a cohort study is feasible. Following education, adolescents reported improved WTP. The high HIV incidence rate in adolescents highlights the importance of including this group in prevention trials.
Journal of Adolescent Health 07/2008; 43(1):8-14. · 3.33 Impact Factor
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ABSTRACT: Despite the high prevalence of both mental disorders and HIV infection in much of sub-Saharan Africa, little is known about the occurrence of mental health disorders among HIV-infected individuals. We conducted a cross-sectional study among individuals enrolled into HIV care and treatment services near Cape Town, South Africa. Psychiatric diagnoses were measured using the Mini-International Neuropsychiatric Interview (MINI) administered by trained research nurses. In addition, all participants were administered brief rating scales for depression (the Center for Epidemiological Studies Depression Scale [CES-D]), posttraumatic stress disorder (PTSD), the Harvard Trauma Questionnaire (HTQ), and alcohol dependence/abuse (the Alcohol Use Disorders Identification Test [AUDIT]). The median age among the 465 participants was 33 years and 75% were female; 48% were receiving antiretroviral therapy. Overall, the prevalence of depression, PTSD and alcohol dependence/abuse was 14% (n = 62), 5% (n = 24), and 7% (n = 35), respectively. In multivariate analysis, the prevalence of all disorders was significantly higher among individuals who spoke Afrikaans compared to Xhosa. While the AUDIT showed excellent sensitivity and specificity in detecting MINI-defined dependence/abuse (area under the receiver-operating characteristic curve, 0.96), the HTQ and CES-D had lower performance characteristics in detecting PTSD (0.74) and depression (0.76), respectively. These data demonstrate high levels of depression, PTSD and alcohol dependence/abuse among HIV-infected individuals in this setting. Additional research is required to refine these rating scales for maximum applicability in cross-cultural populations. More generally, HIV care and treatment services represent an important venue to identify and manage individuals with common mental disorders in resource-limited settings.
AIDS patient care and STDs 03/2008; 22(2):147-58. · 2.68 Impact Factor
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ABSTRACT: Voluntary counseling and testing (VCT) services are a major component of HIV prevention and treatment efforts. We developed a drama-based intervention to promote VCT services in a peri-urban community in South Africa.
Young adults from the community received training in HIV/AIDS and drama, and developed sketches to address perceived barriers to VCT. Over 12 months, 80 performances were held in busy community settings. The intervention was evaluated through changes in VCT uptake at the local clinic compared with comparable communities nearby.
After the start of the intervention in August 2003, a 172% increase in the uptake of VCT services was observed in the intervention community. This was significantly greater than demand for VCT in either of the control communities during the same period (P < 0.0001).
A structured, community-based education program based on drama can lead to substantial increases in the demand for VCT services in resource-limited settings.
Sex Transm Dis 09/2006; 33(8):524-6. · 2.87 Impact Factor
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Leslie Swartz,
Ashraf Kagee,
Zuhayr Kafaar, Joalida Smit,
Arvin Bhana,
Glenda Gray,
Anthea Lesch,
Graham Lindegger,
Cecilia Milford,
Linda Richter,
Soraya Seedat,
Nokuthula Skhosana,
Dan J Stein
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ABSTRACT: Recent data indicate that the worldwide rate of HIV infection in adolescents is steadily increasing. Internationally, more than 7000 youths between 15 and 24 years of age are infected with HIV daily, resulting in more than 2.5 million new infections annually. Almost two thirds (1.7 million) of these new infections occur in Africa. Estimates in 2000 showed that the number of South Africans between 15 and 49 years of age infected with HIV was 4.7 million. This number equates to a prevalence rate of 15.4% in those younger than 20 years. Adolescents form an important target group not only for preventative efforts but also for HIV vaccine trials. This article focuses on the social and psychological factors that affect adolescent decision making by considering adolescent risk-taking behaviors, problems associated with predicting adolescent behavior, peer relationships and decision making, sexual disinhibition, and the role of family relationships in adolescent decision making.
Journal of the International Association of Physicians in AIDS Care (JIAPAC) 01/2006; 4(4):89-92.
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ABSTRACT: A number of countries in sub-Saharan Africa are preparing for HIV vaccine efficacy trials. Social and behavioural factors related to HIV transmission require examination in each setting where these trials are considered. As part of this, several countries have also recently begun preparatory research investigating relevant social and behavioural issues. There is a need for a review of the literature to help focus such research efforts in Sub-Saharan Africa.
To examine key social and behavioural issues that may impact on the conduct of HIV vaccine efficacy trials in sub-Saharan Africa.
Literature review
Major databases (PubMed, PsychInfo, EBSCOhost, and AIDSline) were searched for literature that discussed social and behavioural issues related to HIV vaccine trials. Three areas are highlighted as being particularly significant for HIV vaccine research: (1) willingness to participate in future HIV vaccine efficacy trials, (2) retention of participants in studies, and (3) sexual risk reporting during trials. For each of these topics, major findings from both developed and developing countries are described and avenues for further research are discussed.
There are few data from Sub-Saharan Africa regarding willingness to participate in HIV vaccine trials. Data on participant retention rates varies widely, and maintaining large cohorts of individuals within Phase III trials presents an important challenge. In addition, the possible impact of trial participation on sexual disinhibition, and response bias on sexual risk-reporting remain as issues for HIV vaccine trials in African contexts.
Social and behavioural research forms an important part of preparations for HIV vaccine efficacy trials, and there is a clear need for more research of this type in Sub-Saharan Africa. Innovative approaches are required to address issues such as willingness to participate in vaccine research, participant retention during efficacy trials, and the accurate reporting by participants of sexual risk behaviours.
African health sciences 10/2005; 5(3):198-206.
