HIV Transmission Rates Research Articles

Early infant diagnosis of HIV infection at the John F. Kennedy Medical Center, Monrovia, Liberia

Background: Vertical transmission accounts for majority of new HIV infections among children worldwide. Ninety percent of HIV-positive children reside in Sub- Saharan Africa with their infection predominantly acquired via vertical transmission. In 2004, the vertical transmission rate of HIV in Africa was estimated at 25 − 40% but, remarkably, the rate has significantly decreased to less than 5% in most African countries following implementation and expansion of prevention of MTCT (PMTCT) programs. Objective: To determine the rate of and factors associated with vertical transmission of HIV among attendees of early infant diagnosis (EID) program of an academic and community-based tertiary facility in Liberia. Design: A retrospective cross-sectional analysis. Methods: A retrospective review of medical records of babies seen at Pediatric Unit of Infectious Disease Clinic of John F Kennedy Medical Center (JFKMC) in Monrovia, Liberia between January 1, 2016 and December 31, 2020. All subjects were children born to HIV-positive mothers and who had HIV DNA PCR testing performed between the ages of 6 weeks and 6 months. Children who suffered early neonatal death and those who did not undergo PCR testing were excluded. Demographics of mother to child pairs as well as factors known to influence vertical transmission of HIV such as partial (15.8%) or full (84.2%) participation in prevention of MTCT (PMTCT) programs, mode of delivery, breastfeeding and utilization of post-exposure prophylaxis were collected and assessed. Binomial logistic regression analyses were used to assess factors associated with vertical transmission. Results: During the study timeframe, 284 children had a HIV DNA PCR test with a male:female ratio − 1.3:1. Sixteen tested positive (conducted at a mean of 155 days post birth) giving a vertical transmission rate of 5.6%. For 239 mothers (84.2%) who had full PMTCT, 1.3% of their children tested positive, while for 45 mothers (15.8%) who had partial PMTCT, 28.8% of their children being positive. Two hundred and seventy six children (97%) had exclusive breastfeeding, 13 of whom tested positive while 2 children who were mixed fed tested positive. Children who had Nevirapine vs no prophylaxis (OR = 1.89[95% CI 1.16 − 2.96]), were delivered via caesarian section vs vaginal delivery (OR= 2.26[95% CI 1.92 − 4.12].) and full versus partial participation in PMTCT programs (OR = 4.02[95% CI 2.06 − 4.13] were more likely to have negative HIV test. Conclusion: Vertical transmission rate was found to be high in Liberia and may be driven by suboptimal PMTCT program participation including post-exposure prophylaxis for infants. Therefore, strategies to scale up and improve uptake of PMTCT services are needed to mitigate the burden of HIV among children.

Review of Medical Approaches for the Prevention of Perinatal Transmission of HIV Infection

Although advancements in antiretroviral therapies have reduced the rates of HIV transmission, HIV remains an international public health concern. Perinatal HIV transmission continues to be one of the most common modes of transmission, with most new pediatric HIV infections beginning in utero. In this review, we provide background on the current standard of care in HIV-positive pregnant women. This includes a discussion of antiretroviral monotherapy vs polytherapy, vaginal delivery vs elective cesarean delivery, and avoidance of breastfeeding in the prevention of perinatal transmission of HIV infection. We also review several methods of HIV treatment that are currently under investigation, including shock and kill, block and lock, and gene editing techniques. Further, we discuss the significance of perinatal HIV transmission from a public health perspective both on a global level and on a local level in Washington, DC.

Phylogeographic Assessment Reveals Geographic Sources of HIV-1 Dissemination Among Men Who Have Sex With Men in Kenya.

HIV-1 transmission dynamics involving men who have sex with men (MSM) in Africa are not well understood. We investigated the rates of HIV-1 transmission between MSM across three regions in Kenya: Coast, Nairobi, and Nyanza. We analyzed 372 HIV-1 partial pol sequences sampled during 2006–2019 from MSM in Coast (N = 178, 47.9%), Nairobi (N = 137, 36.8%), and Nyanza (N = 57, 15.3%) provinces in Kenya. Maximum-likelihood (ML) phylogenetics and Bayesian inference were used to determine HIV-1 clusters, evolutionary dynamics, and virus migration rates between geographic regions. HIV-1 sub-subtype A1 (72.0%) was most common followed by subtype D (11.0%), unique recombinant forms (8.9%), subtype C (5.9%), CRF 21A2D (0.8%), subtype G (0.8%), CRF 16A2D (0.3%), and subtype B (0.3%). Forty-six clusters (size range 2–20 sequences) were found—half (50.0%) of which had evidence of extensive HIV-1 mixing among different provinces. Data revealed an exponential increase in infections among MSM during the early-to-mid 2000s and stable or decreasing transmission dynamics in recent years (2017–2019). Phylogeographic inference showed significant (Bayes factor, BF > 3) HIV-1 dissemination from Coast to Nairobi and Nyanza provinces, and from Nairobi to Nyanza province. Strengthening HIV-1 prevention programs to MSM in geographic locations with higher HIV-1 prevalence among MSM (such as Coast and Nairobi) may reduce HIV-1 incidence among MSM in Kenya.

HPV and the Risk of HIV Acquisition in Women.

The risk of HIV acquisition is low on a per-contact basis but increased by transmission co-factors such as other sexually transmitted infections (STIs). Human papillomavirus (HPV) is a prevalent STI that most individuals will acquire HPV in their lifetime. Current HPV vaccines can prevent newly acquired infections, but are largely ineffective against established HPV, complicating worldwide eradication efforts. In addition to being the causative agent of cervical cancer, accumulating evidence suggests that HPV infection and/or accompanying cervical inflammation increase the risk of HIV infection in men and women. The fact that immunological features observed during HPV infection overlap with cellular and molecular pathways known to enhance HIV susceptibility underscore the potential interplay between these two viral infections that fuel their mutual spread. Here we review current insights into how HPV infection and the generation of anti-HPV immunity contribute to higher HIV transmission rates, and the impact of HPV on mucosal inflammation, immune cell trafficking, and epithelial barrier function.

Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis

BackgroundAntiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019.MethodsCountry-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model.ResultsART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = − 0.18, 95% CI − 0.19–− 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18–8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate.ConclusionsART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.

Perinatal Exposure to HIV Infection: The Experience of Craiova Regional Centre, Romania

Background and objectives: HIV infection in pregnant women can be responsible for a number of consequences during pregnancy, such as: maternal anaemia, miscarriage, low birth weight, and preterm birth. The objectives of this study were to determine the maternal–foetal transmission rate of HIV among pregnant women living with HIV from Craiova Regional Centre in order to assess the risk factors for mother-to-child transmission of HIV and to identify the characteristics of newborns perinatally exposed to HIV. Materials and methods: A retrospective study was conducted between 1 January 2011 and 31 December 2020, including children born to HIV-positive mothers. Results: The studied group included 138 newborns and was divided into two subgroups: group A, which included 10 HIV-infected infants; and group B, which included 128 uninfected infants. The mother-to-child transmission rate was 3.5% for women to whom all prophylaxis standards were applied. We found a statistically significant correlation between the level of maternal HIV viremia and perinatal HIV transmission (p = 0.01). Preterm birth and low birth weight were associated with perinatal transmission of the infection. Conclusions: Perinatal transmission of HIV infection during our study was associated with inconsistent application of screening for HIV infection among pregnant women, lack of antiretroviral therapy, poor adherence to treatment, and detectable HIV viral load during pregnancy.

Determinants of HIV infection among children born from mothers on prevention of mother to child transmission programme of HIV in southern Ethiopia: a case–control study

ObjectiveThis study was aimed to identify determinants of HIV infection among children born from mothers on the prevention of mother to child transmission (PMTCT) programme in Southern Ethiopia. It was...

The Determinants of Behavior of HIV Testing in Pregnant Mothers

HIV infection in Indonesia is one of the health problems and infectious diseases that can affect maternal and child mortality. More than 90% of HIV-infected infants are infected by HIV-positive mothers. Transmission can occur during pregnancy, during delivery and during breastfeeding. Early detection of HIV is important so that antiretroviral virus (ARV) drug therapy is carried out more quickly to reduce the rate of HIV transmission from mother to baby. The research, which was conducted at the Balongan Subdistrict Health Center, Indramayu Regency, was conducted to determine the determinants associated with HIV testing behavior during pregnancy. This type of research is quantitative with a cross-sectional study design using the total population. The results of the univariate analysis showed that 71.1% of mothers did not take an HIV test during pregnancy. and education about HIV/AIDS, because the husband is the closest person to the mother so that the husband makes a big contribution to providing support to the mother

Polyunsaturated Fatty Acid Composition in Breast Milk Plasma of HIV-infected and Uninfected Mothers in Relation to Infant Clinical Outcomes.

Background:The increased coverage of prevention of mother to child transmission (PMTCT) services has significantly reduced paediatric HIV infection incidence. The aim of the study was to compare breast milk omega-6 and omega-3 polyunsaturated fatty acid profiles of HIV infected and uninfected mothers and determine the association between fatty acid profiles and postnatal transmission of HIV, morbidity/mortality of HIV exposed and unexposed infants.Methods:A prospective cohort study of 57 HIV infected and 57 HIV uninfected lactating mothers was conducted in Gweru, Zimbabwe from July 2019 to March 2020. The women’s 114 babies (term and preterm) were also enrolled and stratified by HIV exposure and infection status. The mother-infant pairs were followed up at 6 weeks, 16 weeks and 6 months postpartum to determine, HIV transmission rate, breast milk polyunsaturated fatty acid profiles as well as infant clinical outcomes.Results:The mean breast milk docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels in HIV uninfected mothers (0.82 ± 0.92; 0.47 ± 0.75 μg/ml respectively) at 6 weeks postpartum were significantly higher compared to those of HIV infected mothers (0.33 ± 0.32; 0.08 ± 0.14 μg/ml) respectively. The same pattern was observed at 16 weeks postpartum in terms of DHA and EPA mean concentration. However, the arachidonic acid (AA) levels and AA/DHA ratio measured at 6 weeks postpartum were significantly higher in HIV infected mothers (2.31 ± 2.01; 17.18 ± 52.47 respectively) compared to HIV uninfected mothers (0.82 ± 0.54; 9.71 ± 21.80; P < .001). A higher morbidity rate was observed amongst HIV exposed infants than HIV unexposed infants (3.26 ± 0.13; 2.49 ± 0.09; P < .001) respectively. A significant positive correlation was observed between AA and infant morbidity (r = .388; P < .001).Conclusion:Deficiencies in breast milk omega-3 fatty acids were observed in HIV infected women. Maintaining a healthy balance between omega-6 and omega-3 fatty acid diets is critical for breast feeding mothers regardless of their HIV status. The adverse clinical outcomes observed amongst HIV exposed infants emphasise their vulnerability under conditions of maternal universal antiretroviral therapy.

Risk Factors Associated with Mother-to-Child Transmission of HIV in Dar es Salaam, Tanzania

Despite Tanzania's efforts and substantial progress in PMTCT, about 11% new infections were recorded among Tanzanian children in 2019 (UNAIDS 2020a). The objective of this study was to determine the rate of HIV transmission and to identify its risk factors among HIV exposed infants born to HIV-positive mothers in Dar es Salaam, Tanzania. A cross-sectional study was conducted using retrospective data collected from HIV-positive mothers and their exposed babies who were followed and registered in health facilities in four administrative districts (Ilala, Temeke, Kinondoni, and Ubungo) in Dar es Salaam between January 2016 and December 2019. To identify risk factors for MTCT, univariate and multivariate Cox Proportional hazard regression analyses were employed. Out of 18705 registered children exposed to HIV, 586 (3.1%) were positive during the study period, while 18119 (96.9%) were negative. In this study, the following factors were increasing the risks of MTCT of HIV infections, not receiving ARV prophylaxis right at birth (aHR = 2.39, 95% CI: 1.75–3.26, P &lt; 0.001), unsuppressed maternal viral load (aHR = 6.26, 95% CI: 4.91–7.97, P &lt; 0.001), WHO clinical stage 3–4 (aHR = 1.79, 95% CI: 1.44–2.23, P &lt; 0.001), and mixed feeding (aHR = 4.09, 95% CI: 1.80–9.31, P &lt; 0.001). The factors maternal age group 25–34 years (aHR = 0.47, 95% CI: 0.29–0.75, P &lt; 0.001), being married/cohabiting (aHR = 0.47, 95% CI: 0.23–0.95, P = 0.036), duration on ART for &gt; 12 months (aHR = 0.55, 95% CI: 0.45–0.67, P &lt; 0.001), dried blood spot (DBS) tested at 6 weeks (aHR = 0.09, 95% CI: 0.04–0.18, P &lt; 0.001), and exclusive replacement feeding (ERF) (aHR = 0.32, 95% CI: 0.17–0.60, P &lt; 0.001) decreased the risk of MTCT of HIV infections. These findings indicated that further work is required to scale up PMTCT approaches to concentrate on viral load suppression, taking ARV prophylaxis immediately at birth, and EBF practice in the first 6 months of life.&#x0D; Keywords: HIV, PMTCT, risk factors, mother-to-child transmission (MTCT).

844. High Risk Behaviors, Suboptimal HIV Viral Suppression, and Limited PrEP Use among People Who Engage in Transactional Sex

Abstract Background In the United States, high rates of HIV transmission persist, particularly due to sexual transmission in marginalized populations. Transactional sex (TS) is a known risk factor for HIV transmission, yet risk behaviors and engagement in HIV treatment and prevention among those who have TS are poorly understood. Methods GRAVITY is cross-sectional investigation of people living with HIV (PLWH) or HCV in Washington, DC and Baltimore, MD. Epidemiologic survey data were collected at a single timepoint. Patients who endorsed previous year sex in exchange for drugs, money, or shelter were considered positive for TS. Fisher’s exact test was used for statistical analysis. Results Of 500 participants, 81(16%) endorsed TS, the majority of whom were HIV+ (51, 63%) and used drugs daily or more (57,70%; see Table 1). PLWH with TS were more likely to be Black (44, 86%, p= 0.05) and Trans female (17, 33%, p&amp;lt;0.01) than HIV- participants with TS. In the TS cohort, PLWH were more likely to engage in anal sex (38, 75%, p&amp;lt; 0.01), have sex weekly or more (46, 90%; p&amp;lt; 0.01), have sex with more than 2 partners (27, 77%, p=0.03), and have a history of syphilis (14, 27% p= 0.04) compared to HIV- participants. Only 21% and 35% of PLWH and 17% and 22% of HIV- always used condoms in vaginal sex and anal sex, respectively (p &amp;gt;0.05). Though 41 (80%) PLWH took ART, only 19 (41%) reported viral suppression. Of HIV- participants, 59% had interest in starting Pre-Exposure Prophylaxis (PrEP), but few had been offered (3,10%), or ever taken PrEP (2,7%). Table 1: Participant Characteristics and Associations with Transactional Sex and HIV Status Conclusion In this cohort of people with TS, there were high rates of HIV and racial, sexual, and gender minorities. Notably, PLWH had higher rates of frequent sex, multiple partners, and anal sex, as well as suboptimal viral suppression and condom use during anal sex. As such, PLWH +TS may be a consequential part of HIV transmission networks. While those without HIV also had frequent sex and suboptimal condom use, PrEP experience was limited. As the majority had interest in PrEP, targeted strategies to initiate and maintain PrEP in people with TS may be critical in preventing HIV acquisition. Interventions to identify TS, address high-risk behaviors, achieve and maintain viral suppression amongst +TS PLWH, and connect +TS HIV- individuals to PrEP are key to a comprehensive strategy to end the HIV epidemic. Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

Mother-to-Child Transmission of HIV and Associated Factors Among Exposed Infants in Pastoralist Health Facilities, South Omo Zone, Ethiopia, 2020 - A Retrospective Cross-Sectional Study.

BackgroundAlthough HIV/AIDS is affecting all age groups, it is a primary cause of illness and deaths among children globally. A significant bulk of HIV infections in children under the age of 15 were as a result of vertical transmission, where it accounts for 95% of childhood HIV infections in Ethiopia.ObjectiveTo assess the proportion of mother-to-child transmission (MTCT) of HIV and associated factors among exposed infants on follow-up in pastoralist health facilities, South Omo, Ethiopia.MethodologyA retrospective, cross-sectional study was employed among 228 HIV-exposed infants. Medical records of HIV-exposed infant-mother pairs in the study institutions were extracted. The confirmatory HIV serostatus of every infant was taken at the end of 24 months. Data were entered in Epi Data 4.2 version and exported to SPSS version 25 for final analysis. Multivariable logistic regression analysis was used to identify significant predictor variables at P-value < 0.05.ResultsA total of 228 records were included in the analysis. The rate of HIV transmission was 5.3% (95% CI: 2.6–8.3%). Not receiving antiretroviral prophylaxis at birth (AOR = 5.8, 95% CI: 1.02–33.53), absence of maternal antiretroviral prior to current pregnancy (AOR = 5.6, 95% CI: 1.14–28.1), and mother’s advanced World Health Organization clinical stage of HIV (AOR: 10.5, 95% CI: 1.4–81) were associated with MTCT of HIV.ConclusionThis study identified a high proportion of MTCT among exposed infants in the study area. Not receiving antiretrovirals prior to pregnancy and advanced WHO clinical stage of HIV, and not getting antiretroviral prophylaxis at birth resulted in higher risk of MTCT of HIV. Hence, health workers and policy-makers should offer antiretroviral prophylaxis, put mothers on antiretroviral therapy and limit the stage of HIV at lower WHO clinical stages.

Past HIV-1 Medications and the Current Status of Combined Antiretroviral Therapy Options for HIV-1 Patients.

Combined antiretroviral therapy (cART) is treatment with a combination of several antiretroviral drugs that block multiple stages in the virus replication cycle. An estimated 60% of the 38 million HIV-1 patients globally receive some form of cART. The benefits of cART for controlling HIV-1 replication, transmission, and infection rates have led to its universal recommendation. Implementation has caused a substantial reduction in morbidity and mortality of persons living with HIV-1/AIDS (PLWHA). More specifically, standard cART has provided controlled, undetectable levels of viremia, high treatment efficacy, reduction in pill burden, and an improved lifestyle in HIV-1 patients overall. However, HIV-1 patients living with AIDS (HPLA) generally show high viral loads upon cART interruption. Latently infected resting CD4+ T cells remain a major barrier to curing infected patients on long-term cART. There is a critical need for more effective compounds and therapies that not only potently reactivate latently infected cells, but also lead to the death of these reactivated cells. Efforts are ongoing to better control ongoing viral propagation, including the identification of appropriate animal models that best mimic HIV-1 pathogenesis, before proceeding with clinical trials. Limited toxicity profiles, improved drug penetration to certain tissues, and extended-release formulations are needed to cover gaps in existing HIV-1 treatment options. This review will cover past, current, and new cART strategies recently approved or in ongoing development.

492Determinants of mother to child transmission of HIV in West Shewa, Oromiya: Mixed-method study

Abstract Background Without intervention, transmission rate of HIV from mother to child ranges from 15% to 45%, that can be reduced to below 5% with effective intervention. In West Shewa zone transmission rate is 10% currently. Aim of the study is to identify determinants of transmission of HIV from mother to child in West Shewa Zone which has 2.1 million populations. Methods Mixed methods: unmatched case-control study, N = 96(24 cases, 72 controls) and one-on-one questioner was conducted. Variables of interest were collected using structured and semi-structured questioner and data abstraction forms from mothers of exposed infants, medical records of mothers and children. Result Majority among cases(70.8%) were not included in to option B+ program. Home delivery increases 6 times chance of HIV, AOR=6.047, CI(1.549–29.230), none inclusion in to option B+ increase 18 chance of HIV transmission, AOR=18.0;CI(5.0–68.1). Partner noninvolvement to HIV care increases chance of transmission by 7.3 times, AOR=7.3;CI(1.14–37.459). Mother- mother support program decrease chance of transmission by 86.5% with AOR=0.135CI (0.11–0.396). Poor ANC practices among rural residents contributed to unaware MTCT of HIV. Conclusion Mother-to-mother support program has protective effect, while None inclusion to option B+, partner noninvolvement to HIV care, Home delivery and poor ANC practice were determinant factors of HIV transmission from mother to child. Key messages Health education and awareness creation should be implemented by HEW to improve ANC practice, and increase VCT among rural residents.

The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital, Western Region of Saudi Arabia: A Descriptive Study.

Objectives:To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT).Methods:A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate.Results:A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants’ HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section.Conclusion:Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.

Determinants of Utilization of Early Infant HIV Diagnosis Services at Kericho County Referral Hospital, Kericho County, Kenya

HIV and AIDS has become a health challenge globally. It is a major cause of infant and childhood morbidity and mortality in Africa. This research was a cross sectional analytical survey to assess the determinants of utilization of Early Infant Diagnosis (EID) at Kericho County Referral Hospital (KCRH). Data was collected using pretested questionnaires, administered to the postnatal HIV positive mothers and or caretakers of HIV exposed children. Data was analysed using SPSS software version 18.0. Data was analysed using Chi-square and Logistic Regression analysis. Of the 254 respondents, 201 (79.1%) were biological mothers to the children, the rest were caretakers. The children were aged between 1 and 18 months with a mean age of 9.62 months. Majority of the respondents had adequate knowledge of adult HIV infection with regard to what HIV is, routes of transmission, diagnosis and treatment. Knowledge of paediatric HIV infection was however inadequate with only 132 (52%) respondents who knew the approximate rate of HIV transmission from mother to child and 130 (51.2%) who knew about the availability of paediatric Antiretroviral (ARV) drugs. Both adult and paediatric HIV knowledge was better with increasing level of education. The younger respondents were also more knowledgeable than the older ones. The children who had utilized EID were only 75 (29.5%). The significant determinants of EID utilization included: the level of education (p=0.002), the place of delivery (p&lt;0.01), the age of the respondent (p=0.008), the distance to the nearest healthcare facility that offered EID (p=0.004) among others. The most significant determinants of EID utilization were the level of education, accessibility and the age of the respondents. In conclusion, EID utilization is still low in Kericho County. This study recommends that improving maternal education would improve EID uptake.

Impact of recurrent sexually transmitted infections on HIV seroconversion: Results from multi-state frailty models.

After several decades of research, South Africa is still considered to be the epicentre of HIV epidemic. The country also has the highest burden of sexually transmitted infections (STIs) which have been frequently linked to increasing rates of HIV transmission due to biological and behavioural associations between these two pathogeneses. We investigated the cumulative impact of recurrent STIs on subsequent HIV seroconversion among a cohort of South African women. We used the 'frailty' models which can account for the heterogeneity due to the recurrent STIs in a longitudinal setting. The lowest HIV incidence rate was 5.0/100 person-year among women who had no baseline STI and remained negative during the follow-up. This estimate was three times higher among those who had recurrent STIs in the follow-up period regardless of their STI status at baseline (15.8 and 14.0/100 person-year for women with and without STI diagnosis at baseline, respectively). Besides younger age and certain partnership characteristics, our data provided compelling evidence for the impact of recurrent STI. diagnoses on increasing rates of HIV. At the population-level, 65% of HIV infections collectively associated with recurrent STIs. These results have significant clinical and epidemiological implications and may play critical role in the trajectory of the infections in the region.

Maternal and caretaker's knowledge of HIV infections and the existence and benefits of early infant diagnosis (EID) services at Kericho county referral hospital, Kenya.

This study was a cross-sectional analytical survey of the Maternal and caretaker's knowledge of HIV infections and the existence and benefits of early infant diagnosis (EID) services at Kericho county referral hospital in Kenya. Data was collected using pretested questionnaires administered to the postnatal HIV positive mothers and or caretakers of HIV exposed children. Data were analysed using SPSS software version 18.0. Moreover, it was presented using Chi-square and Logistic Regression analysis. Of the 254 respondents, 201 (79.1%) were biological mothers to the children; the rest were caretakers. The children were aged between 1 and 18 months, with a mean age of 9.62 months. Most respondents' knowledge of adult HIV infection is about what HIV is, routes of transmission, diagnosis and treatment. Knowledge of paediatric HIV infection was, however, inadequate with only 132 (52%) respondents who knew the approximate rate of HIV transmission from mother to child and 130 (51.2%) who knew about the availability of paediatric Antiretroviral (ARV) drugs. Both adult and paediatric HIV knowledge was better with an increasing level of education. The younger respondents were also more knowledgeable than, the older ones. Children who had utilised EID were only 75 (29.5%). In conclusion, EID knowledge is still lacking in Kericho County, and it influences the utilisation of these services. EID services and education on the availability should be decentralised where feasible. They should be included as an essential service at all levels of healthcare delivery to reach more children. Further research needs to be done on how to leverage HIV knowledge to increase the uptake of services and alleviate impediments to utilising services. Improving maternal education is strongly recommended, as it would enhance EID uptake.

Immune cell arrival kinetics to peritoneum and role during murine-experimental trichomoniasis.

Trichomonas vaginalis causes trichomoniasis, an inflammatory process related to an increased rate of HIV transmission. In order to study T. vaginalis infection response in a microorganism-free environment, an infection model was established providing a host–parasite interaction system useful to study the interplay between immune cells and the parasite. Infected mice peritoneal cells were immunophenotyped at different times after infection using flow cytometry. Neutrophils and macrophages showed the most relevant increase from third to 12th day post-infection. A high number of B lymphocytes were present on 15th day post-infection, and an increase in memory T cells was observed on sixth day post-infection. The levels of NO increased at day 10 post-infection; no significant influence was observed on T. vaginalis clearance. Increased viability of T. vaginalis was observed when the NETs inhibitors, metformin and Cl− amidine, were administrated, highlighting the importance of this mechanism to control parasite infection (43 and 86%, respectively). This report presents a comprehensive cell count of the immune cells participating against trichomoniasis in an in vivo interaction system. These data highlight the relevance of innate mechanisms such as specific population changes of innate immune cells and their impact on the T. vaginalis viability.

Brief Report: Vaginal Viral Shedding With Undetectable Plasma HIV Viral Load in Pregnant Women Receiving 2 Different Antiretroviral Regimens: A Randomized Clinical Trial.

Pregnant women using antiretrovirals (ARVs) may have persistent vaginal viral shedding, which could be associated with sexual and perinatal HIV transmission. However, there are scant data on vaginal viral load (VVL) in pregnant women with undetectable plasma viral load (PVL). This study was a post hoc analysis of an open-label randomized trial to evaluate the virologic response of 2 ART regimens. The participants were ART-naive women living with HIV initiating ART regimens between 20 and 36 weeks of pregnancy recruited at 19 clinical sites in 6 countries. Participants were randomized to receive 400 mg of raltegravir 2 times a day or 600 mg of efavirenz 4 times a day in addition to 150 mg of lamivudine and 300 mg of zidovudine 2 times a day. VVL and PVL tests were performed at every study visit. The primary outcome measures were HIV-1 PVL and VVL at maternal study week 4 and rates of perinatal HIV transmission. A total of 408 were enrolled, of whom 323 had VVL samples 4 weeks after enrollment and were included in this analysis. Among women with undetectable/nonquantifiable PVL during ART, the overall rate of quantifiable VVL at week 4 was 2.54% (7/275). Of the 275 with nonquantifiable PVL, 99.1% (115/116) and 96.2% (153/159) had nonquantifiable VVL in the efavirenz and raltegravir arms, respectively. None of the 7 women with quantifiable VVL at the week 4 study visit transmitted HIV to their infants. Detectable VVL in pregnant women with undetectable/nonquantifiable PVL while receiving ART was rare and not associated with perinatal HIV transmission.