Introduction
In 2007, the Cameroon Baptist Convention Health Services (CBCHS) initiated an assisted partner notification services (aPNS) public health programme to increase HIV case identification and reduce HIV incidence in the most affected regions of Cameroon. We describe large‐scale implementation of aPNS and overall programmatic achievements in a resource‐limited setting through 2015.
Methods
CBCHS trained health advisors (HAs) from 16 CBCHS facilities and 22 non‐CBCHS facilities to integrate aPNS into their existing jobs in five of the ten Cameroon regions. HAs recorded basic demographic, clinical and risk factor information from consenting index persons (IPs) and similar information about their sexual partners’/contact persons (CPs) on interview records and aPNS registers. These data were entered into an Epi‐Info database. HAs provided pre‐test counselling to CPs and offered them HIV testing in their home or other location. HAs educated IPs and CPs on HIV prevention and risk reduction, and referred IPs and HIV positive CPs to HIV care and treatment centres. Starting in 2014, HAs re‐interviewed IPs 30 days after their initial aPNS interview to ascertain instances of social harms following partner notification. Continuous predictor and outcome variables were summarized using median and interquartile range, while categorical variables were summarized using percentages from 2007 to 2015.
Results
A total of 18,730 IPs (71% women) received aPNS over nine years. IPs identified 21,057 CPs (67% men) (mean CP/IP 1.12), of whom 12,867 (61.1%) were notified of their exposure to HIV. A total of 9202 (71.5% of notified CPs) tested for HIV, 4764 (51.8%) of whom tested HIV positive (number of IPs needed to interview = 3.9); 3112 (65.3%) HIV‐positive partners were referred to HIV care and treatment centres. Of the 976 IPs receiving aPNS in 2014 to 2015, for whom follow‐up data were available, 11 (1.1%) reported physical intimate partner violence from CPs. Thus, 44.3% of 1224 CPs were notified through provider referral. Of the 784 CPs who tested for HIV, 157 were newly diagnosed and the overall HIV prevalence was 41.6% (326/784).
Conclusions
aPNS is feasible, can be brought to scale, yields a high level of case identification, and is infrequently associated with social harms and intimate partner violence.
Women viewed antenatal care as important to a positive pregnancy outcome with access dependent on their families' finances and their partners' ability and willingness to pay for their care. Although pregnancy has traditionally been viewed as a women's affair, the majority of women wanted their partners to participate in their care, including receiving HIV counseling and testing. Women identified men's involvement as an individual belief, saying that many in their community were not supportive of male participation in antenatal care. Multiple options, including couples testing in antenatal clinics, should be available to increase HIV testing in men.
HEU-A and HEU-N infants have lower preprandial insulin levels at 6 weeks of age and appear to use metabolic fuel substrates differently than HUU infants. Future studies are warranted to determine whether observed differences have lasting metabolic implications, such as later insulin resistance.
Objective
Evaluate blood mitochondrial DNA (mtDNA) content in HIV/antiretroviral (ARV)-exposed uninfected (HEU) vs. HIV-unexposed uninfected (HUU) infants and investigate differences in mitochondrial-related metabolites by exposure group.
Design
We enrolled a prospective cohort of HIV-infected and -uninfected pregnant woman/infant pairs in Cameroon.
Methods
Dried blood spot mtDNA:nuclear DNA ratio was measured by monochrome multiplex qPCR in HEU infants exposed to in utero ARVs and postnatal zidovudine (HEU-Z) or nevirapine (HEU-N), and in HUU infants at 6 weeks of life. Acylcarnitines (ACs) and branch-chain amino acids (BCAAs) were measured via tandem mass spectrometry and consolidated into 7 uncorrelated components using principal component analysis (PCA). Linear regression models were fit to assess the association between in utero/postnatal HIV/antiretroviral exposure and infant mtDNA, adjusting for confounders and PCA-derived AC/BCAA component scores.
Results
Of 364 singleton infants, 38 were HEU-Z, 117 HEU-N, and 209 HUU. Mean mtDNA content was lowest in HEU-Z infants (140 vs. 160 in HEU-N vs. 174 in HUU, p=0.004). After adjusting for confounders, HEU-Z infants remained at increased risk for lower mtDNA content compared to HUU infants (β: −4.46, p=0.045), while HEU-N infants did not, compared to HUU infants (β: −1.68, p=0.269. Furthermore, long-chain ACs were associated with lower (β:−2.35, p=0.002) and short-chain and BCAA-related ACs were associated with higher (β:2.96, p=0.001) mtDNA content.
Conclusion
Compared to HUU infants, HEU infants receiving postnatal zidovudine appear to be at increased risk for decreased blood mtDNA content which may be associated with altered mitochondrial fuel utilization in HEU-Z infants.
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