The objectives of the study were to investigate prevalence of cervical human papillomavirus (HPV) genotypes to inform HPV vaccination strategy in South Africa and to study factors associated with HPV prevalence. Sexually active, HIV-negative women, aged 16–22 years recruited from Soweto (n = 143) and Cape Town (n = 148) were tested for cervical HPV and other genital infections. Overall HPV prevalence was 66.7% (194/291) in young women. Cape Town women were more likely to have multiple HPV infections than the Soweto women (48.0%, 71/148 versus 35.0%, 50/143 respectively, p = 0.033) and probable HR-HPV types (34.5%, 51/148 versus 21.7%, 31/143 respectively, p = 0.022). The most frequently detected HPV types were HPV-16 (11.7%), HPV-58 (10.3%), HPV-51 (8.9%), HPV-66 (8.6%), HPV-18 and HPV-81 (7.6% each). HPV types targeted by the bivalent HPV vaccine (HPV-16/18) were detected in 18.6% (54/291) of women, while those in the quadrivalent vaccine (HPV-6/11/16/18) were detected in 24.7% (72/291) of women; and those in the nonavalent vaccine (HPV-6/11/16/18/31/33/45/52/58) were detected in 38.5% (112/291) of women. In a multivariable analysis, bacterial vaginosis remained significantly associated with HPV infection (OR: 4.0, 95% CI: 1.4–12.6). Women were more likely to be HPV positive if they had received treatment for STI during the past 6-months (OR: 3.4, 95% CI: 1.1–12.4) or if they had ever been pregnant (OR: 2.3, 95% CI: 1.1–5.5). Compared to women who reported only one sexual partner, those with increased number of lifetime sex partners were more likely to have HPV (4–10 partners: OR: 2.9, 95% CI: 1.1–8.0). The high prevalence of HPV types targeted by the nonavalent HPV vaccine encourages the introduction of this vaccine and catch-up HPV vaccination campaigns in South Africa. The high burden of BV and concurrent STIs also highlights the need to improve the prevention and appropriate management of sexually-acquired and other genital tract infections in South African youth.

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Background-Tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) is an objective longterm adherence measure but data are limited on its ability to predict virologic suppression (VS) in people on antiretroviral (ARV) treatment. There are also no data comparing DBS TFV-DP with plasma ARV concentrations as predictors of VS.Methods-Women who were on a first-line regimen of tenofovir, emtricitabine, and efavirenz (EFV) were enrolled in a cross-sectional study. Plasma EFV and tenofovir (TFV), DBS TFV-DP assays, and 30-day self-reported adherence were evaluated as predictors of VS (<50 copies/mL) with area under the curve (AUC) of receiver operating characteristics (ROC) and logistic regression.Results-We enrolled 137 women; mean age 33 years; median 4 years on ART; 88 (64%) had VS. In ROC analyses: DBS TFV-DP (0.926 [95%CI 0.876-0.976]) had a higher AUC than plasma TFV (0.864 [0.797-0.932]; p=0.006), while plasma EFV (0.903 [0.839-0.967]) was not significantly different from DBS TFV-DP (p=0.138) or plasma TFV (p=0.140

Objectives: Differentiated service delivery (DSD) models are used to deliver antiretroviral therapy (ART) but data are limited in postpartum women, who are at high risk of non-adherence and elevated viral load (VL) over the extended postpartum period.Design: Randomized controlled trial. Methods:We enrolled consecutive postpartum women who initiated ART during pregnancy and met local DSD eligibility (clinically stable, VL less than 400 copies/ ml) at a large primary healthcare (PHC) clinic. Women were randomized to a community-based 'adherence club' (AC, the local DSD model: community health worker-led groups of 20-30 patients with ART dispensing at a community venue) or routine PHC clinics (local standard of care with nurse/doctor-led services). Follow-up visits with VL separate from routine care took place at 3, 6, 12, 18 and 24 months postpartum. Endpoints were time to VL of at least 1000 copies/ml (primary) and VL of at least 50 copies/ml (secondary) by intention-to-treat.Results: At enrolment (n ¼ 409), the median duration postpartum was 10 days, all women had a VL less than 1000 copies/ml and 88% had a VL less than 50 copies/ml; baseline characteristics did not differ by arm. Twenty-four-month retention was 89%. Sixteen and 29% of women in AC experienced a VL of at least 1000 copies/ml by 12 and 24 months, compared to 23 and 37% in PHC, respectively (hazard ratio [HR] ¼ 0.71; 95% confidence interval [CI] ¼ 0.50-1.01). Thirty-two and 44% of women in ACs had a VL of at least 50 copies/ml by 12 and 24 months, compared to 42 and 56% in PHC, respectively (HR ¼ 0.68; 95% CI ¼ 0.51-0.91). Conclusions:Early DSD referral was associated with reduced viraemia through 24 months postpartum and may be an important strategy to improve maternal virologic outcomes.

Background There are few data on the utility of tenofovir diphosphate (TFV-DP) in dried blood spots to predict future viral load (VL) in postpartum women with HIV on antiretroviral therapy (ART). Methods We conducted a nested case-control study within a trial of postpartum ART delivery strategies. Participants started ART containing tenofovir disoproxil fumarate (TDF) in pregnancy, were &lt;10 weeks postpartum and had a VL &lt;400 copies/mL. VL and TFV-DP samples were taken 3-6 monthly over 24 months. Cases had &gt;1 VL &gt;20 copies/mL; controls were randomly sampled from women with persistent viral suppression (VS; VL &lt;20 copies/mL). Generalized estimating equations were used to calculate likelihood odds ratios (LORs) for future VL &gt;20 copies/mL by TFV-DP concentration at the preceding visit. Results Sixty-one cases and 20 controls contributed 365 DBS-VL pairs (median ART duration 16 months). Sensitivity and specificity of TFV-DP &lt;700 fmol/punch to detect future viremia were 62.9% (95% CI, 54.7%–70.6%) and 89.7% [95% CI, 84.9%–93.4%], respectively. Adjusting for age, ART duration, previous VL and duration between the TFV-DP and VL measures, LORs of viremia for TFV-DP concentrations 350–699 and &lt;350 fmol/punch versus TFV-DP &gt;1850 fmol/punch were 3.5 (95% CI, 1.1–10.8; P=0.033) and 12.9 (95% CI, 3.6–46.6; P&lt;0.0001), respectively. Including only samples taken during VS, the LOR of future viremia for TFV-DP concentration &lt;350 fmol/punch versus TFV-DP &gt;1850 fmol/punch was 9.5 (95% CI, 1.9–47.0). Conclusions TFV-DP concentrations in DBS were strongly associated with future viremia and appear useful to identify non-adherence and predict future elevated VL.