HIV Incidence Rates and Risk Factors for Urban Women in Zambia: Preparing for a Microbicide Clinical Trial

Kapina, Muzala; Reid, Cheri; Román, Karisse; Cyrus, Elena; Kwiecien, Antonia; Weiss, Stephen M.; Vermund, Sten H.

doi:10.1097/olq.0b013e318190191d

Cited by 16 publications

(14 citation statements)

References 19 publications

(15 reference statements)

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“…Similarly, Fonck et al [5] found that BV was more prevalent in HIV positive female sex workers in Kenya, with rates approaching 60%. In contrast, Kapina et al [17] found rates lower than 10% among Zambian HIV negative women in Lusaka. Higher prevalence of BV among HIV positive women has the potential to increase the risk of perinatal and sexual HIV transmission.…”

Section: Discussionmentioning

confidence: 92%

Vaginal Cleansing Practices in HIV Infected Zambian Women

et al. 2011

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Vaginal practices are a variety of behavioral techniques that women use to manage their sexual life and personal hygiene. Women perceive vaginal practices as a beneficial practice. However, vaginal cleansing has been identified as one of the main risk factors for bacterial vaginosis and is potentially implicated in Human Immune Deficiency Virus (HIV) and sexually transmitted infection transmission. This study examined the prevalence of vaginal practices and the types of practices used among a sample of HIV positive women living in Lusaka, Zambia. Over 90% of all women recruited engaged in vaginal practices. Certain practices, such as use of water or soap, were more frequently used for hygiene reasons. Herbs and traditional medicines were mainly used to please sexual partner. Strategies to decrease VP appear urgently needed in the Zambian community.

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Section: Discussionmentioning

confidence: 92%

Vaginal Cleansing Practices in HIV Infected Zambian Women

et al. 2011

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“…We identified 29 publications that were considered duplication of STI data from a single research study; these were excluded from further analysis. 11,24–51 After eligibility assessments, 102 study results were included in this analysis, which were published in 92 articles as eight articles had data from two countries and/or study populations and one from three (Figure 1, Table 2 and S1 Table).…”

Section: Resultsmentioning

confidence: 99%

GenitalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among women in sub-Saharan Africa: A structured review

et al. 2018

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Chlamydia trachomatis and Neisseria gonorrhoeae constitute major public health problems among women, but the burden of infection in sub-Saharan Africa is poorly documented. We conducted a structured review of the prevalence and incidence of genital, oral and anal C. trachomatis and N. gonorrhoeae infection in women in sub-Saharan Africa. We searched Medline, EMBASE and Web of Science over a 10-year period for studies on epidemiology of genital, oral and anal chlamydial infection and gonorrhoea in women in all countries of sub-Saharan Africa. We assessed geographic and demographic differences in prevalence and incidence of infection; weighted mean prevalence estimates were calculated with a random-effect model. A total of 102 study results were included, with data available for 24/49 of sub-Saharan countries. The weighted prevalence of chlamydial infection was lower among women in community-based studies (3.9%; 95% CI: 2.9-5.1%) than for women recruited at primary healthcare facilities (6.0%; 95% CI: 4.2-8.4%, p < 0.001); the same was observed for gonorrhoea (2.2%; 95% CI: 1.2-4.0% vs. 4.2%; 95% CI: 3.2-5.6%, p < 0.001). Prevalence of Chlamydia among sex workers was 5.5% (95% CI: 4.2-7.3%) and gonorrhoea 7.6% (95% CI: 5.4-11%). Seven studies reported on incidence which varied between 0.75-28 and 2.8-17 per 100 person-years-at-risk for chlamydial infection and gonorrhoea, respectively. Only two studies reported on anal infections and one on oral infection. This overview underscores the considerable incidence and prevalence of genital C. trachomatis and N. gonorrhoeae in women in different settings in sub-Saharan Africa. Better control strategies are warranted to reduce the burden of infection and to prevent long-term complications of these infections.

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“…Repeated screening for HIV has been reported to have little impact on change in risk behavior, and it is unclear if it contributed to the observed change in this study[21]. However, other routine interventions that occurred at each study visit, including risk reduction counseling and free access to condoms, have demonstrated success in reducing risk behavior[22–25]. Reduction in risk behavior has not clearly been associated with reduced HIV acquisition, although there was a trend towards reduced HIV incidence associated with increased condom use in HPTN 039 [23].…”

Section: Discussionmentioning

confidence: 96%

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

Novak¹,

Metch

Buchbinder

et al. 2013

Aids

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Objectives Report of risk behavior, HIV incidence, and pregnancy rates among women participating in the Step Study, a phase IIB trial of MRKAd5 HIV-1 gag/pol/nef vaccine in HIV-negative individuals who were at high risk of HIV-1. Design Prospective multicenter, double-blinded, placebo-controlled trial Methods Women were from North American (NA) and Caribbean and South America (CSA) sites. Risk behavior was collected at screening and 6-month intervals. Differences in characteristics between groups were tested with Chi-square, two-sided Fisher’s exact tests, and Wilcoxon rank sum tests. Generalized estimating equation models were used to assess behavioral change. Results Among 1134 enrolled women, the median number of male partners was 18; 73.8% reported unprotected vaginal sex, 15.9% unprotected anal sex and 10.8% evidence of a sexually transmitted infection in the 6 months prior to baseline. With 3344 person-years (p–y) of follow up, there were 15 incident HIV infections: incidence rate was 0.45 per 100/p-y (95% CI 0.25, 0.74). Crack cocaine use in both regions (relative risk [RR]=2.4 [1.7,3.3]) and in CSA, unprotected anal sex (RR=6.4 [3.8. 10.7]) and drug use (RR=4.1 [2.1, 8.0]) were baseline risk behaviors associated with HIV acquisition. There was a marked reduction in risk behaviors after study enrollment with some recurrence in unprotected vaginal sex. Of 963 non-sterilized women, 304 (31.6%) became pregnant. Conclusions Crack cocaine use and unprotected anal sex are important risk criteria to identify high-risk women for HIV efficacy trials. Pregnancy during the trial was a common occurrence and needs to be considered in trial planning for prevention trials in women.

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HIV Incidence Rates and Risk Factors for Urban Women in Zambia: Preparing for a Microbicide Clinical Trial

Cited by 16 publications

References 19 publications

Vaginal Cleansing Practices in HIV Infected Zambian Women

Vaginal Cleansing Practices in HIV Infected Zambian Women

GenitalChlamydia trachomatisandNeisseria gonorrhoeaeinfections among women in sub-Saharan Africa: A structured review

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

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