Schistosomiasis and Human Immunodeficiency Virus in Men in Tanzania

Downs, Jennifer A.; Dood, Claudia J. de; Dee, Hannah E.; McGeehan, Megan; Khan, Hijab; Marenga, Abena; Adel, Patrick E.; Faustine, Edward; Issarow, Benson; Kisanga, Emmanuel F.; Kisigo, Godfrey; Ngahyolerwa, Salvius; Zahoro, Frank; Miyaye, Donald; Magawa, Ruth; Mngara, Julius; Lee, Myung Hee; Corstjens, Paul L. A. M.; Dam, Govert J. van; Fitzgerald, Daniel W.

doi:10.4269/ajtmh.16-0897

Cited by 23 publications

(32 citation statements)

References 28 publications

(38 reference statements)

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“…Social action theory begins by considering contextual influences (figure 1). In the rural villages in which this study was conducted – which characterise much of life in Tanzania – most people have completed seven or less years of education 12 13. Villages typically have a single health dispensary where contraceptives are provided free of charge by the Ministry of Health.…”

Section: Resultsmentioning

confidence: 99%

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

Aristide

Mwakisole

et al. 2020

BMJ Sex Reprod Health

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Background Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. Methods We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. Results Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Postseminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. Conclusions Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.

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Section: Resultsmentioning

confidence: 99%

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

Aristide

Mwakisole

et al. 2020

BMJ Sex Reprod Health

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“…mansoni infection and 2% have S . haematobium infection [ 6 , 21 , 22 ]. In our other studies, less than one-fourth of adults in this region have reported receiving praziquantel treatment in the past five years [ 6 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Effects of schistosomiasis on susceptibility to HIV-1 infection and HIV-1 viral load at HIV-1 seroconversion: A nested case-control study

et al. 2017

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BackgroundSchistosomiasis affects 218 million people worldwide, with most infections in Africa. Prevalence studies suggest that people with chronic schistosomiasis may have higher risk of HIV-1 acquisition and impaired ability to control HIV-1 replication once infected. We hypothesized that: (1) pre-existing schistosome infection may increase the odds of HIV-1 acquisition and that the effects may differ between men and women, and (2) individuals with active schistosome infection at the time of HIV-1 acquisition may have impaired immune control of HIV-1, resulting in higher HIV-1 viral loads at HIV-1 seroconversion.Methodology/Principal findingsWe conducted a nested case-control study within a large population-based survey of HIV-1 transmission in Tanzania. A population of adults from seven villages was tested for HIV in 2007, 2010, and 2013 and dried blood spots were archived for future studies with participants’ consent. Approximately 40% of this population has Schistosoma mansoni infection, and 2% has S. haematobium. We tested for schistosome antigens in the pre- and post-HIV-1-seroconversion blood spots of people who acquired HIV-1. We also tested blood spots of matched controls who did not acquire HIV-1 and calculated the odds that a person with schistosomiasis would become HIV-1-infected compared to these matched controls. Analysis was stratified by gender. We compared 73 HIV-1 seroconverters with 265 controls. Women with schistosome infections had a higher odds of HIV-1 acquisition than those without (adjusted OR = 2.8 [1.2–6.6], p = 0.019). Schistosome-infected men did not have an increased odds of HIV-1 acquisition (adjusted OR = 0.7 [0.3–1.8], p = 0.42). We additionally compared HIV-1 RNA levels in the post-seroconversion blood spots in HIV-1 seroconverters with schistosomiasis versus those without who became HIV-infected in 2010, before antiretroviral therapy was widely available in the region. The median whole blood HIV-1 RNA level in the 15 HIV-1 seroconverters with schistosome infection was significantly higher than in the 22 without schistosomiasis: 4.4 [3.9–4.6] log10 copies/mL versus 3.7 [3.2–4.3], p = 0.017.Conclusions/SignificanceWe confirm, in an area with endemic S. mansoni, that pre-existing schistosome infection increases odds of HIV-1 acquisition in women and raises HIV-1 viral load at the time of HIV-1 seroconversion. This is the first study to demonstrate the effect of schistosome infection on HIV-1 susceptibility and viral control, and to differentiate effects by gender. Validation studies will be needed at additional sites.

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“…Whether differential responses to schistosome infection by sex are mediated by local or systemic changes, or a combination of both, is not clear. Significantly, our group showed that schistosome infection increased rates of HIV acquisition in Tanzanian women, but not men (8). Few studies have investigated whether the sex of the infected host affects the host response to schistosome infection.…”

mentioning

confidence: 76%

“…Individuals provided urine samples that were filtered and examined microscopically in the field and received same-day results. In the villages where we worked, the prevalence of S. haematobium among adults is approximately 5% by urine microscopy and 30% by serum CAA measurement (8,20). Due to the known poor sensitivity of urine screening for S. haematobium infection in adults, all individuals screened received free praziquantel treatment in accordance with World Health Organization (WHO) recommendations (21).…”

Section: Methodsmentioning

confidence: 99%

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Gene Expression Differences in Host Response to Schistosoma haematobium Infection

et al. 2019

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Schistosome worms infect over 200 million people worldwide. They live in the host’s bloodstream and alter host immunity. Epidemiological data suggest that males and females have different responses to schistosome infection, but the effect of sex on systemic response is undetermined. Our objective was to characterize differences in peripheral blood transcriptional profiles in people with or without active Schistosoma haematobium infection and to determine whether this signature differs between males and females. mRNA was isolated using poly(A) selection and sequenced on an Illumina Hi-Seq4000 platform. Transcripts were aligned to the human hg19 reference genome and counted with the HTSeq package. Genes were compared for differential expression using DESeq2. Ingenuity Pathway Analysis (IPA) was used to identify gene networks altered in the presence of S. haematobium. We enrolled 33 participants from villages in rural Tanzania where S. haematobium is endemic. After correction for multiple comparisons, we observed 383 differentially expressed genes between those with or without S. haematobium infection when sex was included as a covariate. Heat-mapping of the genes with >1.5-fold differences in gene expression revealed clustering by S. haematobium infection status. The top networks included development, cell death and survival, cell signaling, and immunologic disease pathways. We observed a distinct whole blood transcriptional profile, as well as differences in men and women, with S. haematobium infection. Additional studies are needed to determine the clinical effects of these divergent responses. Attention to sex-based differences should be included in studies of human schistosome infection.

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Schistosomiasis and Human Immunodeficiency Virus in Men in Tanzania

Cited by 23 publications

References 28 publications

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

Design and pilot testing of a church-based intervention to address interpersonal and intrapersonal barriers to uptake of family planning in rural Tanzania: a qualitative implementation study

Effects of schistosomiasis on susceptibility to HIV-1 infection and HIV-1 viral load at HIV-1 seroconversion: A nested case-control study

Gene Expression Differences in Host Response to Schistosoma haematobium Infection

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