The Epidemiology of HIV and HSV-2 Infections among Women Participating in Microbicide and Vaccine Feasibility Studies in Northern Tanzania

Abstract

ObjectivesTo prepare for future HIV prevention trials, we conducted prospective cohort studies among women working in food and recreational facilities in northern Tanzania. We examined the prevalence and incidence of HIV and HSV-2, and associated risk factors.MethodsWomen aged 18–44 years working in food and recreational facilities were screened to determine their eligibility for the studies. Between 2008–2010, HIV-negative women were enrolled and followed for 12 months. At enrolment and 3-monthly, we collected socio-demographic and behavioural data, and performed clinical examinations for collection of biological specimens that were tested for reproductive tract infections. Risk factors for HIV and HSV-2 incidence were investigated using Poisson regression models.ResultsWe screened 2,229 and enrolled 1,378 women. The median age was 27 years (interquartile range, IQR 22, 33), and median duration working at current facility was 2 years. The prevalences of HIV at screening and HSV-2 at enrolment were 16% and 67%, respectively. Attendance at the 12-month visit was 86%. HIV and HSV-2 incidence rates were 3.7 (95% confidence interval, CI: 2.8,5.1) and 28.6 (95% CI: 23.5,35.0)/100 person-years, respectively. Women who were separated, divorced, or widowed were at increased risk of HIV (adjusted incidence rate ratio, aRR = 6.63; 95% CI: 1.97,22.2) and HSV-2 (aRR = 2.00; 95% CI: 1.15,3.47) compared with married women. Women reporting ≥3 partners in the past 3 months were at higher HIV risk compared with women with 0–1 partner (aRR = 4.75; 95% CI: 2.10,10.8), while those who had reached secondary education or above were at lower risk of HSV-2 compared with women with incomplete primary education (aRR = 0.42; 95% CI: 0.22,0.82).ConclusionsHIV and HSV-2 rates remain substantially higher in this cohort than in the general population, indicating urgent need for effective interventions. These studies demonstrate the feasibility of conducting trials to test new interventions in this highly-mobile population.

An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women

“…Among 30 studies with hormonal contraceptive versus non-use of hormonal contraception comparisons, 24 included estimates specific to (or largely composed of) oral contraceptives [21–24,26,27,29,39,41–46,49–53,55–59,61,62]. Twenty-four included estimates specific to (or largely composed of) injectables [21,24–29,39–48,50–53,55,56,58,60,62] and three included implant-specific estimates [27,39,50,54].…”

“…Twenty-four included estimates specific to (or largely composed of) injectables [21,24–29,39–48,50–53,55,56,58,60,62] and three included implant-specific estimates [27,39,50,54]. All studies assessing DMPA assessed intramuscular DMPA, rather than the lower dose, subcutaneous formulation.…”

Evaluation of PacBio sequencing for full-length bacterial 16S rRNA gene classification

“…For the human vaginal microbiome study, DNA from 11 cervico-vaginal lavage cell pellets from a microbicide feasibility study in Tanzania [17] were extracted using FastDNA® Spin Kit for Soil (Qbiogene, Carlsbad, CA, USA) at the London School of Hygiene and Tropical Medicine and were to the Wellcome Trust Sanger Institute. All PCR reactions were performed using the NEB Q5 high-fidelity polymerase kit, as above.…”

HIV risk and behaviour among part-time versus professional FSW: baseline report of an interventional cohort in Burkina Faso: Table 1

“…As reported earlier from Bobo-Dioulasso,2 PTSW had significantly more risky behaviours than professionals, despite a much lower number of clients, which correlates with a lower self-perception of HIV risk. Unlike other regions,6 7 the vulnerability of these PTSW has merely been reported in West Africa. In Kenya, HIV prevalence among these PTSW (30.6%) was twice higher than that among pregnant,6 and in Tanzania, women working in bars and hotels were also at high risk, with a HIV incidence of 3.7% 7.…”

“…Unlike other regions,6 7 the vulnerability of these PTSW has merely been reported in West Africa. In Kenya, HIV prevalence among these PTSW (30.6%) was twice higher than that among pregnant,6 and in Tanzania, women working in bars and hotels were also at high risk, with a HIV incidence of 3.7% 7. HIV prevention and research programmes should include PTSW in Africa.…”