Following the collapse of the Soviet Union, there was a pronounced change in the availability of modern contraceptive methods and an accompanying shift in the knowledge and attitudes of Georgian ...women related to sexual behaviors. This study describes differences in sexual behaviors, condom use and family planning practices among several generations of reproductive-aged Georgian women.
Study participants were recruited from three large cities in Georgia. Women >25 years were recruited from the Cervical Cancer Screening National Program by consecutive sampling; those <25 years were recruited from universities using random sampling. Data collection included self-administered, anonymous surveys. Bivariate analyses were conducted and adjusted prevalence ratios (PR) with 95% confidence intervals were computed.
Among the 350 participants, independent predictors of age at first sexual intercourse were age (aPR 0.27; 95% CI 0.12-0.57), level of education (aPR 0.23; 95% CI: 0.11-0.44), marital status (aPR 2.8;95% CI:1.3-6.0) and religion (aPR 4.01; 95% CI:1.17-13.68). Younger women were more likely to have a premarital sexual relationship compared to older women (RR=0.85; 95% CI: 0.80-0.89); older women were also significantly more likely to use family planning methods with a current partner (RR=2.15; 95% CI: 1.48-3.13). Similarly, advanced education was associated with family planning (RR=1.66; CI: 1.13-2.45).
This study describes clear generational differences in current sexual behavior among Georgian women of reproductive age and these differences, especially in age at first sexual intercourse, premarital sexual relationship and use of contraceptive methods, are influenced by age, level of education, marital status and religion. This information is vital to designing contextually appropriate strategies to prevent sexually transmitted infections.
Background. Following the collapse of the Union of Soviet Socialist Republic (USSR) in 1991, trans-border mobility increased within the former Soviet Union (FSU) countries. In addition, ...drug-trafficking and injection drug use began to rise, leading to the propagation and transmission of blood-borne infections within and across the FSU countries. To examine the transmission of blood-borne infections within this region, we analyzed the phylogenetic relationship of publically available sequences of two blood-borne viruses, hepatitis C virus (HCV) and human immunodeficiency virus (HIV), from FSU countries. Methods. We analysed 614 and 295 NS5B sequences from HCV genotypes 1b and 3a, respectively, from 9 FSU countries. From 13 FSU countries, we analysed 347 HIV gag and 1282 HIV env sequences. To examine transmission networks and the origins of infection, respectively, phylogenetic and Bayesian analyses were performed. Results. Our analysis shows intermixing of HCV and HIV sequences, suggesting transmission of these viruses both within and across FSU countries. We show involvement of three major populations in transmission: injection drug user, heterosexual, and trans-border migrants. Conclusion. This study highlights the need to focus harm reduction efforts toward controlling transmission of blood-borne infections among the abovementioned high-risk populations in the FSU countries.
Since 2004, the country of Georgia has provided antiretroviral therapy (ART) to all patients in need. A nationwide retrospective cohort study was conducted to assess the effect of universal access to ...ART on patterns of mortality and causes of death among HIV-infected individuals in Georgia. All known HIV-infected adult individuals (age ≥18 years) diagnosed from 1989 through 2012 were included. Rates and causes of death were determined using routinely collected data from the national HIV/AIDS database. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Between 1989 and 2012, 3,554 HIV-infected adults were registered in Georgia contributing to 13,572 person-years (PY) of follow-up. A total of 779 deaths were registered during follow-up. The mortality rate peaked in 2004 with 10.74 deaths per 100 PY (95% CI: 7.92-14.24) and significantly decreased after the universal availability of ART to 4.02 per 100 PY (95% CI: 3.28-4.87) in 2012. In multivariate analysis the strongest predictor of mortality was having AIDS at the time of HIV diagnosis (hazard ratio: 5.69, 95% CI: 4.72-6.85). AIDS-related diseases accounted for the majority of deaths (n=426, 54.7%). Tuberculosis (TB) was the leading cause of death accounting for 21% of the total deaths reported. Universal access to ART significantly reduced mortality among HIV-infected patients in Georgia. However, overall mortality rates remain high primarily due to late diagnosis, and TB remains a significant cause of death. Improving rates of early HIV diagnosis and ART initiation may further decrease mortality as well as prevent new HIV and TB infections.
HIV incidence is a primary metric for epidemic surveillance and prevention efficacy assessment. HIV incidence assay performance is evaluated via false recency rate (FRR) and mean duration of recent ...infection (MDRI). We conducted a meta-analysis of 438 incident and 305 chronic specimens' HIV envelope genes from a diverse global cohort. The genome similarity index (GSI) accurately characterized infection stage across diverse host and viral factors. All except one chronic specimen had GSIs below 0.67, yielding a FRR of 0.33 0-0.98 %. We modeled the incidence assay biomarker dynamics with a logistic link function assuming individual variabilities in a Beta distribution. The GSI probability density function peaked close to 1 in early infection and 0 around two years post infection, yielding MDRI of 420 361, 467 days. We tested the assay by newly sequencing 744 envelope genes from 59 specimens of 21 subjects who followed from HIV negative status. Both standardized residuals and Anderson-Darling tests showed that the test dataset was statistically consistent with the model biomarker dynamics. This is the first reported incidence assay meeting the optimal FRR and MDRI performance standards. Signatures of HIV gene diversification can allow precise cross-sectional surveillance with a desirable temporal range of incidence detection.
The State University of New York (SUNY) – University of the West Indies (UWI) Health Research Consortium (HRC) was implemented in 2015 by the SUNY Global Health Institute (GHI) and the SUNY-UWI ...Center for Leadership and Sustainable Development. The goal was to advance public health in the Caribbean through collaborative research and education among faculty and students at SUNY and UWI. The Consortium is now a dynamic matrix addressing health priorities that were initially agreed upon with the Jamaica Ministry of Health and Wellness. The HRC has built a foundational matrix that is planning for cutting edge laboratory instrumentation, biomedical informatics system, seamless electronic medical records network, national laboratory data management system, and novel biotechnology (e.g., robotic surgery cluster). The SUNY-UWI partnership fills existing gaps through collaborative programs with the SUNY GHI that facilitate UWI faculty interactions with SUNY faculty and core resources and incubators that encourage collaborations while UWI infrastructure expands. The Health Research Consortium utilizes existing academic models at UWI and SUNY to promote collaboration, capacity building, and program implementation. Consortium teams develop sound business development models that foster sustained economic growth and form the pipeline for workforce development and career opportunities. The Caribbean diaspora and UWI alumni are engaged in working together on this effort. In addition, mentoring in K-12 and beyond is needed to create a vision for the next generations.
In the early highly active antiretroviral therapy (HAART) era, kidney dysfunction was strongly associated with death among HIV-infected individuals. We re-examined this association in the later HAART ...period to determine whether chronic kidney disease remains a predictor of death after HAART initiation.
To evaluate the effect of kidney function at the time of HAART initiation on time to all-cause mortality, we evaluated 1415 HIV-infected women initiating HAART in the Women's Interagency HIV Study. Multivariable proportional hazards models with survival times calculated from HAART initiation to death were constructed; participants were censored at the time of the last available visit or December 31, 2006.
Chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m) at HAART initiation was associated with higher mortality risk adjusting for age, race, hepatitis C serostatus, AIDS history, and CD4 cell count (hazard ratio 2.23, 95% confidence interval: 1.45-3.43). Adjustment for hypertension and diabetes history attenuated this association (hazard ratio = 1.89, confidence interval: 0.94-3.80). Lower kidney function at HAART initiation was weakly associated with increased mortality risk in women with prior AIDS (hazard ratio = 1.09, confidence interval: 1.00-1.19, per 20% decrease in estimated glomerular filtration rate).
Kidney function at HAART initiation remains an independent predictor of death in HIV-infected individuals, especially in those with a history of AIDS. Our study emphasizes the necessity of monitoring kidney function in this population. Additional studies are needed to determine mechanisms underlying the increased mortality risk associated with chronic kidney disease in HIV-infected persons.
HIV RNA viral load (VL) is a pivotal outcome variable in studies of HIV infected persons. We propose and investigate two frameworks for analyzing VL: (1) a single-measure VL (SMVL) per participant ...and (2) repeated measures of VL (RMVL) per participant. We compared these frameworks using a cohort of 720 HIV patients in care (4,679 post-enrollment VL measurements). The SMVL framework analyzes a single VL per participant, generally captured within a "window" of time. We analyzed three SMVL methods where the VL binary outcome is defined as suppressed or not suppressed. The omit-participant method uses a 8-month "window" (-6/+2 months) around month 24 to select the participant's VL closest to month 24 and removes participants from the analysis without a VL in the "window". The set-to-failure method expands on the omit-participant method by including participants without a VL within the "window" and analyzes them as not suppressed. The closest-VL method analyzes each participant's VL measurement closest to month 24. We investigated two RMVL methods: (1) repeat-binary classifies each VL measurement as suppressed or not suppressed and estimates the proportion of participants suppressed at month 24, and (2) repeat-continuous analyzes VL as a continuous variable to estimate the change in VL across time, and geometric mean (GM) VL and proportion of participants virally suppressed at month 24. Results indicated the RMVL methods have more precision than the SMVL methods, as evidenced by narrower confidence intervals for estimates of proportion suppressed and risk ratios (RR) comparing demographic strata. The repeat-continuous method had the most precision and provides more information than other considered methods. We generally recommend using the RMVL framework when there are repeated VL measurements per participant because it utilizes all available VL data, provides additional information, has more statistical power, and avoids the subjectivity of defining a "window."
There is limited data on and experience with interventions for antiretroviral therapy (ART) adherence support for patients on ART in Eastern Europe. We sought to identify a feasible adherence support ...intervention for delivery amongst HIV-positive adults receiving care in Estonia, where the HIV/AIDS epidemic has been mainly concentrated among injection drug users (IDUs). Our application of intervention mapping (IM) strategies used existing literature, formative research and multidisciplinary team input to produce a brief clinic-based intervention entitled the Situated Optimal Adherence Intervention Estonia (sOAI Estonia) which uses both Next-Step Counseling (NSC) and Information-Motivation-Behavioral Skills (IMB) Model approach to facilitate integration of ART into the context and demands of daily life. We present the intervention development process, the resulting sOAI Estonia approach, and describe a randomized controlled trial (RCT) which is under way to evaluate the intervention (results due in spring 2013).
To evaluate the association between enrollment into an AIDS Drug Assistance Program (ADAP) and use of highly active antiretroviral therapy (HAART) and antihypertensive therapy.
Cross-sectional ...analyses of data were performed on HAART-eligible women enrolled in the California (n = 439), Illinois (n = 168), and New York (n = 487) Women's Interagency HIV Study sites. A subset of HIV-infected women with hypertension (n = 395) was also analyzed. Unadjusted and adjusted backward stepwise elimination logistic regression measured the association between demographic, behavioral, and health service factors and nonuse of HAART or antihypertensive medication.
In adjusted analysis of HAART nonuse, women without ADAP were significantly more likely not to use HAART (odds ratio OR, 2.4; 95% confidence interval CI, 1.5-3.7) than women with ADAP. In adjusted analysis of antihypertensive medication nonuse, women without ADAP had an increased but not significant odds of antihypertensive medication nonuse (OR, 2.4; 95% CI, 0.93-6.0) than women with ADAP.
Government-funded programs for prescription drug coverage such as ADAP may play an important role in how HIV-positive women access and use essential medications for chronic diseases.
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