Highlights • We compared fingerstick and venous dried blood spots to plasma for HIV monitoring. • Fingerstick dried blood spot viral load estimates universally higher than plasma. • Fingerstick blood ...spots are 100% sensitive and 98% specific vs plasma at 5000 cp/ml. • Lower positive predictive value at 1000 cp/ml could allow premature therapy switch. • Fingerstick source may improve HIV therapy monitoring in resource-limited settings.
According to the International Diabetes Federation (IDF), about 16.8% of live-births are born to women with hyperglycemia in pregnancy 1. Ideally, studies that examine the effect of vaccines on ...glucose tolerance would include a time period close to the vaccination administration, perhaps 0-14days. Since this definition is not currently in use the studies included in this review have not limited the time between vaccination and diagnosis of GDM. ...to avoid selection bias, a restrictive time interval from immunization to onset of GDM should not be an integral part of such a definition. ...we would like to acknowledge the Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project, funded by the Bill and Melinda Gates Foundation.
To assess the effect of the depot medroxyprogesterone acetate injectable (DMPA) and of the levonorgestrel (LNG) implant on genital HIV shedding among women receiving antiretroviral therapy (ART).
We ...randomized HIV-infected Malawian women to either DMPA or LNG implant from May 2014 to April 2015. HIV RNA was measured in cervicovaginal lavage (CVL) fluid and TearFlo Strips (TFS), and HIV DNA was measured in cells collected by CVL. We compared the frequency and magnitude of HIV genital shedding before and for 6 months after initiation of contraception and between arms among women receiving ART. We also compared genital HIV RNA levels obtained by sample type (TFS versus CVL).
We analyzed data for 68 HIV-infected women receiving ART: 33 randomized to DMPA and 35 randomized to the LNG implant. Overall, HIV RNA was more often detectable and the quantity was higher on TFS compared with CVL. HIV DNA was detected very rarely in CVL cell samples (4 of 360 samples). The frequency of genital shedding and the genital HIV quantity did not increase after contraceptive initiation with either DMPA or LNG implant among women receiving ART.
HIV-infected women receiving ART initiating contraception with either DMPA or LNG implant did not have any increase in genital HIV shedding during the first 6 months of contraceptive use. These findings are consistent with growing evidence that progestin contraception is not associated with increased HIV transmission risk from such women to their male partners. Consistent with other studies, genital HIV RNA detection was higher in TFS than in CVL fluid.
In this randomized trial, neither DMPA nor the LNG implant, two of the most commonly used hormonal contraceptives among African women with HIV, was associated with increased genital HIV shedding in HIV-infected women receiving ART. These findings are reassuring and add to the currently limited information available for the highly effective contraceptive, LNG implant.
September 2016 marks 25 years since the College of Medicine of the University of Malawi was established. In this article we reflect on its conception, birth, adolescence, and youth. The contributions ...of multiple stakeholders are celebrated while being mindful of the ongoing efforts to consolidate past and current gains. For instance, the College of Medicine was, until recently, the only medical school in the country, but a new private medical school has just been opened in Lilongwe. International partnerships and wide-ranging resource mobilisation from both internal and international funders has been the hallmark of the growth and expansion of the Malawi College of Medicine. Further, the expanding needs for specialists in several clinical and non-clinical areas among the health professions calls for responsive strategies to address this and other human resources needs.
infection has been documented as an uncommon cause of vesicovaginal fistula (VVF) and can result in impaired wound healing of urogenital tissues. For these reasons, it could potentially be linked to ...an increased rate of obstetric fistula among women who experience obstructed labor and/or in a higher failure rate of fistula repair. Therefore, the primary objective of our study was to determine the prevalence of
infection among women undergoing obstetric VVF repair in Lilongwe, Malawi. Our secondary objectives were to assess if
infection could be a risk factor for obstetric fistula development or unsuccessful VVF repair in our patient population.
From July to October 2013, we conducted
testing via urine microscopy on 96 patients undergoing obstetric VVF repair surgery at the Fistula Care Centre in Lilongwe, Malawi.
The prevalence of
infection among women undergoing obstetric VVF repair was 2% (n=2). Both women with
had successful VVF repairs.
Although
has the potential to be a risk factor for obstetric VVF formation or unsuccessful VVF repair, it was uncommon among the women in our clinic with obstetric VVF.
The HIV situation in virtually all southern African countries is a generalised epidemic. Despite the fact that almost all adult age and social groups have high HIV prevalence estimates, sex workers ...are disproportionally affected, with prevalence estimates higher than the general population. In a qualitative study of 61 male and female sex workers in Swaziland, we found that while poverty drove many into sex work, others reported motivations of pleasure or "sensation seeking", and freedoms from the burden of marriage as perceived benefits of sex work. We also found that penile-vaginal sex was not universal in male-female sexual encounters; and motivation by sex workers for non-condom use included intention to earn more money from unprotected sex, desire for sexual pleasure, and not having time to use condoms. Many sex workers expressed doubts over an alternative lifestyle, even if that change afforded them money to meet their daily necessities. The findings from this study suggest that treating sex workers as a homogenous group that is driven into, or maintain sex work only because of poverty may be problematic, and could hamper HIV-relevant interventions aimed at reducing their vulnerability to sexually transmitted infections. Dans pratiquement tous les pays d'Afrique australe, on assiste à une épidémie généralisée du VIH. Presque tous les adultes et les groupes sociaux sont concernés par des estimations de prévalence élevées, mais les travailleurs du sexe sont touchés de manière disproportionnée avec une prévalence plus forte que dans le reste de la population. Dans une étude qualitative concernant 61 travailleurs et travailleuses du sexe au Swaziland, nous avons constaté que la pauvreté a conduit nombre d'entre eux à se prostituer, mais d'autres ont aussi évoqué des motivations liées au plaisir ou à la recherche de sensations , et à une liberté salutaire au regard du fardeau que représente pour eux le mariage. Nous avons également constaté que les rapports sexuels vaginaux n'étaient pas toujours la règle entre les hommes et les femmes. Aussi, le choix des travailleurs sexuels de ne pas utiliser de préservatifs s'expliquait selon cette étude par la volonté de gagner plus d'argent en moyennant une relation sexuelle non-protégée, par l'envie d'avoir du plaisir sexuel et par la perte de temps que constituait l'utilisation d'un préservatif. Beaucoup de travailleurs du sexe ont exprimé des doutes à l'idée de changer de mode de vie, même si ce changement leur garantissait assez d'argent pour subvenir à leurs besoins quotidiens. Les résultats de cette étude suggèrent qu'il peut être problématique de considérer les travailleurs du sexe comme un groupe homogène qui serait poussé à la prostitution et poursuivrait cette activité uniquement en raison de la pauvreté. La croyance dans cette idée pourrait entraver la mise en place d'interventions pertinentes contre le VIH visant À réduire la vulnérabilité des travailleurs du sexe aux infections sexuellement transmissibles (IST).
The HIV situation in virtually all southern African countries is a generalised epidemic. Despite the fact that almost all adult age and social groups have high HIV prevalence estimates, sex workers ...are disproportionally affected, with prevalence estimates higher than the general population. In a qualitative study of 61 male and female sex workers in Swaziland, we found that while poverty drove many into sex work, others reported motivations of pleasure or "sensation seeking", and freedoms from the burden of marriage as perceived benefits of sex work. We also found that penile-vaginal sex was not universal in male-female sexual encounters; and motivation by sex workers for non-condom use included intention to earn more money from unprotected sex, desire for sexual pleasure, and not having time to use condoms. Many sex workers expressed doubts over an alternative lifestyle, even if that change afforded them money to meet their daily necessities. The findings from this study suggest that treating sex workers as a homogenous group that is driven into, or maintain sex work only because of poverty may be problematic, and could hamper HIV-relevant interventions aimed at reducing their vulnerability to sexually transmitted infections. Dans pratiquement tous les pays d'Afrique australe, on assiste à une épidémie généralisée du VIH. Presque tous les adultes et les groupes sociaux sont concernés par des estimations de prévalence élevées, mais les travailleurs du sexe sont touchés de manière disproportionnée avec une prévalence plus forte que dans le reste de la population. Dans une étude qualitative concernant 61 travailleurs et travailleuses du sexe au Swaziland, nous avons constaté que la pauvreté a conduit nombre d'entre eux à se prostituer, mais d'autres ont aussi évoqué des motivations liées au plaisir ou à la recherche de sensations , et à une liberté salutaire au regard du fardeau que représente pour eux le mariage. Nous avons également constaté que les rapports sexuels vaginaux n'étaient pas toujours la règle entre les hommes et les femmes. Aussi, le choix des travailleurs sexuels de ne pas utiliser de préservatifs s'expliquait selon cette étude par la volonté de gagner plus d'argent en moyennant une relation sexuelle non-protégée, par l'envie d'avoir du plaisir sexuel et par la perte de temps que constituait l'utilisation d'un préservatif. Beaucoup de travailleurs du sexe ont exprimé des doutes à l'idée de changer de mode de vie, même si ce changement leur garantissait assez d'argent pour subvenir à leurs besoins quotidiens. Les résultats de cette étude suggèrent qu'il peut être problématique de considérer les travailleurs du sexe comme un groupe homogène qui serait poussé à la prostitution et poursuivrait cette activité uniquement en raison de la pauvreté. La croyance dans cette idée pourrait entraver la mise en place d'interventions pertinentes contre le VIH visant À réduire la vulnérabilité des travailleurs du sexe aux infections sexuellement transmissibles (IST).
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