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Peer Reviewed

Title: Oral contraceptives for functional ovarian cysts.
Source: Obstetrics and Gynecology. 2009 Sep;114(3):679-80.
Abstract: BACKGROUND:: Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early oral contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. OBJECTIVES:: This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts. SEARCH STRATEGY:: We searched the databases of CENTRAL, MEDLINE, POPLINE, and EMBASE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles and wrote to authors of identified trials to seek articles we had missed. SELECTION CRITERIA:: We included randomized controlled trials in any language that included oral contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials. DATA COLLECTION AND ANALYSIS:: Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we used Peto odds ratios with 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences with 95% CI. MAIN RESULTS:: We identified seven randomized controlled trials from four countries; the studies included a total of 500 women. Treatment with combined oral contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. AUTHORS' CONCLUSION:: Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006134. DOI: 10.1002/14651858.CD006134.pub2. Copyright the Cochrane Collaboration, reproduced with permission.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | INCIDENCE | OVARIAN CYSTS | ORAL CONTRACEPTIVES | TREATMENT | EXAMINATIONS AND DIAGNOSES | Measurement | Research Methodology | Diseases | Contraceptive Methods | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342569

3.
Title: Incidence and diagnoses of HIV infection - Puerto Rico, 2006.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 5;58(21):589-91.
Abstract: In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection. To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >or=13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30-39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services.
Language: English
Keywords:
PUERTO RICO | SUMMARY REPORT | INCIDENCE | MEN | HISPANICS | IV DRUG USERS | MEN HAVING SEX WITH MEN | HIV INFECTIONS | PROGRAM EVALUATION | Caribbean | Americas | Developed Countries | Measurement | Research Methodology | Demographic Factors | Population | Ethnic Groups | Cultural Background | Population Characteristics | Drug Use and Abuse | Behavior | Sex Behavior | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 341589

4.
Title: Progress toward the 2012 measles elimination goal--Western Pacific Region, 1990-2008.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 26;58(24):669-73.
Abstract: In 2003, the World Health Organization (WHO) Regional Committee of the Western Pacific Region (WPR) formally declared a measles elimination goal, and in 2005, the committee established a target date of 2012 for regional measles elimination. Key strategies recommended by WHO for achievement of measles elimination include 1) very high (>or=95%) vaccination coverage with 2 doses of measles-containing vaccine (MCV1 and MCV2) through routine vaccination and/or supplemental immunization activities (SIAs); 2) high-quality case-based measles surveillance; and 3) access to an accredited measles laboratory network for testing of suspected measles cases and identification of measles virus genotypes. This report describes progress toward measles elimination in the WPR through 2008. Measles likely has been eliminated or nearly eliminated in 24 of the 37 countries and areas in the WPR (referred to in this report as countries). However, large numbers of measles cases continue to be reported from several countries. During 2008, a total of 131,441 confirmed measles cases (98.4 per million population) were reported from China and 11,015 cases (86.1 per million population) from Japan, two countries that account for 82% of the region's population and >97% of its confirmed measles cases. Intensified efforts by WPR countries, particularly China and Japan, will be required to achieve the 2012 goal.
Language: English
Keywords:
OCEANIA | SUMMARY REPORT | INCIDENCE | MEASLES | VACCINES | IMMUNIZATION | PREVENTION AND CONTROL | MONITORING | SCREENING | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Primary Health Care | Evaluation | Examinations and Diagnoses
Document Number: 341752

Title: Family Health International's Site Identification and Development Initiative (SIDI).
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, [2009]. [3] p. (Research Briefs on HIV Prevention)
Abstract: Successful HIV prevention research requires the participation of tens of thousands of women and men at risk for HIV infection. Ultimately, success hinges on the development of multiple international research sites. To increase the number and readiness of such sites, Family Health International (FHI) began the Site Identification and Development Initiative (SIDI) in July 2006.
Language: English
Keywords:
AFRICA | ASIA | PROGRESS REPORT | CLINICAL RESEARCH | HIV PREVENTION | INCIDENCE | NEEDS | USAID | GOALS | STANDARDS | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Measurement | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Planning | Organization and Administration
Document Number: 331712

Title: [Global Burden of Diseases, Injuries and Risk Factors Study] operations manual. Final draft.
Author: Harvard University; University of Washington. Institute for Health Metrics and Evaluation; Johns Hopkins University; University of Queensland; World Health Organization [WHO]
Source: [Cambridge, Massachusetts, Harvard University, 2009 Jan 20 142 p.
Abstract: The final draft of the Global Burden of Diseases, Injuries and Risk Factors Study Operations Manual is intended to serve as a guide for the Expert Groups working on the GBD Study. There are opportunities to provide input and feedback, and instructions to do so are included in the operations manual. The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization WHO). It is the first major effort since the GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. By November 2010 the project will produce a final set of estimates. (Excerpts)
Language: English
Keywords:
GLOBAL | MANUAL | DATA ANALYSIS | ESTIMATION TECHNIQUES | DISABLED PERSONS AND DISABILITIES | DISEASES | ACCIDENTS AND INJURIES | MORTALITY | RISK FACTORS | EPIDEMIOLOGY | INCIDENCE | PREVALENCE | RISK ASSESSMENT | BIAS | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Population Dynamics | Public Health | Measurement | Evaluation | Error Sources
Document Number: 331797

Title: Development of Assays to Estimate HIV Incidence. Meeting proceedings, Chapel Hill, North Carolina, May 13-14, 2009.
Author: Meeting on the Development of Assays to Estimate HIV Incidence (2009: Chapel Hill)
Source: [Research Triangle Park], North Carolina, Family Health International [FHI], 2009. [70] p.
Abstract: Family Health International (FHI) convened a meeting on the Development of Assays to Estimate HIV Incidence on May 13-14, 2009 at the Carolina Inn in Chapel Hill, North Carolina. The purpose of this meeting was to assess how new and existing technologies and research could be applied to advance the development of assays to estimate HIV incidence. Nearly fifty leading experts including immunologists, epidemiologists, HIV transmission experts, assay developers, virologists, industry representatives, and potential users of assays participated in the meeting. The meeting was primarily supported by the Bill & Melinda Gates Foundation and in conjunction with and the support of the World Health Organization (WHO), the HIV Prevention Trials Network (HPTN), and the Center for HIV / AIDS Vaccine Immunology (CHAVI). (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | RESEARCH METHODOLOGY | VALIDITY | ESTIMATION TECHNIQUES | INCIDENCE | EPIDEMIOLOGY | STUDY DESIGN | HIV INFECTIONS | AWARENESS | TREATMENT | PROGRAM ACTIVITIES | PROGRAM EVALUATION | Measurement | Public Health | Health | Viral Diseases | Diseases | Knowledge | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Programs | Organization and Administration
Document Number: 331753

Title: Headache induced by the use of combined oral contraceptives.
Author: Allais G; Gabellari IC; Airola G; Borgogno P; Schiapparelli P; Benedetto C
Source: Neurological Sciences. 2009 May;30 Suppl 1:S15-7.
Abstract: Although combined oral contraceptives (COCs) are a safe and highly effective method of birth control, they may also give rise to problems of clinical tolerability in migraine patients. Indeed, headache is among the most common side effects reported with the use of COCs, frequently leading to their being discontinued. The latest International Classification of Headache Disorders identified at least two entities evidently related to the use of COCs, i.e., exogenous hormone-induced headache and estrogen-withdrawal headache. As to the former, the newest formulations of COCs are generally well tolerated by migraine without aura patients, but can worsen headache in migraine with aura patients. Headache associated with COCs, generally, tends to improve as their use continues. However, although it is not yet clear if there is an association between headache and the composition of COCs (both in the type and amount of hormones), it has been observed that the incidence of headache during COC use seems greater if migraine is associated with menstrual trigger. The estrogen-withdrawal headache is a headache that generally appears within the first 5 days after cessation of estrogen use and resolves within 3 days, even if in some cases it may appear on the sixth or seventh day after pill suspension and lasts more than 3 days.
Language: English
Keywords:
ITALY | LITERATURE REVIEW | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | HEADACHE | MIGRAINE | INCIDENCE | HORMONES | ESTROGENS | Developed Countries | Europe, Southern | Europe | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Signs and Symptoms | Diseases | Vascular Diseases | Measurement | Research Methodology | Endocrine System | Physiology | Biology
Document Number: 342617

10.

Peer Reviewed

Title: Increased access to emergency contraception: why it may fail.
Author: Baecher L; Weaver MA; Raymond EG
Source: Human Reproduction. 2009 Apr;24(4):815-9.
Abstract: BACKGROUND: To explore why increased access to emergency contraception (EC) failed to reduce pregnancies in a recent randomized controlled trial. METHODS: We used multivariable logistic regression to identify risk factors for unintended pregnancy using data from a trial involving sexually active women (n = 1490, aged 14-24 years) randomly assigned to either increased access or standard access to EC. We used predictive modeling to generate estimated pregnancy risk scores for each participant. We then examined EC use among women at low or high baseline risk of pregnancy. RESULTS: Gravidity, recent history of unprotected sex (within 14 days of enrollment to study) and lower aversion to pregnancy predicted unintended pregnancy. Women in the increased access group were more likely than women in the standard access group to use EC repeatedly. This difference was significantly stronger (P = 0.03) among low risk women than high risk women [Relative risk (RR) 10.0, 95% confidence interval (CI) 6.5-15.4 and RR 5.5, 95% CI 3.8-7.9, respectively]. CONCLUSIONS: Increased access to EC had a greater impact on women who were at lower baseline risk of pregnancy. This may explain in part why increased access to EC has had no measurable benefit in clinical trials.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PREGNANCY, UNPLANNED | INCIDENCE | RISK FACTORS | PSYCHOSOCIAL FACTORS | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Measurement | Health | Behavior
Document Number: 341661

11.
Title: Circumcision's place in the vicious cycle involving herpes simplex virus type 2 and HIV [editorial]
Author: Bailey RC; Mehta SD
Source: Journal of Infectious Diseases. 2009 Apr 1;199(7):923-5.
Abstract: HSV-2 as a biological cofactor in HIV acquisition and transmission has likely contributed substantially to the HIV epidemic. Although it remains possible that HSV-2 suppressive therapy will be efficacious in reducing HIV transmission, it is not clear how and whether a twice daily regimen of acyclovir will be manageable and effective at a population level. Research is needed to develop and test a prophylactic vaccine that, even if only partially protective against HSV-2 acquisition, is likely to be effective in both concentrated epidemics and in generalized epidemics in which a large proportion of HIV transmission occurs in stable partnerships. (excerpt)
Language: English
Keywords:
AFRICA | EUROPE | SUMMARY REPORT | INCIDENCE | HERPES GENITALIS | HIV INFECTIONS | MALE CIRCUMCISION | SEX BEHAVIOR | HIV TESTING | LABORATORY PROCEDURES | Developing Countries | Developed Countries | Measurement | Research Methodology | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341208

12.

Peer Reviewed

Title: Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007.
Author: Barnighausen T; Tanser F; Newell ML
Source: AIDS Research and Human Retroviruses. 2009 Apr;25(4):405-9.
Abstract: To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in age-stratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p > or = 0.338) and jointly insignificant (p = 0.764 and p = 0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p > or = 0.387) and jointly insignificant (p = 0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | RURAL POPULATION | HIV INFECTIONS | HIV PREVENTION | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 341543

13.
Title: Estimating HIV-1 incidence using the serologic testing algorithm for recent HIV infections at HIV counseling and testing centers in the city of Sao Paulo, Brazil.
Author: Bassichetto KC; Bergamaschi DP; Veras MA; Sucupira MC; Mesquita F; Diaz RS
Source: Brazilian Journal of Infectious Diseases. 2009 Feb;13(1):9-12.
Abstract: The network of HIV counseling and testing centers in Sao Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | ESTIMATION TECHNIQUES | STATISTICAL STUDIES | CLIENTS | HIV TESTING | HIV INFECTIONS | INCIDENCE | LABORATORY PROCEDURES | EPIDEMIOLOGY | PREVALENCE | TIME FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Public Health | Population Dynamics | Demographic Factors | Population
Document Number: 342655

14.
Title: Primary and secondary tuberculosis preventive treatment in HIV clinics: simulating alternative strategies.
Author: Basu S; Maru D; Poolman E; Galvani A
Source: International Journal of Tuberculosis and Lung Disease. 2009 May;13(5):652-8.
Abstract: BACKGROUND: Isoniazid preventive treatment (IPT) has been recommended for human immunodeficiency virus (HIV) infected individuals. OBJECTIVE/DESIGN: We used a mathematical model to simulate the benefits and risks of preventive treatment delivered through antiretroviral (ARV) clinics using clinical data from Botswana. RESULTS: Preventive treatment was found to reduce the incidence of tuberculosis (TB) by at least 12 cases per 100000 population per year versus the scenario without such treatment over a 50-year simulation. Isoniazid (INH) resistant TB was observed to increase by <1% per year, even when using pessimistic assumptions about resistance emergence. The use of tuberculin skin testing had little impact as a screening procedure, while secondary treatment was observed to nearly double the impact of a preventive treatment program. Regardless of whether or not preventive treatment was implemented, INH-resistant TB rose in the context of increasing HIV prevalence, but was minimally amplified by preventive treatment itself. CONCLUSIONS: IPT programs implemented through ARV clinics may be effective at reducing TB incidence. The resistance contribution of IPT appears unlikely to supersede its overall incidence and mortality benefits.
Language: English
Keywords:
BOTSWANA | RESEARCH REPORT | MATHEMATICAL MODEL | PERSONS LIVING WITH HIV/AIDS | CLIENTS | TUBERCULOSIS | DRUGS | TESTING | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | INCIDENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Theoretical Models | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Infections | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement
Document Number: 341945

15.

Peer Reviewed

Title: High human herpesvirus 8 (HHV-8) prevalence, clinical correlates and high incidence among recently HIV-1-infected subjects in Sao Paulo, Brazil.
Author: Batista MD; Ferreira S; Sauer MM; Tomiyama H; Giret MT; Pannuti CS; Diaz RS; Sabino EC; Kallas EG
Source: PloS One. 2009;4(5):e5613.
Abstract: BACKGROUND: Human herpesvirus 8 (HHV-8) is the etiological agent for Kaposi Sarcoma, which occurs especially in HIV-infected subjects. HHV-8 infection and its clinical correlates have not been well characterized in recently HIV-1-infected subjects, especially men who have sex with men (MSM). METHODOLOGY/ PRINCIPAL FINDINGS: We assessed the HHV-8 seroprevalence, clinical correlates, and incidence after one year of follow-up in a cohort of 228 recently HIV-1-infected individuals, of whom 83.6% were MSM, using indirect immunofluorescence assay. The prevalence of HHV-8 infection at the time of cohort enrollment was 25.9% (59/228). In the univariate model, there were significant associations with male gender, black ethnicity, MSM practice, and previous hepatitis B virus and syphilis infections. In the multivariate model we could still demonstrate association with MSM, hepatitis B, and black ethnicity. No differences in mean CD4+ cell counts or HIV viral load according to HHV-8 status were found. In terms of incidence, there were 23/127 (18.1%) seroconversions in the cohort after 1 year. CONCLUSIONS: HHV-8 is highly prevalent among recently HIV-1-infected subjects. Correlations with other sexually transmitted infections suggest common transmission routes.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | MEN HAVING SEX WITH MEN | HERPES GENITALIS | PREVALENCE | INCIDENCE | IMMUNOLOGICAL EFFECTS | SEROCONVERSION | LABORATORY PROCEDURES | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Sex Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Measurement | Immunity | Immune System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342160

16.

Title: Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review.
Author: Berghella V; Airoldi J; O'Neill AM; Einhorn K; Hoffman M
Source: BJOG. 2009 Aug;116(9):1151-7.
Abstract: BACKGROUND: Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied. OBJECTIVE: To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery. SEARCH STRATEGY: Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed. SELECTION CRITERIA: Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately. DATA COLLECTION AND ANALYSIS: Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture. MAIN RESULTS: The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy. CONCLUSIONS: Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | ABORTION | CESAREAN SECTION | UTERINE EFFECTS | RISK FACTORS | INCIDENCE | Developed Countries | North America | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Measurement
Document Number: 342794 Notification

17.

Title: Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country.
Author: Bernabe-Ortiz A; White PJ; Carcamo CP; Hughes JP; Gonzales MA; Garcia PJ; Garnett GP; Holmes KK
Source: CMAJ. 2009 Feb 3;180(3):298-304.
Abstract: BACKGROUND: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS: We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.
Language: English
Keywords:
LATIN AMERICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | WOMEN | RISK FACTORS | ABORTION | ABORTION, SPONTANEOUS | SEX EDUCATION | RISK ASSESSMENT | Americas | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Biology | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Education | Evaluation
Document Number: 330468 Notification

18.

Peer Reviewed

Title: Incidence and correlates of 'catastrophic' maternal health care expenditure in India.
Author: Bonu S; Bhushan I; Rani M; Anderson I
Source: Health Policy and Planning. 2009 Aug 17;
Abstract: Using data from the 60(th) round of the National Sample Survey of India (2004), the study investigates the incidence and correlates of 'catastrophic' maternal expenditure (ME) in India. Data on ME come from 6879 births that took place during 365 days prior to the survey. The study adapts earlier definitions and methods for catastrophic total health care expenditure to measure 'catastrophic' ME as: (i) maternal health care expenditure more than 10% of the annual normative household consumption expenditure (ME-1), and (ii) maternal health care expenditure more than 40% of the annual 'capacity to pay' (ME-2). The 'capacity to pay' was derived by subtracting state-wise poverty-line household expenditure from household consumption expenditure. The average maternal expenditure varied by place of delivery: US$9.5, US$24.7 and US$104.3 for birth at home, in a public facility and in a private facility, respectively. Sixteen per cent of households incurred ME of more than 10% of total household consumption expenditure (ME-1), while 51% households incurred ME of more than 40% of household 'capacity to pay' (ME-2). While incidence of ME-1 increased with income decile, the reverse was observed for ME-2, reflecting higher non-utilization of institutional maternal care and its non-affordability among poorer households. All the households from the poorest decile and 99% from the second poorest decile paid more than 40% of their capacity to pay. Multivariate regression results indicate that antenatal care and delivery care in private facilities increased the chances of ME-1 and ME-2 (P < 0.001). Measuring maternal expenditure against 'capacity to pay' (ME-2) may be better than measuring it as a proportion of overall household expenditure when assessing financial constraints in the use of maternal services. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase utilization of maternal services and reduce the financial distress associated with ME.
Language: English
Keywords:
INDIA | RESEARCH REPORT | EXPENDITURES | INCIDENCE | MATERNAL HEALTH | UTILIZATION OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | FEES | Asia, Southern | Asia | Developing Countries | Financial Activities | Economic Factors | Measurement | Research Methodology | Health | Health Services | Delivery of Health Care | Primary Health Care
Document Number: 342553

19.

Title: [Contraceptive use and incidence of pregnancy among women after HIV testing in Abidjan, Ivory Coast] Pratiques contraceptives et incidence des grossesses chez des femmes apres un
Author: Brou H; Viho I; Djohan G; Ekouevi DK; Zanou B; Leroy V; Desgrees-du-Lou A
Source: Revue d'Epidemiologie et de Sante Publique. 2009 Mar 20;
Abstract: BACKGROUND: Within the framework of programs for the prevention of mother-to-child HIV transmission, women who discover their HIV-infection during their pregnancy receive perinatal interventions in order to reduce the risk of HIV transmission to the child. They also receive family planning counselling and free contraceptives in order to avoid a new pregnancy. In this study, we compared contraceptive use and pregnancy incidence between HIV-positive and HIV-negative women who were offered HIV counselling and testing during a program of prevention of mother-to-child HIV transmission. METHODS: In the Ditrame Plus program in Abidjan, 546 HIV-positive and 393 HIV-negative women were HIV-tested prenatally and followed up 2years after delivery. At each post-partum visit, proportions of contraceptive use were noted, by method. The pregnancy incidence was calculated as the number of pregnancies for 100 women-years at risk. Factors related to the arrival of a new pregnancy were analyzed by Cox model. RESULTS: Between 6 and 24 months post-partum, proportions of women using modern contraception varied from 52 to 65% among HIV-positive women, and from 65 to 75% among HIV-negative women. Pregnancy incidence for 100 women-years at risk was 5.70 (95%CI: 4.17-7.23) and 4.37 (95%CI : 2.83-5.91) (p=0.237) and unwanted pregnancy incidence was 1.07 (95%CI: 0.41-1.73) and 2.39 (95%CI: 1.25-3.53) (p=0.023), respectively among HIV-positive and HIV-negative women. The end of post-partum abstinence, the death of the index child and the end of breastfeeding were positively linked to the arrival of a new pregnancy in the post-partum period. CONCLUSION: Among these women prenatally HIV-tested, family planning counselling and regular follow-up was accompanied by a high rate of contraceptive use after delivery, and consecutively to a low pregnancy incidence irrespective of serostatus. In particular, HIV-positive women had fewer unwanted pregnancies than HIV-negative women. Integration of adequate family planning services in the post-partum follow-up in prevention programs plays an important role in reducing the risk of mother-to-child transmission, by reducing pregnancies among HIV-positive women.
Language: French
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | INCIDENCE | PREGNANCY | WOMEN | HIV TESTING | CONTRACEPTIVE USAGE | CLINIC VISITS | VOLUNTARY COUNSELING AND TESTING | POSTPARTUM | FAMILY PLANNING | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Reproduction | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | Service Statistics | Program Activities | Programs | Organization and Administration | Puerperium | Program Evaluation
Document Number: 330856

20.

Title: Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa.
Author: Chhagan MK; Van den Broeck J; Luabeya KK; Mpontshane N; Tucker KL; Bennish ML
Source: European Journal of Clinical Nutrition. 2009 Jul;63(7):850-7.
Abstract: BACKGROUND/OBJECTIVE: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children. METHODS: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting. RESULTS: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children. CONCLUSIONS: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | DOUBLE-BLIND STUDIES | INFANT | DIARRHEA, INFANTILE | INCIDENCE | HIV INFECTIONS | FOOD SUPPLEMENTATION | ZINC | VITAMIN A | VITAMINS AND MINERALS | ANTHROPOMETRY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Measurement | Viral Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Metals | Physiology | Biology
Document Number: 342462

21.
Peer Reviewed

Title: The incidence and clinical presentation of infantile rotavirus diarrhoea in Sierra Leone.
Author: de Villiers FP; Sawyerr TN; de Villiers GK
Source: South African Medical Journal. 2009 Apr;99(4):249-52.
Abstract: OBJECTIVES: An effective vaccine is needed to protect against severe rotavirus disease, an important cause of gastroenteritis. Since there are no data on the incidence and antigenic diversity of rotavirus infection in Sierra Leone, we studied its epidemiology to enable an effective vaccine strategy to be designed. METHODS: Children between the ages of 3 and 30 months presenting with gastroenteritis to the Ola During Children's Hospital in Freetown, Sierra Leone, were enrolled. Stool specimens were tested in South Africa using polyacrylamide gel electrophoresis to confirm rotavirus infection. RESULTS: Over a 5-month period 143 children presenting with gastroenteritis were recruited. Stool samples obtained from 128 study subjects were tested for the presence of rotavirus; 45% were aged between 3 and 9 months (mean age 10.85 months), and 48 stool samples (37.5%) tested positive for rotavirus. The incidence of rotavirus infection was 20% higher in boys than in girls, a gender difference confirmed elsewhere in West Africa. The prevalence of rotavirus-positive stools peaked in August, coinciding with the rainy season. About 90% of the rotavirus-positive patients had severe diarrhoea, as opposed to only about two-thirds of the patients whose diarrhoea was not caused by rotavirus; this difference was statistically significant. CONCLUSIONS: There is a high incidence of rotavirus infection in Sierra Leone, with rotavirus causing 37.5% of the gastroenteritis in this study. Patients with rotavirus gastroenteritis almost all had severe diarrhoea. The high incidence of rotavirus infection and the severity of the disease presentation make the institution of a rotavirus vaccine programme in Sierra Leone imperative.
Language: English
Keywords:
SIERRA LEONE | SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | INFANT | ROTAVIRUS | VACCINES | GASTROINTESTINAL EFFECTS | DIARRHEA | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Africa, Southern | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 342499

22.

Peer Reviewed

Title: Intensified case finding for tuberculosis in prevention of mother-to-child transmission programs: a simple and potentially vital addition for maternal and child health.
Author: Deluca A; Chaisson RE; Martinson NA
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):196-9.
Abstract: The intersection of HIV and tuberculosis (TB) poses a serious threat to HIV-infected women and their children. The majority of patients with TB in sub-Saharan Africa are infected with HIV, and together the overlapping epidemics synergistically accelerate illness and death. Escalating case rates, increased mortality, and the recent emergence of extensively drug-resistant TB highlights how catastrophic a once preventable and curable disease has become among people with HIV/AIDS. The HIV epidemic requires new strategies to control TB in high-burden areas especially as women of reproductive age are disproportionately affected by the epidemic. Intensified case finding for TB has the potential to reduce morbidity and mortality for people living with HIV, especially pregnant women, their families, and infants. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | LITERATURE REVIEW | RECOMMENDATIONS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | COMPLICATIONS | INTEGRATED PROGRAMS | PREVALENCE | INCIDENCE | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Measurement
Document Number: 330367

23.

Title: Advances and future directions in HIV surveillance in low- and middle-income countries.
Author: Diaz T; Garcia-Calleja JM; Ghys PD; Sabin K
Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):253-9.
Abstract: PURPOSE OF REVIEW: To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries. RECENT FINDINGS: From 2001 to 2008, 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003-2004 to almost 2500 in 2005-2006, becoming more representative of rural areas. Between 2003 and 2007, at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations, although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected, and systems are now in place to measure HIV drug resistance. However, the reliable monitoring of trends and the measuring of HIV incidence, morbidity, and mortality is still a challenge. SUMMARY: In the past 5 years, there have been substantial improvements in the quantity and quality of HIV surveillance studies, especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence, morbidity, and mortality surveillance and to use data more effectively.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | RECOMMENDATIONS | HIV INFECTIONS | AIDS | EPIDEMICS | MONITORING | MORTALITY | PREVALENCE | HIV TESTING | DRUG RESISTANCE | INCIDENCE | Viral Diseases | Diseases | Evaluation | Population Dynamics | Demographic Factors | Population | Measurement | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment
Document Number: 342342

24.
Title: Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database.
Author: Einarson A; Choi J; Einarson TR; Koren G
Source: Journal of Obstetrics and Gynaecology Canada. 2009 May;31(5):452-6.
Abstract: OBJECTIVE: The use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in early pregnancy. METHODS: In a cohort of women who contacted the Motherisk program during pregnancy, we compared two groups of women, one exposed and the other not exposed to antidepressants during pregnancy, and calculated the associated rates of SA and TA. RESULTS: Among 937 women exposed to antidepressants prior to and during early pregnancy, there were 122 SAs (13.0%) including three ectopic pregnancies, and in the comparison group there were 75 SAs (8.0%) and no ectopic pregnancies. The relative risk was 1.63 (95% CI 1.24-2.14). Three-fold more women reported a TA in the exposed group, 26 (2.4%) compared to 8 (0.7%) in the non-exposed group (RR 3.25; 95% CI 1.48-7.14). A sub-analysis revealed that in both groups, of 338 women with a prior SA, 58 (17.2%) reported having a SA in the current pregnancy, compared with 61/652 (9.4%) with no prior SA (chi square = 12.09, P lt; 0.001). In the antidepressant group, the incidence was 20.7%, and in the non-exposed group, it was 13.3%. Logistic regression confirmed that only antidepressant exposure and prior SA were significantly associated with current SA. CONCLUSION: Exposure to antidepressants in the first trimester of pregnancy appears to be associated with a small but statistically significant increased risk of SA and decision to terminate a pregnancy. The risk for SA is further elevated with a history of previous SA. However, any underlying depression must be taken into consideration when evaluating these results.
Language: English
Keywords:
CANADA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | ABORTION, SPONTANEOUS | ABORTION | RISK FACTORS | DEPRESSION | DRUGS | PREGNANCY, FIRST TRIMESTER | INCIDENCE | INTERVIEWS | Developed Countries | North America, Northern | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Health | Mental Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Pregnancy | Reproduction | Measurement | Data Collection
Document Number: 342785 Notification

25.

Peer Reviewed

Title: HIV/AIDS epidemic features and trends in iran, 1986-2006.
Author: Fallahzadeh H; Morowatisharifabad M; Ehrampoosh MH
Source: AIDS and Behavior. 2009 Apr;13(2):297-302.
Abstract: This study describes the reported HIV/AIDS data for all verified cases in Iran between 1986 and 2006. The cumulative number of the reported cases of HIV/AIDS among Iranians, up to the end of September 2006 was 13,702. Over the 20-year surveillance period, the rate of HIV/AIDS infections diagnosed annually among Iranian citizens gradually increased and, over the period 1997-2004, it reached from 1.38 to 4.6 cases per 100,000 populations per year. Our findings highlight the need for intensified HIV prevention efforts with men who use drugs via injection and strengthened efforts to encourage the individual at risk to get tested for HIV.
Language: English
Keywords:
IRAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | LONGITUDINAL STUDIES | IV DRUG USERS | PERSONS LIVING WITH HIV/AIDS | MEN | PREVALENCE | HIV INFECTIONS | EPIDEMICS | INCIDENCE | HIV TESTING | Middle East | Developing Countries | Research Methodology | Studies | Drug Use and Abuse | Behavior | Viral Diseases | Diseases | Demographic Factors | Population | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 340129

26.

Peer Reviewed

Title: Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries.
Author: Filippi V
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):389-400.
Abstract: Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams to document and help reduce barriers to obstetric care in the most useful way and makes practical suggestions on interviews, analytical framework, ethical issues and staff motivation. Review of the evidence shows that case reviews and confidential enquiries appear particularly suitable to the understanding of delays. Criterion-based audits can also achieve this by establishing criteria for referral. However, hospital staff have limited intervention tools at their disposal to address barriers to emergency care at the community level. It is therefore important to involve the district management team and representatives of the community in auditing the health care seeking and treatment of women with near-miss complications.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | INCIDENCE | PREGNANT WOMEN | PREGNANCY COMPLICATIONS | EMERGENCY SERVICES | QUALITY OF HEALTH CARE | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341304

27.

Peer Reviewed

Title: Population-level effect of potential HSV2 prophylactic vaccines on HIV incidence in sub-Saharan Africa.
Author: Freeman EE; White RG; Bakker R; Orroth KK; Weiss HA; Buve A; Hayes RJ; Glynn JR
Source: Vaccine. 2009 Feb 5;27(6):940-6.
Abstract: Herpes simplex virus type-2 (HSV2) infection increases HIV transmission. We explore the impact of a potential prophylactic HSV2 vaccination on HIV incidence in Africa using STDSIM an individual-based model. A campaign that achieved 70% coverage over 5 years with a vaccine that reduced susceptibility to HSV2 acquisition and HSV2 reactivation by 75% for 10 years, reduced HIV incidence by 30-40% after 20 years (range 4-66%). Over 20 years, in most scenarios fewer than 100 vaccinations were required to avert one HIV infection. HSV2 vaccines could have a substantial impact on HIV incidence. Intensified efforts are needed to develop an effective HSV2 vaccine.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | INCIDENCE | HIV | HIV INFECTIONS | HIV PREVENTION | VACCINES | Africa | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330823

28.

Peer Reviewed

Title: Cervical human papillomavirus incidence and persistence in a cohort of HIV-negative women in Zimbabwe.
Author: Fukuchi E; Sawaya GF; Chirenje M; Magure T; Tuveson J; Ma Y; Shiboski S; Da Costa M; Palefsky J; Moscicki AB; Makunike-Mutasa R; Chipato T; Smith-McCune KK
Source: Sexually Transmitted Diseases. 2009 May;36(5):305-11.
Abstract: BACKGROUND: Persistent infections with oncogenic human papillomavirus (HPV) types are causally related to cervical cancer. Little is known about the distribution of HPV types, independent risk factors of incidence and persistence, and patterns of persistence in sub-Saharan Africa. METHODS: A cohort of 2040 Zimbabwean women was enrolled in a randomized trial assessing the effect of diaphragm/gel provision on human immunodeficiency virus and HPV acquisition. Data from the study arms were pooled for this analysis because diaphragm/gel provision did not affect HPV acquisition and clearance. Clinicians collected cervical samples for HPV testing at enrollment, 12 months, and exit (median 21 months). RESULTS: HPV prevalence was 24.5% for any HPV type and 16.1% for oncogenic types. HPV incidence at 12 months was 23.3% for any HPV type and 11.4% for oncogenic types. HPV58 had the highest baseline prevalence (5.0%) and incidence (2.4%). Type-specific persistence was 29.8% among all HPV infections over a median of 21 months of follow-up. Baseline predictors of incident HPV infection were younger age, having more than 1 lifetime sexual partner, infrequent condom use, herpes simplex virus-2 positive serology, and having a sexually transmissible infection or a different HPV type at enrollment. Baseline predictors of persistent HPV infection were younger age, having more than 1 lifetime sexual partner, and having a high-risk partner. CONCLUSIONS: The novel association between herpes simplex virus-2 seropositivity and incident HPV infection warrants further investigation. Having a high-risk partner is a potentially modifiable risk factor for persistent HPV infection. The relatively high prevalence of HPV58 has implications for vaccine development.
Language: English
Keywords:
ZIMBABWE | RESEARCH REPORT | COHORT ANALYSIS | WOMEN | HPV | INCIDENCE | PREVALENCE | CERVICAL CANCER | RISK FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Cancer | Neoplasms | Health
Document Number: 341440

30.
Title: [A fixed dose anti-HIV combination for the poor? Triomune] Triom une: la tritherapie du pauvre ?
Author: Garcia MV; Mukeba-Tshialala D; Vaira D; Moutschen M
Source: Revue Medicale De Liege. 2009 Jan;64(1):32-6.
Abstract: Despite a relative global stabilization of its incidence, HIV infection remains a major threat for public health, principally in Africa where it concerns more than 22 million people and constitutes the first cause of death on the continent. To face the emergency of the HIV/AIDS epidemics on the African continent, the primary goal is to make available to all patients free and efficient antiretroviral medications. Such a goal cannot be dissociated from large scale prevention campaigns. In 2000, Triomune, one of the first fixed dose combinations of three antiretrovirals (stavudine, lamivudine & nevirapine) was launched by the Indian drug company Cipla, specialized in the production of low cost medications. Its convenient pill burden (one pill twice a day) and its very low cost (around 30 US $ per month) make Triomune an appealing solution for the treatment of HIV/AIDS in Africa. Unfortunately, Triomune presents several drawbacks (low genetic barrier, frequent side effects) and one of its constituents is not used in Europe anymore. Other first line treatments are urgently needed.
Language: French
Keywords:
AFRICA | RESEARCH REPORT | INCIDENCE | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | HIV INFECTIONS | FEES | NEEDS ASSESSMENT | PREVENTION AND CONTROL | TREATMENT | PROGRAM ACCESSIBILITY | Developing Countries | Measurement | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341155


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