Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda.
Ontology highlight
ABSTRACT:
SUBMITTER: Monod M
PROVIDER: S-EPMC10769880 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
Publications
Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda.
Monod Mélodie M Brizzi Andrea A Galiwango Ronald M RM Ssekubugu Robert R Chen Yu Y Xi Xiaoyue X Kankaka Edward Nelson EN Ssempijja Victor V Abeler-Dörner Lucie L Akullian Adam A Blenkinsop Alexandra A Bonsall David D Chang Larry W LW Dan Shozen S Fraser Christophe C Golubchik Tanya T Gray Ronald H RH Hall Matthew M Jackson Jade C JC Kigozi Godfrey G Laeyendecker Oliver O Mills Lisa A LA Quinn Thomas C TC Reynolds Steven J SJ Santelli John J Sewankambo Nelson K NK Spencer Simon E F SEF Ssekasanvu Joseph J Thomson Laura L Wawer Maria J MJ Serwadda David D Godfrey-Faussett Peter P Kagaayi Joseph J Grabowski M Kate MK Ratmann Oliver O
Nature microbiology 20231205 1
HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep-sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Ugand ...[more]
Similar Datasets
Project description:Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23-0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18-0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.
| S-EPMC10878534 | biostudies-literature
Project description:IntroductionHIV transmission to sexual partners is determined jointly by viraemia and condomless sex, both of which are higher among adolescents living with HIV compared with adults. Moreover, decisions around condom use vary day to day. We are the first study to investigate both the stable and time-varying factors contributing to HIV transmission risk.MethodsThe cohort study enrolled 251 adolescent boys 15-19 years old who were born with HIV and resided in Soweto, South Africa. Participants had viral load testing concurrently with completing baseline and 12-month follow-up surveys. Over the study year, participants completed repeated mobile surveys to capture time-variant exposures and condom use in the past 24 hours. Associations between baseline factors and high transmission risk (a composite of detectable viral load and any reported non-condom use) were analysed using logistic regression models. Associations between time-variant factors and condomless sex were analysed using generalised linear mixed-effect models.ResultsExperiencing an additional adverse event in the last year (adjusted OR (aOR) 1.33; 95% CI 1.09, 1.64), intimate partner violence (IPV; aOR 6.07; 95% CI 1.69, 21.80) and depression (aOR 2.96, 95% CI 1.03, 8.57) each increased the adjusted odds of being in the high-risk group for HIV transmission. When we examined time-variant factors, we found that a 10% higher average experience of stress (aOR 1.23; 95% CI 1.04, 1.46) and anger (aOR 1.26; 95% CI 1.04, 1.53) was significantly associated with increased odds of having condomless sex. There was no evidence that day-to-day changes in exposure to potential risk factors influenced condom use decisions.DiscussionGlobal strategies largely focus on reducing HIV infection risk from the perspective of adolescent girls and young women. This study adds to the growing evidence that childhood adversity, IPV victimisation and depression are related to sexual transmission risk, and importantly extends this finding to the expanding population of adolescent boys born with HIV. Tailoring violence and mental health support services to the needs of adolescent boys may have important implications for their well-being and the health of their partners.
| S-EPMC11843014 | biostudies-literature
Project description:BackgroundHIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings.MethodsThis was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory.ResultsA total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again.ConclusionsPlasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407.
| S-EPMC4746783 | biostudies-literature
Project description:BackgroundThe HIV/AIDS epidemic has been fuelled by gender inequality and disparity resulted in violation of women reproductive right. The "feminization" of the pandemic is more apparent in Sub-Saharan Africa where the larger numbers of HIV infected people are living. Although they carry the higher proportion of HIV cases; access to care and treatment is lower among women. In Ethiopia where HIV is prevalent and gender violence is common, the disparity may be higher. Therefore, this research aimed to assesses trends in gender disparity in the HIV/AIDS epidemic in Ethiopia to bring evidence for action.MethodsThis study was conducted using aggregates of HIV/AIDS indicator data from 1990 to 2016 of UNAIDS data bases. The data was compiled and analyzed with excel and STATA Version 11. The trend was assessed, gender difference was measured and rate of change was compared between genders and specific age groups.ResultAdult females (age 15+) accounted 61.5% of the HIV cases and new infection among adults. While, adolescent females (age 10-19) and young women (age 15-24) accounted 52.3 and 57.5% of prevalent cases and 74 and 68% of new infection in their age category respectively. HIV is 1.62 times more prevalent among adult women than men. Since 1990, HIV cases among adults has risen markedly in the first decade with 24 and 20%, then declined by 41.5% in the second decade and rose again by 5 and 8.7% among women and men respectively. The overall prevalence is declined by 72.4 and 71.5% from the maximum record. Women and men have equal access for ART; 62% of men and 61% of women from all adults living with HIV were on ART. While 61% of deaths were among adult women and the death rate is similar among adolescent women and men. AIDS- related death has been declined by 76% from the maximum record.ConclusionHIV/AIDS prevalence, new infection and AIDS-related death are by far higher among adult women than men. While the coverage of treatment and HIV care is equal among both genders. Vulnerable age groups (adolescent females and young women) take the lion's share of the new infections and prevalent cases. Therefore due attention is needed to avert gender disparity with a particular emphasis for adolescents and young women.
| S-EPMC6139900 | biostudies-literature
Project description:HIV nucleotide sequence data can identify clusters of persons with genetically similar strains suggesting transmission. We simulated the effect of lowered data completeness, defined by the percent of persons with diagnosed HIV with a reported sequence, on transmission patterns and detection of growing HIV transmission clusters. We analyzed HIV surveillance data for persons with HIV diagnosed during 2008-2014 who resided in Michigan or Washington. We calculated genetic distances, constructed the inferred transmission network for each jurisdiction, and compared transmission network characteristics and detection of growing transmission clusters in the full dataset with artificially reduced datasets. Simulating lower levels of completeness resulted in decreased percentages of persons linked to a cluster from high completeness (full dataset) to low completeness (5%) (Michigan: 54%-18%; Washington, 46%-16%). Patterns of transmission between certain populations remained robust as data completeness level was reduced. As data completeness was artificially decreased, sensitivity of cluster detection substantially diminished in both states. In Michigan, sensitivity decreased from 100% with the full dataset, to 62% at 50% completeness and 21% at 25% completeness. In Washington, sensitivity decreased from 100% with the full dataset, to 71% at 50% completeness and 29% at 25% completeness. Lower sequence data completeness limits the ability to detect clusters that may benefit from investigation; however, inferences can be made about transmission patterns even with low data completeness, given sufficient numbers. Data completeness should be prioritized, as lack of or delays in detection of transmission clusters could result in additional infections.
| S-EPMC8593790 | biostudies-literature
Project description:Previous research has shown that woman-headed households, more than man-headed ones, experience food insecurity. The purpose of this article is to contribute on the determinants that are linked to this gender disparity. Using a nationally representative dataset from Chile, we found that food security household head gender disparity is associated with marital status (having or not a partner) and household composition (having children or seniors). In contrast, gender disparity is not strongly associated with household income and household head educational differences. In this way, we expect to bring evidence to inform new alternatives that help mitigate food security gender disparity.
| S-EPMC10426994 | biostudies-literature
Project description:The genesis of hepatocellular carcinoma (HCC) is closely related to hyper-activated Ras signals and male factors. This study aimed to characterize the underlying mechanisms by examining the transcriptome of Hras12V transgenic mice (Ras-Tg, HCC model). A transcriptomic database was established via RNA-Seq of HCC (T) and the adjacent precancerous liver tissue (P) of Ras-Tg and the normal liver tissue of wild-type mice (W) of both sexes. Bioinformatics analysis as well as metabolite and gene expression assays were performed. Totally, 2708 differentially expressed genes (DEGs) were screened out (FC ≥ 2 and q < 0.05). Longitudinal comparative analysis within W, P, and T and correlation expression pattern analysis revealed common/unique cluster-enriched items towards HCC between the sexes. Specifically, the numbers of DEGs were much higher in females than in males, and tumor suppressor genes, such as p21Waf1/Cip1 and C6, were significantly higher in the female P. This finding denotes the higher sensitivity of female hepatocytes to the Ras oncogene and, therefore, the difficulty in developing HCC. Moreover, convergence in HCC between the sexes suggests the underlying mechanisms for ineffectiveness of sex hormone therapies. Additionally, expression pattern analysis revealed that the DEGs and their relevant pathways were either positively or negatively associated with the HCC/Ras oncogene. Among them, the vital role of glutathione metabolism in HCC was established. The systemic transcriptomic database of the Ras oncogene-induced HCC with sex disparities provides valuable clues for elucidating the underlying mechanisms, selecting the diagnostic biomarker, and planning the clinical therapy in HCC.
2024-05-18 | GSE232694 | GEO
Project description:BackgroundAlcohol use is a major contributor to mortality and morbidity worldwide. Uganda has a high level of alcohol use per capita. Compared to men, women are less likely to consume alcohol globally; however, women who drink have increased risks for co-occurring conditions, including depression, intimate partner violence, and HIV. This study assessed the prevalence of alcohol use and correlates of harmful alcohol use by gender and HIV status in rural Uganda.MethodsWe used cross-sectional data from a study among women and men aged 15-59 residing in rural, central Uganda and accepting home-based HIV testing (Nov 2017 to Dec 2020). We estimated the prevalence of levels of alcohol use (categorized as no alcohol use (score 0), low (score 1-3 for men; 1-2 for women), medium (score 4-5 for men; 3-5 for women), high (score 6-7), and very-high (score 8-12) use with the AUDIT-C), stratified by gender and HIV status. We assessed correlates of harmful alcohol use using multivariable logistic regression models for women and men.ResultsAmong 18,460 participants, 67% (95% CI: 66-67%) reported no alcohol use, 16% (95% CI: 16-17%) reported low, 5% (95% CI: 4.8-5%) reported medium, 5% (95% CI: 4-5%) reported high, and 3% (95% CI: 2.8-3) reported very high alcohol use. Compared to women, men were more likely to report alcohol use (Chi-squared p-value<0.0001). People diagnosed with HIV (both newly diagnosed and previously aware of their status prior to home-based HIV testing) were more likely to report low, medium, high, and very high alcohol use compared to those who were HIV negative (Chi-squared p-value<0.0001). Among women, those who were newly diagnosed were more likely report alcohol use, compared to those who were HIV negative. In multivariable models, being newly diagnosed with HIV (compared to HIV negative) increased the odds of harmful alcohol use among women, but not men.ConclusionWhile alcohol use was higher among men and people living with HIV, being newly diagnosed with HIV had a stronger relationship with harmful alcohol use among women than men. More research is needed to understand how alcohol use may increase the risks of HIV acquisition among women and to identify gender-responsive services to address harmful alcohol use and increase access to HIV testing and linkage to care for women who use harmful levels of alcohol.
| S-EPMC11251619 | biostudies-literature
Project description:BackgroundPrediction of HIV transmission cluster growth may help guide public health action. We developed a predictive model for cluster growth in North Carolina (NC) using routine HIV surveillance data.MethodsWe identified putative transmission clusters with ≥2 members through pairwise genetic distances ≤1.5% from HIV-1 pol sequences sampled November 2010-December 2017 in NC. Clusters established by a baseline of January 2015 with any sequences sampled within 2 years before baseline were assessed for growth (new diagnoses) over 18 months. We developed a predictive model for cluster growth incorporating demographic, clinical, temporal, and contact tracing characteristics of baseline cluster members. We internally and temporally externally validated the final model in the periods January 2015-June 2016 and July 2016-December 2017.ResultsCluster growth was predicted by larger baseline cluster size, shorter time between diagnosis and HIV care entry, younger age, shorter time since the most recent HIV diagnosis, higher proportion with no named contacts, and higher proportion with HIV viremia. The model showed areas under the receiver-operating characteristic curves of 0.82 and 0.83 in the internal and temporal external validation samples.ConclusionsThe predictive model developed and validated here is a novel means of identifying HIV transmission clusters that may benefit from targeted HIV control resources.
| S-EPMC6692892 | biostudies-literature
Project description:BackgroundRespiratory cryptosporidiosis is recognized as a late-stage complication in persons with human immunodeficiency virus (HIV) infection and AIDS. However, respiratory signs and symptoms are common in otherwise healthy children with intestinal cryptosporidiosis, which suggests that respiratory infection may occur in immunocompetent hosts.MethodsWe recruited children 9-36 months of age who presented with diarrhea to Mulago Hospital in Kampala, Uganda, from November 2007 through January 2009. Children with stool samples positive or negative for Cryptosporidium species were selected for further evaluation, including sputum induction in those with cough or unexplained respiratory signs and collection of saliva and blood specimens. Sputum samples were subjected to comprehensive bacteriologic testing, and both sputum and saliva specimens were tested for Cryptosporidium species by nested polymerase chain reaction.ResultsOf 926 fecal samples screened, 116 (12.5%) were positive for Cryptosporidium. Seventeen (35.4%) of 48 sputum samples tested from children with positive stool samples were positive for Cryptosporidium. Sixteen (94.1%) of the 17 children with confirmed respiratory cryptosporidiosis were HIV seronegative, and 10 (58.8%) of 17 children were not malnourished. None of the 12 sputum specimens from children with negative stool samples tested positive for Cryptosporidium (P = .013, compared with children who tested positive for Cryptosporidium in the stool). Parasite DNA was detected in only 2 (1.9%) of 103 saliva samples (P < .001, compared with sputum samples).ConclusionsRespiratory cryptosporidiosis was documented in one-third of HIV-seronegative children who were tested. These novel findings suggest the potential for respiratory transmission of cryptosporidiosis. Trial registration. ClinicalTrials.gov identifier: NCT00507871.
| S-EPMC2856758 | biostudies-literature