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Degradation Phenomena upon "Homemade" Explanted Aortic Linen Endografts.
BACKGROUND HPTN071(PopART) was a community-randomised trial of a universal testing-and-treatment intervention on HIV incidence at population-level in Zambia and South Africa. In Zambia, a trial of community-based distribution of HIV self-testing (HIVST) kits, including secondary distribution, as an option for HIV-testing was nested within four PopART intervention communities. We used data from the intervention arm of the nested trial to measure levels of and factors associated with acceptance and use of secondary distribution HIVST kits. METHODS Community HIV Care Providers (CHiPs) offered the PopART combination HIV-prevention intervention door-to-door, systematically visiting all households and enumerating all household members. From 1 February-30 April 2017, individuals ≥16-years consenting to PopART were offered the option to HIV self-test, if eligible for HIV-testing services. Individuals ≥18-years who reported a partner absent during household visits were offered an HIVST kit for secondary distribution to this partner. We used two data sources to measure acceptance and use of secondary distribution HIVST kits. RESULTS Among 9,105 individuals ≥18-years consenting to PopART, 9.1% (n=825) accepted an HIVST kit for secondary distribution. 55.8% reported that the kit had been used. Women were more likely to accept, and men more likely to use, secondary distribution HIVST kits. find more Kits were more likely to be used by individuals aged 30+ and who had not participated in a previous round of PopART. 6.8% had a reactive result. CONCLUSIONS Community-based secondary distribution of HIVST kits reached men absent during CHiPs household visits and is a complement to facility- and community-based HIV-testing services, which often miss men.INTRODUCTION Repeat HIV testing among pregnant and postpartum women enables incident HIV infection identification for targeted interventions. We evaluated oral HIV self-testing (HIVST) for repeat HIV testing among pregnant and postpartum women attending busy public clinics in East Africa. METHODS Between October 2018, and January 2019, we conducted a mixed methods pilot to evaluate the acceptability of oral based HIVST among pregnant and postpartum women within three public health facilities in Kisumu, Kenya. We invited 400 seronegative pregnant and postpartum women to choose between clinic-based oral HIVST and the standard finger prick provider-initiated testing and counselling for repeat HIV testing. We measured the frequency of each choice and described the participants' experiences with the choices, including data from three focus group discussions. RESULTS Slightly over half of women (53.8%, 95% confidence interval (CI) 48.7, 58.7) chose oral HIVST. Unmarried women were more likely to use HIVST (prevalence ratio (PR) 1.26, 95% CI 1.01, 1.57, p less then 0.05). The most frequent reason for oral HIVST selection was fear of the needle prick (101/215, 47.0%). More HIVST than PITC users indicated lack of pain (99.1% vs 34.6%, p less then 0.001) and need for assistance (18.1% vs 1.1%, p less then 0.001) as reflective of their HIV testing experiences. Participants choosing HIVST cited privacy, ease and speed of procedure as the main reasons for their preference. CONCLUSIONS The use of HIVST in Kenyan antenatal and postpartum settings appears to be feasible and acceptable for repeat HIV testing. Future work should explore the practical mechanisms for implementing such a strategy.BACKGROUND Higher cumulative burden of depression among people with HIV (PWH) is associated with poorer health outcomes; however, longitudinal relationships with neurocognition are unclear. This study examined hypotheses that among PWH 1) higher cumulative burden of depression would relate to steeper declines in neurocognition, and 2) visit-to-visit depression severity would relate to neurocognition within persons. SETTING Data was collected at a university-based research center from 2002-2016. METHODS Participants included 448 PWH followed longitudinally. All participants had >1 visit (M=4.97; SD=3.53) capturing depression severity (Beck Depression Inventory-II) and neurocognition (comprehensive test battery). Cumulative burden of depression was calculated using an established method that derives weighted depression severity scores by time between visits and total time on study. Participants were categorized into low (67%), medium (15%), and high (18%) depression burden. Multilevel modeling examined between- and within-person associations between cumulative depression burden and neurocognition over time. RESULTS The high depression burden group demonstrated steeper global neurocognitive decline compared to the low depression burden group (b=-0.100, p=0.001); this was driven by declines in executive functioning, delayed recall, and verbal fluency. Within-person results showed that compared to visits when participants reported minimal depressive symptoms, their neurocognition was worse when they reported mild (b=-0.12 p=0.04) or moderate-to-severe (b=-0.15, p=0.03) symptoms; this was driven by worsened motor skills and processing speed. CONCLUSIONS High cumulative burden of depression is associated with worsening neurocognition among PWH, which may relate to poor HIV-related treatment outcomes. Intensive interventions among severely depressed PWH may benefit physical, mental, and cognitive health.BACKGROUND A large-scale evaluation of mother-to-child transmission (MTCT) with dolutegravir (DTG)-based antiretroviral treatment (ART) has not been conducted previously. SETTING Botswana was the first African country to change from efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC) to DTG/TDF/FTC first-line ART. METHODS From April 2015-July 2018, the Early Infant Treatment Study offered HIV DNA testing at less then 96 hours of life. Maternal ART regimen was available for screened infants who could be linked to the separate Tsepamo surveillance study database. We evaluated characteristics of HIV-positive infants, and compared MTCT rates by ART regimen for linked infants. RESULTS Of 10,622 HIV-exposed infants screened, 42 (0.40%) were HIV-positive. In total, 5,064 screened infants could be linked to the surveillance database, including 1,235 (24.4%) exposed to DTG/TDF/FTC and 2,411 (47.6%) exposed to EFV/TDF/FTC. MTCT was rare when either regimen was started prior to conception 0/213 (0.00%, 95% CI 0.00%, 1.
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