Predictors of HIV Infection Risk among Health-Care Workers in Sub-Saharan Africa: A Systematic Review

The study set out to investigate the determinants of HIV infection risk among healthcare workers in SSA through a systematic review. The aim of the study was to identify, collect and systematically review and synthesize existing literature articles on the determinants of HIV infection risk among healthcare workers in SSA. The objectives of the study were to: determine the prevalence of health care workers' exposure to HIV risky conditions in health care settings in SSA; identify selected determinants of HIV infection risk among Health care workers in SSA (major focus in Nigeria, South Africa, and Tanzania) and apply effective strategies to prevent issues associated with HIV infection risk among Health care workers. The study conceptualizes that HCWs in the SSA region are at risk of HIV infection due to factors related to lack of healthcare resources, their knowledge, attitude and practice, and barriers to reporting. The combined effect of these factors is that hoped to determine the propensity of HCWs to be infected by HIV/AIDS. The key themes guiding the systematic review were: risk to exposure to HIV among HCWs; lack of health care resources and facilities. The findings of the study confirmed all the three alternative study hypotheses that: there is a significant relationship between lack of health care resources and facilities and the risk of HIV infection among HCWs in SSA; there is a significant relationship between HCWs’ knowledge, attitude, and practice on HIV and their risk of HIV infection in SSA and; there is a significant relationship between barriers to reporting and the risk of HIV infection among HCWs in SSA. In this regard, the study found out that HCWs in SSA are at high risk of HIV exposure whilst working. In this regard, this is a result of lack of enough equipment, poor practices at work and barriers to reporting, including stigmatization and lack of well-stipulated reporting guidelines. As such, the following recommendations were made:: there is a need to increase funding in the health care sector to enhance access to the right equipment, microbicides, vaccination, and PEP for HCWs; there is a need for psychosocial support systems to make it easy for HCWs to report infection with ease and that; the government should adopt recommended global best standards to enhance protection of HCWs while at work in SSA. Two areas for further study were also recommended. As such, there is a need for studies on each of the study objectives, and; there is a need for a descriptive study on the topic under investigation in this study for correlation purposes.

Risk of Subsequent HIV Infection Following Sexually Transmissible Infections Among Men Who Have Sex With Men

Background HIV and bacterial sexually transmissible infection (STI) notifications among men who have sex with men (MSM) have increased in Australia and many other countries. The relationship between HIV infection and other STIs has been demonstrated previously. However, the relationship between the cumulative history of STIs and subsequent HIV infection remains largely unexplored and limits our understanding of the mechanisms underpinning the elevated HIV risk. Methods Data from HIV-negative MSM who attended high–HIV caseload primary care clinics in Melbourne, Australia, from 2007 to 2014 with 2 or more HIV and STI tests were included. Controlling for sexual behaviors self-reported at clinic visits, discrete time survival analyses using generalized linear modeling estimated the effect of an STI at the prior test event and the cumulative history of STIs (none, 1, 2, or more [repeated]) on risk of HIV infection. Results A total of 8941 MSM met the study criteria; 227 (2.5%) were diagnosed with HIV over the follow-up period. Adjusting for sexual behaviors, a cumulative history of repeated rectal gonorrhea infections (adjusted hazard ratio [aHR], 6.27; 95% confidence interval [CI], 2.68–14.50) and a single rectal gonorrhea infection (aHR, 2.09; 95% CI, 1.15–3.79) were associated with increased HIV infection risk. Conclusions Repeated and single rectal gonorrhea infections were independently associated with increased HIV infection risk. These findings suggest that MSM with any history of rectal gonorrhea, particularly repeat rectal gonorrhea, represent a group for whom preventive interventions for HIV should be emphasized.

Revisiting the Correlate of Reduced HIV Infection Risk in the Rv144 Vaccine Trial

ABSTRACT The RV144 vaccine trial is the only clinical study to have shown a modest but statistically significant decrease in HIV infection risk. RV144 and the subsequent studies identifying the level of V1V2-specific antibodies as a correlate of reduced infection risk are still controversial despite many papers supporting and expanding the initial study. We address these controversies and summarize active-immunization and passive-immunization experiments in nonhuman primates that support the initial finding.

Age-disparate partnerships and HSV-2 among adolescent girls and young women in South Africa: implications for HIV infection risk

ObjectiveThere is an urgent need to understand high HIV-infection rates among young women in sub-Saharan Africa. While age-disparate partnerships have been characterised with high-risk sexual behaviours, the mechanisms through which these partnerships may increase HIV-risk are not fully understood. This study assessed the association between age-disparate partnerships and herpes simplex virus type-2 (HSV-2) infection, a factor known to increase HIV-infection risk.MethodsCross-sectional face-to-face questionnaire data, and laboratory HSV-2 and HIV antibody data were collected among a representative sample in the 2014/2015 household survey of the HIV Incidence Provincial Surveillance System in KwaZulu-Natal, South Africa. Among 15–24-year-old women who reported having ever had sex (n=1550), the association between age-disparate partnerships (ie, male partner ≥5 years older) and HSV-2 antibody status was assessed using multivariable Poisson regression models with robust variance. Analyses were repeated among HIV-negative women.ResultsHSV-2 prevalence was 55% among 15–24-year-old women. Women who reported an age-disparate partnership with their most recent partner were more likely to test HSV-2 positive compared with women with age-similar partners (64% vs 51%; adjusted prevalence ratio (aPR):1.19 (95% CI 1.07 to 1.32, p<0.01)). HSV-2 prevalence was also significantly higher among HIV-negative women who reported age-disparate partnerships (51% vs 40 %; aPR:1.25 (95% CI 1.05 to 1.50, p=0.014)).ConclusionsResults indicate that age-disparate partnerships are associated with a greater risk of HSV-2 among young women. These findings point towards an additional mechanism through which age-disparate partnerships could increase HIV-infection risk. Importantly, by increasing the HSV-2 risk, age-disparate partnerships have the potential to increase the HIV-infection risk within subsequent partnerships, regardless of the partner age-difference in those relationships.