Abstract Occupational settings offer an ideal opportunity to provide preventive health services for HIV-infected workers. A specialized clinic was established in a mining hospital in the Free State, South Africa, with the primary aim of delivering preventive therapy such as isoniazid to those at high risk of tuberculosis (individuals with HIV infection or silicosis), and cotrimoxazole to those at highest risk for opportunistic infections. The clinic design has taken regard of the importance of minimizing stigma, protecting confidentiality, monitoring potential side effects, supporting adherence and identification of prophylaxis failure. The clinic opened in April 1999 and, by August 2001, 1773 patients had attended at least once; 1762 are HIV-infected and 11 have silicosis. Of those with HIV infection, most were asymptomatic at their first visit. The clinic has achieved high acceptability: 99% of persons who were actively recruited to the service agreed to attend. The number still attending after a median of 13 months from recruitment was 1,270 (72%) and only 48 (2.7%) have declined continued attendance. Most losses were due to termination of employment unrelated to a medical condition. The clinic has already been successfully replicated in two other regions of the mining health service in South Africa and provides a model for workplace HIV clinical services that could be used for implementation of further interventions such as antiretroviral therapy. Acknowledgments The authors thank the staff of Ernest Oppenheimer Hospital (EOH) outpatients department and medical department for their assistance in establishing the clinic. The assistance of the laboratory and radiology departments at EOH is gratefully acknowledged. The efforts of the staff of Aurum Health Research in recruitment of patients, establishing the focus group and assistance with training are appreciated. Anglogold provided funding for the study.

Attendance

10.1080/09540120310001633967

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Additional file 2 of Cluster randomised trials with a binary outcome and a small number of clusters: comparison of individual and cluster level analysis method

Figshare (2022)

JA Thompson Clémence Leyrat Katherine Fielding Richard Hayes

Additional file 2. Code to replicate illustrative example.

10.6084/m9.figshare.20484843

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HIV-associated adult mortality in a rural Tanzanian population

AIDS (1997)

Jim Todd Rebecca Balira Heiner Grosskurth Philippe Mayaud Frank Mosha

Objective: To measure HIV-associated adult mortality in a rural population in Tanzania. To record the signs and symptoms associated with deaths of HIV-positive adults. Design: Prospective cohort study conducted in the context of a randomized controlled trial to evaluate the impact of a sexually transmitted disease treatment programme. Methods: A cohort consisting of a random sample of 12 501 adults aged 15–54 years was recruited from 12 rural communities in Mwanza region, Tanzania in 1991/1992. Baseline HIV prevalence was 4.0%. The cohort was followed up after 2 years to record mortality according to baseline HIV status. A verbal autopsy questionnaire was administered for each of the deaths reported. Results: A total of 196 deaths were recorded, of which 73 (37%) occurred in HIV-positive individuals. Mortality rates per 1000 person-years were 6.0 in HIV-negatives and 93.5 in HIV-positives. The age-adjusted mortality rate ratio was 15.68 (95% confidence interval, 11.18–21.03). The proportion of adult deaths attributed to HIV infection was 35% overall and 53% in those aged 20–29 years. Verbal autopsies showed that HIV-positive deaths were significantly associated with fever, rash, weight loss, anaemia, cough, chest pain, abdominal pain and headache, but the specificity of individual symptoms was low. The World Health Organization clinical case definition of AIDS was satisfied for only 13 deaths, of which seven were HIV-positive at baseline. Only seven respondents reported that the death was associated with HIV or AIDS. Conclusions: This study confirms the strong association of HIV infection and mortality in rural Africa, with an annual death rate in adult seropositives of over 9%. In this rural population with a relatively low HIV prevalence of 4%, HIV has increased overall adult mortality by more than 50%. Signs and symptoms associated with HIV deaths were non-specific, and the population seemed largely unaware of the contribution of HIV to mortality, an important obstacle to prevention efforts.

Verbal autopsy

10.1097/00002030-199706000-00013

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Irish Historical Sources in Foreign Archives

Archivalische Zeitschrift (1955)

Richard Hayes

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10.7788/az-1955-jg21

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Impact of HIV on tuberculosis in Zambia: a cross sectional study.

BMJ (1990)

Alison M. Elliott N. Luo Godwin Tembo B Halwiindi G Steenbergen

OBJECTIVE--To examine the contribution of HIV infection to the apparently increasing incidence of tuberculosis in central Africa. DESIGN--Cross sectional study. SETTING--Outpatient clinic in teaching hospital, Lusaka, Zambia. PATIENTS--346 Adult patients with tuberculosis. RESULTS--Overall, 206 patients (60%; 95% confidence interval 54% to 65%) were positive for HIV--in one or both assays used. The peaks for both tuberculosis and HIV infection were among men aged 25-34 years and women aged 14-24 years. Of patients with confirmed pulmonary tuberculosis, 73/149 (49%; 41% to 57%) were positive for HIV; 67/83 (81%; 70% to 89%) patients with pleural disease and 16/19 (84%; 60% to 97%) patients with pericardial disease were positive. HIV positive patients with positive sputum culture were less likely to have had a positive sputum smear, and their chest x ray films less often showed classic upper zone disease or cavitation. Of 72 patients who fulfilled clinical criteria for AIDS, 17 were negative for HIV. CONCLUSIONS--The high prevalence of HIV in patients with tuberculosis suggests that an epidemic of reactivating tuberculosis is arising in those who are infected with HIV. The redirection of public health priorities towards tuberculosis would focus on a major treatable and preventable complication of the AIDS epidemic.

Cross-sectional study

Sputum culture

10.1136/bmj.301.6749.412

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The epidemiology of HSV-2 infection and its association with HIV infection in four urban African populations

AIDS (2001)

Helen A. Weiss A. Buvé Noah Jamie Robinson Eric Van Dyck Maina Kahindo

To estimate age- and sex-specific herpes simplex virus type-2 (HSV-2) prevalence in urban African adult populations and to identify factors associated with infection.Cross-sectional, population-based samples of about 2000 adults interviewed in each of the following cities: Cotonou, Benin; Yaoundé, Cameroon; Kisumu, Kenya and Ndola, Zambia. Consenting study participants were tested for HIV, HSV-2 and other sexually transmitted infections.HSV-2 prevalence was over 50% among women and over 25% among men in Yaoundé, Kisumu and Ndola, with notably high rates of infection among young women in Kisumu and Ndola (39% and 23%, respectively, among women aged 15-19 years). The prevalence in Cotonou was lower (30% in women and 12% in men). Multivariate analysis showed that HSV-2 prevalence was significantly associated with older age, ever being married, and number of lifetime sexual partners, in almost all cities and both sexes. There was also a strong, consistent association with HIV infection. Among women, the adjusted odds ratios for the association between HSV-2 and HIV infections ranged from 4.0 [95% confidence interval (CI) = 2.0-8.0] in Kisumu to 5.5 (95% CI = 1.7-18) in Yaoundé, and those among men ranged from 4.6 (95% CI = 2.7-7.7) in Ndola to 7.9 (95% CI = 4.1-15) in Kisumu.HSV-2 infection is highly prevalent in these populations, even at young ages, and is strongly associated with HIV at an individual level. At a population level, HSV-2 prevalence was highest in Kisumu and Ndola, the cities with the highest HIV rates, although rates were also high among women in Yaoundé, where there are high rates of partner change but relatively little HIV infection. The high prevalence of both infections among young people underlines the need for education and counselling among adolescents.

Cross-sectional study

10.1097/00002030-200108004-00011

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Antenatal syphilis screening in sub‐Saharan Africa: lessons learned from Tanzania

Tropical Medicine & International Health (2005)

Deborah Watson‐Jones Monique Oliff Fern Terris‐Prestholt John Changalucha Balthazar Gumodoka

Summary Objectives To synthesise data from four recent studies in Tanzania examining maternal syphilis screening and its operational implementation in routine antenatal clinics (ANC), drawing lessons for strengthened antenatal services for the prevention of mother‐to‐child transmission (PMTCT) of HIV. Methods The impact of untreated maternal syphilis was examined in a retrospective cohort of 380 Tanzanian women. Effectiveness and cost‐effectiveness of screening and single dose benzathine penicillin treatment were prospectively examined in 1688 pregnant women. Observation, interviews and facility audits were carried out in health facilities within nine districts to determine the operational reality of syphilis screening. Results Overall, 49% of women with untreated high titre syphilis experienced an adverse pregnancy outcome compared with 11% of uninfected women. Stillbirth and low birthweight rates among those treated for high‐ or low‐titre syphilis were reduced to rates similar to those for uninfected women. The economic cost was $1.44 per woman screened and $10.56 per disability‐adjusted life year saved. In the operational study, only 43% of 2256 ANC attenders observed were screened and only 61% of seroreactive women and 37% of their partners were treated. Adequate training, continuity of supplies, supervision and quality control are critical elements for strengthened antenatal services, but are frequently overlooked. Conclusions Maternal syphilis has a severe impact on pregnancy outcome. Same‐day screening and treatment strategies are clinically effective and highly cost‐effective, but there are significant challenges to implementing syphilis screening programmes in sub‐Saharan Africa. Current PMTCT interventions present an opportunity to reinforce and improve syphilis screening. Increasing PMTCT coverage will involve similar operational challenges to those faced by syphilis screening programmes.

10.1111/j.1365-3156.2005.01473.x

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Developing a Testing Device for Total Pavements Acceptance

Kenneth H. Stokoe Loukas F. Kallivokas Boo Hyun Nam Claire K Carpenter Jung-Su Lee

During the second year of Project 0-6005, significant progress was made towards building the Total Pavement Acceptance Device (TPAD). The TPAD will be a multi-function device that will be used to profile continuously along pavements at speeds in the range of 5 to 10 mph. The test functions will include those associated with Rolling Dynamics Deflectometer (RDD), ground penetrating radar (GPR), Distance Measurement Instrument (DMI) and high-precision differential Global Positioning System (GPS), and surface temperature measurements, as well as digital video imaging of the pavement and right-of-way conditions. The specifications, bid documents, bid acceptances, and purchase of the TPAD mobile platform and the TPAD transportation equipment (tractor and trailer) were completed by the University of Texas Center for Transportation Research team. Construction of the TPAD is well underway and the acceptance testing will be done in early Year 3. Progress was also made in developing (1) improved rolling sensors and associated data analysis methods commensurate with the target testing speeds and (2) a second-generation integrated data acquisition and display system which records all test functions on the same time and distance baselines.

Tractor

Acceptance testing

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Rising HIV-1 prevalence among sexually transmitted disease clinic attenders in Jamaica: traumatic sex and genital ulcers as risk factors.

PubMed (1994)

Figueroa Jp A R Brathwaite J Morris Elizabeth Ward Armando Peruga

Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4-72], past history of genital ulcer (OR, 4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1-9.5), and history of genital ulcer (OR, 2.9; CI, 1.0-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)

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Improving the lives of married adolescent girls in Amhara Ethiopia: a summary of the evidence.

Jeffrey Edmeades Richard Hayes G Gaynair

Overall ICRW’s evaluation findings demonstrate that the lives of married adolescent girls were greatly enhanced by girls’ participation in TESFA particularly those involved in the SRH group. Large and significant improvements in communication among couples in the girls’ mental health and in the community’s support for the girls were documented -- each of which affects young wives’ health and economic behavior. In terms of ICRW’s key research question the evaluation produced little evidence indicating that combining economic empowerment and sexual and reproductive health programming results in even better outcomes than when offering these curricula separately. While the improvements in the economic outcomes were similar across the project groups there was no area where the Combined arm consistently outperformed the EE group. This was also true when examining the SRH outcomes. However the Combined arm generally experienced changes in both the EE and SRH dimensions that were greater than the Comparison group and than arms that received solely one type of intervention. This suggests that while there is no evidence of a synergistic effect girls receiving the Combined package may have experienced the greatest overall gains from program participation benefiting significantly in terms of both economic and health outcomes. Overall ICRW’s findings from TESFA provide a rich deeper understanding of the needs of married adolescent girls. However we have much more to learn including how to: Best reach the most marginalized of girls including those who are divorced or widowed; Better meet the economic needs of married girls; More effectively work with couples rather than individuals to improve the lives of married girls; Assess the long-term effects of interventions targeting child brides and how integrated programming can best work on their behalf. (Excerpts)

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