Roger Bayingana

Influence network effectiveness in promoting couples HIV voluntary counseling and testing in Kigali Rwanda.

Objective:To identify predictors of promotion of couples’ HIV voluntary counseling and testing (CVCT) in Kigali, Rwanda. Design:Analysis of CVCT promotional agent [influential network leaders (INLs), influential network agents (INAs)], and couple/invitation-level predictors of CVCT uptake. Methods:Number of invitations and couples tested were evaluated by INL, INA, and couple/contextual factors. Multivariable logistic regression accounting for two-level clustering analyzed factors predictive of couples’ testing. Results:Twenty-six INLs recruited and mentored 118 INAs who delivered 24 991 invitations. 4513 couples sought CVCT services after invitation. INAs distributed an average of 212 invitations resulting in an average of 38 couples tested/agent. Characteristics predictive of CVCT in multivariate analyses included the invitee and INA being socially acquainted [adjusted odds ratio (aOR) = 1.4; 95% confidence interval (CI) 1.2–1.6]; invitations delivered after public endorsement (aOR = 1.3; 95% CI 1.1–1.5); and presence of a mobile testing unit (aOR = 1.4; 95% CI 1.0–2.0). In stratified analyses, predictors significant among cohabiting couples included invitation delivery to the couple (aOR = 1.2; 95% CI 1.0–1.4) and in the home (aOR = 1.3; 95% CI 1.1–1.4), whereas among noncohabiting couples, predictors included invitations given by unemployed INAs (aOR = 1.7; 95% CI 1.1–2.7). Cohabiting couples with older men were more likely to test, whereas younger age was associated with testing among men in noncohabiting unions. Conclusions:Invitations distributed by influential people were successful in prompting couples to seek joint HIV testing, particularly if the invitation was given in the home to someone known to the INA and accompanied by a public endorsement of CVCT. Mobile units also increased the number of couples tested. Country-specific strategies to promote CVCT programs are needed to reduce HIV transmission among those at highest risk for HIV in sub-Saharan Africa.

Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia.

BACKGROUND HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods--intrauterine devices (IUD) and hormonal implants--among HIV-discordant couples in Rwanda and Zambia. STUDY DESIGN Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD or implant on-site. RESULTS Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a womans younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms. CONCLUSIONS Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.

Syphilis Treatment Response Among HIV-Discordant Couples in Zambia and Rwanda

BACKGROUND Syphilis continues to be a common sexually transmitted infection, despite the availability of inexpensive and effective treatment. Infection in human immunodeficiency virus (HIV)-discordant couples is important because syphilis increases the risk of HIV acquisition. Current US treatment guidelines recommend 1 dose of benzathine penicillin for early syphilis, irrespective of HIV status, but data from coinfected patients are limited. METHODS Retrospective analysis of 1321 individuals in 2 African HIV-discordant couple cohorts was performed. Cox proportional hazards analysis and multivariable modeling were used to assess predictors of serologic response to treatment at 180 days and 400 days. Modeling was performed for all episodes of positive rapid plasma reagin (RPR) test results and on a subset with higher RPR titers (≥1:4). RESULTS A total of 1810 episodes of syphilis among 1321 individuals were treated with penicillin between 2002 and 2008. Although a positive RPR was more common in the HIV-infected partners, HIV infection did not impact the likelihood of serologic response to therapy (odds ratio [OR], 1.001; P = .995). By 400 days, 67% had responded to therapy, 27% were serofast, and 6.5% had documented reinfection. Prevalent infections were more likely to remain serofast than incident infections (33% vs 20% at 400 days). CONCLUSIONS In 2 HIV-serodiscordant couple cohorts in Africa, incident syphilis had a very good likelihood of response to penicillin therapy, irrespective of HIV infection. This supports current Centers for Disease Control and Prevention treatment guidelines. A high proportion of prevalent RPR-positive infections remain serofast despite treatment.

What the better half is thinking: A comparison of men’s and women’s responses and agreement between spouses regarding reported sexual and reproductive behaviors in Rwanda

Objective To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda. Design Cross-sectional survey. Methods Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires. Participants were recruited from a three-year old cohort of 1458 antenatal clinic attendees enrolled in a prospective study in 1988. Analyses compared responses at the gender- and couple-level for agreement and disagreement. Results Couples were in disagreement more than agreement. Women reported occasionally refusing sex, suggesting condom use, and believing married men were unfaithful. Men reported being in a faithful relationship, greater condom use, and being understanding when wives refused sex. Agreement included relationship characteristics, safety of condoms, and whether condoms had ever been used in the relationship. Disagreement included the preferred timing of next pregnancy, desire for more children, and whether a birth control method was currently used and type of method. Conclusions Rwandan husbands and wives differed in sexual behavior and reproductive-related topics. Couple-level reporting provides the most reliable measure for relationship aspects as couples’ agreement cannot be assumed among cohabiting partnerships. Furthermore, HIV prevention programs for couples should incorporate communication skills to encourage couple agreement of HIV-related issues.

Tolerability and acceptability of electroporation during a Phase 1 vaccine trial at two sites in Uganda and Rwanda

Background DNA vaccines are weakly immunogenic in humans and one way of increasing their immunogenicity is by administering the vaccines using electroporation (EP). This technique increases the uptake of the DNA into the cell by producing an electrical field which makes the cellular membrane more permeable. In the ongoing trial, we are using the ICHOR TriGrid Delivery system (TDS-IM) to administer bilateral injections of an HIV pDNA vaccine by EP into the medial deltoid muscles.

P14-09. Use of HIV rapid tests for assessment of persistence of vaccine induced antibodies among HIV vaccine recipients.

Methods Between September 2005 and May 2006, 57 healthy, HIVuninfected adult volunteers (36 males and 21 females) were enrolled in a phase-I, randomized, placebo-controlled HIV vaccine trial at Projet San Francisco in Kigali, Rwanda. At the end of the trial and after unblinding, all volunteers were asked to participate in a long-term followup study for continuous clinical and immunological evaluation. HIV testing using three rapid tests (Abbott DetermineTM HIV1-2, Trinity Biotech CapillusTM HIV-1/HIV-2 and Trinity Biotech Uni-GoldTM HIV) and an ELISA test (Bio-Merieux Vironostika HIV Uniform II Ag/Ab) was performed every three months.

Rwandan stakeholder perspectives of integrated family planning and HIV services

Summary The purpose of this qualitative study was to understand the knowledge, attitudes, and practices among key Rwandan policymakers and stakeholders related to family planning (FP) and integrated HIV/FP services. Motivational in‐depth interview format and content was developed after an extensive policy review. A convenience sample of 10 high‐level HIV and FP Rwandan policymakers and stakeholders completed the interview. Stakeholders demonstrated strong foundational knowledge of HIV and FP. Given the choice, stakeholders would allocate more monies to FP and less to HIV than currently distributed. Respondents felt that improved FP method knowledge, especially long‐acting reversible contraception, among clients/couples and providers, was needed to address myths, misconceptions, and biases. The most often cited way to integrate HIV/FP services was development of integrated tools (eg, training materials, data collection tools, and advocacy and policy guidance). We recommend strategies for policy advancement supportive of HIV/FP service integration inclusive of couples and long‐acting reversible contraception methods.

HIV disease progression compared by linkage status in Rwanda and Zambia

Background Recently HIV infected individuals are followed up at Rwanda-Zambia HIV Research Group (RZHRG) sites to establish markers of disease progression. Here we compare disease progression between seroconverters infected by their spouses (linked transmission) to those infected by non-spousal partners (unlinked transmission) where a greater fraction of individuals are infected by multiple virus variants. Methods Seroconverters (SC) were identified from HIV discordant couples enrolled from the Couples’ VCT program into a prospective cohort study. Linkage of transmission was established by comparing viral DNA sequences in the SC to that of the suspected index partner. SCs were followed up to six years to collect clinical and laboratory data. Data analysis using STATA was done on CD4 and viral load trajectories and a comparison of disease progression with respect to time to endpoints of CD4 <350 cells/uL and initiation of ARVs. Log rank test of equality for survival function was performed for each endpoint and p-values calculated.

Sexual behavior among volunteers enrolled in a Phase I HIV vaccine trial: experience of Projet San Francisco in Kigali, Rwanda

Background Phase 1 HIV vaccine trials are conducted among HIVuninfected, healthy volunteers at low risk for HIV. Study volunteers are counseled to maintain low risk behavior for HIV acquisition. The objective of this study was to assess sexual behavior of volunteers in a Phase 1 vaccine trial, conducted in Kigali, Rwanda. Methods Concordant HIV-negative couples who were counseled and tested together were considered as low risk group for HIV acquisition and were invited to participate in Phase 1 HIV vaccine trial to evaluate safety and immunogenicity of a multiclade HIV-1 DNA plasmid vaccine followed by a recombinant, multiclade HIV-1 adenoviral vector vaccine (IAVI V001). HIV risk reduction counseling, assessment of sexual behavior and screening for sexually transmitted infections (STI) were conducted quarterly. After completion of the vaccine trial, participants and their partners were invited to participate in a long-term 5-year follow-up study from their last vaccination for further assessment of sexual behavior and continuous risk reduction counseling. Results