Valencia P. Remple

Fertility intentions of women of reproductive age living with HIV in British Columbia, Canada.

Background:We undertook a study to examine the fertility intentions and reproductive health issues of women living with HIV in a broad-based sample in British Columbia, Canada. Methods:Between November 2003 and December 2004, we invited women with HIV at all HIV clinics and AIDS service organizations in the province of British Columbia, Canada, to complete the survey instrument ‘Contraceptive Decisions of HIV-positive Women’. Logistic regression analysis was conducted to calculate adjusted odds ratios to identify factors that may be significant predictors of the intention of women living with HIV to have children. Results:Of the 230 surveys completed, 182 women (79.1%) were of reproductive age (≤ 44 years), and 25.8% of women living with HIV indicated an intention to have children. In multivariate modeling, non-aboriginal ethnicity, younger age and having a regular partner were associated with an increased likelihood of reporting the intention to have children in the future. Discussion:In this study, we found that the predictors of fertility intention of women with HIV were age, ethnicity and marital status. Women who were HIV-positive described an intention to have children at levels approaching those among the general population and regardless of their clinical HIV status. Public policy planners and health practitioners need to consider and plan for the implications of increased numbers of women with HIV who may choose to have children.

Intention of parents to have male children vaccinated with the human papillomavirus vaccine

Background: Although already approved for use in males in some jurisdictions, there is little information about parental attitudes toward having their sons receive the human papillomavirus (HPV) vaccine. The goal of this study was to ascertain parental intentions to vaccinate their sons with an HPV vaccine and to determine factors that predict this intention. Methods: Parents of children aged 8–18 years were recruited from across Canada through random digit dialling. Participants were asked to respond to a series of questions in the context of a Grade 6 (age 11/12 years old), publicly funded school-based HPV vaccine programme, including their intention to vaccinate their sons with the HPV vaccine. Parents were also asked about a series of characteristics thought to predict intention to vaccinate as well as demographic characteristics. Backwards logistic regression was conducted to calculate adjusted odds ratios (AOR) to identify the factors that are predictive of parents’ intention to vaccinate their son(s) against HPV. Results: Of the 1381 respondents with male children, 67.8% (95% CI 65.3 to 70.3) intend to vaccinate their son(s) against HPV. Parents who had positive attitudes toward vaccines and the HPV vaccine in particular (AOR 41.5, 95% CI 9.5 to 181.7), parents who were influenced by subjective norms (AOR 7.8, 95% CI 5.8 to 10.5), parents who felt that the vaccine had limited influence on sexual behaviour (AOR 2.3, 95% CI 1.6 to 3.3) and parents who were aware of HPV (AOR 1.4, 95% CI 1.1 to 2.0) were significantly more likely to report an intention to vaccinate boys against HPV. In contrast, residence in British Columbia compared to Atlantic Canada (AOR 0.4, 95% CI 0.2 to 0.8) and higher education (AOR 0.7, 95% CI 0.5 to 0.9) were negatively associated with intention to vaccinate. Parents who reported an intention to vaccinate their daughters were also highly likely to report an intention to vaccinate their sons (κ = 0.9, p<0.001). Discussion: The majority of Canadian parents would intend to have their male children receive the HPV vaccine in the context of a publicly funded school-based immunisation programme. Overall attitudes toward vaccine, recommendations from health professionals and impact of the vaccine on sexual practices are important predictors of intention to have a male child receive the HPV vaccine.

Clients of indoor commercial sex workers : Heterogeneity in patronage patterns and implications for HIV and STI propagation through sexual networks

Objectives: To determine whether “high-risk” clients occupied important sociometric positions in sexual networks of commercial sex workers and to estimate whether they were more likely to be HIV and STI infected. Goal: To determine whether a classification of high-risk clients could be validated by network analysis. Study Design: We used proxy data on clients collected from a cross-sectional survey of 49 indoor female sex workers. Results: Two types of clients were categorized as high risk, including those who created sexual bridges between sex establishments and those who had sex with most or all the FSW at an establishment. High-risk clients were significantly more central and were more likely to be members of cohesive subgroups than were lower-risk clients. The few known HIV and STI infections were in high-risk clients. Conclusions: It is possible to identify theoretically high-risk commercial sex clients from the network perspective using simple data collection and categorization approaches.

Serum Concentrations, Efficacy, and Safety of a New, Intravenously Administered Varicella Zoster Immune Globulin in Pregnant Women

Chickenpox is teratogenic in humans, and varicella zoster immune globulin (VZIG) is given to pregnant women believed to be susceptible to the virus after contact with chickenpox. Available VZIG is given as intramuscular injections. The objective of this study was to evaluate the efficacy, safety, and serum concentrations of a new VZIG that can be given intravenously. The new VZIG (Cangene Pharm, Inc.) was compared to the standard VZIG (Massachusetts Public Health Biologic Laboratories) in a randomized protocol in 57 pregnant women seronegative to varicella zoster virus (VZV). Pregnant women received 125 units per 10 kg body weight to a maximal dose of 625 units. Women were evaluated on days 2, 7, 14, and 28 and at other times if symptoms developed into clinical varicella, which was scored by the Constitutional Illness Score. The new VZIG was comparable to the standard VZIG on all parameters of efficacy and safety. Levels of VZV antibodies at day 2 postinjection were significantly higher among those receiving the new preparation intravenously. The authors concluded that the new intravenous form of VZIG confers higher initial levels of VZV antibodies and is comparable in terms of its maternal efficacy and safety to the standard form of VZIG.

Community-based HIV and STI prevention in women working in indoor sex markets.

Community research into women’s experiences in the indoor commercial sex industry illustrated an urgent need for sexually transmitted infection (STI) and HIV education, prevention, testing, and treatment and culturally appropriate services to support the sexual and reproductive health of commercial sex workers (CSWs). This work also revealed that a high number of immigrant—primarily Asian—women are involved in the indoor sex industry. In response, the authors developed a community–academic research partnership to design and implement a blended outreach research program to provide STI and HIV prevention interventions for indoor CSWs and their clients. This Community Health Worker Model HIV Prevention and Health Promotion Program incorporated health education, primary care referrals, STI testing using self-swab techniques, and a point-of-care HIV screening test. Here the authors report on program implementation, design, and the experiences of participants and team members and provide research and vaccination recommendations for future work in this area. This work work affirms that community-based service providers can be a key entry point for indoor CSWs to access health care and sexual health promotion and education and may be a solution to missed opportunities to provide culturally and contextually appropriate education and services to this population.

Psychometric assessment of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of HIV-infected women.

Since the late 1980s, several HIV-specific quality of life instruments have been developed; however, little testing has been done in terms of their validity and reliability for HIV-infected women. The purpose of this study was to test the content validity, concurrent validity, internal consistency, and test–retest reliability of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of 85 HIV-infected women. The MQOL-HIV is a 40-item scale comprised of 10 dimensions. Most of the items and all of the domains were determined content valid but revision of some of the items and domains is recommended. Concurrent validity was measured between the MQOL-HIV and the MOS-HIV and ranged from 0.51–0.81 between similar domains. 7 Of the 10 domains and the entire instrument, had a Cronbachs α over 0.70 (range 0.43–0.92). Eight domains and the entire instrument achieved test–retest correlation coefficients over 0.70 (range 0.60–0.96). Although some revision may make the scale more content-valid for HIV-infected women, given due care in the interpretation of results, the MQOL-HIV can be used with female populations in its current form.

Solicited Adverse Events After Influenza Immunization Among Infants, Toddlers, and Their Household Contacts

OBJECTIVES. We assessed adverse events, including oculorespiratory syndrome, following influenza immunization during the first year of a publicly-funded program for infants, toddlers and their household members in Canada. METHODS. Parents bringing infants and toddlers for influenza immunization to clinics in Quebec or British Columbia consented to structured telephone interview 5 to 10 days later. One adult provided information for all household members. Symptom experience commencing before and after immunization was assessed. Non-immunized persons also served as a comparison group for immunized household members. RESULTS. Sample included 690 immunized infants and toddlers and 1801 household members, 1374 immunized. Only fussiness, fever, decreased appetite, drowsiness, and nasal congestion/coryza were reported for >5% of infants/ toddlers within 72 hours of immunization, but only arm discomfort was reported among >5% of immunized household contacts. In multivariate analysis, muscle ache was the only systemic symptom reported more often by immunized household members compared to non-immunized persons. Oculorespiratory symptoms were infrequent and there was no difference between immunized and non-immunized household members in their report. Less than 1% of adults required time off work because of adverse events following influenza immunization in the household. Less than 2% of subjects experiencing an adverse event following influenza immunization were considered unlikely to be vaccinated again. CONCLUSION. Influenza vaccine is well-tolerated by infants, toddlers and their household members. Post-marketing observational designs are an expedient way to assess adverse events following influenza immunization. These methods should be established and rehearsed annually in preparation for a pandemic.

The Association of Placental Abnormalities with Maternal and Neonatal Clinical Findings: A Retrospective Cohort Study

OBJECTIVES (1) To determine the nature and extent of placental pathologic findings; (2) to associate placental pathologic findings with clinical indicators of infection; (3) to evaluate placental pathology in the context of the guidelines outlined by the College of American Pathologists (CAP). METHODS A retrospective cohort study, through review of maternal and neonatal charts and placental pathology, of 100 sequential pregnancies in which placentas were submitted to pathology. Data were examined using descriptive statistics, and proportional differences were compared using the chi-square test and Fishers exact test. RESULTS Overall, 75% of placentas submitted for pathology review had pathologic abnormalities. Fifty percent had findings consistent with inflammation, 38% had findings consistent with vascular abnormalities, and 18% had findings consistent with meconium. Fetal clinical indicators of infection were associated with placental findings of chorioamnionitis (p < or = 0.01), while maternal clinical indicators were not. Similarly, fetal clinical indicators were associated with placental findings of fetal inflammation (p < or = 0.025), whereas maternal indicators were not associated with placental findings of maternal inflammation. A diagnosis of chorioamnionitis in labour by the attending physician was associated with pathologic findings (p < or = 0.05). A CAP indication was found in 75% of the placentas. There was no difference in incidence of placental pathology between those placentas submitted with and without a CAP indication. CONCLUSION Placental findings of inflammation or infection were associated with fetal clinical indicators of infection, but not with maternal indicators. Placental pathology is very useful in identifying undiagnosed maternal infection or inflammation.

Conducting HIV/AIDS Research With Indoor Commercial Sex Workers: Reaching a Hidden Population

Background: Although comprising up to 80% of the commercial sex industry in Canada, indoor female sex workers (FSW) are generally not represented in research because they are a hidden population and difficult to access. Objectives: This paper describes a community–academic partnership model that was established to gain access to, deliver outreach services to, and conduct community-based research with the indoor commercial sex industry in four cities in British Columbia. Methods: The project employed an ongoing community consultation, peer-delivered approach to reaching this overlooked segment of the commercial sex industry. Peers (former and current FSW) were hired, trained, and supported as outreach workers and participated in the development, implementation, and evaluation of the project. Outreach teams visited sex establishments to deliver harm reduction Observations: During the first 2 years of the project, more than 50 sex establishments were visited by outreach teams and 37 allowed repeat visits. Research interviews have been conducted with 49 FSW in seven establishments from four cities. Conclusions: Although the high cost in terms of time and resources must be recognized, this project represents a successful research and outreach model that permits access to the hidden commercial sex industry.

Use of Sno Strip filter-paper wicks for collection of genital-tract samples allows reproducible determination of human immunodeficiency virus type 1 (HIV-1) RNA viral load with a commercial HIV-1 viral load assay.

ABSTRACT To assess the reproducibility of measurements of cervical and vaginal human immunodeficiency virus (HIV) viral load, 92 duplicate cervical and 88 duplicate vaginal samples were collected from 13 HIV-infected women using Sno Strip filter-paper wicks. RNA was eluted from the strips, extracted, and assayed using a modified protocol for the Roche Cobas Amplicor HIV-1 Monitor assay. Pearsons correlation coefficient (R), coefficient of determination (D), and Bland-Altman plots (BA) were used to compare paired log10-transformed viral loads. Analysis of duplicate same-site samples showed good reproducibility (cervix: R = 0.72, D = 52%, BA = 89% within range; vagina: R = 0.72, D = 51%, BA = 87% within range); paired cervix/vagina measurements showed moderate correlation only (R = 0.56; D = 31.3%). Standardized sample collection and simple modification of the Roche Cobas Amplicor HIV-1 Monitor assay allows reproducible measurement of genital viral load.