Browsing by Author "Kigozi, G."

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    HIV Prevention Efforts and Incidence of HIV in Uganda
    (New England Journal of Medicine, 2017) Grabowski, M.K.; Serwadda, D.M.; Gray, R.H.; Nakigozi, G.; Kigozi, G.; Kagaayi, J.; Ssekubugu, R.; Nalugoda, F.; Lessler, J.; Lutalo, T.; Galiwango, R.M.; Makumbi, F.; Kong, X.; Kabatesi, D.; Alamo, S.T.; Wiersma, S.; Sewankambo, N.K.; Tobian, A.A.R.; Laeyendecker, O.; Quinn, T.C.; Reynolds, S.J.; Wawer, M.J.; Chang, L.W.
    To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participantreported male circumcision, viral-load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) — from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). CONCLUSIONS In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a populationlevel effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.)
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    Immune correlates of HIV exposure without infection in foreskins of men from Rakai, Uganda
    (Mucosal immunology, 2014) Prodger, J. L.; Hirbod, T.; Kigozi, G.; Nalugoda, F.; Reynolds, S. J.; Galiwango, R.; Shahabi, K.; Serwadda, D.; Wawer, M.J.; Gray, R. H.; Kaul, R.
    Human immunodeficiency virus (HIV) susceptibility is heterogenous, with some HIV-exposed but seronegative (HESN) individuals remaining uninfected despite repeated exposure. Previous studies in the cervix have shown that reduced HIV susceptibility may be mediated by immune alterations in the genital mucosa. However, immune correlates of HIV exposure without infection have not been investigated in the foreskin. We collected sub-preputial swabs and foreskin tissue from HESN (n¼20) and unexposed control (n¼57) men undergoing elective circumcision. Blinded investigators assayed swabs for HIV-neutralizing IgA, innate antimicrobial peptides, and cytokine levels. Functional T-cell subsets from foreskin tissue were assessed by flow cytometry. HESN foreskins had elevated a-defensins (3,027 vs. 1,795 pgml 1,P¼0.011) and HIV-neutralizing IgA(50.0 vs. 13.5%ofmen,P¼0.019).Foreskin tissue from HESN men contained a higherdensityofCD3 T cells (151.9 vs. 69.9 cellsmm 2, P¼0.018), but a lower proportion of these was Th17 cells (6.12 vs. 8.04%of CD4 Tcells, P¼0.007), and fewer produced tumor necrosis factor a (TNFa) (34.3 vs. 41.8% of CD4 Tcells, P¼0.037; 36.9 vs. 45.7%of CD8 T cells, P¼0.004). A decrease in the relative abundance of susceptible CD4 T cells and local TNFa production, in combination with HIV-neutralizing IgA and a defensins, may represent a protective immune milieu at a site of HIV exposure.
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    Stigma as a barrier to the use of occupational health units for tuberculosis services in South Africa
    (The International Journal of Tuberculosis and Lung Disease, 2017) Sommerland, N.; Wouters, E.; Masquillier, C.; Engelbrecht, M.; Kigozi, G.; Uebel, K.; Janse van Rensburg, A.; Rau, A.
    Tuberculosis (TB) is the leading cause of death in South Africa, and health care workers (HCWs) are disproportionally affected. The resulting absenteeism strains the already overburdened health system. Although hospital occupational health care units (OHUs) are cost-effective and of crucial importance in tackling the TB epidemic, the fear of being stigmatized by other colleagues might lead HCWs to avoid using OHUs. To investigate whether the perception of TB stigma among colleagues has a negative effect on the willingness to use OHUs for TB services. In the Free State Province, South Africa, a representative sample of 804 HCWs from six hospitals were surveyed on workplace stigma as a predictor for the use of OHUs for TB services. Applying structural equation modelling, we also controlled for exogenous variables.