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      Factors associated with risk of HIV-infection among pregnant women in Cameroon: Evidence from the 2016 national sentinel surveillance survey of HIV and syphilis

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          Abstract

          Background

          Human Immunodeficiency Virus infection (HIV) remains a public health concern in Cameroon that requires regular surveillance for informed policy-making to guide programmatic interventions. Using data from the 2016 HIV national sentinel survey in Cameroon, we ascertained HIV prevalence and factors associated with risk of infection among pregnant women

          Methods

          A cross-sectional study was conducted throughout 2016 in the 10 regions of Cameroon, targeting 7000 first antenatal care (ANC-1) attendees (4000 from urban and 3000 from rural areas) in 60 sentinel health facilities. HIV serological test was performed using the national serial algorithm at the National Reference Laboratory (NRL). Prevalence was determined, and multivariate logistic regression was used to assess determinants of HIV infection, with p-value<0.05 considered statistically significant.

          Results

          Of the 7000 targeted participants, a total of 6859 first ANC-1 attendees were enrolled (98.0% sampling coverage). Median age was 26 [IQR: 21–30] years and 47,40% had a secondary school level of education. The national prevalence of HIV was 5.70% (95% CI: 4.93–6.40) and range from 9.7% in East region to 2.6% in North region. The prevalence was 5.58% (95% CI: 95%: 4.88–6.35) in urban and 5.87% (95% CI: 5.04–6.78) in rural settings. Factors that were associated with HIV infection included marital status, women who were married or living with their partner are less likely to be infected than singles women (aOR = 0.60; 95% CI: 0.46–0.78), multiparity [aOR = 1.5(95%CI:1.0–2.2)] and been living in the Centre, East, North-west and South-west regions. HIV infection was also significantly associated with age, with the risk of being infected increasing with age.

          Conclusion

          Pregnant women in Cameroon are still disproportionately infected with HIV compared with the general population (prevalence 4.3%). Preventive actions to curb the epidemic amongst pregnant women should prioritize interventions targeting single pregnant women, who are older, and residing particularly in the Centre, East, North West and South West regions of the country.

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          Most cited references5

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          Determinants of HIV infection among adolescent girls and young women aged 15–24 years in South Africa: a 2012 population-based national household survey

          Background South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. Methods A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. Results Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20–24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women’s models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). Conclusion These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption.
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            Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011

            Background The HIV epidemic in East Africa is of public health importance with an increasing number of young people getting infected. This study sought to identify spatial clusters and examine the geographical variation of HIV infection at a regional level while accounting for risk factors associated with HIV/AIDS among young people in Uganda. Methods A secondary data analysis was conducted on a survey cross-sectional design whose data were obtained from the 2011 Uganda Demographic and Health Survey (DHS) and AIDS Indicator Survey (AIS) for 7 518 young people aged 15-24 years. The analysis was performed in three stages while incorporating population survey sampling weights. Maximum likelihood-based logistic regression models were used to explore the non-spatially adjusted factors associated with HIV infection. Spatial scan statistic was used to identify geographical clusters of elevated HIV infections which justified modelling using a spatial random effects model by Bayesian-based logistic regression models. Results In this study, 309/533 HIV sero-positive female participants were selected with majority residing in the rural areas [386(72%)]. Compared to singles, those currently [Adjusted Odds Ratio (AOR) =3.64; (95% CI; 1.25-10.27)] and previously married [AOR = 5.62; (95% CI: 1.52-20.75)] participants had significantly higher likelihood of HIV infections. Sexually Transmitted Infections [AOR = 2.21; (95% CI: 1.35-3.60)] were more than twice likely associated with HIV infection. One significant (p < 0.05) primary cluster of HIV prevalence around central Uganda emerged from the SaTScan cluster analysis. Spatial analysis disclosed behavioural factors associated with greater odds of HIV infection such as; alcohol use before sexual intercourse [Posterior Odds Ratio (POR) =1.32; 95% (BCI: 1.11-1.63)]. Condom use [POR = 0.54; (95% BCI: 0.41-0.69)] and circumcision [POR = 0.66; (95% BCI: 0.45-0.99)] provided a protective effect against HIV. Conclusions The study revealed associations between high-risk sexual behaviour and HIV infection. Behavioural change interventions should therefore be pertinent to the prevention of HIV. Spatial analysis further revealed a significant HIV cluster towards the Central and Eastern areas of Uganda. We propose that interventions targeting young people should initially focus on these regions and subsequently spread out across Uganda.
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              Factors Associated with HIV/AIDS in Sudan

              Objectives. To assess participants' knowledge about HIV/AIDS and to identify the factors associated with HIV/AIDS in Sudan. Methods. Observational cross-sectional study carried out at Omdurman National Voluntary Counseling and Testing Centre, Sudan covered 870 participants. Sociodemographic data as well as information related to sexual behavior were collected. Results. Most of the respondents were knowledgeable about the true transmission modes for AIDS virus. Very few respondents knew someone infected with AIDS (4.5%), died of AIDS (8.1%), accepted to live with someone infected with AIDS (4.7%) or to work with someone infected with AIDS (2.1%). Regarding sexual behavior, 96.5% had reported their first sexual experience between 20 and 30 years, with 85.7% reporting one or two partners, and only 1.8% reported using condom. Multivariate logistic regression showed that circumcision, religion, marital status, age at first sex, number of sexual partners, education level, and misconception of knowledge are the main risk factors associated with HIV/AIDS. Conclusion. Our results showed that a number of diversity risk factors were associated with HIV/AIDS. It is unlikely that a holistic approach will be found to immediately change sexual-risk-relating behavior. Interventions including sustained educational programs, promotion of condom, and encouragement of voluntary testing and active involvement of the country's political and religious leaders will be needed to alleviate this problem.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: SupervisionRole: Writing – review & editing
                Role: Data curationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Supervision
                Role: ConceptualizationRole: Data curationRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: Project administrationRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 April 2019
                2019
                : 14
                : 4
                : e0208963
                Affiliations
                [1 ] National AIDS Control Committee, Yaoundé, Cameroon
                [2 ] Chantal BIYA International Reference Centre (CBIRC) for research on HIV/AIDS prevention and management, Yaoundé, Cameroon
                [3 ] Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon
                [4 ] National HIV drug resistance surveillance and prevention Working Group, National AIDS Control Committee, Yaoundé, Cameroon
                [5 ] National Public Health Laboratory, Yaoundé, Cameroon
                [6 ] Higher Teachers’ Training College, University of Yaoundé I, Yaoundé, Cameroon
                National Institute of Health, ITALY
                Author notes

                Competing Interests: JF received consultancy honorarium for the sentinel survey. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-1332-0906
                Article
                PONE-D-18-33129
                10.1371/journal.pone.0208963
                6461244
                30978189
                3eb1ebeb-019c-4725-b6af-d28aa1e5342c
                © 2019 Anoubissi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 November 2018
                : 29 March 2019
                Page count
                Figures: 1, Tables: 3, Pages: 10
                Funding
                This study was funded by the Global Fund to fight AIds, tuberculosis and malaria( https://www.theglobalfund.org). The Ministry of public Health was the PI of the funds and JF received consultancy honorarium for the sentinel survey. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Medicine and health sciences
                Infectious diseases
                Viral diseases
                HIV infections
                Biology and Life Sciences
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                Medical Microbiology
                Microbial Pathogens
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                Immunodeficiency Viruses
                HIV
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                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
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                Custom metadata
                The data underlying this study have been deposited to Figshare and are available via the URL https://figshare.com/s/e703ed5a70476158621c.

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