Edmore Marinda | Mott MacDonald Ltd (original) (raw)

Papers by Edmore Marinda

Research paper thumbnail of Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa

Global Health Action, 2013

Background: Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan A... more Background: Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan Africa, and 2.5% of South African children live with HIV. As HIV care and treatment programmes are scaled-up, a rise in loss to follow-up (LTFU) has been observed. Objective: The aim of the study was to determine the rate of LTFU in children receiving antiretroviral treatment (ART) and to identify baseline characteristics associated with LTFU in the first year of treatment. We also explored the effect of patient characteristics at 12 months treatment on LTFU in the second year. Methods: The study is an analysis of prospectively collected routine data of HIV-infected children at the Harriet Shezi Children's Clinic (HSCC) in Soweto, Johannesburg. Cox proportional hazards models were fitted to investigate associations between baseline characteristics and 12-month characteristics with LTFU in the first and second year on ART, respectively. Results: The cumulative probability of LTFU at 12 months was 7.3% (95% CI 7.1Á8.8). In the first 12 months on ART, independent predictors of LTFU were age B1 year at initiation, recent year of ART start, mother as a primary caregiver, and being underweight (WAZ 5(2). Among children still on treatment at 1 year from ART initiation, characteristics that predicted LTFU within the second year were recent year of ART start, mother as a primary caregiver, being underweight (WAZ 5(2), and low CD4 cell percentage. Conclusions: There are similarities between the known predictors of death and the predictors of LTFU in the first and second years of ART. Knowing the vital status of children is important to determine LTFU. Although HIV-positive children cared for by their mothers appear to be at greater risk of becoming LTFU, further research is needed to explore the challenges faced by mothers and other caregivers and their impact on long-term HIV care. There is also a need to investigate the effects of differential access to ART between mothers and children and its impact on ART outcomes in children.

Research paper thumbnail of Significantly Diminished Long-Term Specificity of the BED Capture Enzyme Immunoassay Among Patients With HIV1 With Very Low CD4 Counts and Those on Antiretroviral Therapy

Jaids-journal of Acquired Immune Deficiency Syndromes, 2010

Objective: To estimate the proportion who test as recent infections by the BED capture enzyme imm... more Objective: To estimate the proportion who test as recent infections by the BED capture enzyme immunoassay (BED) among patients about to commence, and those receiving, antiretroviral therapy.

Research paper thumbnail of Effects of infant sex on mother-to-child transmission of HIV1 according to timing of infection in Zimbabwe

Aids, 2006

We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal ... more We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal HIV transmission among 4495 infants born to HIV-infected mothers in Harare, Zimbabwe. Intrauterine transmission was 8.6%, and consistent with other studies was higher among girl than boy infants (AOR 1.53; 95% CI 1.23-1.91). Unlike previous studies, we observed no independent effect of infant sex on intrapartum or breastfeeding-associated HIV transmission. Sex-specific postnatal prevention strategies are not warranted in this population.

Research paper thumbnail of The Impact of Safer Breastfeeding Practices on Postnatal HIV1 Transmission in Zimbabwe

American Journal of Public Health, 2007

Research paper thumbnail of Early exclusive breastfeeding reduces the risk of postnatal HIV1 transmission and increases HIVfree survival

Aids, 2005

Objectives: The promotion of exclusive breastfeeding (EBF) to reduce the postnatal transmission (... more Objectives: The promotion of exclusive breastfeeding (EBF) to reduce the postnatal transmission (PNT) of HIV is based on limited data. In the context of a trial of postpartum vitamin A supplementation, we provided education and counseling about infant feeding and HIV, prospectively collected information on infant feeding practices, and measured associated infant infections and deaths.

Research paper thumbnail of Significantly Diminished Long-Term Specificity of the BED Capture Enzyme Immunoassay Among Patients With HIV1 With Very Low CD4 Counts and Those on Antiretroviral Therapy

Jaids-journal of Acquired Immune Deficiency Syndromes, 2010

Objective: To estimate the proportion who test as recent infections by the BED capture enzyme imm... more Objective: To estimate the proportion who test as recent infections by the BED capture enzyme immunoassay (BED) among patients about to commence, and those receiving, antiretroviral therapy.

Research paper thumbnail of 225 COMPARING SIGNS AND SYMPTOMS OF THE DN4 AND THE BRIEF PERIPHERAL NEUROPATHY SCREENING TOOL IN HIV NEUROPATHY IN SOUTH AFRICA

European Journal of Pain Supplements, 2010

Research paper thumbnail of Child Mortality According to Maternal and Infant HIV Status in Zimbabwe

Pediatric Infectious Disease Journal, 2007

HIV causes substantial mortality among African children but there is limited data on how this is ... more HIV causes substantial mortality among African children but there is limited data on how this is influenced by maternal or infant infection status and timing. Children enrolled in the ZVITAMBO trial were divided into 5 groups: those born to HIV-negative mothers (NE, n = 9510), those born to HIV-positive mothers but noninfected (NI, n = 3135), those infected in utero (IU, n = 381), those infected intrapartum (IP, n = 508), and those infected postnatally (PN, n = 258). Their mortality was estimated. Two-year mortality was 2.9% (NE infants), 9.2% (NI), 67.5% (IU), 65.1% (IP), and 33.2% (PN). Between 8 weeks and 6 months, mortality in IU infants quintupled (from 309 to 1686/1000 c-y). The median time from infection to death was 208, 380, and >500 days for IU, IP, and PN infants, respectively. Among NI children, advanced maternal disease was predictive of mortality. Acute respiratory infection was the major cause of death. Perinatally infected infants are at particular risk of death between 2 and 6 months: cotrimoxazole prophylaxis and early pediatric HAART should be scaled up. Uninfected infants of infected mothers have at least twice the mortality risk of infants born to uninfected mothers: all HIV-exposed infants should be targeted with child survival interventions. HIV-positive mothers with more advanced disease are not only more likely to infect their infants, but their infants are more likely to die, whether infected or not: provision of antiretroviral treatment to pregnant and lactating women is an urgent need for both mothers and their children.

Research paper thumbnail of Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study

British Medical Journal, 2010

Research paper thumbnail of Declining HIV prevalence and incidence in perinatal women in Harare, Zimbabwe

Epidemics, 2011

Background: In several recent papers it has been suggested that HIV prevalence and incidence are ... more Background: In several recent papers it has been suggested that HIV prevalence and incidence are declining in Zimbabwe as a result of changing sexual behavior. We provide further support for these suggestions, based on an analysis of more extensive, age-stratified, HIV prevalence data from 1990 to 2009 for perinatal women in Harare, as well as data on incidence and mortality. Methodology/principal findings: Pooled prevalence, incidence and mortality were fitted using a simple susceptible-infected (SI) model of HIV transmission; age-stratified prevalence data were fitted using doublelogistic functions. We estimate that incidence peaked at 5.5% per year in 1991 declining to 1% per year in 2010. Prevalence peaked in 1998/9 [35.9% (CI95: 31.3-40.7)] and decreased by 67% to 11.9% (CI95: 10.1-13.8) in 2009. For women b20 y, 20-24 y, 25-29 y, 30-34 y and ≥35 y, prevalence peaked at 25., respectively, declining thereafter in every age group. Among women b 25 y, prevalence peaked in 1994 at 28.8% declining thereafter by 69% to 8.9% (CI95: 6.8-11.5) in 2009. Conclusion/significance: HIV prevalence declined substantially among perinatal women in Harare after 1998 consequent upon a decline in incidence starting in the early 1990s. Our model suggests that this was primarily a result of changes in behavior which we attribute to a general increase in awareness of the dangers of AIDS and the ever more apparent increases in mortality.

Research paper thumbnail of Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe1-3

Background: Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding m... more Background: Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding mothers improves the vitamin A status of their infants, but there are no data regarding its effect on infant mortality, and data on the effect of directly supplementing infants during the first few weeks of life are conflicting. Objective: The objective was to measure the effect on infant mortality of supplementing neonates and their HIV-negative mothers with single, large doses of vitamin A during the immediate postpartum period. Design: A randomized, placebo-controlled, 2-by-2 factorial design trial was conducted in 14 110 mothers and their infants; 9208 of the mothers were HIV-negative at delivery, remained such during the postpartum year, and were retained in the current analysis. The infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A (Aa), mothers received vitamin A and infants received placebo (Ap), mothers received placebo and infants received vitamin A (Pa), and both mothers and infants received placebo (Pp). The vitamin A dose in the mothers was 400 000 IU and in the infants was 50 000 IU. The mother-infant pairs were followed to 12 mo. Results: Hazard ratios (95% CI) for 12 mo mortality among infants in the maternal-supplemented and infant-supplemented groups were 1.17 (0.87, 1.58) and 1.08 (0.80, 1.46), respectively. Hazard ratios (95% CI) for the Aa, Ap, and Pa groups compared with the Pp group were 1.28 (0.83, 1.98), 1.27 (0.82, 1.97), and 1.18 (0.76, 1.83), respectively. These data indicate no overall effect. Serum retinol concentrations among a subsample of women were similar to reference norms. Conclusion: Postpartum maternal or neonatal vitamin A supplementation may not reduce infant mortality in infants of HIVnegative women with an apparently adequate vitamin A status.

Research paper thumbnail of Clinical performance of an in-house real-time RT-PCR assay using a fluorogenic LUX™ primer for quantitation of human immunodeficiency virus type-1 (HIV1

Journal of Virological Methods, 2007

The South African National Antiretroviral Treatment Guideline recommends the use of HIV viral loa... more The South African National Antiretroviral Treatment Guideline recommends the use of HIV viral load assays for routine monitoring of HIV-1 positive patients on Highly Active Antiretroviral Therapy (HAART). Approved commercial HIV-1 viral load assays are expensive for developing countries where a large number of patients are treated in the public sector. The evaluation of an in-house HIV-1 viral load assay (LUX assay) is described using 458 plasma specimens. Good specificity of the LUX assay was demonstrated using 50 seronegative plasma specimens. A group of 142 HIV-1 positive patients was used to assess the agreement between the LUX assay and the COBAS Amplicor assay. An intra class correlation (ICC) coefficient of 0.85 (CI 95%) indicated good agreement between the assays. The Bland-Altman model showed good agreement between the assays for ∼87% of the results (mean 0.03 [−1.26; 1.32], CI 95%). In a cohort of 55 patients followed-up longitudinally the LUX assay showed similar declines in viral load to the COBAS Amplicor assay in response to therapy. Viral rebound was detected in 5 patients out of 55 by both assays. Thus, the LUX assay compares well to the gold standard and represents an affordable alternative for high volume testing in resource limited settings.

Research paper thumbnail of Morbidity and Mortality among Infants Born to HIV-Infected Women in South Africa: Implications for Child Health in Resource-Limited Settings

Journal of Tropical Pediatrics, 2010

Background: We examined correlates of infant morbidity and mortality within the first 3 months of... more Background: We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. Methods: We conducted a prospective cohort study of 848 mother-child dyads. Multivariable Cox proportional hazards models were used. Results: The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40-4.85; p ¼ 0.002) and maternal plasma viral load (PVL) >100 000 copies ml À1 (HR: 1.87; 95% CI: 1.01-3.48; p ¼ 0.048), and lower with maternal age <20 years (HR: 0.25; 95% CI: 0.07-0.88; p ¼ 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18-14.31; p ¼ 0.027) and maternal PVL >100 000 copies ml À1 (HR: 6.93; 95% CI: 1.64-29.26; p ¼ 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. Conclusions: Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.

Research paper thumbnail of Sexual Behavior and Reproductive Health Among HIV-Infected Patients in Urban and Rural South Africa

Jaids-journal of Acquired Immune Deficiency Syndromes, 2008

Background: With the rollout of antiretroviral therapy in South Africa and its potential to prolo... more Background: With the rollout of antiretroviral therapy in South Africa and its potential to prolong the lives of HIV-infected individuals, understanding the sexual behavior of HIV-positive people is essential to curbing secondary HIV transmission.

Research paper thumbnail of Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics

Aids, 2010

Objective-In light of increasing access to highly active antiretroviral treatment (HAART) in sub-... more Objective-In light of increasing access to highly active antiretroviral treatment (HAART) in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics.

Research paper thumbnail of Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa

Global Health Action, 2013

Background: Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan A... more Background: Ninety percent of the world's 2.1 million HIV-infected children live in sub-Saharan Africa, and 2.5% of South African children live with HIV. As HIV care and treatment programmes are scaled-up, a rise in loss to follow-up (LTFU) has been observed. Objective: The aim of the study was to determine the rate of LTFU in children receiving antiretroviral treatment (ART) and to identify baseline characteristics associated with LTFU in the first year of treatment. We also explored the effect of patient characteristics at 12 months treatment on LTFU in the second year. Methods: The study is an analysis of prospectively collected routine data of HIV-infected children at the Harriet Shezi Children's Clinic (HSCC) in Soweto, Johannesburg. Cox proportional hazards models were fitted to investigate associations between baseline characteristics and 12-month characteristics with LTFU in the first and second year on ART, respectively. Results: The cumulative probability of LTFU at 12 months was 7.3% (95% CI 7.1Á8.8). In the first 12 months on ART, independent predictors of LTFU were age B1 year at initiation, recent year of ART start, mother as a primary caregiver, and being underweight (WAZ 5(2). Among children still on treatment at 1 year from ART initiation, characteristics that predicted LTFU within the second year were recent year of ART start, mother as a primary caregiver, being underweight (WAZ 5(2), and low CD4 cell percentage. Conclusions: There are similarities between the known predictors of death and the predictors of LTFU in the first and second years of ART. Knowing the vital status of children is important to determine LTFU. Although HIV-positive children cared for by their mothers appear to be at greater risk of becoming LTFU, further research is needed to explore the challenges faced by mothers and other caregivers and their impact on long-term HIV care. There is also a need to investigate the effects of differential access to ART between mothers and children and its impact on ART outcomes in children.

Research paper thumbnail of Significantly Diminished Long-Term Specificity of the BED Capture Enzyme Immunoassay Among Patients With HIV1 With Very Low CD4 Counts and Those on Antiretroviral Therapy

Jaids-journal of Acquired Immune Deficiency Syndromes, 2010

Objective: To estimate the proportion who test as recent infections by the BED capture enzyme imm... more Objective: To estimate the proportion who test as recent infections by the BED capture enzyme immunoassay (BED) among patients about to commence, and those receiving, antiretroviral therapy.

Research paper thumbnail of Effects of infant sex on mother-to-child transmission of HIV1 according to timing of infection in Zimbabwe

Aids, 2006

We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal ... more We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal HIV transmission among 4495 infants born to HIV-infected mothers in Harare, Zimbabwe. Intrauterine transmission was 8.6%, and consistent with other studies was higher among girl than boy infants (AOR 1.53; 95% CI 1.23-1.91). Unlike previous studies, we observed no independent effect of infant sex on intrapartum or breastfeeding-associated HIV transmission. Sex-specific postnatal prevention strategies are not warranted in this population.

Research paper thumbnail of The Impact of Safer Breastfeeding Practices on Postnatal HIV1 Transmission in Zimbabwe

American Journal of Public Health, 2007

Research paper thumbnail of Early exclusive breastfeeding reduces the risk of postnatal HIV1 transmission and increases HIVfree survival

Aids, 2005

Objectives: The promotion of exclusive breastfeeding (EBF) to reduce the postnatal transmission (... more Objectives: The promotion of exclusive breastfeeding (EBF) to reduce the postnatal transmission (PNT) of HIV is based on limited data. In the context of a trial of postpartum vitamin A supplementation, we provided education and counseling about infant feeding and HIV, prospectively collected information on infant feeding practices, and measured associated infant infections and deaths.

Research paper thumbnail of Significantly Diminished Long-Term Specificity of the BED Capture Enzyme Immunoassay Among Patients With HIV1 With Very Low CD4 Counts and Those on Antiretroviral Therapy

Jaids-journal of Acquired Immune Deficiency Syndromes, 2010

Objective: To estimate the proportion who test as recent infections by the BED capture enzyme imm... more Objective: To estimate the proportion who test as recent infections by the BED capture enzyme immunoassay (BED) among patients about to commence, and those receiving, antiretroviral therapy.

Research paper thumbnail of 225 COMPARING SIGNS AND SYMPTOMS OF THE DN4 AND THE BRIEF PERIPHERAL NEUROPATHY SCREENING TOOL IN HIV NEUROPATHY IN SOUTH AFRICA

European Journal of Pain Supplements, 2010

Research paper thumbnail of Child Mortality According to Maternal and Infant HIV Status in Zimbabwe

Pediatric Infectious Disease Journal, 2007

HIV causes substantial mortality among African children but there is limited data on how this is ... more HIV causes substantial mortality among African children but there is limited data on how this is influenced by maternal or infant infection status and timing. Children enrolled in the ZVITAMBO trial were divided into 5 groups: those born to HIV-negative mothers (NE, n = 9510), those born to HIV-positive mothers but noninfected (NI, n = 3135), those infected in utero (IU, n = 381), those infected intrapartum (IP, n = 508), and those infected postnatally (PN, n = 258). Their mortality was estimated. Two-year mortality was 2.9% (NE infants), 9.2% (NI), 67.5% (IU), 65.1% (IP), and 33.2% (PN). Between 8 weeks and 6 months, mortality in IU infants quintupled (from 309 to 1686/1000 c-y). The median time from infection to death was 208, 380, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 days for IU, IP, and PN infants, respectively. Among NI children, advanced maternal disease was predictive of mortality. Acute respiratory infection was the major cause of death. Perinatally infected infants are at particular risk of death between 2 and 6 months: cotrimoxazole prophylaxis and early pediatric HAART should be scaled up. Uninfected infants of infected mothers have at least twice the mortality risk of infants born to uninfected mothers: all HIV-exposed infants should be targeted with child survival interventions. HIV-positive mothers with more advanced disease are not only more likely to infect their infants, but their infants are more likely to die, whether infected or not: provision of antiretroviral treatment to pregnant and lactating women is an urgent need for both mothers and their children.

Research paper thumbnail of Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study

British Medical Journal, 2010

Research paper thumbnail of Declining HIV prevalence and incidence in perinatal women in Harare, Zimbabwe

Epidemics, 2011

Background: In several recent papers it has been suggested that HIV prevalence and incidence are ... more Background: In several recent papers it has been suggested that HIV prevalence and incidence are declining in Zimbabwe as a result of changing sexual behavior. We provide further support for these suggestions, based on an analysis of more extensive, age-stratified, HIV prevalence data from 1990 to 2009 for perinatal women in Harare, as well as data on incidence and mortality. Methodology/principal findings: Pooled prevalence, incidence and mortality were fitted using a simple susceptible-infected (SI) model of HIV transmission; age-stratified prevalence data were fitted using doublelogistic functions. We estimate that incidence peaked at 5.5% per year in 1991 declining to 1% per year in 2010. Prevalence peaked in 1998/9 [35.9% (CI95: 31.3-40.7)] and decreased by 67% to 11.9% (CI95: 10.1-13.8) in 2009. For women b20 y, 20-24 y, 25-29 y, 30-34 y and ≥35 y, prevalence peaked at 25., respectively, declining thereafter in every age group. Among women b 25 y, prevalence peaked in 1994 at 28.8% declining thereafter by 69% to 8.9% (CI95: 6.8-11.5) in 2009. Conclusion/significance: HIV prevalence declined substantially among perinatal women in Harare after 1998 consequent upon a decline in incidence starting in the early 1990s. Our model suggests that this was primarily a result of changes in behavior which we attribute to a general increase in awareness of the dangers of AIDS and the ever more apparent increases in mortality.

Research paper thumbnail of Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe1-3

Background: Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding m... more Background: Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding mothers improves the vitamin A status of their infants, but there are no data regarding its effect on infant mortality, and data on the effect of directly supplementing infants during the first few weeks of life are conflicting. Objective: The objective was to measure the effect on infant mortality of supplementing neonates and their HIV-negative mothers with single, large doses of vitamin A during the immediate postpartum period. Design: A randomized, placebo-controlled, 2-by-2 factorial design trial was conducted in 14 110 mothers and their infants; 9208 of the mothers were HIV-negative at delivery, remained such during the postpartum year, and were retained in the current analysis. The infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A (Aa), mothers received vitamin A and infants received placebo (Ap), mothers received placebo and infants received vitamin A (Pa), and both mothers and infants received placebo (Pp). The vitamin A dose in the mothers was 400 000 IU and in the infants was 50 000 IU. The mother-infant pairs were followed to 12 mo. Results: Hazard ratios (95% CI) for 12 mo mortality among infants in the maternal-supplemented and infant-supplemented groups were 1.17 (0.87, 1.58) and 1.08 (0.80, 1.46), respectively. Hazard ratios (95% CI) for the Aa, Ap, and Pa groups compared with the Pp group were 1.28 (0.83, 1.98), 1.27 (0.82, 1.97), and 1.18 (0.76, 1.83), respectively. These data indicate no overall effect. Serum retinol concentrations among a subsample of women were similar to reference norms. Conclusion: Postpartum maternal or neonatal vitamin A supplementation may not reduce infant mortality in infants of HIVnegative women with an apparently adequate vitamin A status.

Research paper thumbnail of Clinical performance of an in-house real-time RT-PCR assay using a fluorogenic LUX™ primer for quantitation of human immunodeficiency virus type-1 (HIV1

Journal of Virological Methods, 2007

The South African National Antiretroviral Treatment Guideline recommends the use of HIV viral loa... more The South African National Antiretroviral Treatment Guideline recommends the use of HIV viral load assays for routine monitoring of HIV-1 positive patients on Highly Active Antiretroviral Therapy (HAART). Approved commercial HIV-1 viral load assays are expensive for developing countries where a large number of patients are treated in the public sector. The evaluation of an in-house HIV-1 viral load assay (LUX assay) is described using 458 plasma specimens. Good specificity of the LUX assay was demonstrated using 50 seronegative plasma specimens. A group of 142 HIV-1 positive patients was used to assess the agreement between the LUX assay and the COBAS Amplicor assay. An intra class correlation (ICC) coefficient of 0.85 (CI 95%) indicated good agreement between the assays. The Bland-Altman model showed good agreement between the assays for ∼87% of the results (mean 0.03 [−1.26; 1.32], CI 95%). In a cohort of 55 patients followed-up longitudinally the LUX assay showed similar declines in viral load to the COBAS Amplicor assay in response to therapy. Viral rebound was detected in 5 patients out of 55 by both assays. Thus, the LUX assay compares well to the gold standard and represents an affordable alternative for high volume testing in resource limited settings.

Research paper thumbnail of Morbidity and Mortality among Infants Born to HIV-Infected Women in South Africa: Implications for Child Health in Resource-Limited Settings

Journal of Tropical Pediatrics, 2010

Background: We examined correlates of infant morbidity and mortality within the first 3 months of... more Background: We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. Methods: We conducted a prospective cohort study of 848 mother-child dyads. Multivariable Cox proportional hazards models were used. Results: The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40-4.85; p ¼ 0.002) and maternal plasma viral load (PVL) >100 000 copies ml À1 (HR: 1.87; 95% CI: 1.01-3.48; p ¼ 0.048), and lower with maternal age <20 years (HR: 0.25; 95% CI: 0.07-0.88; p ¼ 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18-14.31; p ¼ 0.027) and maternal PVL >100 000 copies ml À1 (HR: 6.93; 95% CI: 1.64-29.26; p ¼ 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. Conclusions: Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.

Research paper thumbnail of Sexual Behavior and Reproductive Health Among HIV-Infected Patients in Urban and Rural South Africa

Jaids-journal of Acquired Immune Deficiency Syndromes, 2008

Background: With the rollout of antiretroviral therapy in South Africa and its potential to prolo... more Background: With the rollout of antiretroviral therapy in South Africa and its potential to prolong the lives of HIV-infected individuals, understanding the sexual behavior of HIV-positive people is essential to curbing secondary HIV transmission.

Research paper thumbnail of Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics

Aids, 2010

Objective-In light of increasing access to highly active antiretroviral treatment (HAART) in sub-... more Objective-In light of increasing access to highly active antiretroviral treatment (HAART) in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics.