HIV/AIDS
a) Prevention
Male Circumcision and Population-level HIV Incidence in Kenya
This prospective cohort study assesses the potential epidemiological, clinical and social effects, and cost-effectiveness of delivering three public health interventions in an area of rural Kenya with high HIV prevalence. We will implement home-based HIV testing and diagnosis; circumcision for HIV-uninfected, uncircumcised men; and care and treatment for HIV-infected adults and children. We intend to measure the acceptability, feasibility, satisfaction, safety, cost and cost-effectiveness of male circumcision delivery models, sexual behavior compensation, and HIV incidence at baseline and over time.
Cambodian Young Women’s Health Study
This study is a collaboration between a small, women-run, non-governmental organization––the Cambodian Women's Development Association––and the National Center for HIV, AIDS, Dermatology, and STDs. The study will explore probable associations between drug use and sexual risk, as measured by HIV infection, STDs, and human papilloma virus infection among young women in Phnom Penh, Cambodia who have multiple sexual partners. As well, recruitment and follow-up strategies will be piloted in a cohort of young, high-risk women in preparation for future larger prevention research studies, including HIV vaccine, microbicide, and chemoprophylaxis trials.
b) Preventing Mother-to-Child Transmission (PMTCT)
Reproductive Intentions and Outcomes among Women on ART in Rural Uganda
This study examined the reproductive intentions and outcomes over two years of follow-up among 733 HIV-infected women on ART who were enrolled in a prospective cohort study in rural Uganda. After enrollment, women were offered free family planning counseling and services at a clinic next door to their ART clinic, and women subsequently were tested for pregnancy periodically throughout the study. Our faculty concluded that women on ART and their partners should be consistently counseled on the effects of ART in restoring fertility and offered regular free and comprehensive family planning services as part of their standard care.
c) Care & Treatment
Quality of Pediatric Care at an ART Clinic in Kampala, Uganda
In this study, we reviewed the treatment outcomes in HIV-infected children for a three-year period. The evaluation assesses (1) the immunologic and clinical outcomes to 45 months after ART initiation; (2) estimated adherence to ART among children (<18 years old); (3) demographic, socioeconomic, clinical, and immunologic characteristics associated with the above outcomes; and (4) the occurrence of adverse events associated with the treatment.
Adult ART Study
The University of California, San Francisco, is assisting in a randomized controlled trial to evaluate the effectiveness of clinic-centered, clinic- and home-centered, and standard strategies for reducing risk of HIV transmission and increasing drug adherence in HIV-infected adults initiating ART in a peri-urban area of Uganda. The primary objective will be to measure the effects of these strategies on sexual behavior at 6 and 12 months after randomization. We also will examine the effects on drug adherence, family planning, uptake of HIV voluntary counseling and testing among participants' household members, and drug resistance, as well as the cost-effectiveness of the different approaches. We will explore the factors associated with poor adherence and changes in sexual behavior that may occur over time among participants. The evaluation will be conducted in partnership with the Mildmay Centre near Kampala, Uganda. All clinical care, including provision of ART, will be provided by the Mildmay Centre, following national guidelines approved by the Ministry of Health.