Papers by Hilton Humphries
African Journal of AIDS Research
PLOS ONE
Background In sub-Saharan Africa, high HIV incidence rates in adolescent girls and young women (A... more Background In sub-Saharan Africa, high HIV incidence rates in adolescent girls and young women (AGYW) persist despite extensive HIV prevention efforts. Methods A prospective cohort of 2,710 HIV-negative AGYW (15–24 years) in KwaZulu-Natal, South Africa were interviewed at baseline and followed-up approximately 18 months later (2014–2017). Associations between HIV seroconversion and socio-demographic and behavioural variables measured at baseline and follow-up were examined using Cox regression and a proximate determinants framework. Inter-relationships between determinants were measured using logistic regression. Separate models were built for 15–19 and 20-24-year-olds. Results Weighted HIV incidence was 3.92 per 100 person-years (95% confidence interval: 3.27–4.69; 163 seroconversions over 4,016 person-years). Among 15-19-year-olds, absence of family support (adjusted hazards ratio (aHR): 3.82 (1.89–7.72)), having a circumcised partner (aHR: 0.5 (0.27–0.94)) or one who was HIV-posi...
Current Opinion in HIV and AIDS
Journal of the International AIDS Society, 2015
Sensitive assays are needed for detection of residual HIV in patients with undetectable plasma vi... more Sensitive assays are needed for detection of residual HIV in patients with undetectable plasma viral loads to determine if eradication strategies are effective. The gold standard quantitative viral outgrowth assay (QVOA) underestimates the magnitude of the viral reservoir, while sensitive PCR-based assays lack the ability to distinguish replication competent from defective virus. We sought to determine whether xenograft of leukocytes from HIV-1 infected patients with undetectable plasma viral loads into severely immunocompromised mice would result in viral amplification and measurable viral loads within the aberrant murine host. Methods: We evaluated whether xenograft of 1) peripheral blood mononuclear cells (PBMCs) from five HIV-1' patients on suppressive antiretroviral therapy (ART), 2) PBMCs or purified resting CD4' T cells from 5 HIV-1' elite suppressors (ES), or 3) PBMCs from a Simian Immunodeficiency Virus (SIV)' pigtailed macaque on suppressive ART, all with undetectable plasma viral loads, into NOD. Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) mice resulted in viral amplification in the mouse. Successful xenograft of mice was confirmed by flow cytometry. Human CD8' T cells were depleted in humanized mice with depleting antibody, and CD4' T cells were activated in a subset of mice with activating anti-CD3. Plasma viral loads in xenografted mice were quantified using qRT-PCR, and compared to plasma viral load and QVOA results from the human or macaque donor. Results: With this murine viral outgrowth assay (MVOA), we amplified HIV-1 from all 10 HIV' subjects with undetectable plasma viral load, including an ES from whom we were unable to recover virus by QVOA. We detected HIV in mice an average of 20 days after xenograft with PBMCs from patients on suppressive ART, and an average of 28 days after xenograft with PBMCs or resting CD4' T cells from ES. For two of the mice xenografted with CD4' T cells from ES, we detected HIV only after activation with anti-CD3. We similarly detected SIV in macaquized mice by seven days post-xenograft. Conclusions: The MVOA has the potential to serve as a powerful tool to identify residual HIV-1 in patients with undetectable viral loads, such as those who have undergone promising cure therapies.
HIV Medicine, 2010
Objective-To evaluate HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to scre... more Objective-To evaluate HIV-1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women in the "window period" of acute HIV infection (AHI) in rural South Africa. Methods-In 2007 and 2008, 750 consecutive pregnant women at their first prenatal care visit to primary health care clinics were tested anonymously for HIV infection. HIV-1 RNA pooled NAAT was performed on HIV antibody negative samples. All positive pools were tested individually and positive samples were classified as incident cases to calculate HIV incidence. Results-The overall HIV prevalence was 37.3% [95% confidence interval (CI) 34.3-41.3]. Of the 467 HIV antibody negative samples, four (0.9%) were HIV-1 RNA positive. The mean viral copies/ml in the four samples was 386260 (range 64 200 to 1228130). The HIV incidence was 11.2% per year (95% CI 0.3-22.1) and all women with AHI were ≤ 21 years of age. Conclusions-Identifying AHI in pregnancy is important for health interventions to reduce perinatal and heterosexual transmission of HIV; and to estimate HIV incidence for epidemiological surveillance.
Culture, Health & Sexuality
Additional file 1:. Topic guides for interviews and focus groups
Additional file 2: Table S1 Additional quotes highlighting key themes
The Lancet Child & Adolescent Health, 2022
Women comprise one-half of people infected with the human immunodeficiency virus in the world, an... more Women comprise one-half of people infected with the human immunodeficiency virus in the world, and about 70 % of them live in sub-Saharan Africa. Advancing, untreated HIV disease in women has resulted in substantial declines in fertility rates, life expectancy and infant mortality rates, and an increased burden of tuberculosis. Three decades into the pandemic, our knowledge of HIV acquisition in women remains sparse, as are options of what women can use to reduce their risk of acquiring HIV. Here, we describe the role of pre-HIV responses to venereal diseases and then discuss unwanted pregnancies, early perceptions of the HIV epidemic in setting prevention priorities, and the history of microbicide development. Opportunities to reduce HIV risk in women through sexual reproductive health services are highlighted. Women are key to turning the tide of the HIV pandemic. Microbicides provide an opportunity to ensure survival of women while addressing the power disparities that underpin w...
complex experience of communities
PLOS ONE, 2022
Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic ... more Preventing new HIV infections, especially amongst young women, is key to ending the HIV epidemic especially in sub-Saharan Africa. Potent antiretroviral (ARV) drugs used as pre-exposure prophylaxis (PrEP) are currently being formulated as long-acting implantable devices, or nanosuspension injectables that release drug at a sustained rate providing protection from acquiring HIV. PrEP as implants (PrEP Implants) offers an innovative and novel approach, expanding the HIV prevention toolbox. Feedback from providers and future users in the early clinical product development stages may identify modifiable characteristics which can improve acceptability and uptake of new technologies. Healthcare workers (HCWs) perspectives and lessons learned during the rollout of contraceptive implants will allow us to understand what factors may impact the roll-out of PrEP implants. We conducted eighteen interviews with HCWs (9 Nurses and 9 Community Healthcare Workers) in rural KwaZulu-Natal, South Afri...
Sexually Transmitted Infections, 2013
Background STI prevalence or incidence data among HIV infected can help to distinguish population... more Background STI prevalence or incidence data among HIV infected can help to distinguish populations with different levels of sexual HIV transmission risk. Herpes simplex virus type 2 (HSV-2) is considered useful because it is almost exclusively sexually transmitted, cannot be cured and leads to the production of lifelong antibodies. Unfortunately, few IDU studies include HSV-2 prevalence data. Aim of the current work is to examine prevalence of and associations between HSV-2 infection, and HIV infection among injecting drug users (IDUs) in Kohtla-Järve, Estonia. Methods Current IDU were recruited using chain referral methodology (RDS). Informed consent was obtained, a structured questionnaire including demographics, drug use history, and sexual risk behaviour was administered, and a blood sample was collected for HIV and HSV-2 antibody testing. Results A total of 600 subjects were recruited in 2012. Subjects were primarily male (73%), with a mean age of 30 (SD 4.9) years. The prevalences of HIV and HSV-2 were 62%, and 32%, accordingly. Odds for being HSV-2 positive was higher among HIV infected IDUs (OR 1.9.95% CI 1.3-2.9). One third (27%) of the sexually active IDUs reported always using condoms (with in the last 4 weeks) prior the study. Being HSV-2 positive was not associated with reported injection risk behaviour. HSV-2 seropositivity was associated with gender (higher among women; OR 2.7, 95% CI 1.8-4.0), and sexual behaviour: higher among those reporting IDU-sexual partners (OR 1.7, 95% CI 1.1-2.7), and those not always using condom (OR 2.0, 95% CI 1.2-3.4). Conclusion HSV-2 seroprevalence can be used as a marker of (long-term) sexual risk. However, it might not capture more recent behaviour change in response to the HIV/AIDS among population groups studied. High prevalence of HSV2 infection coupled with low reported condom use highlight the need of targeted sexual risk reduction interventions for IDU and their partners.
BMC Public Health, 2014
Background: Young people in South Africa are at high risk of HIV infection and yet may have more ... more Background: Young people in South Africa are at high risk of HIV infection and yet may have more limited access to prevention and treatment services than others in the population. Testing facilitates the sharing of prevention messages but also enables the linkage to care and treatment of those who test positive and therefore has wider public health implications. Methods: This baseline survey conducted in 2005 for a community randomized trial in rural KwaZulu-Natal explored factors associated with a history of ever, repeat and recent testing amongst sexually debuted men and women aged 18 to 32 years. Results: Over 35% of this rural population ever tested for HIV, with men less likely to ever (unadjusted OR 0.26, 95% CI: 0.21-0.32) and repeatedly test than women (adjusted OR (aOR) 0.68, 95% CI: 0.48-0.97). Men aged 24-28 years (aOR 2.02, 95% CI: 1.10-3.71) and 29-32 years (aOR 2.69, 95% CI: 1.46-4.94) were more likely to ever test than those <20 years. Those who reported having discussed HIV with others had significantly greater odds of reporting ever (men's aOR 2.83, 95% CI: 1.63-4.89; women's aOR 3.36, 95% CI: 2.50-4.53), recent (irrespective of sex, aOR 2.87, 95% CI: 2.02-4.09) and repeat testing (aOR 2.02, 95% CI: 1.28-3.19). Conclusion: These findings highlight the need for novel youth-and men-friendly testing services and emphasises the importance of discussions about HIV in the home and community to encourage testing.
Sexually Transmitted Infections, 2014
Objective Adolescents in southern African high schools are a key population for HIV prevention in... more Objective Adolescents in southern African high schools are a key population for HIV prevention interventions. We report on the prevalence of HIV, HSV-2 and pregnancy as indicators of high-risk sexual behaviour among high school students in rural KwaZulu-Natal. Design Bio-behavioural cross-sectional survey. Methods Students completed a self-administered structured, standardised demographic and sexual behavioural questionnaire. Dried blood spot specimens were collected for HIV and HSV-2 testing. Urine specimens were used for pregnancy testing in female students. Results A total of 2675 (1423 females, 1252 males) consenting students were enrolled from 14 high schools between September and November 2010. The median age of students was 16 years (IQR 15-18). HIV prevalence was 1.4% (95% CI 0.9 to 1.9) in males and 6.4% (95% CI 4.6 to 8.3) in females (p<0.001). HSV-2 prevalence was 2.6% (95% CI 1.6 to 3.7) in males and 10.7% (95% CI 8.8 to 12.6) in females (p<0.001). Pregnancy prevalence was 3.6% (95% CI 2.6 to 4.5). Risk factors for prevalent HIV infection in female students included being over 18 years of age (adjusted OR (aOR)=2.67, 95% CI 1.67 to 4.27; p<0.001), prevalent HSV-2 infection (aOR=4.35, 95% CI 2.61 to 7.24; p<0.001), previous pregnancy (aOR=1.66, 95% CI 1.10 to 2.51; p=0.016) and experience of two or more deaths in the household in the previous year (aOR=1.97, 95% CI 1.13 to 3.44; p=0.016). Conclusions The high prevalence of HIV, HSV-2 and pregnancy underscore the need for school-based sexual and reproductive health services, and provide further impetus for the inclusion of adolescents in behavioural and biomedical trials with HIV incidence endpoints.
Culture, Health & Sexuality, 2015
While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has on... more While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them. This paper reports on qualitative work conducted in the context of a home-based HIV testing study in a high-HIV-prevalence, rural community in KZN, South Africa, where circumcision uptake is low. The paper explores how sexual performance and masculinity may influence the decisions men make regarding VMMC in this context and describes how understanding how these factors could help us understand how men perceive VMMC as a public health intervention. Methods Study setting The study was conducted in Vulindlela, a rural district in KZN, South Africa, nested within a larger study that provided home-based HIV testing (HBCT) with associated linkages to HIV treatment and VMMC (Van Rooyen et al. 2013). The qualitative study was http://repository.uwc.ac.za
PLoS ONE, 2014
Background: Epidemiological data from South Africa demonstrate that risk of human immunodeficienc... more Background: Epidemiological data from South Africa demonstrate that risk of human immunodeficiency virus (HIV) infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision (VMMC) in high HIV prevalence-, low circumcision practice-settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal. Methods and Findings: Following community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: (i) community consultation and engagement; (ii) in-school VMMC awareness sessions and centralized HIV counselling and testing (HCT) service access; and (iii) peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa (CAPRISA) clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority (71%) in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures/month in initial community engagement phases, to an average of 308 procedures/month on initiation of the peer recruitmentdecentralized service phase. Post-operative adverse events were rare (1.2%), mostly minor and self-resolving. Conclusions: Optimizing a high volume, adolescent-targeted VMMC program was feasible, acceptable and safe in this setting. Adaptive demand-creation strategies are required to sustain high uptake.
Education as Change, 2007
Due to increasing popularity and widespread adoption service-learning is in danger of becoming a ... more Due to increasing popularity and widespread adoption service-learning is in danger of becoming a technical practice with a 'charity' oriented form of engagement with communities. The purpose of the current study was to explore a more 'justice' oriented approach to researching the effect of service-learning on the communities that serve as sites for this form of curriculum. This was attempted through, firstly, developing an understanding of how two communities (learners and schools) experienced a service learning programme run as a psychology module at the University of KwaZulu Natal, and secondly, exploring what the use of participatory techniques might be in service-learning research. The results revealed that participatory approaches to research with communities may be more suited to the complex context of service-learning than traditional nonparticipatory approaches. The effect of service-learning on the communities involved in the research revealed that practitioners need to move beyond notions of 'benefit' to explore the paradoxical and ambivalent nature of the engagement between higher education institutions and communities that are the object of service.
Culture, Health & Sexuality, 2013
Given the success of recent clinical trials establishing the safety and efficacy of adult medical... more Given the success of recent clinical trials establishing the safety and efficacy of adult medical male circumcision in Africa, attention has now shifted to barriers and facilitators to programmatic implementation in traditionally non-circumcising communities. In this study, we attempted to develop a fuller understanding of the role of cultural issues in the acceptance of adult circumcision. We conducted four focus group discussions with 28 participants in Mutoko in Zimbabwe, and 33 participants in Vulindlela, in KwaZulu-Natal, South Africa, as well as 19 key informant interviews in both settings. We found the concept of male circumcision to be an alien practice, particularly as expressed in the context of local languages. Cultural barriers included local concepts of ethnicity, social groups, masculinity, and sexuality. On the other hand, we found that concerns about the impact of HIV on communities resulted in willingness to consider adult male circumcision as an option if it would result in lowering the local burden of the epidemic. Adult medical male circumcision promotional messages that create a synergy between understandings of both traditional and medical circumcision will be more successful in these communities.
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Papers by Hilton Humphries