Papers by Philippe Mayaud
Objectives: To determine the prevalence and interrelation of cervical human papillomavirus (HPV) ... more Objectives: To determine the prevalence and interrelation of cervical human papillomavirus (HPV) genotypes, squamous intraepithelial lesions (SIL), HIV, and other reproductive tract infections (RTIs) among urban antenatal clinic attenders in Mwanza, Tanzania. Methods: Genital swabs were collected from 660 pregnant women and tested for a range of RTIs and for cervical cytology. Cervical HPV-DNA was detected by PCR and genotyped. HIV and syphilis serologies were performed. Results: HPV prevalence was 34% (209/612 women). Of the 144 typeable samples, 83% were high risk (HR-HPV) oncogenic strains (56% HPV 16 related types). SIL was detected in 43 women (7%), with high grade SIL in 3%. There was a high prevalence of HIV (15%), and of any RTI (83%). Genital warts were detected in 20 women (3%). HPV infection was associated with some behavioural factors (short duration of relationship, single status, not using condoms) and gonorrhoea. There was no overall association between HPV and HIV (OR=1.02, 95% CI 0.6-1.6), but a non-significant trend towards a stronger association with HR-HPV in women aged 15-19 (OR=2.79, 95% CI 0.8-9.5) and women aged >30 (OR=3.20, 95% CI 0.7-15). SIL was associated with HPV (OR=3.66, 95% CI 1.9-7.0), but not significantly with HIV (OR=1.54, 95% CI 0.7-3.4). Prevalence of SIL was higher among women dually positive for HPV/HIV compared to HPV infection only (21% v 12%), although this diVerence was not statistically significant (p=0.17). Conclusions: HPV infection was highly prevalent in this young antenatal population. The association of HIV with HR-HPV types in older women may suggest that the principal HIV/HPV interaction in this population is for HIV to upregulate HPV persistence, leading to subsequent development of SIL.
log10copies/mL. Most ulcers were due to HSV-2 (67.1%). Overall 85% of ulcers were healed at Day 1... more log10copies/mL. Most ulcers were due to HSV-2 (67.1%). Overall 85% of ulcers were healed at Day 14 and this was similar among those on acyclovir or placebo RR=1.02, 95%CI 0.93-1.15. Among HIV-1/HSV-2 dually seropositive patients, acyclovir was associated with reduced detection of lesional and seminal HIV-1 RNA (lesional: adjusted RR=0.60, 95%CI 0.34-1.03; seminal: RR=0.58, 95%CI 0.39-0.89). There was no impact of acyclovir on detection of cervical HIV-1, nor on plasma HIV-1 RNA at Day 28. Conclusions: Adding acyclovir to syndromic management had little impact on ulcer healing rates, but reduced detection of lesional and seminal HIV-1 RNA. This suggests that herpes therapy may reduce genital HIV-1 transmission.
Background: Current syndromic management of genital ulcer disease (GUD) in Malawi covers treatmen... more Background: Current syndromic management of genital ulcer disease (GUD) in Malawi covers treatment for syphilis and chancroid, but does not include treatment for genital herpes. A randomised placebo-controlled trial evaluating the impact of additional acyclovir as episodic treatment for HSV-2 on ulcer healing and HIV-1 genital shedding is underway in Lilongwe, Malawi. Methods:Patients are interviewed, examined and samples collected prior to randomisation and at follow-up visits on days 2 or 4, 7, 14 and 28. GUD aetiology is determined by real-time multiplex PCR of lesional swabs. Blood is tested for HIV-1, syphilis, and HSV-2 serologies. CD4 count and plasma HIV-1 RNA are measured among HIV-1 sero-positive patients. Results: By Nov 2005, 250 patients (204 men, 46 women) were enrolled and randomised. 60% were HIV-1 sero-positive, 74% were HSV-2 sero-positive and 4% had a positive syphilis serology. Ulcer aetiology among 177 patients showed: HSV-2 58%, H. ducreyi 19%, LGV 7%, T. palli...
Contemporary Clinical Trials, 2021
Background: Human papillomavirus (HPV) infection is the primary cause of cervical cancer. In 2018... more Background: Human papillomavirus (HPV) infection is the primary cause of cervical cancer. In 2018, the World Health Organization (WHO) Director General announced his commitment to eliminate cervical cancer, with HPV vaccination as a priority. However, the costs of setting up a multi-dose HPV vaccination programme remain a barrier to its introduction. Methods/Design: We are conducting a randomised-controlled trial of reduced dose schedules of HPV vaccine in Tanzania to establish whether a single dose produces immune responses that will be effective in preventing cervical cancer. 930 girls aged 9-14 years in Mwanza, Tanzania, were randomised to one of 6 arms, comprising 3 different dose schedules of the 2-valent (Cervarix) and 9-valent (Gardasil-9) HPV vaccines: 3 doses; 2 doses given 6 months apart; or a single dose. All participants will be followed for 36 months; those in the 1 and 2 dose arms will be followed for 60 months. Trial outcomes focus on vaccine immune responses including HPV 16/18-specific antibody levels, antibody avidity, and memory B cell responses. Results will be immunobridged to historical cohorts of girls and young women in whom efficacy has been demonstrated. Discussion: This is the first randomised trial of the single dose HPV vaccine schedule in the target age group. The trial will allow us to examine the quality and durability of immune responses of reduced dose schedules in a population with high burden of malaria and other infections that may affect vaccine immune responses. Initial results (24 months) are expected to be published in early 2021.
Poster presentations, 2021
Background As a component of an ongoing cohort study measuring the incidence of HIV among transge... more Background As a component of an ongoing cohort study measuring the incidence of HIV among transgender women in Sao Paulo, Brazil, this study assessed the acceptability of introducing self-collected sampling for the etiological diagnosis of sexually transmitted infections (STIs). Etiological diagnosis would require sampling potential anatomical infection sites, including oropharyngeal, anorectal, urethral, neovaginal and urine samples. Methods A convenience sample of 23 participants during a scheduled study visit were recruited to this study between October and November 2018. All participants reported being assigned male sex at birth and identified with a feminine gender identity at time of study, with one participant having gender-affirmative surgery to remove their male genitalia. Data collection was through a short investigator-led questionnaire in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams for self-sampling. Three supplem...
PLOS ONE, 2022
IntroductionSolid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus... more IntroductionSolid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women.MethodsCross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck®) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies.Results125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent wo...
The Journal of Infectious Diseases, May 10, 2012
Background. Cervical cancer is a major public health problem for women in sub-Saharan Africa. Ava... more Background. Cervical cancer is a major public health problem for women in sub-Saharan Africa. Availability of a human papillomavirus (HPV) vaccine could have an important public health impact. Methods. In this phase IIIb, double-blind, randomized, placebo-controlled, multicenter trial (NCT00481767), healthy African girls and young women seronegative for human immunodeficiency virus (HIV) were stratified by age (10-14 or 15-25 years) and randomized (2:1) to receive either HPV-16/18 AS04-adjuvanted vaccine (n = 450) or placebo (n = 226) at 0, 1, and 6 months. The primary objective was to evaluate HPV-16/18 antibody responses at month 7. Seropositivity rates and corresponding geometric mean titers (GMTs) were measured by enzymelinked immunosorbent assay. Results. In the according-to-protocol analysis at month 7, 100% of initially seronegative participants in the vaccine group were seropositive for both anti-HPV-16 and anti-HPV-18 antibodies (n = 130 and n = 128 for 10-14-year-olds, respectively; n = 190 and n = 212 for 15-25-year-olds). GMTs for HPV-16 and HPV-18 were higher in 10-14-year-olds (18 423 [95% confidence interval, 16 185-20 970] and 6487 [5590-7529] enzyme-linked immunosorbent assay units (EU)/mL, respectively) than in 15-25-year-olds (10 683 [9567-11 930] and 3743 [3400-4120] EU/mL, respectively). Seropositivity was maintained at month 12. No participant withdrew owing to adverse events. No vaccine-related serious adverse events were reported. Conclusions. The HPV-16/18 AS04-adjuvanted vaccine was highly immunogenic and had a clinically acceptable safety profile when administered to healthy HIV-seronegative African girls and young women.
PLOS ONE, 2021
Introduction This study estimated the costs and incremental cost per case detected of screening s... more Introduction This study estimated the costs and incremental cost per case detected of screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+) in women living with HIV (WLHIV) attending HIV clinics in Burkina Faso. Methods The direct healthcare provider costs of screening tests (visual inspection with acetic acid (VIA), VIA combined visual inspection with Lugol’s iodine (VIA/VILI), cytology and a rapid HPV DNA test (careHPV)) and confirmatory tests (colposcopy, directed biopsy and systematic four-quadrant (4Q) biopsy) were collected alongside the HPV in Africa Research Partnership (HARP) study. A model was developed for a hypothetical cohort of 1000 WLHIV using data on CIN2+ prevalence and the sensitivity of the screening tests. Costs are reported in USD (2019). Results The study enrolled 554 WLHIV with median age 36 years (inter-quartile range, 31–41) and CIN2+ prevalence of 5.8%. The average cost per screening test ranged from US$3.2 for VIA to US$24.8 for cy...
Sex Education, 2021
Indigenous adolescents in Panama are at high-risk for sexually transmitted infections, due in par... more Indigenous adolescents in Panama are at high-risk for sexually transmitted infections, due in part to limited access to condoms and comprehensive sexual and reproductive health (SRH) education. There is a paucity of evidence for how to develop sexual and reproductive health education programmes that incorporate different sources of learning. We used Bronfenbrenner's Ecological Theory to understand two sources of learning: non-caregivers (school or healthcare personnel) and caregivers (parents/grandparents/stepparents). Better understanding sexual and reproductive health learning sources could provide a foundation for the development of targeted, culturally-congruent interventions. This study included ethnographic observation in two Indigenous communities in Panama, followed by semi-structured interviews with young people and caregivers. Findings suggest non-caregiver SRH education was commonly provided by teachers, which is subject to teachers' knowledge and attitudes, and increasingly through the internet. Caregivers focused on topics of abstinence/delaying sexual debut, pregnancy, and STIs/HIV. Condoms were not mentioned by caregivers or adolescents. Traditional SRH teaching by same-gender caregivers was through the rituals of mokän (girls at menarche) and grön (boys 13-14 years). To most effectively make culturally-congruent interventions, we suggest programmes to improve SRH knowledge and access to condoms, and which respect and build on social and traditional SRH learning spaces.
Poster presentations, 2021
Introduction Sexually Transmitted Infections (STIs) disproportionately affect transgender women (... more Introduction Sexually Transmitted Infections (STIs) disproportionately affect transgender women (TGW). This group faces barriers to accessing health care, especially due to stigma and discrimination. The literature is scarce on data of STIs among TGW in Brazil. We aimed to estimate the prevalence of syphilis and to analyze the completeness of treatment among TGW in two Brazilian cities. Methods A cross-sectional study was conducted in Sao Paulo (SP) and Salvador (SSA) from December 2019 to January 2021, as part of the TransOdara study. Participants aged 18 to 65 years old were recruited using Respondent Driven Sampling (RDS), completed a standard questionnaire and samples were collected for rapid syphilis testing. After laboratory and clinical evaluation by a doctor/nurse, a prescription for antibiotic treatment (oral or injectable) was given, if necessary. Results Of the 562 participants recruited, 71.7% (n=403) were from SP and 28.3% (n=159) from SSA. Most were 20–29 years old (45...
LGBTQ populations – TRANS and BI, 2021
Conclusion Nuanced messaging from healthcare providers and media is necessary to properly educate... more Conclusion Nuanced messaging from healthcare providers and media is necessary to properly educate and engage TGW in HIV prevention strategies such as PrEP. A one-size-fits-all approach is inappropriate given the diversity among TGW regarding sexual behaviors and HIV risk factors. Discussions between TGW and healthcare providers should focus on individual HIV risk and patient concerns when determining whether or not PrEP is appropriate.
The mention of specifi c companies or of certain manufacturers' products does not imply that ... more The mention of specifi c companies or of certain manufacturers' products does not imply that they are endorsed or recommended by UNAIDS in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. UNAIDS does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO Library Cataloguing-in-Publication Data HIV/AIDS and STI prevention and care in Rwandan refugee camps in the United Republic of Tanzania.
BMC Infectious Diseases, 2019
Background The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium design... more Background The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. Methods Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1–3, 4–6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the...
PLOS Medicine, 2021
Background Cervical cancer screening strategies using visual inspection or cytology may have subo... more Background Cervical cancer screening strategies using visual inspection or cytology may have suboptimal diagnostic accuracy for detection of precancer in women living with HIV (WLHIV). The optimal screen and screen–triage strategy, age to initiate, and frequency of screening for WLHIV remain unclear. This study evaluated the sensitivity, specificity, and positive predictive value of different cervical cancer strategies in WLHIV in Africa. Methods and findings WLHIV aged 25–50 years attending HIV treatment centres in Burkina Faso (BF) and South Africa (SA) from 5 December 2011 to 30 October 2012 were enrolled in a prospective evaluation study of visual inspection using acetic acid (VIA) or visual inspection using Lugol’s iodine (VILI), high-risk human papillomavirus DNA test (Hybrid Capture 2 [HC2] or careHPV), and cytology for histology-verified high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) at baseline and endline, a median 16 months later. Among 1,238 women (BF: 615; ...
AAS Open Research, 2020
Background: High-risk sexual behaviours (HRSBs) among young adults are a key risk for Sexually Tr... more Background: High-risk sexual behaviours (HRSBs) among young adults are a key risk for Sexually Transmitted Infections (STIs), HIV and unplanned pregnancies. The World Health Organization has identified the 15-24 year age-group as high-risk for STIs. Students at Higher Learning Institutions (HLIs) may be at higher risk because they are free of immediate parental supervision, a transient migratory population, and probably at peak years of sexual activity. Here, we describe risky sexual behaviours and preventive practices among young adults attending HLIs in Mbeya, Tanzania. Methods: Cross-sectional study was conducted from March 2019 to January 2020 among students aged 18-24 years enrolled in HLIs within Mbeya. A self-administered questionnaire was used to collect information on sexual health education, activity, behaviour and STI knowledge. Results: 504 students were enrolled; mean age of 21.5 (SD 1.74) years. 377 (74.8%) students were sexually active. Mean age of first sexual encoun...
PLOS ONE, Apr 17, 2020
Background Members of uniformed armed forces are considered to be at high risk for HIV infection ... more Background Members of uniformed armed forces are considered to be at high risk for HIV infection and have been proposed as suitable candidates for participation in HIV intervention studies. We report on the feasibility of recruitment and follow up of individuals from the community of the Uganda Police Force (UPF) for an HIV vaccine preparedness study. Methods HIV-negative volunteers aged 18-49 years, were identified from UPF facilities situated in Kampala and Wakiso districts through community HIV counselling and testing. Potential volunteers were referred to the study clinic for screening, enrolment and quarterly visits for one year. HIV incidence, retention rates were estimated and expressed as cases per 100 person years of observation (PYO). Rate ratios were used to determine factors associated with retention using Poisson regression models. Results We screened 560 to enroll 500 volunteers between November 2015 and May 2016. One HIV seroconversion occurred among 431 PYO, for an incidence rate of 0.23/100 PYO (95% confidence interval [CI]: 0.03-1.64). Overall, retention rate was 87% at one year, and this was independently associated with residence duration (compared to <1 year, 1 to 5 years adjusted rate ratio (aRR) = 1.19, 95%CI: 1.00-1.44); and >5 years aRR = 1.34, 95%CI: 0.95-1.37); absence of genital discharge in the last 3 months (aRR = 1.97, 95% CI: 1.38-2.83, absence of genital ulcers (aRR = 1.90, 95%CI: 1.26-2.87, reporting of new sexual partner in the last month (aRR = 0.57, 95%CI: 0.45-0.71, being away from home for more
Poster Presentations, 2019
JAMA Network Open, 2019
IMPORTANCE Despite a global increase in sexually transmitted infections (STIs), there is limited ... more IMPORTANCE Despite a global increase in sexually transmitted infections (STIs), there is limited focus and investment in STI management within HIV programs, in which risks for STIs are likely to be elevated. OBJECTIVE To estimate the prevalence of STIs at initiation of HIV preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate) and the incidence of STIs during PrEP use.
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Papers by Philippe Mayaud