Relevant bibliographies by topics / HIV infections – Diagnosis – Malawi

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  2. Dissertations / Theses
  3. Books
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Academic literature on the topic 'HIV infections – Diagnosis – Malawi'

Author: Grafiati
Published: 4 June 2021
Last updated: 1 February 2022

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Journal articles on the topic "HIV infections – Diagnosis – Malawi"

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Chen, Jane S., Mitch Matoga, Shiraz Khan, Edward Jere, Cecilia Massa, Beatrice Ndalama, Arlene C. Seña, et al. "Estimating syphilis seroprevalence among patients in a sexually transmitted infections clinic in Lilongwe, Malawi." International Journal of STD & AIDS 31, no. 4 (February 19, 2020): 359–63. http://dx.doi.org/10.1177/0956462420906762.

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The syndromic management of genital ulcer disease (GUD) misses asymptomatic syphilis cases but is widely utilized in resource-limited settings without diagnostic capabilities to ensure treatment for the most common etiologies of GUD. We used rapid serology tests for syphilis screening at a Malawian sexually transmitted infections clinic. The estimated seroprevalence was 9% and was highest among patients with genital ulcers (26%) and newly diagnosed HIV infection (19%). Rapid syphilis screening has the potential to increase syphilis detection, but accurate patient histories regarding syphilis diagnosis and prior treatment are needed.
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Slaymaker, Emma, Estelle McLean, Alison Wringe, Clara Calvert, Milly Marston, Georges Reniers, Chodziwadziwa Whiteson Kabudula, et al. "The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA): Data on mortality, by HIV status and stage on the HIV care continuum, among the general population in seven longitudinal studies between 1989 and 2014." Gates Open Research 1 (November 6, 2017): 4. http://dx.doi.org/10.12688/gatesopenres.12753.1.

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Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum. This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART.
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Ellis, Jayne, Newton Kalata, Eltas Dziwani, Agnes Matope, Duolao Wang, Síle F. Molloy, Thomas S. Harrison, David G. Lalloo, Derek Sloan, and Robert S. Heyderman. "Co-prevalent infections in adults with HIV-associated cryptococcal meningitis are associated with an increased risk of death: a nested analysis of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) cohort." Wellcome Open Research 6 (February 1, 2021): 19. http://dx.doi.org/10.12688/wellcomeopenres.16426.1.

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Background: HIV-associated cryptococcal meningitis accounts for 15% of AIDS related deaths globally. In sub-Saharan Africa, acute mortality ranges from 24% to 100%. In addition to the mortality directly associated with cryptococcosis, patients with HIV-associated cryptococcal meningitis are at risk of a range of opportunistic infections (OIs) and hospital acquired nosocomial infections (HAIs). The attributable mortality associated with co-prevalent infections in cryptococcal meningitis has not been evaluated. Methods: As part of the Advancing Cryptococcal meningitis Treatment for Africa (ACTA) trial, consecutive HIV-positive adults with cryptococcal meningitis were randomised to one of five anti-fungal regimens and followed up until 10-weeks. We conducted a retrospective case note review of ACTA participants recruited from Queen Elizabeth Central Hospital in Blantyre, Malawi to describe the range and prevalence of OIs and HAIs diagnosed, and the attributable mortality associated with these infections. Results: We describe the prevalence of OIs and HAIs in 226 participants. Baseline median CD4 count was 29 cell/mm3, 57% (129/226) were on anti-retroviral therapy. 56% (127/226) had at least one co-prevalent infection during the 10-week study period. Data were collected for 187 co-prevalent infection episodes. Suspected blood stream infection was the commonest co-prevalent infection diagnosed (34/187, 18%), followed by community-acquired pneumonia (32/187, 17%), hospital-acquired pneumonia (13/187, 7%), pulmonary tuberculosis (12/187, 6%) and confirmed blood stream infections (10/187, 5%). All-cause mortality at 10-weeks was 35% (80/226), diagnosis of an OI or HAI increased the risk of death at 10 weeks by nearly 50% (HR 1.48, 95% CI 1.01-2.17, p=0.04). Conclusion: We demonstrate the high prevalence and broad range of OIs and HAIs occurring in patients with HIV-associated cryptococcal meningitis. These co-prevalent infections are associated with a significantly increased risk of death. Whether a protocolised approach to improve surveillance and proactive treatment of co-prevalent infections would improve cryptococcal meningitis outcomes warrants further investigation.
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Loyse, Angela, Godfrey S. Mfinanga, Cecilia Kanyama, Charles Kounfack, Sokoine Lesikari, Chimwemwe Chawinga, Muirgen Stack, and Sile Molloy. "OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY." BMJ Global Health 4, Suppl 3 (April 2019): A10.2—A10. http://dx.doi.org/10.1136/bmjgh-2019-edc.24.

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BackgroundDREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.MethodsA before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.ResultsThe observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.
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Makombe, Simon D., Anthony D. Harries, Joseph Kwong-Leung Yu, Mindy Hochgesang, Eustice Mhango, Ralf Weigel, Olesi Pasulani, Margaret Fitzgerald, Erik J. Schouten, and Edwin Libamba. "Outcomes of patients with Kaposi's sarcoma who start antiretroviral therapy under routine programme conditions in Malawi." Tropical Doctor 38, no. 1 (January 2008): 5–7. http://dx.doi.org/10.1258/td.2007.060023.

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AIDS-associated Kaposi's sarcoma (KS) is the most common AIDS-related malignancy in sub-Saharan Africa, with a generally unfavourable prognosis. We report on six-month and 12-month cohort treatment outcomes of human immunodeficiency virus (HIV)-positive KS patients and HIV-positive non-KS patients treated with antiretroviral therapy (ART) in public sector facilities in Malawi. Data were collected from standardized antiretroviral (ARV) patient master cards and ARV patient registers. Between July and September 2005, 7905 patients started ART-488 (6%) with a diagnosis of KS and 7417 with a non-KS diagnosis. Between January and March 2005, 4580 patients started ART-326 (7%) with a diagnosis of KS and 4254 with a non-KS diagnosis. At six-months and 12-months, significantly fewer KS patients were alive and significantly more had died or defaulted compared to non-KS patients. HIV-positive KS patients on ART in Malawi have worse outcomes than other patients on ART. Methods designed to improve these outcomes must be found.
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Rucinski, Katherine B., Sarah E. Rutstein, Kimberly A. Powers, Dana K. Pasquale, Ann M. Dennis, Sam Phiri, Mina C. Hosseinipour, et al. "Sustained Sexual Behavior Change After Acute HIV Diagnosis in Malawi." Sexually Transmitted Diseases 45, no. 11 (November 2018): 741–46. http://dx.doi.org/10.1097/olq.0000000000000873.

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Chinguwo, Felix, and Alinane Linda Nyondo-Mipando. "Integration of Early Infant Diagnosis of HIV Services Into Village Health Clinics in Ntcheu, Malawi: An Exploratory Qualitative Study." Journal of the International Association of Providers of AIDS Care (JIAPAC) 20 (January 1, 2021): 232595822098125. http://dx.doi.org/10.1177/2325958220981256.

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Integration of Early Infant Diagnosis(EID) of HIV into Village Health Clinics (VHCs) would increase the uptake of services. This study assessed mothers and health care workers’ acceptability of integration of EID of HIV services into VHCs in Ntcheu, Malawi. We conducted an exploratory qualitative study in the phenomenological tradition among 20 mothers of either HIV exposed or non-exposed infants and 18 health care workers (HCWs) from February to July 2019. We analyzed the data using a thematic approach and guided by the theoretical framework for acceptability. There were positive perceptions of the integration of services. Acceptability is influenced by attitudes, perceived burden, intervention coherent services, and perceived effectiveness of services. The successful integration of EID of HIV into VHCs requires strengthening of the health system and community awareness. Efforts to mitigate stigma should be prioritized when integrating the services to optimize uptake of the services at a community level.
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Low, Andrea, Chloe Teasdale, Kristin Brown, Danielle T. Barradas, Owen Mugurungi, Karam Sachathep, Harriet Nuwagaba-Biribonwoha, et al. "Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data." Clinical Infectious Diseases 73, no. 4 (April 29, 2021): 594–604. http://dx.doi.org/10.1093/cid/ciab031.

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Abstract Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.
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Cromwell, Elizabeth A., Anna E. Dow, Daniel Low, Chawanangwa Chirambo, Robert S. Heyderman, Queen Dube, and Annelies Van Rie. "Barriers to Successful Early Infant Diagnosis of HIV Infection at Primary Care Level in Malawi." Pediatric Infectious Disease Journal 34, no. 3 (March 2015): 273–75. http://dx.doi.org/10.1097/inf.0000000000000625.

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Gupta-Wright, Ankur, Katherine Fielding, Douglas Wilson, Joep J. van Oosterhout, Daniel Grint, Henry C. Mwandumba, Melanie Alufandika-Moyo, et al. "Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa." Clinical Infectious Diseases 71, no. 10 (November 29, 2019): 2618–26. http://dx.doi.org/10.1093/cid/ciz1133.

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Abstract Background Tuberculosis (TB) is the major killer of people living with human immunodeficiency virus (HIV) globally, with suboptimal diagnostics and management contributing to high case-fatality rates. Methods A prospective cohort of patients with confirmed TB (Xpert MTB/RIF and/or Determine TB-LAM Ag positive) identified through screening HIV-positive inpatients with sputum and urine diagnostics in Malawi and South Africa (Rapid urine-based Screening for Tuberculosis to reduce AIDS Related Mortality in hospitalized Patients in Africa [STAMP] trial). Urine was tested prospectively (intervention) or retrospectively (standard of care arm). We defined baseline clinical phenotypes using hierarchical cluster analysis, and also used Cox regression analysis to identify associations with early mortality (≤56 days). Results Of 322 patients with TB confirmed between October 2015 and September 2018, 78.0% had ≥1 positive urine test. Antiretroviral therapy (ART) coverage was 80.2% among those not newly diagnosed, but with median CD4 count 75 cells/µL and high HIV viral loads. Early mortality was 30.7% (99/322), despite near-universal prompt TB treatment. Older age, male sex, ART before admission, poor nutritional status, lower hemoglobin, and positive urine tests (TB-LAM and/or Xpert MTB/RIF) were associated with increased mortality in multivariate analyses. Cluster analysis (on baseline variables) defined 4 patient subgroups with early mortality ranging from 9.8% to 52.5%. Although unadjusted mortality was 9.3% lower in South Africa than Malawi, in adjusted models mortality was similar in both countries (hazard ratio, 0.9; P = .729). Conclusions Mortality following prompt inpatient diagnosis of HIV-associated TB remained unacceptably high, even in South Africa. Intensified management strategies are urgently needed, for which prognostic indicators could potentially guide both development and subsequent use.
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Dissertations / Theses on the topic "HIV infections – Diagnosis – Malawi"

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Kankuwe, Hector Master. "Comparison of the prevalence of HIV infection in circumcised and uncircumcised men from Salima District in Malawi." Thesis, University of Fort Hare, 2012. http://hdl.handle.net/10353/462.

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The overall objective of the study was to investigate the relationship between male circumcision status and HIV infection in men from Salima district in Malawi. A cross-sectional survey-based study of men aged 15 years or more was conducted at three sites in Salima district, each of which targeted 90 participants, half of whom were circumcised and the other half uncircumcised. These participants had already decided on their own to visit HIV Testing and Counseling centres at these sites to know their HIV serostatus. Consenting men were drawn into the study using quota sampling, interviewed through a structured questionnaire in local language and tested for HIV during January and March 2011. Measures of association were performed using analysis of contingency tables and Pearson’s chi-square tests or Fisher’s exact tests for comparison of proportions in STATA version 11.0 and PASW Statistics 18.0 software. Unadjusted odds ratios were used to approximate the direction and strength of association. Further, a multivariable logistic regression model was fit to determine which other variables were significantly associated with HIV infection. The study was approved by University of Fort Hare Interim Research Ethics Committee and National Health Sciences Research Committee in Malawi. The overall prevalence of HIV infection was 11.5 percent. However, it was less than half in circumcised males (7.4 percent) compared with uncircumcised counterparts (15.6 vi percent). While Fisher’s exact test revealed a borderline statistically significant association between male circumcision status and HIV infection (p 0.055), Pearson’s chi-square test showed a stronger significant association between the two variables ( p 0.036). The strength of the association was manifested by the odds of HIV infection being roughly 0.43 times lower for circumcised males than their uncircumcised counterparts with a 95 percent confidence interval of (0.20 0.96). Although the association was maintained after controlling for some variables, it lost statistical significance when adjusted for other variables. A multivariable logistic regression revealed that three other variables had significant associations with HIV infection and these were: falling in the age group of 25 years or more (OR 4.69; p 0.020), having had sex with an HIV positive partner (OR 12.15; p 0.000) and having contracted a sexually transmitted infection (OR 3.25; p 0.032). Male circumcision status is significantly related to HIV infection. Although the study involved a small sample size and undertaken in one district in Malawi, the finding is consistent with existing clinic-based findings in literature that indicate a lower risk of HIV infection in circumcised males than in uncircumcised males. Consequently, male circumcision could be considered if it can prove to be a public health intervention in the Malawi context aimed at reducing the risk of uncircumcised males becoming infected by HIV.
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Nolte, Jeanine Lucasta. "The formulation and refinement of a polymerase chain reaction (PCR) assay for early diagnosis of paediatric HIV infection and genetic analysis of variants involved in vertical transmission of HIV-1." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/26361.

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Paediatric human immunodeficiency virus (HIV) infection has become a major socio-economic health problem in recent years as the number of HIV-1 infected children steadily increases. The majority of these infants are infected through mother-to-child transmission, with the frequency of vertical transmission varying between 12,9% and 65%. In order to implement appropriate management and possible treatment of these infected neonates, it is essential to have reliable laboratory tests for the early diagnosis of an HIV infection. At the time that this study was initiated, the diagnosis of HIV-1 infection in the Groote Schuur Hospital Virology Laboratory depended almost exclusively on serological assays. Such assays are of limited value for infants under 18 months of age, as maternal lgG antibody to HIV-1 is transferred via the placenta and may persist in the baby for up to 18 months. Available lgG antibody tests do not distinguish reliably between passively acquired maternal antibody and that produced by the infant itself. A valuable method of establishing the presence of true infection is provided by the polymerase chain reaction (PCR) technique which allows the identification, and subsequent exponential amplification of low levels of specific viral nucleic acid using specific oligonucleotide primers. A major aim of this study was to develop and instigate a (PCR) assay for the early diagnosis of HIV infection in infected infants. This was successfully achieved by the adaptation and optimization of an existing standard PCR protocol to suit the specific needs of a routine diagnostic service. Preliminary requirements involved the selection of primers and probes and establishing optimal parameters for: ionic strength, Taq DNA polymerase concentration, primer concentration, deoxynucleotide triphosphate concentration, and hybridization conditions for most efficient functioning of the test. The devised method entailed the extraction of proviral DNA from peripheral blood mononuclear cells, amplification of HIV-1 specific sequences by PCR, and identification by Southern blot hybridization with digoxigenin (DIG)-labelled probes. Thereafter the efficacy of the assay was tested on 45 infants (under 15 months of age) all born to seropositive mothers and therefore at risk for HIV infection. Forty-two of these infants had antibodies to HIV-1 and the remaining 3 were seronegative. The latter 3 also tested negative for HIV proviral DNA when PCR was performed, using at least 2 different HIV-1 primer pairs and their respective DIG-labelled probes. However, 27 (64%) of the 42 seropositive infants were also HIV-PCR positive and the remaining 15 (36%) seropositive infants were negative for HIV proviral DNA. Positive PCR tests correlated well with clinical data indicative of active HIV-1 infection for the majority of infants in the neonatal period, although it could not provide proof of infection in newborn babies (less than 1 week of age). The development of an in-house PCR protocol specific for HIV-1 has not only provided a valuable diagnostic assay for neonatal infection, but has also given insight into the parameters required for high sensitivity and the stringent precautionary measures that need to be applied to avoid contamination problems. The second part of this study was devoted to DNA sequence analysis of cloned HIV isolates from an infected mother and her 3-month-old infant. Nucleotide sequence variation between isolates of HIV-1 has been well documented. Examination of the third variable region (particularly the V3- loop) in the env gene of HIV-1 of our mother-infant pair confirmed this variation and provided the first genetic epidemiological data of this nature in the local community. Proviral DNA from both mother and baby was amplified using V3-specific degenerate primers and cloned. Clones containing the insert DNA were 2 identified by colony-blot hybridization. Their nucleotide and amino acid sequences were analyzed by using various computer programs. The degree of similarity between variants from the mother and infant in this study differed to a large extent from previous studies. The virus population harboured by the mother displayed highly homogeneous V3 sequences (1,04% variation) compared to the isolates from her 3-month-old infant, which showed a higher degree (1,8%) of heterogeneity. Phylogenetic analysis of the different isolates from mother and infant demonstrated that an HIV-1 subtype C virus was the infectious agent. This classification was confirmed by the characteristic amino-acid sequence of the tetrapeptide motif of the V3 loop present in the isolates from both mother and infant as well as the absence of a potential N-linked glycosylation site proximal to the first cysteine of the V3 loop, which is characteristic of subtype C viruses. Based on the amino acids present at positions 306 and 320 of the V3 loop, it could also be concluded that isolates from both the mother and her baby were consistent with the non-syncytium inducing (NSI) phenotype of HIV-1, thus indicating that, contrary to popular belief, NSI variants can be responsible for initiating infection. Data obtained from these genetic investigations of variants involved in vertical transmission of HIV-1 can form a useful basis for future comparative studies.
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Hon, Kit-sum Annie, and 韓潔心. "Can home-based HIV testing improve test uptake in Africa?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45172353.

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Liang, Jianguo, and 梁建国. "HIV-1 early diagnosis of men having sex with men in Hong Kong and discovery of novel agents for HIV-1 treatment from traditional Chinese herbal medicine." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196459.

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Over the 30 years since it was first identified, the HIV/AIDS epidemic has had historically unprecedented severity and impact. There are approximately 33.4 million people living with HIV-1/AIDS which urges to seek novel approaches for HIV-1 diagnosis and HIV-1 therapy. Men who have sex with men (MSM) are severely affected by HIV-1 and constitute a large proportion of HIV-infected individuals. In Hong Kong, the transmission route of homosexual and bisexual contacts accounted for nearly 50% of incidence in 2012. To investigate HIV-1 prevalence among MSM in Hong Kong, the combination of fast antibody test (FAT) and real-time dried-blood-spot-based quantitative polymerase chain reaction (DBS-qPCR) was employed for 474 participants chosen randomly from community testing sites of MSM within a one-year period which showed a 4.01% (19/474) rate of HIV-1 prevalence among MSM in Hong Kong with three cases at the acute phase among the newly infected participants. The new survey demonstrated that the risk factors of MSM are mostly correlated with the receptive role during anal sex and syphilis infection. In this study, two traditional Chinese herbal medicines (TCHM), Sanguisorba officinalis (SO) and Spatholobus suberectus (SS), inhibited the infection of model cell lines expressing HIV-1 targets by HIV-1 pseudoviruses, while the anti-HIV-1 properties of SO were demonstrated for the first time. Both SO and SS were able to block not only infection by pseudoviral HIV-1 CCR5-tropic and CXCR4-tropic strains, but also RT and PI drug-resistant strains. Mechanistic studies revealed that SO and SS interact with the viral envelope to prevent the infection of target cells by HIV-1. Two compounds derived from SO and SS, named Gallic acid (GA) and Jiazhi (JZ), retained anti-HIV-1 properties and blocked HIV-1 infection by acting on the viral envelope. Small molecules derived from TCHM were also investigated for their capacity to activate HIV-1 from latency. A small molecule derived from SS, Daidzein (DDZ), demonstrated the potentials to trigger HIV-1 reactivation in latently infected cell lines. DDZ enhanced gene expression from HIV-1 LTR in which the Sp1 binding site plays an important role. The Akt pathway is also involved in the initiation of DDZ-induced activation. Phosflow analysis revealed that DDZ activated the Akt pathway in various subpopulations of T cells, including memory CD4+ T cells which are considered to be a major reservoir for HIV-1. The structure-activity relationships (SARs) study demonstrated the 4'-hydroxyisoflavone as bio-functional core structure. Addition of a hydroxyl group on C-5 position significantly decreases its biological function of HIV-1 latency activation. In summary, this study investigates HIV prevalence and incidence using an assay for early HIV-1 diagnosis and performs an analysis of risk factors of behavior which contributes to the effective control of HIV transmission in Hong Kong and its neighbors in Asia. It also demonstrates a drug research sourced from traditional Chinese herbal medicines that which sheds lights on drug discovery from traditional herbal medicines and facilitates mechanistic drug design for HIV-1 eradication.
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Microbiology
Doctoral
Doctor of Philosophy
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Munthali, Spy Mbiriyawaka. "An institutional analysis of community and home based care and support for HIV/AIDS sufferers in rural households in Malawi." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1002719.

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Standard economic models often emphasize inputs, outputs and an examination of the structures in order to conduct an economic performance evaluation. This study applies the Institutional and Development Framework (IAD) in the broader context of New Institutional Economics (NIE) in order to examine the transaction costs of delivering Community and Home Based Care and Support (CHBC) to HIV/AIDS sufferers. For purposes of unveiling the empirical reality guiding decision making processes in the CHBC service delivery, comparative qualitative research techniques of normative variable and concept formation have been adopted to draw out the relative institutional influences from the HIV/AIDS national response partnerships. The study identifies the conflict between the predominantly standardized and more rigid formal management techniques adopted by key members of the national response and the informal cultural techniques familiar to the rural communities, and a lack of motivational incentives in the CHBC structures as the key factors against CHBC capacities to draw external funding for service delivery. CHBCs are also weakened by incoherent governance structures at the district level for facilitation of funding and information flow exacerbating the community vulnerability. Rationalization of the institutional arrangements and a clarification of roles from district to community levels, a shift of focus to facilitation of informal techniques and an integration of performance enhancing incentives are the critical policy insights envisaged to spur CHBCs to work better.
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Berggren, Palme Ingela. "Tuberculosis and HIV interaction in Ethiopian children : aspects on epidemiology, diagnosis and clinical management /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-296-5/.

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Ng, Jenny, and 吳仲嫣. "Reducing HIV infections in Hong Kong: a systematic review of the cost-effectiveness of expanded screening." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48425138.

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Background Routine voluntary HIV screening has been found to be cost-effective in regions with undiagnosed prevalence > 0.1%. However, a large proportion of infected patients are still unaware of their status and presenting to care late, leading to greater risk s for infection. As expanded ART has been shown to be highly effective in improving patient health and reducing HIV viral load, a strategy of expanded screening with earlier initiation of ART may be effective at reducing the numbers of new infections. Aim A systematic review was carried out with the aim of understanding what drives the cost-effectiveness of expanded HIV screening at low prevalence rates. A thorough investigation of sensitivity analysis was done to determine if low prevalent regions can implement screening at good value for cost and how money should be spent to maximize benefits. Methods An extensive literature review of studies published in English between 1996 and 2010 were identified from various electronic databases, included gray literature search and hand search. A qualitative assessment of the literature was undertaken. Results Results of the analysis found that expanded screening can be cost-effective at undiagnosed prevalence rates below that of current recommendations. Factors of linkage to care, and benefits of reduced secondary transmissions through reduced risk behaviors had the most impact on models. Screening while maximizing benefits due to linkage to care and secondary transmissions can may be appropriate for low prevalence regions such as Hong Kong, however further analysis would be necessary.
published_or_final_version
Public Health
Master
Master of Public Health
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Mohaleni, Mamabolo Promise. "Pre-and post-HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province." Thesis, University of Limpopo (Turfloop Campus), 2013. http://hdl.handle.net/10386/1049.

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Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013
Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.
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Orikiriza, Patrick. "Improving diagnosis of childhood tuberculosis in a high TB-HIV prevalent setting." Thesis, Montpellier, 2019. http://www.theses.fr/2019MONTT026.

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L’Organisation Mondiale de la Santé estime qu’en 2017 près d’un million d’enfants de moins de 15 ans ont développé la tuberculose mais seulement la moitié des cas ont été notifiés. Les difficultés pour recueillir des échantillons de crachat chez les enfants et la nature paucibacillifère de la tuberculose pédiatrique représentent de véritables challenges diagnostiques. Cela aboutit à la prescription fréquente de traitement empirique avec un risque de sur- ou sous-diagnostic. De plus, peu de laboratoires dans les pays à ressources limitées ont les capacités du diagnostic de la tuberculose. Les échantillons doivent être transportés vers des laboratoires de référence pouvant affecter les performances des tests, notamment en l’absence de chaine de froid.Trois études ont été menées à Mbarara (Ouganda) pour évaluer des échantillons non-respiratoires et des méthodes de conservation des échantillons pour améliorer le diagnostic de la tuberculose de l’enfant. Dans la première étude, nous avons évalué les performances de l’XpertMTB/RIF sur les expectorations et les selles d’enfants avec présomption de tuberculose et nous avons documenté le devenir des enfants selon la décision thérapeutique. Dans la deuxième étude, nous avons évalué les performances de l’XpertMTB/RIF dans les selles et du test lipoarabinomanann (LAM) dans les urines chez des enfants admis dans un état critique. Dans la troisième étude, nous avons déterminé le taux de détection avec XpertMTB/RIF et la culture MGIT d’échantillons de crachats frottis-positifs conservés à température ambiante sans traitement, ou traités avec Omnigène ou éthanol à différents périodes de temps.Sur 392 enfants (âge médian 3,9 ans, 45,5% de filles et 31% VIH positifs) inclus dans la 1e étude, 4,3% ont été confirmés microbiologiquement. L’XpertMTB/RIF dans le crachat avait une sensibilité de 90,9% et une spécificité de 99,1% contre un test de référence microbiologique. La sensibilité et la spécificité de l’Xpert dans les selles étaient de 55,6% et 98,2%. La mortalité était de 6,9% à trois mois, et était plus importante chez les enfants traités (10,7%) que chez les enfants non-traités (4,5%). Aucun des enfants traités pour une tuberculose microbiologiquement confirmée n’est décédé contre 12,3% de ceux traités de façon empirique.Parmi les 234 enfants (âge médian 16,5 mois, 48,3% de filles, 31,6% VIH positifs et 58,5% sévèrement malnutris) inclus dans la 2e étude, 5,1% avaient une tuberculose microbiologiquement confirmée. XpertMTB/RIF dans les selles avait une sensibilité de 50% et une spécificité de 99,1%. La sensibilité du test urinaire LAM était de 50% et la spécificité de 74,1%. Les faux positifs LAM étaient plus fréquents parmi les résultats positifs LAM de bas grade et dans les urines avec une contamination bactérienne.Dans la 3e étude, après 15jours, il n’y avait pas de différence de détection par XpertMTB/RIF entre les échantillons traités avec Omnigène ou éthanol et les échantillons non traités, ne montrant pas de bénéfice de l’ajout d’un conservateur. Nous avons décrit une baisse substantielle de viabilité de Mycobacterium tuberculosis dans les échantillons traités par Omnigène, ce qui n’est pas en faveur de l’utilisation de l’Omnigène pour le transport des échantillons avant culture MGIT.En conclusion, XpertMTB/RIF dans les selles a montré des résultats prometteurs chez les enfants ne pouvant pas cracher et pourrait être une alternative intéressante à des méthodes plus complexes comme l’induction du crachat et l’aspiration gastrique pour les centres de santé primaire des pays à ressources limitées. La faible spécificité du LAM dans les urines nécessite des investigations complémentaires avant son utilisation pour le diagnostic de la tuberculose de l’enfant. En dépit des résultats encourageants de l’XpertMTB/RIF sur les échantillons conservés avec Omnigène ou l’éthanol, des investigations complémentaires dans des conditions programmatiques sont nécessaires
The world health organization estimates that in 2017, close to 1 million children below 15 years developed tuberculosis but only half of them were notified. Difficulty to obtain sputum in children and the paucibacillary nature of intrathoracic childhood tuberculosis challenge the diagnosis of tuberculosis in children. This leads to the common use of empirical treatment with a high risk of over or under diagnosis. Besides that, few facilities in low resource settings have adequate laboratory capacity to diagnose tuberculosis. Samples must be transported to a reference laboratory, which can effect performance of the tests, especially in the absence of cold chain.Three studies were conducted in Mbarara (Uganda) to evaluate non-respiratory samples and specimen preservation methods to improve diagnosis of pediatric tuberculosis. In the first study, we assessed the performance of XpertMTB/RIF on sputum and stool in children with presumptive tuberculosis and documented outcomes of children according to the tuberculosis treatment decision. In the second study, we assessed the performance of stool XpertMTB/RIF and urine lipoarabinomanann (LAM) among children admitted with severe illness. In the 3rd study, we determined XpertMTB/RIF and MGIT culture recovery rates of smear positive sputum specimen kept untreated at room temperature and treated with either Omnigene or ethanol over different time periods.Of 392 children (median age 3.9 years, 45.4% female and 31% HIV infected) enrolled in the 1st study, 4.3% (17/392) were microbiologically confirmed tuberculosis. Using a microbiological reference standard, sputum XpertMTB/RIF had a 90.9% sensitivity and specificity of 99.1%. The sensitivity and specificity of stool XpertMTB/RIF was 55.6% and 98.2%. The study reported mortality of 6.9% within three months with a higher proportion (10.7%) among children treated for tuberculosis compared to the non-treated children (4.5%). None of treated children with bacteriologically confirmed tuberculosis died compared to 12.3% of those treated empirically.Of 234 patients (median age 16.5 months, 48.3% female, 31.6% HIV infected, 58.5% severely malnourished) enrolled in the 2nd study, 5.1% were microbiologically confirmed tuberculosis. Stool XpertMTB/RIF had a sensitivity of 50% and specificity of 99.1%. For the urine LAM test, it was 50% and 74.1%, respectively. False positive LAM results were more common among low grade positive LAM results and occurred more frequently when urine samples had bacterial contamination.The 3rd study documented that by 15th day, there was no difference of XpertMTB/RIF recovery rate between samples treated with Omnigene or ethanol and untreated samples, meaning that in the study conditions there was no benefit of adding any preservative for samples stored at room temperature up to 15 days. We observed a substantial loss of viability of Mycobacterium tuberculosis on samples treated with Omnigene, which does not support the use of Omnigene for sample transportation before MGIT testing.In conclusion, XpertMTB/RIF on stool gave promising results for the use in children unable to provide sputum and could be an interesting alternative to more complex methods such as sputum induction and gastric aspirate for primary health care centers of limited resource countries. The low specificity of the urine LAM requires further investigation before its use for diagnosis of tuberculosis in children. Despite the encouraging XpertMTB/RIF results from specimen preserved either with Omnigene or ethanol further evaluation under routine field conditions is necessary
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Poulin, Michelle J. "The sexual and social relations of youth in rural Malawi : strategies for AIDS prevention /." Citation, abstract and full text online, 2007. http://proquest.umi.com/pqdweb?did=1158526321&sid=1&Fmt=2&clientId=3740&RQT=309&VName=PQD.

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Books on the topic "HIV infections – Diagnosis – Malawi"

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Yoder, P. Stanley. Voluntary counselling and testing (VCT) for HIV in Malawi: Public perspectives and recent VCT experiences. Calverton, Md: ORC Macro, 2004.

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Moses, Philip F. HIV Testing and Counselling (HTC): The 5 year plan to scale up HIV testing and counselling services in Malawi, 2006-2010. [Lilongwe]: Ministry of Health, 2007.

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Foreman, Martin. Men and HIV in Malawi. [Lusaka, Zambia]: Panos Southern Africa, 2000.

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Kakhongwe, Paul. Malawi: HIV and AIDS research database. Zomba [Malawi]: University of Malawi, Centre for Social Research, 2004.

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Medical Laboratory and Clinical Scientists Council (Zimbabwe). Rapid HIV testing: Trainer's guide. 3rd ed. [Harare]: Ministry of Health and Child Welfare, 2006.

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Commission, Malawi National AIDS. The Malawi HIV and AIDS policy development process. Lilongwe, Malawi: National AIDS Commission, 2009.

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Tomas, Lievens, Ngoma Peter, Humphrey Ed, and Oxford Policy Management, eds. Sustainable financing for HIV/AIDS in Malawi. Oxford, UK: Oxford Policy Management Limited, 2012.

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V, Deutsche AIDS-Hilfe e. HIV-Test 2000: Bestandsaufnahme und Perspektiven. Berlin: Deutsche AIDS-Hilfe e.V., 2000.

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Phair, John P. Contemporary diagnosis and management of HIV/AIDS infections. Newtown, PA: Handbooks In Health Care, 1997.

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P, Flaherty John, ed. Contemporary diagnosis and management of HIV/AIDS infections. 2nd ed. Newtown, Pa: Handbooks in Health Care, 2003.

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Book chapters on the topic "HIV infections – Diagnosis – Malawi"

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Gürtler, L. G., L. Zekeng, J. M. Tsague, A. Brunn, E. Afane Ze, J. Eberle, and L. Kaptue. "HIV-1 subtype O: epidemiology, pathogenesis, diagnosis, and perspectives of the evolution of HIV." In Imported Virus Infections, 195–202. Vienna: Springer Vienna, 1996. http://dx.doi.org/10.1007/978-3-7091-7482-1_17.

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Tay, Andy Kah Ping, Bee Luan Khoo, and Majid Ebrahimi Warkiani. "Microfluidics for Fast and Frugal Diagnosis of Malaria, Sepsis, and HIV/AIDS." In Frugal Innovation in Bioengineering for the Detection of Infectious Diseases, 57–75. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-66647-1_4.

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Rudén, U., P. A. Broliden, J. Trojnar, and B. Wahren. "Synthetic peptides in the diagnosis of HIV-1 and HIV-2 infections." In Peptides 1990, 911–13. Dordrecht: Springer Netherlands, 1991. http://dx.doi.org/10.1007/978-94-011-3034-9_373.

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Nguyen, Nang L., Rodney Arcenas, and Yi-Wei Tang. "Laboratory Diagnosis of HIV-1 Infections: State of the Art." In Advanced Techniques in Diagnostic Microbiology, 445–73. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-95111-9_18.

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Tang, Yi-Wei. "Molecular Diagnosis of HIV-1 Infections: Current State of the Art." In Advanced Techniques in Diagnostic Microbiology, 785–812. Boston, MA: Springer US, 2012. http://dx.doi.org/10.1007/978-1-4614-3970-7_41.

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Kwoh, Deborah Y., and Thomas R. Gingeras. "The Use of Transcription-based Amplification Systems in the Diagnosis of HIV-1 Infections." In Applied Virology Research, 33–58. Boston, MA: Springer US, 1994. http://dx.doi.org/10.1007/978-1-4757-9265-2_3.

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Wilkinson, Ian B., Tim Raine, Kate Wiles, Anna Goodhart, Catriona Hall, and Harriet O’Neill. "Infectious diseases." In Oxford Handbook of Clinical Medicine, 378–443. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199689903.003.0009.

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This chapter discusses infectious diseases, and includes bacterial infection, antibiotics, gram-positive bacteria, gram-negative bacteria, tuberculosis (TB), influenza, human immunodeficiency virus (HIV) diagnosis, complications, and HIV antiretroviral therapy (ART), herpes, immunization, fungi, healthcare-associated (nosocomial) infection, sexually transmitted infection, fever in the returning traveller, enteric fever, malaria, mosquito-borne disease, vector-borne disease, zoonoses, viral haemorrhagic fever (VHF), gastroenteritis, gastrointestinal parasites, schistosomiasis and liver disease, neurological disease, eye disease, skin disease, and pyrexia of unknown origin.
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Colbert, Dom. "The Returned Traveller." In MCQs in Travel Medicine. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199664528.003.0020.

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Respiratory illness, fever, diarrhoea, and dermatitis are the four most frequent medical problems in the returned traveller. Unexplained fever is the most urgent of these because febrile conditions such as malaria, meningitis, and typhoid can all deteriorate rapidly and become life-threatening. Respiratory infections are also very common and are often viral in origin. A persistent cough or a doubtful CXR warrants further investigation. Diarrhoea that persists may well be helminthic in origin with giardiasis high on the list. In cases already treated with antibiotics one must consider C. difficile infection while the unmasking of inflammatory bowel disease or irritable bowel syndrome is probably more common than supposed. Dermatitis is often due to exacerbation of an existing condition, e.g. psoriasis or eczema. Tropical-related dermatitis is most frequently due to infected arthropod bites. CLM is the main parasitic cause. Exanthems and enanthems occur in a variety of systemic conditions ranging from acute HIV to dengue fever to coxsackie infection. Rashes are seldom diagnostic unless the cause is obvious, e.g. scabies or typhoid (rose spots). In all cases the practitioner should adhere to a strict protocol that involves a good history, careful physical examination, and routine screening and microscopy of blood, urine, and stool. Simple X-rays and ultrasound examination may also be considered. In no case should the practitioner hesitate to refer the patient to a specialist physician. Nowadays computer-assisted diagnosis is becoming more popular and more reliable. The Kabisa Travel System, developed in Antwerp, has been shown to perform equally well with travel physicians in diagnosing the cause of fever in those returned from a tropical environment. Kabisa is the Swaili word for ‘hand in the fire, I am absolutely certain’!
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"Human Immunodeficiency Viruses: HIV-1 and HIV-2." In Lennette's Laboratory Diagnosis of Viral Infections, 399–416. CRC Press, 2016. http://dx.doi.org/10.3109/9781420084962-25.

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Vigil, Karen J. "Nonopportunistic Infections." In Fundamentals of HIV Medicine 2019, 399–402. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190942496.003.0037.

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Upon completion of this chapter, the reader should be able to • Demonstrate knowledge regarding the diagnosis and treatment of respiratory complications in patients living with HIV infection. Review and characterize the respiratory complications related to HIV infection to provide early and accurate diagnosis and treatment....
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Conference papers on the topic "HIV infections – Diagnosis – Malawi"

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Chen, Jane, Mitch Matoga, Shiraz Khan, Edward Jere, Cecilia Massa, Beatrice Ndalama, Arlene Seña, et al. "P733 Evaluating the use of rapid syphilis testing among patients in a sexually transmitted infections clinic in lilongwe, malawi." In Abstracts for the STI & HIV World Congress (Joint Meeting of the 23rd ISSTDR and 20th IUSTI), July 14–17, 2019, Vancouver, Canada. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/sextrans-2019-sti.793.

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McCartney, D., T. Pinheiro, J. Gomez, P. Galdino, M. de Sousa Mascena Veras, and P. Mayaud. "P386 Acceptability of self-collected samples for diagnosis of sexually transmitted infections among transgender women in São Paulo cohort study." In Abstracts for the STI & HIV World Congress, July 14–17 2021. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/sextrans-2021-sti.421.

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Medland, N., C. Fairley, J. Wu, X. Wu, E. Chow, X. Xu, Z. Ge, X. Zhuang, and L. Zhang. "P341 Predicting the diagnosis of HIV and sexually transmitted infections among men who have sex with men using machine learning approaches." In Abstracts for the STI & HIV World Congress, July 14–17 2021. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/sextrans-2021-sti.391.

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Consolacion, Theodora, Janyn Mercado, Olga Mazo, Venessa Ryan, Linda Hoang, Muhammad Morshed, Mark Gilbert, Mark Hull, Troy Grennan, and Jason Wong. "P747 Characteristics of chlamydia/gonorrhea infections associated with a subsequent syphilis diagnosis in british columbia, canada." In Abstracts for the STI & HIV World Congress (Joint Meeting of the 23rd ISSTDR and 20th IUSTI), July 14–17, 2019, Vancouver, Canada. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/sextrans-2019-sti.806.

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Abe, T., T. Terao, Y. Nakayama, Y. Kato, M. Kazama, and I. Takahashi. "HEMOPHILIAC MENINGITIS WITH PARTICULAR MANIFESTATION AND HIV ANTIBODIY IN SPINAL FLUID." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1644139.

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A 25-year-old patient with hemophilia A, who had had thrombocytopenia since 1985, was admitted to a hospital in August 1986 because of headache and slight disturbance of consciousness. Diagnosis of cerebral bleeding was made based on brain CT scan. Lymphadanopathy was noted then, and after relief of the symptoms S. aureus sepsis developed. Examination of serum for HIV antibody performed at this time gave a positive result. He was transferred to our hospital for evaluation of AIDS-relatedimmunologic disorder. The ratio of T4/T8 was 0.16, but no definitive opportunistic infections were found. Soon later, he developed headache and fever. There were no other neurological signs. Spinal fluid examination revealedlymphocytic pleocytosis without bacilli, fungi or antibodiesto viruses commonly causing encephalomeningitis. However, antibodyto HIV was detected in the spinalfluid. By a supportive care with useof antibacterial agents thesymptoms were alleviated with diminishing of the pleocytosis in spinal fluid. Lentinan, an antitumor polysaccharide, was administered with some effect on his immunologic functions. Three months later, meningitis recurred which wasalsorelieved by a supportive care.HIV is known to cause meningeal and CNS diseases. In this case the presence of HIV antibody in the spinal fluid was interpreted to be due to HIV invasion of nervous system. Furthermore, this casehas some particular feature in consideration of the common pictureof neurological involvements of AIDS, indicating that HIV induced a variety of meningeal and CNS manifestations.
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Reports on the topic "HIV infections – Diagnosis – Malawi"

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Erling, Norrby, and Eva M. Fenyo. Human Immunodeficiency Virus (HIV) Infections: Strain and Type Variations; Diagnosis and Prevention. Fort Belvoir, VA: Defense Technical Information Center, April 1991. http://dx.doi.org/10.21236/ada237815.

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Orme, I. M. Early Diagnosis and Treatment of Opportunistic Mycobacterial Infections in HIV-Seropositive AIDS Patients. Fort Belvoir, VA: Defense Technical Information Center, August 1990. http://dx.doi.org/10.21236/ada227796.

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Impulsiveness, depression, sexual behavior, and sexually transmitted infections and HIV-related outcomes among out-of-school adolescent girls and young women in rural southern Malawi. Population Council, 2021. http://dx.doi.org/10.31899/hiv12.1018.

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