450 for risky sex

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Metrics details. While the effects of initiation of antiretroviral treatment ART on risky sexual behavior have been extensively studied, less is known about the long-term changes in risky sexual behavior over time in resource-poor settings. We conducted a secondary longitudinal analysis of one rural and one urban cohort of patients who initiated ART in Uganda between April and July followed up-to Data on sexual behavior were collected every 6 months for 3. We report characteristics overall, and by cohort. We used multivariable generalized estimating equations logistic regression to assess the effects of time on ART on risky sexual behavior.

Of participants, Mean age was Mean duration of follow-up was Risky sexual behavior declined from Receiving care at a rural clinic aOR 4. Not being married aOR 0. Rural, male and young individuals had higher odds of self-reported risky sexual behavior. ART programs should continue to emphasize risk reduction practices, especially among people receiving care in rural health facilities, males, younger individuals and those who are married. Antiretroviral therapy ART transforms HIV infection from a fatal disease to a chronic, manageable condition, increases the quality of life of people living with HIV, greatly improves survival, and reduces the risk of transmission of HIV to a sexual partner [ 123 ].

Beginning inART use in sub-Saharan Africa was dramatically expanded using a public health approach, which led to a rapid expansion of access to treatment in resource-limited settings [ 124 ]. Inan estimated In Uganda, the of people on ART is aboutin [ 5 ]. Prior studies have evaluated the association between ART and risky sexual behavior in the first one to 3 years following ART initiation. Prospective cohort studies in South Africa and Uganda found a decrease in risky sexual behavior. In Uganda, risky sexual behavior in men decreased from These conflicting highlight the complexity of examining the association of ART and risky sexual behavior and its variations in different settings, study participants and treatment program characteristics.

Two meta-analyses summarized the association between ART and sexual risk behavior. Another meta-analysis of 55 prospective and cross-sectional studies in SSA also found lower sexual risk-taking OR 0. To date, most studies examined the effect of ART on sexual risk behavior in the first year s of ART; and mainly compared risky sexual behavior before and after ART initiation. Using data from two clinical cohorts, we evaluated long-term changes in risky sexual behavior among people receiving ART in urban and rural Uganda.

The two cohorts had a 2-year difference in ART initiation timelines and this limited direct comparison. IDI 450 for risky sex a large outpatient clinic with over 30, patients ever enrolled and cares for people living in five Kampala municipalities. A study doctor and adherence counsellor evaluated patients at study enrolment and every 6 months thereafter, while they attended the general clinic for monthly ART medication refills [ 22 ]. At each study visit, a physical examination was performed and information was recorded about HIV status of the partner ssocial support, and sexual history in the past month including promotion of condom use, adherence using visual analogue scale, and reasons for non-adherence.

ART was monitored every 6 months through viral load VL testing. Adherence strategies used by the patient were reviewed, and an adherence action plan developed. Between July 1,and December 31,all individuals receiving first-line ART for at least 4 years were eligible to participate in the cohort study and were included after written informed consent.

Participants continued to receive adherence counselling and condom use from TASO counsellors and peer educators mostly in groups as part of routine care. VL was re-assessed after 3 months. Patients were followed up for additional 3. Every 6 months, cohort participants completed an interviewer-administered standardized questionnaire adapted from the HAARP study [ 24 ] to collect behavioral and treatment outcomes.

Laboratory monitoring included CD4 counts and VL every 6 months. CD4 counts were performed at the Jinja referral hospital regional laboratory. The IDI urban cohort data were directly collected into an electronic behavioral medical record by study counsellors who provided risk reduction counselling including condom use promotion and periodically validated by a senior data manager. The TASO rural cohort, data were collected by the research assistants counsellors using an interview administered behavioral questionnaire but they did not provide counselling on condom use promotion.

Data were double entered using Epi-Info and imported into Access for data management and storage. For this study, data extracted from TASO and IDI database included socio-demographic information age, gender, educational level, employment, and marital statusART start date and regimen, clinical data collected at enrollment, including WHO clinical stage, CD4 cell counts, viral load and sexual behavior of partners in past 6 months and consistency of condom use and adherence data at enrolment and subsequent clinic visits.

For all patients included in the cohort, data was extracted for an additional 3. All participants were followed until death, loss to follow up, transfer out, withdrawal of consent, or 3. Continuous variables were compared using an unpaired t-test or Wilcoxon rank sum test if not normally distributed. Pearson Chi-square was used to compare categorical variables.

The main exposure of interest was time on ART coded as 6-month periods. Other covariates of interest were the site, age, CD4 cell count, viral load, gender, 450 for risky sex level, marital status, occupation, and ART regimen at baseline and calendar year of ART initiation. In order to examine the effect of long-term ART on sexual behaviors, separate analyses were performed. At baseline, we performed multivariable logistic regression and included variables in the initial model based on prior knowledge or association of the selected covariates with risky sexual behavior in bivariable analysis.

Using a backwards elimination procedure, we started with all covariates in the model and then stepwise removed the covariate with the largest p-value until all the remaining covariates had a p-value less than 0. To model the association between the binary outcome risky sexual behavior and the exposure of time on ART, we used a Generalized Estimating Equations GEE logistic regression model, with a logit link function to model the association between the binary outcome risky sexual behavior and the 450 for risky sex of time on ART.

Using a GEE logistic regression, odds ratios ORs were derived that took into the repeated measures in individual participants and missing data in response variables, using robust standard errors to for within-subject correlation. Co-variates with a p-value less than 0.

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We assessed for effect modification by the following variables: gender and sexual partners, marital status and sexual partners, current age group and sexual partners. Of these Most patients were female At baseline, the mean age was Slightly over a half At baseline, the most common ART regimen 450 for risky sex zidovudine, lamivudine and nevirapine in the rural cohort and a tenofovir-based regimen in the urban cohort.

The mean duration of follow-up was After enrollment, 38 3. Overall, The type of risky sexual behavior was predominantly inconsistent or no condom use while engaged in a sexual relationship with a single partner In univariate logistic regression analysis, rural residence OR 4. Not being married was associated with lower odds of risky sexual behavior OR 0. In multivariable logistic analysis, rural residence adjusted odds ratio [aOR] 9. Not being married remained associated with lower odds of risky sexual behavior 450 for risky sex 0.

The proportion of rural patients self-reporting risky sexual behavior declined from In contrast, the proportion of urban patients self-reporting risky sexual behavior remained stable: 9. Trends in risky sexual behavior among urban and rural cohort participants after additional 3. In the multivariable GEE logistic regression model, taking repeated measures over time intorural residence aOR 4. Risky sexual behavior was predominately due to poor condom use and much less due to multiple sexual partners. Risky sexual behavior increased with younger age, with a 2.

When taking the sexual behavior over the entire period of long-term ART intothe odds of risky sexual behavior was higher among male compared to female participants aOR 1. Comparison with other studies in sub-Saharan Africa is difficult as longitudinal data on risky sexual behaviors among people on long-term ART is limited. Our findings do suggest that the reduction in risky sexual behavior observed in the first year s of ART in several studies in sub-Saharan Africa [ 91214202125262728293031 ] does not revert into increased risky sexual behavior over time, but instead either stabilizes at a relatively low rate as observed in the urban cohort or further decreases over time as observed in the rural cohort.

Even though the risk reduced or stabilized over time, the continued risk-taking emphasizes that it remains important to focus on individual risk reduction practices such as consistent condom use even among patients who are already several years on ART. We found that rural residence, male gender, and younger age were associated with increased odds of risky sexual behavior, similar to what was observed in sub-Saharan Africa studies of individuals during the first one to 4 years of ART [ 1112131421272829 ].

For example, in a South African cohort study, people receiving ART at urban and rural health care facilities found younger age, being married and male gender was associated with risky sexual behavior [ 12 ]. Our finding of increased risky sexual behavior among males and married is also similar to Ugandan studies that found, among those on ART for one to 4 years, higher or even increased risky sexual behavior among men and those that are married were observed [ 1113142730 ].

The increased risky sexual behavior observed among men could be because of the gender and power dynamics, where men are the major decision-makers in sexual issues in Africa. Among the married, the increased risk of sexual behavior is attributed to the desire to have children, fear of HIV status disclosure to the sexual partner sand the beliefs that condom use is not necessary for HIV positive couples and reduces sexual satisfaction.

The difference in risky sexual behavior among people receiving care at urban and rural facilities could be due to differences in rural vs urban environment with urban participants having greater exposure to HIV prevention messaging and more likely to be of a higher socioeconomic status.

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Furthermore, condom promotion was mainly done to urban cohort participants. Our study had several strengths, including its prospective de, the inclusion of a cohort in both a rural and urban setting, and the large sample size which allowed us to assess and identify factors that are independently associated with risky sexual behavior.

Several limitations need to be taken into when interpreting the. Second, only patients from HIV centers of excellence were included, which may not be representative for smaller centers or primary care settings. Furthermore, at the IDI urban cohortpatients were asked about sexual behavior from ART initiation by the counsellors which were providing risk-reduction counselling, which may lead to patients being less likely to report risky sexual behavior due to social desirability bias. However, the study team was trained to ask questions in a professional and non-judgmental approach to minimize any social desirability.

Fact sheet. Accessed 16 Dec World Health Organization, March supplement to 450 for risky sex consolidated guideline on the use of antiretroviral drugs for treating and prevention HIV infection. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis. Article Google Scholar. HIV treatment as prevention: debate and commentary-will early infection compromise treatment-as-prevention strategies?

PLoS Med. Kirby D. Changes in sexual behavior leading to the decline in the prevalence of HIV in Uganda: confirmation from multiple sources of evidence. Sex Transm Infect.

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The impact of HIV treatment on risk behavior in developing countries: a systematic review. AIDS Care. Attitudes and perceived impact of antiretroviral therapy on sexual risk behavior among young people in Kahe, Moshi Rural District, Tanzania. Tanzania J Health Res. CAS Google Scholar. Disinhibition in risky sexual behavior in men, but not women, during four years of antiretroviral therapy in rural, southwestern Uganda.

Sexual behaviour and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3-year follow-up.

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Risky sexual behavior among patients on long-term antiretroviral therapy: a prospective cohort study in urban and rural Uganda