Browsing by Author "Bekker, L"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Restricted
    Fertility Intentions and Reproductive Health Care needs of People Living with HIV in Cape Town, South Africa: Implications for Intergrating reproductive Health and HIV Care Services
    (2009) Cooper, D D; Moodley, J R; Zweigenthal, V; Bekker, L; Shah, I; Myer, L
    Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on HAART strongly associated with women’s fertility intentions. Gender differences were also apparent in participants’ key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counseling and services that account for the diverse reproductive needs of these populations.
  • Thumbnail Image
    Item
    Open Access
    HIV vaccine trial safety and retention among 18-20 year olds in the HVTN 503/Phambili study support the inclusion of adolescents in future trials
    (BioMed Central Ltd, 2012) Volk, JE; Hessol, NA; Gray, GE; Kublin, JG; Churchyard, G; Mlisana, K; Nchabeleng, M; Buchbinder, SP; Bekker, L
    Worldwide, many adolescents, especially women, acquire HIV before age 18. Yet to date, no HIV vaccine trials have enrolled adolescents. Reasons for excluding adolescents from these trials include regulations protecting vulnerable subjects and concerns regarding informed consent, social harms, adverse events, and loss to follow-up.
  • Thumbnail Image
    Item
    Open Access
    A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study
    (BioMed Central Ltd, 2012) Lindegger, G; Quayle, M; Singh, S; Welsh, S; Mark, D; Wallace, M; Roux, S; Bekker, L; Mwananyanda, L; Kilembe, W; Chomba, E; Allen, S; Priddy, F; Fast, P
    Assessments of understanding (AoUs) in clinical trials are often composed of true/false multiple choice questions, however, these tools can be difficult for volunteers with limited education or without prior testing experience.
  • Thumbnail Image
    Item
    Open Access
    P06-08. Building an African HIV preventive trial network
    (BioMed Central Ltd, 2009) Price, M A; Allen, S; Anzala, O; Bekker, L; Gilmour, J; Kaleebu, P; Kamali, A; Karita, E; Lakhi, S; Latka, M; Twesigye, R; Sanders, EJ; Amornkul, P; Stevens, G; Thomson, H; H Iavi
    Africa is a crucial setting for preventive HIV clinical trials. We present our experience of setting up a collaborative network of African clinical research centers (CRC).
  • Thumbnail Image
    Item
    Open Access
    P14-07. Offering new prevention modalities in HIV vaccine trials: experience with male circumcision in the Phambili trial
    (BioMed Central Ltd, 2009) de Bruyn, G; Mlisana, K; Metch, B; Churchyard, G; Nchabeleng, M; Bekker, L; Roux, S; Naicker, N; Latka, M; Corey, L; Kublin, J; Gray, G
    Background: New prevention options will be added to the 'standard of prevention' offered in HIV vaccine efficacy trials as new methods prove effective. The HVTN503/Phambili trial was initiated in January 2007, shortly after results from 3 randomized controlled trials of male circumcision (MC) demonstrated that MC reduces the risk of HIV acquisition. Thus, HVTN503 investigators made plans to offer MC at no cost to enrolled male participants. Methods: All participants were informed of the benefits of MC as a component of HIV risk reduction counseling, including how and where MC could be accessed. One site offered on-site MC and the others provided referral to local services for men who requested MC. We present data on uptake of MC post-enrollment. Results: Prior to discontinuation of enrolment, 441 men joined the trial, of whom 312 (70.7%) were uncircumcised. Of these, 82 (26.3% of uncircumcised men) requested MC after enrolment. Uptake varied by site, being lower (70%) at the eThekwini site, the site with lowest baseline MC prevalence. Among 3 sites with intermediate baseline MC prevalence, uptake varied from 3.3 to 37.6%, being highest at the site providing MC on site. Uptake was similar in vaccine and placebo arms of the trial [42 (26.1%) vs. 40 (26.5%)]. There was no significant difference by arm in the timing of circumcision relative to randomization assignment being provided to participants following release of the STEP trial results [post-unblinding, vaccine 18 (42.9%) vs. placebo 13 (32.5%), p = 0.37]. Conclusion: MC, a new prevention modality, was offered as part of HIV prevention services in HVTN503. Uptake varied by provision of care model and inversely with baseline MC prevalence, but did not differ between treatment arms, and remained similar even after provision of treatment.
  • Thumbnail Image
    Item
    Open Access
    P15-13. HVTN 503(Phambili) trial discontinuation of enrolment/vaccination: the impact on trial participant attitudes to vaccine trials and scientific research
    (BioMed Central Ltd, 2009) Mark, D; Middelkoop, K; Roux, S; Gray, G; Mlisana, K; Nchabaleng, M; Churchyard, G; De Bruyn, G; Latka, M; Magagula, D; Kublin, J; Allen, M; Bekker, L; t NIAID HIV Vaccine Trials Network
    Background: The HVTN 503/Phambili trial, a phase IIB study of the Merck Ad-5 HIV vaccine, suspended enrollment and vaccinations following results of the HVTN502/STEP study. Participants were notified of their treatment allocation and continue to be followed. We investigated the impact of the suspension on trial participants' attitudes towards HIV vaccine trials and scientific research. Methods: A self-administered questionnaire investigating knowledge and attitudes utilising a five-point likert scale, was administered 12–18 months post suspension at the 4 Phambili trial sites implementing the latest protocol. Results: Of 544 participants enrolled at 4 sites, 490 completed the questionnaire. 51% understood that vaccination, and 31% that enrolment had been permanently discontinued. Although 85% knew Phambili DSMB recommendations were based on results of the STEP study, only 51% knew that the results showed more infections in the vaccine arm. Although 90% knew they should continue protecting themselves against HIV, only 33% acknowledged trialists' concerns that the vaccine may make them more susceptible to HIV. Knowledge was similar across sites. 12% had tested for HIV antibodies outside of the trial before unblinding to establish their treatment allocation. 46% felt disappointed, angry or afraid, primarily because the vaccine would not prevent HIV in their community. 79% said they would engage in less risk behaviour. 94% thought the study team had made the correct decision by unblinding them and 96% thought site-participant communication was appropriate. 91% felt they made the right decision to enrol in Phambili and 91% planned to continue attending scheduled visits. 86% support scientific research and 80% would want to participate in future HIV vaccine. Conclusion: Despite site communications, knowledge levels were low. Importantly, most knew they should continue to protect themselves against HIV. Although almost half of participants reported negative feelings, most attitudes towards trial sites, scientific research and HIV vaccine trials were positive.
  • Thumbnail Image
    Item
    Restricted
    Special Report on the State of HIV/AIDS in South Africa
    (2012) Navario, P; Bekker, L; Blecher, M; Darkoh, E; Hecht, R; McIntyre, J; Nattrass, N; Ramjee, G; Rees, H; Venter, F; Whiteside, A; Wolvaardt, G; Wood, R
    It is axiomatic that the global fight against HIV/AIDS cannot be won without a decisive victory in South Africa, home to 20 percent of all people living with HIV/AIDS. So how is South Africa doing? And what is the likelihood it will meet the demand for essential prevention and treatment interventions by 2015? On Jan. 21 in Cape Town, Council on Foreign Relations Global Health Fellow Dr. Peter Navario convened a meeting of South Africa's foremost HIV/AIDS thinkers, policy-makers and practitioners to discuss the state of prevention and treatment at the epicenter of the pandemic. In this article, the experts weigh in on program gaps, the major challenges to achieving universal coverage of essential prevention and treatment interventions, and what it will take to surmount these challenges.