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Thindwa, Deus, Mwalukomo, Thandie S, Msefula, Jacquline, Jambo, Kondwani 
ORCID: https://orcid.org/0000-0002-3195-2210, Brown, Comfort, Kamng'ona, Arox, Mwansambo, Charles, Ojal, John, Flasche, Stefan, French, Neil, Heyderman, Robert S and Swarthout, Todd D
(2022)
'Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi.'. AIDS, Vol 36, Issue 14, pp. 2045-2055.
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Abstract
Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4-years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors. Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015-2019. We fitted generalised additive models to estimate the risk of sex, social economic status (SES), living with a child <5y, and ART duration on carriage. Of 2,067 adults, median age was 33y (range 28-37), 1,427 (69.0%) were females, 1,087 (61.4%) were in low-middle socio-economic-status (SES), 910 (44.0%) were living with a child <5y, and median ART duration was 3.0 years (range 0.004-17). We estimated 38.2% and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child <5y and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child <5y and male sex. Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > Preventive Medicine > WA 115 Immunization WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 217 Pneumococcal infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications |
| Faculty: Department: | Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1097/QAD.0000000000003365 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 13 Oct 2022 14:47 |
| Last Modified: | 09 Mar 2023 16:20 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/21085 |
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