Thindwa, Deus, Mwalukomo, Thandie S, Msefula, Jacquline, Jambo, Kondwani C, Brown, Comfort, Kamng'ona, Arox, Mwansambo, Charles, Ojal, John, Flasche, Stefan, French, Neil 
ORCID: 0000-0003-4814-8293 et al (show 2 more authors)
(2022)
Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi.
AIDS, 36 (14).
pp. 2045-2055.
Abstract
<h4>Objective</h4>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.<h4>Methods</h4>Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage.<h4>Results</h4>Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 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 less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex.<h4>Conclusion</h4>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 |
|---|---|
| Uncontrolled Keywords: | antiretroviral, herd immunity, HIV, Malawi, pneumococcal carriage, pneumococcal conjugate vaccine, risk factors |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 02 Sep 2022 14:17 |
| Last Modified: | 18 Jan 2023 20:46 |
| DOI: | 10.1097/QAD.0000000000003365 |
| Open Access URL: | https://journals.lww.com/aidsonline/Abstract/9900/... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3163179 |
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