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Introduction: At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre‐requisite for achieving an AIDS‐free generation and attaining epidemic control. Discussion: Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age‐disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender‐based violence, increased genital inflammation, and amplification of effects of transmission co‐factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence‐based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community‐based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti‐retrovirals and conditional cash transfers for HIV prevention in these populations. Conclusions: There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV‐specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative., Introduction Southern Africa is at the epicentre of the global HIV epidemic, bearing almost 40% of the global burden of infection despite being home to less than 2% of the [...]

Introduction: Optimizing methods for genital specimen collection to accurately characterize mucosal immune responses is a priority for the HIV prevention field. The menstrual cup (MC) has been proposed as an alternative to other methods including cervicovaginal lavage (CVL), but no study has yet formally compared these two methods. Methods: Forty HIV-infected, antiretroviral therapy-naïve women from the CAPRISA 002 acute HIV infection cohort study were randomized to have genital fluid collected using the MC with subsequent CVL, or by CVL alone. Qualitative data, which assessed levels of comfort and acceptability of MC using a 5-point Likert scale, was collected. Luminex multiplex assays were used to measure HIV-specific IgG against multiple gene products and 48 cytokines. Results: The majority (94%) of participants indicated that insertion, wearing and removal of the MC was comfortable. Nineteen MCs with 18 matching, subsequent CVLs and 20 randomized CVLs were available for analysis. Mucosal IgG responses against four HIV-antigens were detected in 99% of MCs compared to only 80% of randomized CVLs (p = 0.029). Higher specific antibody activity and total antibodies were observed in MCs compared to CVL (all p<0.001). In MCs, 42/48 (88%) cytokines were in the detectable range in all participants compared to 27/48 (54%) in CVL (p<0.001). Concentrations of 22/41 cytokines (53.7%) were significantly higher in fluid collected by MC. Both total IgG (r = 0.63; p = 0.005) and cytokine concentrations (r = 0.90; p<0.001) correlated strongly between MC and corresponding post-MC CVL. Conclusions: MC sampling improves the detection of mucosal cytokines and antibodies, particularly those present at low concentrations. MC may therefore represent an ideal tool to assess immunological parameters in genital secretions, without interfering with concurrent collection of conventional CVL samples. [ABSTRACT FROM AUTHOR]

Background The Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial demonstrated a 39% reduction in HIV infection, with a 54% HIV reduction in women who used tenofovir gel consistently. A confirmatory trial is expected to report results in early 2015. In the interim, we have a unique window of opportunity to prepare for and devise effective strategies for the future policy and programmatic scale-up of tenofovir gel provision. One approach is to integrate tenofovir gel provision into family planning (FP) services. The CAPRISA 008 implementation trial provides an opportunity to provide posttrial access to tenofovir gel while generating empiric evidence to assess whether integrating tenofovir gel provision into routine FP services can achieve similar levels of adherence as the CAPRISA 004 trial. Methods/design This is a two-arm, open-label, randomized controlled non-inferiority trial. A maximum of 700 sexually active, HIV-uninfected women aged 18 years and older who previously participated in an antiretroviral prevention study will be enrolled from an urban and rural site in KwaZulu-Natal, South Africa. The anticipated study duration is 30 months, with active accrual requiring approximately 12 months (following which an open cohort will be maintained) and follow-up continuing for approximately 18 months. At each of the two sites, eligible participants will be randomly assigned to receive tenofovir gel through either FP services (intervention arm) or through the CAPRISA research clinics (control arm). As part of the study intervention, a quality improvement approach will be used to assist the FP services to expand their current services to include tenofovir gel provision. Discussion This protocol aims to address an important implementation question on whether FP services are able to effectively incorporate tenofovir gel provision for this at-risk group of women in South Africa. Provision of tenofovir gel to the women from the CAPRISA 004 trial meets the ethical obligation for post-trial access, and helps identify a potential avenue for future scaleup of microbicides within the public health system of South Africa. [ABSTRACT FROM AUTHOR]

An abstract of the article "Softcup Compared to Cervicovaginal Lavage Sampling: Determining Total and HIV-specific IgGs in the Female Genital Tract - A Randomized Study" by Lenine Julie Liebenberg, Lise Werner and colleagues is presented.

An abstract of the article "Gel Use Disclosure in an Open-label 1% Tenofovir Gel Trial: Perspectives from Participants, Partners and Community Men in KwaZulu-Natal, South Africa" by Kathleen M. MacQueen, Sarah Dlamini and colleagues is presented.

An abstract of the article "Tenofovir Gel as a Component of the HIV Prevention Mix: Perspectives from Participants, Partners and Community Men in KwaZulu-Natal, South Africa" by Kathleen M. MacQueen, Sarah Dlamini, Brian Perry, and colleagues is presented.

An abstract of the article "Group Adherence Support (GAS) - Experiences from CAPRISA 008" by Chitra Singh, Nelisiwe Ngcobo, Sarah Dlamini and colleagues is presented.

An abstract of the article "A Randomized Study Comparing Softcup and Cervicovaginal Lavage Sampling to Measure Genital Cytokine Concentrations in HIV-infected Women" by Lenine J. Liebenberg, Nigel Garrett, Lise Werner and colleagues is presented.

An abstract of the article "Introducing Microbicides: Estimated Cost of QI Approach and Tenofovir Gel Delivery with Family Planning Services in the CAPRISA 008 Trial" by Rick Homan, Sarah Dlamini, Leila Mansoor is presented.