(2009) have shown is required for maturation of the S-layer, but that is not essential for virulence. Of the two proteins classified as ABC transporters, neither conformed to the expected architecture for such a protein, namely, a leader

peptide containing an N- and C-domain completely lacking an intervening hydrophobic domain, in addition to a double-glycine motif N-terminal of the signal peptide cleavage site. All the other ‘transport’ proteins identified contained a significant hydrophobic domain between the N- and the C-domain of the predicted signal peptide, in addition to a number of other motifs usually associated with the twin arginine translocation or Sec secretion pathways. None of the 23 proteins contained any C-terminus cell wall anchor motifs commonly found in Gram-positive bacteria,

such as LPxTG, NPQTN or TLxTC (Dramsi et al., 2005; Desvaux et al., 2006). As in our previous work, we used the pathway reconstruction Dorsomorphin molecular weight tool biocyc (Karp Tofacitinib molecular weight et al., 2005) to analyse pathways inferred from our proteomics dataset. The snapshot of C. difficile metabolism presented here reflects the nutritional complexity of BHI broth, which contains glucose, proteose peptone and bovine BHI solids. We could, therefore, reconstruct a number of key central metabolic pathways (Djordjevic et al., 2003) that would be expected to be active in clostridial cells including glycolysis, mixed acid fermentation and fermentation of amino acids Celecoxib (Gottschalk, 1979) (see Figs. S1-S3). The metabolic processes we have identified in C. difficile

are, therefore, broadly similar to those described in a recent proteomic investigation of the Gram-negative gut anaerobe, Fusobacterium varium. Potrykus et al. (2008) report that F. varium may play both beneficial and pathogenic roles in the human gut. While the antics of C. difficile left unchecked have given it a deservedly bad reputation (Heap et al., 2009), its ability to produce butyrate (Fig. S3), as is known to occur in F. varium, could mean that in asymptomatic carriers of C. difficile, the organism has the potential to contribute to colonocyte health. Such a counterintuitive hypothesis highlights the need, not only from a basic science perspective but also from a position of concern for public health, to know the frequency of asymptomatic C. difficile carriers within the general population: therefore, we see an urgent requirement to develop a better understanding of C. difficile biology within the human microbiome. The pathogenicity of C. difficile is dependent on a combination of toxin synthesis, p-cresol production and a diverse range of amino acid fermentations (Kim et al., 2008). Leucine is reported to be indispensible for the growth of this organism and may be metabolized by a reductive pathway, to isocaproate, or by means of an alternative oxidative pathway in which isovalerate and ammonia are produced.

, 2004). Some pathogens such as Haemophilus influenzae also use the transported sialic acid to decorate their own cell surface, which is an important mechanism for their persistence in the body (Bouchet et al., 2003). Corynebacterium glutamicum is a Gram-positive, nonmotile bacterium that belongs to the phylum Actinobacteria. It was first isolated from soil in 1975 during a screen for glutamate-producing bacteria

(Kinoshita et al., 1957). Because VE-822 order of its ability to produce high levels of glutamate and lysine, it has become a widely used organism in industrial biotechnology (Kumagai, 2000). Every year around 1.5 million tons of l-glutamate and 0.75 million tons of l-lysine are produced commercially using C. glutamicum (Kelle et al., 2005; Kimura, 2005). Besides glucose as a sole carbon source,

it is able to utilize a wide range of other carbon sources, such as fructose, sucrose, gluconate, acetate, propionate, pyruvate, l-lactate and ethanol as well as the amino acids glutamate and serine (Cocaign et al., 1993; Peters-Wendisch et al., 1998; Claes et al., 2002; Netzer et al., 2004). The C. glutamicum FK506 ic50 ATCC 13032 genome is around 3.3 Mb and encodes metabolic pathways for utilization of a range of sugars, many of which have been well studied in relation to providing high outputs of l-amino acids (Kalinowski et al., 2003). A recent phenotype array study of Rhodococcus opacus PD630, which included C. glutamicum ATC 13032 as a control organism, revealed that Neu5Ac can support growth of C. glutamicum. Upon further investigation, it appears that C. glutamicum has a potential set of genes that would allow it to transport and catabolize Neu5Ac as a sole carbon source (Holder et al., 2011). As sialic acid utilization is normally associated with animal commensal or pathogenic bacteria and the presence of these genes has not been detected

in other recent analysis of sialic acid utilization genes in bacteria (Almagro-Moreno & Boyd, 2009), we wished to verify this novel finding and identify the gene(s) responsible for sialic acid uptake into this soil-dwelling actinobacterium. Escherichia coli DH5α was grown aerobically in 37 °C in Luria–Bertani medium. Corynebacterium glutamicum ATCC 13032 was cultivated aerobically at 30 °C in complex brain–heart infusion medium (BHI; Thymidylate synthase Difco Laboratories) or in minimal CGXII medium (Elleling & Reyes, 2005), supplemented with 1% (w/v) glucose or other carbon sources as indicated. Growth of C. glutamicum was monitored at 600 nm. Kanamycin was added to culture when required at 25 μg mL−1 for C. glutamicum or 30 μg mL−1 for E. coli. For liquid growth experiments with C. glutamicum, cells from starter cultures grown during the day in 5 mL of BHI medium were used to inoculate 10 mL of CGXII media supplemented with 1% (w/v) glucose for overnight growth. The overnight cultures were diluted to an OD600 of c.

, 2010; Hu et al., 2010). Serotyping, a procedure that relies on the composition of capsular material, is an important

step in the identification of S. suis. While initially classified in the early 1960s under the Lancefield scheme (S, R, and RS), strains of S. suis have subsequently been classified into SCH772984 serotype 1 (group S), serotype 2 (group R), and serotype 1/2 (RS) (Gottschalk et al., 2001). Currently, there are 35 serotypes of S. suis (1 to 34 and 1/2) (Messier et al., 2008). All serotypes are not responsible for serious diseases and pathogenicity may vary within the same serotype. Serotype 2 is most frequently associated with pathology (Gottschalk et al., 2001), although other serotypes are also the source of many infections (Tian et al., 2004; Costa et al., 2005; Zhang

et al., 2008). The existence of nontypeable isolates of S. suis has been reported (Marois et al., 2007; Wei et al., 2009). More specifically, Wei et al. (2009) characterized 407 strains of S. suis isolated from diseased pigs in China and recovered 5.4% of nontypeable isolates, while serotype 2 represented 43.2% of the isolates. In Canada, between 12% and 20% of strains recovered from diseased pigs are untypeable (Higgins & Gottschalk, 2001). In the present study, seven nontypeable strains BMS-907351 solubility dmso of S. suis isolated from infected animals were characterized with regard to their cell surface properties and compared with serotype 2 strains. The S. suis strains used in this study and their origins are listed in Table 1. Bacteria were routinely grown aerobically in Todd Hewitt Broth (THB, BBL Microbiology Systems, Cockeysville, MA) without agitation at 37 °C. Bacteria used in the assays described below were harvested from overnight (16–18 h) cultures. Wells of a flat-bottomed microtitre plate (Nunc-Immuno® MaxiSorp; Nalge Nunc International, Rochester, NY) were filled with 100 μL of fibronectin (0.1 mg mL−1; Chemicon International, Danvers, MA) or bovine serum albumin (BSA) as a control (1 mg mL−1; Fisher Scientific, very Ottawa, ON, Canada), and the plate was incubated overnight at room temperature. The

protein solution was then removed by aspiration and 0.05% glutaraldehyde (100 μL) was subsequently added. After 45 min at room temperature, glutaraldehyde was removed and the wells were washed twice with distilled water. Cells of S. suis harvested from an overnight culture were suspended in 50 mmol L−1 phosphate-buffered saline (PBS; pH 7.2) to an OD660 nm of 1 and 100 μL was added to each well. The plate was incubated at 37 °C for 90 min under agitation. Unbound bacteria were then removed by aspiration and the wells were washed three times with PBS containing 0.01% Tween 20 to minimize nonspecific hydrophobic interactions. Adherent bacteria in the wells were fixed with 100 μL of methanol for 15 min, washed extensively with distilled water and then stained with 0.

Here, we observe that the largest numbers of deaths among Scots travelers occurred in Europe and, to a lesser degree, the Americas, in the main due to natural causes. As to the observation concerning age at death from circulatory system failure and travel abroad, additional research is required on which, if any, aspects of travel exacerbate existing conditions.29 Considering the relatively

low death rate, prospective studies would be resource intensive and require large numbers to produce statistically meaningful check details data. Nonetheless, a body of evidence exists which highlights natural causes, such as coronary heart disease,19,24,32 and injury22,24–26,32 as major causes of death among travelers. Certainly, travel health services should move beyond advising travelers to developing countries on infectious disease risks, to becoming venues for providing key advice and preventative means to all travelers, including those to developed countries. In addition, those agencies, organizations, and companies who deal with travelers along their journey should

also engage with travel health experts and practitioners to reduce the risk of adverse Staurosporine purchase outcomes, including death, to travelers. We acknowledge the advice and assistance of Prof. Chris Robertson of the University of Strathclyde with respect to the analysis of circulatory disease deaths with respect to age. The authors state they have no conflicts of interest to declare. “
“Background. This study aimed to determine the knowledge, attitudes, and practices of Swiss business travelers with regard to influenza and the use of antiviral medication. Methods. Questionnaires, available in three languages, were distributed manually and online through companies,

organizations, and travel medicine specialists in Switzerland to business travelers who were traveling during the period January 2005 to April 2009. Result. In total, 661 questionnaires were fully completed and evaluated. A total of 58.9% (n = 388) of the respondents stated that they had contracted Methocarbamol influenza in the past; some 48.6% (n = 321) of the travelers had been vaccinated against seasonal influenza at least once in their lifetime; 87.1% (n = 576) of the travelers knew that influenza can be transmitted by droplets; and 62.3% (n = 412) were aware of transmission by direct contact. Almost all respondents (96.8%; n = 633) recognized fever as a main symptom of influenza, 80.0% (n = 523) knew about muscular aches and pain, 79.5% (n = 520) about shivering, and 72.9% (n = 477) about joint pain. Some 38.0% (n = 250) of the respondents stated that the annual vaccination is their preferred prevention method for influenza, 35.6% (n = 234) would neither do an annual vaccination nor carry antiviral medication, 16.0% (n = 105) would carry antiviral medication, 8.

We recommend therapy-naïve patients start combination Selleck Gemcitabine ART containing TDF and FTC as the NRTI backbone (1A). We suggest ABC and 3TC is an acceptable alternative NRTI backbone in therapy-naïve patients who, before starting ART, have a baseline VL≤100 000 copies/mL

(2A). ABC must not be used in patients who are HLA-B*57:01 positive (1A). Three RCTs have compared TDF-FTC with ABC-3TC as the NRTI backbone in combination with different third agents: ATV/r or EFV [2-6], EFV [7-9] and LPV/r [10]. Assessment of virological efficacy as a critical outcome was complicated by different definitions across the three studies. In our analysis for GRADE (see Appendix 3.1), there was no difference in rates of virological suppression at selleck products 48 weeks or 96 weeks but the analysis excluded the largest of

the three trials (ACTG 5202) and the quality of evidence for this outcome was assessed as low or very low. Assessment of the risk of protocol-defined virological failure at 48 weeks favoured TDF-FTC (RR 0.76, 95% CI 0.53–1.07); the effect was not statistically significant and heterogeneity in the analysis was relatively high (I2 46%). Assessment of protocol-defined virological failure at 96 weeks showed a significant difference favouring TDF-FTC (RR 0.73, 95% CI 0.59–0.92). Data were only available from one study [4] for this analysis; however, this was by far the largest of the three trials and the quality of evidence

assessment for this outcome was rated as high. The difference in virological failure was assessed by the Writing Group to be large enough to be above the clinical threshold for decision-making. The difference equates to a Protein kinase N1 number needed to treat to prevent one case of virological failure of approximately 20 patients treated for 1 year. The results of ACTG 5202 [2-4] are complicated by early termination of those individuals with a baseline VL >100 000 copies/mL at the recommendation of the data and safety monitoring board due to significantly inferior performance in those subjects receiving ABC-3TC. No difference in virological efficacy between the TDF-FTC and ABC-3TC arms was seen in those in the lower VL stratum (baseline VL <100 000 copies/mL). The subsequent 96-week analysis, after discontinuation of those subjects in the higher VL stratum, may therefore underestimate the difference between the two backbones. HLA-B*57:01 screening was not routine in ACTG 5202 and this potentially may have influenced some of the safety endpoints, but appears not to have influenced the primary virological outcome. In the higher VL strata the number of patients with suspected hypersensitivity reactions was equal between both arms and virological failure in these patients was infrequent.

Co-trimoxazole prophylaxis against PCP is effective, but there are no data on when to initiate it in infants of indeterminate Apitolisib purchase HIV status being followed up after in utero exposure to HIV. A maternal VL of 1000 HIV RNA copies/mL is an arbitrary cut-off to define infants at higher risk of transmission, in whom it is recommended to start prophylaxis until lack of transmission has been established.

8.3.1 Infants born to HIV-positive mothers should follow the routine national primary immunization schedule. Grading: 1D Generally, BCG vaccine should only be given when the exclusively formula-fed infant is confirmed HIV uninfected at 12–14 weeks. However, infants considered at low risk of HIV transmission (maternal VL <50 HIV RNA copies/mL at or after 36 weeks' gestation) but with a high risk of tuberculosis exposure may be given BCG at birth. Where the mother is coinfected with HBV, immunization against HBV infection should be as per the Green Book and does not differ

this website from management of the HIV-unexposed infant [49]. With sensitivity to concerns about confidentiality, families should be strongly encouraged to inform primary health carers, including midwives, health visitors and family doctors about maternal HIV and indeterminate infants. This will enable the local team to give appropriate support and advice, especially regarding infant feeding and where the infant or mother is unwell. 8.4.1 All mothers known to be HIV positive, regardless of ART, and infant PEP, should be advised to exclusively formula feed from birth. Grading: 1A It is well established that HIV can be transmitted from mother to child by breastfeeding [[50][[51][#[52]]Ent]288]. RCT evidence from Kenya puts the transmission rate at 16% over 2 years, accounting for almost half the total MTCTs [52]. Complete avoidance of breastfeeding removes this risk altogether [[52][[53][#[54]]Ent]290] and is the current standard of care in the UK [[3],[55]]. This is in line with previous World Health Organization (WHO) guidance, that exclusive feeding with infant formula milk should be recommended for women with HIV where it is affordable, feasible, acceptable,

sustainable and safe [56]. Recently, cohort [[57][[58][#[59]][60]]296] and RCT [[5],[8],[61]] data from Africa have shown that ART can significantly reduce the risk of HIV transmission from breastfeeding. This is in settings where breastfeeding Phosphatidylinositol diacylglycerol-lyase is not affordable, feasible, acceptable, sustainable and safe, and mortality from formula feeding outweighs additional mortality from HIV transmission by breastfeeding [[62],[63]]. WHO guidance remains that in countries where formula feeding is safe, a national or regional policy decision should be made on feeding policy [64]. Although breastfeeding transmission is reduced by ART, it is not abolished [[8],[57],[59][[60][#[61]][65]][66],301,302]. There is laboratory evidence that the breast milk of HIV-positive women on ART contains cells that may shed virus [67].

Close liaison with the obstetric team is recommended. 4.2.6 In the event that a woman who has initiated HAART during pregnancy has not achieved a plasma VL of <50 copies/mL at 36 weeks the following interventions are recommended: Grading 1C Review

adherence and concomitant medication. Perform resistance test if appropriate. Consider TDM. Optimize to best regimen. Consider intensification. http://www.selleckchem.com/products/epz015666.html For a woman who conceives on HAART that is not fully suppressive or loses virological control during pregnancy, these interventions should be undertaken as soon as possible. If treatment failure occurs when the infant is likely to be delivered prematurely and may be unable to take medication enterally, intensification should consist of therapies that readily cross the placenta such as double-dose tenofovir, raltegravir and single-dose nevirapine. “
“The aim of the study was to evaluate the predictive value of clinical and molecular risk factors, including peripheral blood mononuclear cell (PBMC) mitochondrial DNA (mtDNA) and mitochondrial RNA (mtRNA), for the development of lactic acidosis (LA) and symptomatic hyperlactataemia (SHL). In a substudy of a large multicentre, randomized trial of three antiretroviral regimens, all containing

didanosine (ddI) and stavudine (d4T), in antiretroviral-naïve, HIV-1-infected patients, INK 128 cell line patients with LA/SHL (‘cases’) were compared with those without LA/SHL in a univariate analysis, with significant parameters analysed in a multivariate model. In a molecular substudy, PBMC mtDNA and mtRNA from

cases and matched controls at baseline and time of event were examined. In 911 subjects followed for a median of 192 weeks, 24 cases were identified (14 SHL and 10 LA). In univariate analysis, cases Montelukast Sodium were more likely to be female (P=0.05) and to have a high body mass index (BMI) (P=0.02). In multivariate analyses, only BMI remained an independent predictor of the development of LA/SHL (P=0.03). Between cases and controls there was no significant difference in mtDNA copy number at baseline (389 vs. 411 copies/cell, respectively; P=0.60) or at time of event (329 vs. 474 copies/cell, respectively; P=0.21), in the change in mtDNA copy number from baseline to event (−65 vs. +113 copies/cell, respectively; P=0.12), in mtRNA expression at baseline or time of event, or in the change in mtRNA expression from baseline to event. The development of LA/SHL was associated with increased BMI, but PBMC mtDNA and mtRNA did not predict LA/SHL. This demonstrates the ineffectiveness of routine measurement of PBMC mtDNA in patients on ddI and d4T as a means of predicting development of LA/SHL. Highly active antiretroviral therapy (HAART) has greatly reduced mortality and morbidity in patients with HIV-1 infection [1].

Previous studies have shown that Obx induces hyperactivity in the OF test (Kelly et al., 1997; Cryan et al., 2002; Harkin et al., 2003; Song & Leonard,

2005; Zueger et al., 2005; Breuer et al., 2007; Song & Wang, 2010) and increased anxiety-like behavior (Harkin et al., 2003; Song & Leonard, 2005; Wang et al., 2007), this last alteration being reversed by anxiolytic drugs (Wieronska & Papp, 2001). In the present study, we observed that Obx induced hyperactivity and was anxiogenic, as the Obx group spent less time in the open arms and more time in the closed arms of the EPM. Also, in the OF test, the Obx group walked a greater distance in the peripheral than in the central zone of the apparatus, Lumacaftor cost corroborating the findings of the above-mentioned studies. Interestingly, there was no effect of FO as such on hyperactivity

or anxiety-like behavior. Rather, the supplementation prevented the motor alterations induced by Obx, as the ObxFO group no longer differed from the C and FO groups. These results are in agreement with previous studies from our group, using supplementation during pregnancy and lactation, investigating the long-term effects of this PUFA on the forced swimming test (Naliwaiko et al., 2004; Ferraz et al., 2008), on depressive-like behavior (Vines et al., 2012), and on the prevention of stress-induced cognitive, anxiety-like BI2536 and depressive-like behaviors (Ferraz et al., 2011). Regarding the MFST, which Selleck Erastin is a predictive test of antidepressant-like effects, the results showed that FO had an antidepressant effect even in sham-operated rats, as offspring that had received supplementation showed less depressive-like behavior, as reflected by decreased immobility

and increased swimming frequencies. Bulbectomised rats, on the other hand, showed the expected depressive-like behavior, which was prevented by FO supplementation. By using the OLT, we showed memory impairment in Obx rats, indicating that Obx caused impairment of spatial memory, which requires hippocampal integrity (Song & Leonard, 2005; Ostrovskaya et al., 2007). Considering the known cognition-enhancing effect of ω-3 PUFAs (Asl et al., 2008; Gomez-Pinilla, 2008; Wu et al., 2008; Song et al., 2009; Venna et al., 2009; Su, 2010; Ferraz et al., 2011), we observed maintenance of cognitive function in the ObxFO group. The negative discrimination index shown by Obx rats supports the idea that FO prevented the adverse effects of Obx on spatial memory. Importantly, the behavioral results were not attributable to the hyperactivity induced by Obx.

Enteritidis str. P125109 (Table 3). Its homolog on the genome sequence of S. Typhimurium LT2 accession no. NC_003197 is located at the STM0660 locus and encodes a cytoplasmic protein. caiC and SEN0629 display a GC content of 54.2% and 55.2%, respectively. The combined use of caiC and SEN0629 sequences for typing 102 S. Enteritidis strains representing 38 phage types enabled the identification of 16 sequence types and intraphage type discrimination (Table 1, Fig. 1). Isolates kept http://www.selleckchem.com/products/ABT-263.html their initial sequence type after being resequenced, thus indicating the high stability of caiC and SEN0629 as marker genes for S. Enteritidis subtyping. A

diverse set of 102 isolates representing a wide range of phage types (PT1, 2, 3, 4, 4a, 5, 5a, 6, 6a, 6b, 7, 8, 9, 9a, 9b, 10, 11, 11a, 12, 13, 13a, 14, 14b, 15, 15a, 16, 17, 18, 19, 20, 20a, 22-SC2, 24, 27, 28, 31, 32 and 40-SC2) from different sources, year of isolation, geographical locations and epidemiological backgrounds was used for validation. They originated from egg-related or environmental sources. All isolates tested could be amplified using primers targeting the two loci caiC and SEN0629 and could be assigned a sequence type. All sequencing reactions were performed in both directions to ensure accuracy. The two-loci sequence typing scheme was

able to define a total of 16 sequence types among the 102 isolates tested (Fig. 1). A total of 94 polymorphic sites were identified and mostly shared among ST14, 15 and 16 (Fig. 2). The two-loci sequence typing scheme also allowed for subtype discrimination within Talazoparib order a phage type. Ten phage types represented by at least two strains

PT1 (n = 2), PT4 (n = 18), PT6a (n = 10), PT6b (n = 3), PT7 (n = 2), PT8 (n = 5), PT9a (n = 3), PT13 (n = 4), PT13a (n = 7), PT14b (n = 2) were further divided into 2, 2, 2, 1, 1, 2, 2, 3, 3, and 2 sequence types, respectively (Table 1). Briefly, the workflow of the two-loci sequence typing scheme for S. Enteritidis strains consisted of isolating DNA from a pure culture, performing PCR, direct sequencing and phylogenetic analysis and finally assigning a sequence type. Each of the tested phage types is associated with at least one sequence type; hence, Adenosine triphosphate the proposed method is as discriminatory – and sometimes even more – than phage typing. A total of 31 S. Enteritidis strains representing phage types 1, 4, 6, 6a, 6b, 8, 13, 13a, 14b were initially phage typed by NVSL and later sent to the same institution for a second phage typing. Of the 31 S. Enteritidis strains, 13 presented phage types that differ from the ones determined originally (Fig. 1, Table 1). One ATCC strain (ATCC 13076) was initially typed as PT1 and subsequently typed as RDNC. Three strains were originally typed as PT6b and subsequently typed as PT5a, PT5a and untypeable. Two other strains were initially typed as PT4 and were later typed as PT1a and RDNC.

In the current study, we set out to determine which personal, socioeconomic, treatment-related and disease-related characteristics were independently associated with reported difficulty taking antiretroviral therapy (ART) in those respondents who were taking ART at the time of completing the HIV Futures 6 survey. The HIV Futures 6 survey was an anonymous, self-complete, cross-sectional survey. The survey contained 189 items organized into eight sections: demographics; accommodation; health and treatments; services and communities; sex and relationships;

employment; recreational drug use; and finances. The survey was largely based on the HIV Futures 5 survey [26], which was BIBW2992 molecular weight in turn based on the four previous surveys AG 14699 [27–30]. The content of the survey was developed in consultation with a number of organizations and individuals in the HIV/AIDS sector. Survey respondents were recruited through community organizations and clinical settings, as

well as through online and paper-based advertisements in community organization and gay media within Australia. Previous survey respondents who indicated that they were interested in participating in future research projects were also approached. Any HIV-positive individual residing in Australia was eligible to complete the survey. Data were collected from October 2008 to April 2009. The HIV Futures 6 survey included two items that asked respondents about their Cediranib (AZD2171) adherence to ART over the previous 2 days: ‘How many doses (dose times) of antiretroviral drugs did you miss yesterday?’ and ‘How many doses (dose times) of antiretroviral drugs did you miss the day before yesterday?’, with scores in the range 0–5 (a score of 5 representing ≥5 missed doses). The data from these survey items were highly skewed, with only 1.5% [13]

of those respondents currently taking ART indicating any nonadherence in the previous 2 days. As a result, we needed to use a proxy variable to assess factors associated with nonadherence to cART. We considered using two other survey items: (i) self-reported most recent viral load (detectable vs. undetectable) and (ii) self-reported difficulty taking ART (‘Do you experience any difficulties in taking antiretroviral drugs?’; yes/no responses). The viral load variable was also fairly skewed, with only 48 respondents currently taking ART (5.5%) reporting a detectable viral load. Hence, we chose to use self-reported difficulty taking ART as our outcome variable. This variable was found to be highly associated with both self-reported adherence (Fisher’s exact test; P=0.001) and respondents’ most recent viral load test result (detectable vs. undetectable viral load; χ2-test; P=0.018), and was therefore deemed to be a suitable proxy variable for investigating factors associated with poor adherence to ART.