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Mar 2026 DOI 10.14302/issn.2994-6743.ijstd-26-6060
Objective To describe the clinical features and real-world treatment of people living with human immunodeficiency virus (PLHIV) using fixed-dose or free combinations of 2-drug regimens (2DR) of antiretroviral therapy (ART). Design Italian retrospective cohort study. Methods Data were extracted from PLHIV who initiated or switched to 2DR: Group 1 (fixed dose), Group 2 (free combination). Results Group 1 was younger and more predominantly male, and had shorter time from AIDS-defining diagnosis to 2DR-ART and from diagnosis to baseline, a lower prevalence of resistance, and fewer comorbidities than Group 2. Median baseline viral load was <50 copies/mL in both groups, but Group 1 had a higher mean due to outliers. The most common ART classes before switching to 2DR were Integrase Strand Transfer Inhibitor (INSTI)-based (48.97%), Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based (22.73%), and Protease Inhibitor (PI)-based (16.53%). Distribution varied: Group 1: INSTI-based (53.13%), NNRTI-based (24.31%), and PI-based (15.04%); Group 2: INSTI-based (29.41%), PI-based (23.53%), and NNRTI-based (15.29%). After switching, Group 1 was on dolutegravir/lamivudine (79,33%) and dolutegravir/rilpivirine (20,67%); Group 2 mostly on INSTI-PI (52.81%), followed by NNRTI combinations, mainly with doravirine (19.10%). Duration of ART after switching was shorter in Group 1. Conclusion Italian PLHIV on 2DR fixed-dose combinations were younger, virologically suppressed individuals at baseline, with a shorter lead time from diagnosis, lower prevalence of resistance and lower comorbidity rate compared to those on free combinations. These findings underscore an unmet need for 2DR fixed-dose combinations, as the free combinations were predominantly utilized for more challenging populations.
Dec 2025 DOI 10.14302/issn.2641-4538.jphi-25-5613
Background Domestic violence among HIV discordant couples poses significant public health challenges, affecting treatment adherence and HIV transmission risks. This study examined factors contributing to domestic violence among HIV discordant couples in Kicukiro District, Rwanda. Methods A cross-sectional study was conducted among 384 HIV discordant couples from eleven health centers using stratified systematic sampling. Data were collected through structured face-to-face interviews and analyzed using descriptive statistics and bivariate analysis. Results Domestic violence prevalence was 41.1% physical violence, 34.2% sexual coercion, and 52.3% emotional abuse. Key socio-demographic risk factors included female gender (56% vs. 29% males, p<0.001), older age (61% in ≥55 years vs. 32% in 18-24 years, p=0.004), unemployment (55% vs. 34% formal employment, p=0.014), and financial hardship (63% vs. 25% comfortable situations, p=0.002). Behavioral factors included alcohol use (58% vs. 38%, p=0.021), substance abuse (62% vs. 35%, p<0.001), and poor conflict resolution (72% vs. 25%, p<0.001). Contextual factors like hostile HIV disclosure reactions (68% vs. 34%, p<0.001) and HIV-related stigma (60% vs. 35%, p<0.001) significantly increased violence risk. Conclusions Domestic violence among HIV discordant couples is multifactorial, driven by socio-economic, behavioral, and HIV-related factors. Integrated interventions addressing economic empowerment, conflict resolution skills, stigma reduction, and couple-centered counseling are urgently needed.
Dec 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5715
Recruitment for research studies focused on communicable diseases such as HIV (Human Immunodeficiency Virus) has historically been challenging, particularly among populations who have been underrepresented in media messaging, yet maintain a significant vulnerability to new HIV cases, like Black women. This study examines the recruitment strategies utilized in Aim 2 of pilot study at the University of Texas Health Science Center (UTHealth) in Houston, Texas that was funded by the Ujima Mentoring Program to develop, implement, and evaluate a video log (vlog)-based intervention. The overarching goal of the pilot study was to promote the uptake of pre-exposure prophylaxis (PrEP) among cisgender Black women in Harris County, Texas. Aim 2 involved the creation of a culturally relevant vlog for use in Aim 3, which sought to educate and motivate participants to consider PrEP as an HIV prevention strategy. With the growing role of digital platforms in public health outreach, social media was employed alongside traditional recruitment methods such as flyers and word-of-mouth referrals. Despite an expanded online reach, engagement remained low, and participation rates did not increase proportionally to the number of individuals who viewed recruitment materials. The reluctance to participate was largely attributed to stigma surrounding HIV and concerns about being publicly associated with an HIV prevention study based on participants feedback to the research team. Even the availability of research incentives to encourage participation did not significantly improve recruitment accrual goals, particularly among healthcare providers who experienced limitations with eligibility due to institutional policies. This study underscores the need to better understand the social and cultural barriers that prevent Black women and healthcare providers from engaging in HIV prevention research. While digital recruitment strategies can enhance visibility to a larger audience, they must be supported with trust-building efforts, community partnerships, and culturally competent messaging to encourage meaningful participation. These findings point to the critical need for multi-faceted recruitment strategies that go beyond social media campaigns and actively build trust within communities, ensuring that HIV prevention research and interventions are both accessible and culturally resonant.
Dec 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5515
Background Peripheral neuropathy (PN) is a common and debilitating complication in people living with HIV (PLHIV). While HIV itself contributes to neuropathy, certain antiretroviral therapy (ART) drugs, particularly nucleoside reverse transcriptase inhibitors (NRTIs) such as stavudine (d4T) and zidovudine (AZT), are known for their neurotoxic effects. Objectives To evaluate the impact of ART on HIV-associated peripheral neuropathy (HIV-PN) and to determine whether certain ART regimens increase the risk or severity of neuropathy. Materials and Methods A cross-sectional study was conducted among 158 HIV-positive patients. Neuropathy was diagnosed using clinical criteria, Total Neuropathy Score (TNS), and nerve conduction studies (NCS). Patients were grouped based on their ART regimen, and statistical analysis was performed to assess the association between ART type and peripheral neuropathy severity. Results It was noted that patients on older NRTIs (stavudine, zidovudine) had significantly higher rates of peripheral neuropathy (p=0.002) and tenofovir-based regimens were associated with lower peripheral neuropathy prevalence (p=0.01). There was a significant correlation between the duration of ART exposure and peripheral neuropathy severity (p<0.001), suggesting a cumulative neurotoxic effect. Conclusion Older ART regimens, particularly stavudine and zidovudine, significantly contribute to HIV-PN. The study supports the WHO recommendation to phase out neurotoxic ART and highlights the importance of early ART regimen optimisation to prevent long-term neurological complications.
Dec 2025 DOI 10.14302/issn.2997-2108.jcc-25-5518
Cervical cancer is the fourth most common cancer in women globally, with 660,000 new cases and 350,000 deaths in 2022. The burden is disproportionately high in low- and middle-income countries (LMICs), particularly sub-Saharan Africa. Despite proven interventions like HPV vaccination and screening, uptake remains low. While cervical cancer screening has been studied in the general population, little is known about uptake among refugee women in Uganda, which hosts approximately 1.7 million refugees. This study examines cervical cancer screening uptake and associated factors among refugee women in Uganda. Methods We conducted a cross-sectional secondary analysis of the 2021 Uganda Refugee Population-based HIV Impact Assessment (RUPHIA) survey, focusing on women aged 21–49 in refugee settlements in the West Nile and South-Western regions, which host 90% of Uganda’s refugee population. The primary outcome was self-reported cervical cancer screening status. We used descriptive statistics and logistic regression to identify factors associated with screening uptake. Results Among 731 women, only 72 (9.8%) reported undergoing cervical cancer screening. The mean age of screened women was 37 years (±7), compared to 32 years (±8) for unscreened women. Screening uptake was significantly higher among women aged 31–39 years (AOR = 2.67, 95% CI: 1.32–5.52, p = 0.007), married women (AOR = 12.0, 95% CI: 1.76–163, p = 0.03), and those in polygamous relationships (AOR = 4.76, 95% CI: 1.96–11.1, p < 0.001) Conclusion Cervical cancer screening uptake among refugee women in Uganda is critically low. Integrating culturally sensitive screening programs into refugee health services and addressing socio-economic barriers could improve access and utilization.
Jun 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5559
Background HIV status disclosure is a complex process influenced by multiple factors beyond health system support. Understanding these factors is essential for developing comprehensive interventions to promote disclosure and improve HIV prevention and care outcomes. Methods A descriptive cross-sectional study was conducted in 10 health facilities offering comprehensive HIV/AIDS care in Mukono district, Uganda. Data was collected from 317 clients through interview-guided questionnaires. Data was entered using EPI data and analyzed using SPSS version 16, including logistic regression to identify factors associated with disclosure. Results Multiple factors influenced HIV status disclosure. Individual factors included knowledge about HIV (OR=2.34, 95% CI: 1.45-3.78), self-efficacy (OR=3.12, 95% CI: 1.87-5.21), and psychological readiness (OR=2.89, 95% CI: 1.76-4.75). Relationship factors included relationship quality (OR=3.56, 95% CI: 2.13-5.94), communication patterns (OR=2.78, 95% CI: 1.65-4.69), and anticipated partner reaction (OR=4.23, 95% CI: 2.54-7.05). Community factors included perceived stigma (OR=0.34, 95% CI: 0.21-0.56), cultural norms (OR=0.45, 95% CI: 0.27-0.75), and religious beliefs (OR=1.87, 95% CI: 1.12-3.14). Structural factors included economic dependence (OR=0.38, 95% CI: 0.23-0.63) and access to support services (OR=2.45, 95% CI: 1.47-4.08). Conclusions HIV status disclosure is influenced by a complex interplay of individual, relationship, community, and structural factors. Effective interventions to promote disclosure must address these multiple levels of influence, going beyond health system support to create enabling environments for disclosure at the individual, relationship, community, and structural levels.
Jul 2024 DOI 10.14302/issn.2641-4538.jphi-24-5017
Background Frailty is an ageing-associated state linked to poor prognostic outcomes. Chronic inflammation due to HIV-infection, AIDS-related infections. and the adverse effects of antiretroviral therapy (ART) all contribute to frailty in people living with HIV/AIDS (PLHA). Frailty has been comprehensively studied in populations comprising predominantly of Caucasian PLHA. However, there remains a dearth of such data in Indian populations, especially in younger PLHA. Methodology This cross-sectional study aimed to estimate the prevalence of frailty in PLHA (18 - 50 years) who had been on ART for 24-60 months and identify markers linked to frailty. Frailty was assessed in 152 subjects using the Fried frailty-index. Parameters measured included the mid-upper arm and calf circumferences, pain-severity (using the Brief Pain Inventory), highly-sensitivity C-reactive protein, d-dimer, and interleukin-6. Results The prevalence of frailty and pre-frailty were 6.58% and 23.02%, respectively. Reduced grip strength and self-reported exhaustion were associated with frailty (15.79% and 13.16%, respectively). Low calf-circumference and mid-upper arm circumference were not significantly associated with frailty/pre-frailty. The prevalence of pain was 21.7% and both pain severity and pain interference were significantly associated with frailty/pre-frailty. CD-4 counts at the time of assessment showed an inverse association with frailty. Elevated C-reactive protein (CRP of 0.04 associated with 0.49 probability of frailty (95% CI 0.40 – 0.59), CRP of 0.12 associated with 0.63 probability of frailty (95% CI 0.47 – 0.76)). D-dimer levels were not significantly associated with frailty /pre-frailty. Conclusion In this first-of-its-kind study on frailty in young PLHA (mean age 37 years) from the Indian sub-continent, the prevalence of frailty and pre-frailty was 6.58% and 23.02%, respectively. Multivariate analysis showed a strong association of frailty with pain severity, CD4 count at time of assessment, hs-CRP levels and duration of ART.
Apr 2024 DOI 10.14302/issn.2692-5257.ijgp-24-5041
Introduction Globally, 36.7 million individuals live with HIV/AIDS, with 2.5 million new cases annually. Youth (14-25 years) account for 45% of these new infections. Those aged 15-24 years are less likely to be aware of their HIV status and engage in HIV care compared to older adults. This study explores the use of HIV self-testing to improve access to HIV care among Kenyatta University undergraduates. Objective To identify barriers and facilitators to HIV self-testing in this group. Methodology Employing multistage cluster sampling, 398 students were surveyed using a self-administered questionnaire. Results Of the participants (median age 21 years, 1:1.03 male-to-female ratio), 91.7% understood HIV's seriousness, with sexual intercourse as the primary transmission mode. Self-testing usage was 28.8%. Key barriers included fear of partner reaction, stigma, and lack of confidence. Significant facilitators were being female, knowledgeable about HIV, and sexually active. Conclusion Only 24% had prior HIV testing experience. The study highlights the importance of addressing fears and misconceptions while leveraging knowledge and sexual activity awareness to promote HIV self-testing.
Jan 2024 DOI 10.14302/issn.2642-9241.jrd-23-4809
Introduction People living with HIV (PLHIV) are susceptible to developing non- communicable chronic respiratory diseases. Our objective was to study the spirometric profile of this population. Material and methods This was a descriptive and analytical cross-sectional retro-prospective study conducted from March 15 to June 15, 2022 and relating to the analysis of the medical files of asymptomatic and eligible for spirometry PLHIV, aged 18 years and above. They were received in the voluntary counselling and testing (VCT) centres of one of the two pulmonology departments in Abidjan. Results The study involved 54 subjects including 22 men (40.7%) and 32 women (59.3%) with an average age of 48.9 years. The majority of patients were non-smokers (81.4%) and the main history was pulmonary tuberculosis (35.2%). Only 29.6% had chronic respiratory symptoms and 42.6% had a normal BMI. The frequency of spirometric abnormalities was 57.4%. These spirometric abnormalities included 40.7% peripheral obstructive pattern; 9.3% restrictive pattern; 3.7% asthma and 3.7% COPD. A more than 10 years duration of HIV infection (p=0.001 OR= 0.2 (0.1 – 0.7)) and a duration of ART of at least 10 years (p=0.001 OR= 0, 2 (0.1 – 0.7)) were significantly associated with the existence of ventilatory abnormalities. Conclusion The high frequency of ventilatory anomalies in PLHIV independently of the existence of chronic respiratory signs leads us to propose spirometry in the follow-up assessment of PLHIV while paying particular attention to those on ARVs for more than 10 years.
Dec 2023 DOI 10.14302/issn.2324-7339.jcrhap-23-4634
Introduction Human Immunodeficiency Virus (HIV) remains a persistent global public health challenge. In 2020, approximately 37.9 million individuals were living with HIV globally, including 1.7 million children <15 years old, with a global HIV prevalence of 0.8% among adults. A larger portion of people living with HIV are found in low-and middle-income countries, and Sub-Saharan Africa (SSA) is home to about 68% of people living with HIV in the world. Strikingly, with increased uptakes in PMTCT, challenges in ART programs, and high viremia among children and adolescents in SSA, the success rate of ART might be quickly compromised, with possible HIVDR emergence, particularly after years of paediatric ART exposure. Therefore, monitoring ART response in children and adolescents in terms of HIVDR patterns and other socio-economic determinants of disease progression might help achieve better treatment outcomes at individual levels. At a programmatic level, this can guide further optimization of treatment options for SSA especially Zimbabwean rural where there is paucity of information on HIVDR prevalence in children and adolescents. Methods We enrolled 89 children and adolescents experiencing virologic failure from Chidamoyo Christian Hospital in Hurungwe. We managed to amplify all the 89 using nested PCR and 32.5% (29) had resistance to at least one ART drug and analysis was done using the 29 samples. Results Among the 89 participants with virologic failure,29 were resistant to at least one of their ART drugs. 39.2% of males and 23.07% of females had HIV-1 with resistance to at least one medication. Among 29 participants with HIVDR mutations, the prevalence of at least one HIVDR mutation to protease inhibitors (PIs), Nucleotide Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) were 6.47% ,46.76% and 46.76% respectively. Of the 29 participants who had HIVDR 19 (65.5%) had resistance to a drug they were currently taking and they needed to be switched to a better effective ART regimen Conclusion Use of HIVDR testing in guiding and monitoring development of HIVDR at the start of ART or at 1st failure can be very important in treatment options and patient management.
Mar 2023 DOI 10.14302/issn.2994-6743.ijstd-22-4411
Background HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision. Method From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression. Result Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination. Conclusion Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.
May 2022 DOI 10.14302/issn.2576-9383.jhhr-21-3994
In this article the author reviews research on high risk factor of Human Immunodeficiency Virus in homosexuals and how lack of awareness & unprotected anal sex contribute substantially to new infections among this population. current HIV prevention efforts by providing insight into the patterns of Indian MSM behavior and sexual partnerships, and the specific cultural, social inequality, the gaps and lack of knowledge and psychological context in which HIV risk is occurring. And the need to develop effective awareness programs for well-functioning prevention of HIV and considerable understanding of the logistical and socio-cultural barriers MSM experience while accessing HIV prevention services. And in last will put light on therapeutic interventions for Human Immunodeficiency Virus, behavioral interventions that are socially and culturally appropriate for the population or community being prioritized and addressing multilevel psychosocial factors, including skills building and strategies to foster self-acceptance and increased social support for MSM. At the same time, prevention messages need to be designed and adapted to the knowledge level and culture of people.
Nov 2021 DOI 10.14302/issn.2324-7339.jcrhap-21-4010
Background: HIV / AIDS affects all social strata and including female sex workers who are a particularly vulnerable group at risk of HIV infection. Objective To assess the risky sexual behavior of female sex workers in Bamako, Mali. Methods This is a quantitative cross-sectional analytical study conducted among 288 female sex workers in the city of Bamako, Mali. This study used a questionnaire to collect information from January to April 2021. Results Out of 288 sex workers, 41% came from neighboring countries (Burkina Faso, Cote d'Ivoire, Mauritania). More than half of the participants had started working as sex workers before the age of 20. More than half of sex workers do not always use a condom. About 32% of female sex workers had previously had anal sex, 20% had experienced group sex, and less than a quarter smoked or drank alcohol before sex. A significant relationship was found between the behavior or practice of sex workers with the following variables: ethnicity (P = 0.04); marital status (P = 0.01); monthly income (P = 0.001), age at first sexual intercourse (P = 0.03); the presence of STDs in the past (P = 0.02), knowledge of HIV status (P = 0.04) and nationality (P = 0.03). Conclusions This study highlights negative risk behaviors of sex workers such as not using condoms consistently, anal sex, alcohol, and smoking. It is therefore important to develop education actions to improve the knowledge, attitude, and practice of sex workers related to HIV/ AIDS in Mali.
May 2021 DOI 10.14302/issn.2641-4538.jphi-21-3820
In Rwanda the prevalence of mother-to-child HIV transmission is 1.5%, the prevalence was found to be higher in rural area. The purpose of this study was to determine the Prevalence and Risk Factors of HIV Infection among Children born from HIV Positive Women in Musanze District. The study findings help to decrease the rate of HIV infection among children born from mother HIV positive to zero. This study was conducted in Musanze District, Northern Province in Rwanda. The study targeted 420 HIV positive mothers who delivery in different health facilities located in Musanze district form January 2019 to December 2020 and their children. SPSS version 22 was used for analysis. Of 420 children born from HIV positive mothers 91.7% were aged between 18-24 months, 55.2% were female. The majority of HIV positive mothers 80.2% who participated in the study were married. The prevalence of HIV infection among children born from HIV positive women was 2.9%. Children whose mother had poor adherence to ART were 1.5 times more likely to get HIV at birth compared to those whose mother had good adherence (AOR = 1.5; 95% CI: (1.12-2.21)). Children born from mothers in WHO stage II were more likely to get HIV from their mother (AOR = 1.24; 95% CI: (1.32-2.207)). Children born from HIV positive mother with one ANC visit were 2.5 times more likely to get HIV from their mothers (AOR = 1.56; 95% CI: (2.31-5.17)).
Jan 2021 DOI 10.14302/issn.2324-7339.jcrhap-20-3633
Introduction HIV prevention services to in-school adolescents need good planning and management. HIV risk reduction interventions are geared toward measuring sexual risk behaviour outcomes of adolescents that predispose them to HIV infection. The sexual behaviour of adolescents, especially in-school adolescents should be assessed in the process. Adolescents have been identified as the most vulnerable group for acquiring human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) and as such, measures should be taken to prevent them from infection. One important reason for higher HIV prevalence among adolescents, especially girls, is the frequent practice of age-discrepant partnering, where older men, who are more likely to be infected with HIV, form sexual partners with younger girls. The objective of this study is to assess the knowledge and sexual behaviour of in-school adolescents in the prevention of HIV and AIDs in rural areas of Abia State. Materials and Methods This is a descriptive cross-sectional survey that was conducted between January and March 2020. Information was collected from 66 students of a community secondary school in the state. Participants were selected by a multi-stage sampling method and data were obtained using a semi-structured pre-tested questionnaire. Results Respondents consisted of 40(60.6%) females and 26(39.4%) males with ages ranging from 13 to 19. Some of the respondents 28 (42.4%), are living with parents while 24(36.4%) live with close relatives. A good number of the respondents 39(59.1%), accepted that their friends are HIV positive. Majority of them 49(74.2%) have not been approached for sexual relationships. About 17(25.8%) of the respondents accepted that they have boyfriends and girlfriends. Out of this number, 12(18.2%) of them said they have been approached for sex and only 2(3%) of them accepted having sexual relationships with the opposite sex. Finding showed that only 1(1.5%) of the respondents claimed to have ever used condoms during sex. Of the sexually active respondents, 49(74.2%) of them are aware that HIV is a virus infection caused by having multiple sex partners while 14(21.2%) were not sure whether HIV is a virus or bacterial infection. Conclusion The study revealed a gap in the knowledge of HIV prevention as well as inappropriate sexual behaviour among the respondents. Therefore, meaningful strategies that will be culturally sensitive to modify adolescent sexual risk behaviours should be adopted.
Aug 2020 DOI 10.14302/issn.2324-7339.jcrhap-20-3003
Human immunodeficiency virus (HIV) is a retroviral disease in which the viruses copy their genetic material into the genetic material of the human beings. Infected cells remain infected for the whole of their life. First discovered in the year 1981, Human immunodeficiency virus infections is considered to be a pandemic by the World Health organization.
Jun 2020 DOI 10.14302/issn.2691-8862.jvat-20-3417
Background Decreased antioxidant ability is one of the worsening conditions in AIDS.We aimed to evaluate total antioxidant ability among others, and their variation in HIV infected patients following their CD4+T cells count and viral load, in a context of new ART scarcity in most LMICs. Material and Methods We conducted a cross sectional study on 167 individuals (76 controls, 33 treatments naïve and 58 HIV-1 infected patients on ART). We assessed their plasma total antioxidant ability (FRAP), malondialdehyde (MDA) and thiol (SH) groups using standard spectrophotometric methods, then we calculated lipid peroxidation index (LPI). Statistical analysis was performed using GraphPad Prism 6. Data were analyzed by two-tailed unpaired t-test for two groups’ comparison and ANOVA for more than two groups. Pearson correlation between CD4+T cells count, viral load and the above markers was determined; P ≤ 0.05 was considered statistically significant. Results The following controls/naïve/treated subjects’ values for FRAP(mM) (1.907±0.074/1.77±0.05/1.695±0.03); MDA(μΜ) (0.781±0.081/1.115±0.118/ 1.342±0.109); SH (μΜ) (2.747±0.130/1.582±0.197/1.498 ±0.140)and LPI (0.43±0.61/ 0.61±0.7/2.59±0.83) were all obtained with P ≤ 0.05. The FRAP increased only with 3TC+TDF+EFV and 3TC+ABC+NVP cART while MDA decrease significantly with the later(p=0.027). MDA and LPI significantly increased in heavily treated patients with p<0.0014 and p=0.0001 respectively. overall, the patients showed an increase of viral loads following a decrease of CD4+T cells (r= -0.803, p=0.016) but 3TC+TDF+EFV seem to better manage the both. The only significant correlation was established between SH groups and CD4+Tcells count (r=0.447; p=0.0006); Conclusion Our study showed that thiol groups may be protective againstCD4+Tcells count depletion and that the cART 3TC+TDF+EFV, 3TC+ABC+NVP may be helpful in fighting against free radical generation and particularly 3TC+TDF+EFV as controlling CD4+Tcells count and viral load in long term treated patients. The study particularly showed the implication of cART in increasing lipid peroxidation index following the treatment duration in heavily treated patients, which aggravated their conditions in an area where drug options are limited, calling for new drugs availability and personalized medicine.
May 2020 DOI 10.14302/issn.2328-0182.japst-20-3347
The study evaluated the impact of co-infection of malaria parasitaemia, and HIV positive indices on the CD4 cell count of 120 HIV infected subjects, who were already diagnosed and visiting Braithwaite Memorial Specialist Hospital Port Harcourt for routine Medical check-up. Also, a control group of 40 HIV negative were included as part of the study control group. The subjects were between the age ranges of ≤10–79 years respectively. A double check laboratory assay was conducted to detect the presence of antibody to HIV as confirmed using immunocomb 11 and Determine for HIV status. A thick Blood film stained with field stain (A and B) was used to detect the presence of malaria parasite in the subject’s blood. Furthermore, CD4 cell count was assayed using Partec cyflow counter (Partec, Germany). Excel and Graphpad statistical software were used for analysis of the data generated. The result among the HIV positive subjects and control subjects revealed that the highest positive for malaria infection was observed among ≤10 years age group as 2 (100%) and 11 (84.61%) respectively. In the HIV positive subjects, the distribution of malaria infection among sex revealed a high rate in male 42(77.78%) than in female 44 (66.67%). Similarly, the control recorded a high rate of malaria infection in male 11 (57.89%) than in female 7 (33.33%). However, 86 (71.67%) had malaria and HIV co-infection while 34 (65%) had only HIV mono infection. The positive HIV subjects who had CD4 cells count below 200 cells/mm3 were 15%, above 200-499cells/mm3 were 58.3% while 500 cells/mm3 and above had normal CD4 cells counts for 26%. Nonetheless, for the control subjects, no CD4 cells count of below 200cells/ mm was observed, 2.5% fell within the moderate category while 75% had normal CD4 cells count. Statistical analysis using ANOVA and t-test showed that there is significant difference between CD4 of seropositive and seronegative subjects infected with or without malaria (p=0.00). In addition, a t-test further demonstrated Comparison of Mean CD4 Cell Count among HIV and Malaria Infected and Non-Infected Subjects. MP/HIV Co-Infection and Mono Infection with No Infection showed strong mean difference (p=0.00) in the various CD4 counts while HIV Mono-Infection and others only had a non significant (p=0.44) mean difference between HIV Mono-Infection and No HIV or Malaria Infection. A robust and effective malaria and HIV control management programme should be strongly underpinned; so as to improve the quality of life of patients and HIV patients should be encouraged to live a healthy life style, through the provision of antiretroviral drugs and regular health education engagement, even as the provision of antimalarial treated net would be helpful to the subjects.
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-19-2610
Background The relationship between predictors and the variable of interest was estimated using a structural equation model which is used to predict latent variables. The main advantage of the SEM is the ability to estimate the direct and indirect pathways of the effect of the primary independent variable on the outcome, given sufficient sample sizes. Despite not directly modeling the mediated pathways, GLMMs excluding mediating variables performed well with respect to power, bias and coverage probability in modeling the total effect of the primary independent variables on the outcome. In longitudinal studies, data are collected from subjects at several time points. The main purpose of longitudinal analysis is to detecting the trends or trajectories of the variables of interest. Methods A longitudinal study was conducted on 792 adults living with HIV/AIDS who commenced HAART. Structural equation modeling was used to construct a model to detecting predictors of CD4 cell count change. The procedure was illustrated by applying it to longitudinal health-related quality-of-life data on HIV/AIDS patients, collected from September 2008 to August 2012 monthly for the first six months and quarterly for remaining study period. Results The result of current investigation indicates that CD4 cell count change was highly influenced by certain socio-demographic and clinical variables. Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. Conclusions The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-20-3261
Efforts to control the Human Immunodeficiency Virus epidemic in Rwanda have seen remarkable success over the years. Effective antiretroviral therapy has played great role in improving longevity among people living with HIV/AIDS (PLWH). While this is the case, there are various nutritional challenges, which are often faced, among PLWH. Guided by the Rwanda country guidelines for nutritional management for PLWH and WHO recommendations, this study aimed to explore the perspectives of health care providers (HCPs) working with PLWH on nutritional challenges faced by their clients in Kigali, Rwanda. We conducted a qualitative study using in-depth interviews to collect data. A non-probability purposive sampling was employed to recruit HCPs. Data analysis was based on the naturalistic paradigm. We followed the hybrid approach in conducting thematic analysis. Three themes were identified. First, HCPs had good knowledge on nutritional requirements for PLWH. They demonstrated good communication skills and adequate counseling skills that were necessary for addressing concerns on nutrition from their clients. Secondly, it emerged that HCPs perceived a lack of resources to be the major challenge faced in nutritional management of their clients. From theme three, it emerged that, from HCPs experiences, food insecurity and lack of feeding supplements were the main causes of malnutrition among PLWH in Kigali, Rwanda. From the HCPs perspective, there is a need to improve healthcare institutions capacity to manage nutritional challenges faced by PLWH. To achieve this, policy makers need to channel adequate resources for this cause.
Jul 2019
Co-infection of HIV with Mycobacterium tuberculosis is a common event, particularly in developing countries. The emergence and spread of multidrug resistant tuberculosis (MDR-TB) is an increasing public problem in India. The drug-resistant M. tuberculosis strains are posing a significant challenge to TB control. This study used PCR to characterize mutations inside the rifampicin resistance-determining region (RRDR) of the rpoB gene in the rifampicin-resistant M. tuberculosis co-infected with HIV. All the rifampicin-resistant strains had missense mutations. Sequence analysis detected a single or multiple hotspot mutations in the RRDR region of the rpoB gene at codons 516, 512 and 531, in most strains. Furthermore, mutations also occur at codons 512, 514, 517 and 526. The results suggest that hotspot mutations in the rpoB gene are not the sole contributors to MDR-TB co-infected with HIV.
May 2019 DOI 10.14302/issn.2324-7339.jcrhap-19-2847
Background Carissa carandas L. is a well-known wild fruit plant distributed through-out the India and also present in other countries. The fruits are rich in nutrients and minerals. A number of medicinally important phytochemicals such as carrisone, carindone, carandinol, lupeol, scopoletin, stigmasterol, β-sitosterol, myo-inositol, β-amyrin, Des-n-methylnoracronycine etc. have been reported from the extract of this plant. Being safe and cost effective molecules, the activity of phytochemicals against HIV-1 enzymes needs to be screened. Objective The aim of this study was to screen the potent phytocompound of C. carandas against human immunodeficiency virus-1 using docking method. Methods Total nine compounds viz. carandinol, caridone, carrisone, lupeol, p-coumaric acid, gallic acid, rutin, scopoletin and ursolic acid were used for in-silico study towards drug development against human immunodeficiency virus-1 reverse transcriptase (HIV-1RT; PDB ID: 1REV) and human immunodeficiency virus-1 protease (PDB ID:1EBY) using Autodock software. Results The qualitative characterization of the extracts showed the presence of a number of phytochemicals such as phenolics, flavonoids, alkaloids, terepnoids, terpenes, steroids, glycosides etc. Carandinol was observed as most effective anti-HIV-1 molecule having lowest binding energy and small inhibition coefficient. Another compound, p-coumaric acid, showed least effectiveness against human immunodeficiency virus- 1 reverse transcriptase or human immunodeficiency virus-1 protease showing highest binding energy and inhibition coefficients among all the evaluated phytocompounds. Conclusion The in-silico study demonstrated that some phytoconstituents of C. carandas exhibit potential anti-human immunodeficiency virus -1 activity and hence can be optimized to develop as a drug candidate in future.
May 2019 DOI 10.14302/issn.2324-7339.jcrhap-19-2746
Human immunodeficiency viruses causes HIV infection in humans belongs to two species of Lentivirus. It damages the cells of immune system which leads to weak immune system and the ability to fight from infections and diseases. This study was conducted to investigate the prevalence rate of HIV infection among pregnant women of different age groups attending Ajiko medical clinic, Damaturu, Nigeria. The prevalence rate was maximum (12.5%) in 36-45 age group and minimum (5%) in 26-35 age group but their was no HIV infection in 15-25 age group. The overall prevalence rate among pregnant women was 4%. General knowledge , training and campaigns of HIV prevention need to be tailored towards older women of age group 36-45 because of high prevalence rate.
Feb 2019 DOI 10.14302/issn.2324-7339.jcrhap-18-2533
This study was conducted in two (VCTs) at Elgenina town, the capital of West Darfur State in Sudan in period from November 2010 to February 2011, the study included all people attending VCTs in Elgeniena town for voluntary checking one hundred and fifty clients who visited the (VCT) centers and volunteered were included in this study, nonprobability sample, 150 volunteers was taken and covered all ages, One ml of blood was taken from each of the study sample and tested by rapid Immune Chromatographic (ICT) for HIV, a structured questionnaire was designed and the interviewed after a written consent to participate in the study was signed, data was analyzed using the SPSS statistical programmer and for possible association between study variables, the Chi square test was used, the study showed that 35 volunteers (23.33%) were positives, of whom 54.3% 19 were males. People having more than one sex partner were high 63.6% with statistically significant factor of getting infection (P.value = 0.00). Also, practicing unsafe sex were 5.2% another major risky (P.value = 0.00). Among the HIV positive cases 34.3% were drug users, compared to 20.9% from the HIV negatives (p. value = 0.10). There is no relation between education level and infection with HIV (p .value = 0.154). Forty two percent of the participants were single, 30% married, 10% divorced, 7.3% widows and 10.7% were separate
Jan 2019 DOI 10.14302/issn.2641-4538.jphi-18-1973
Introduction Adherence to ART is a challenge among pregnant women living with HIV/AIDS. This has an effect on the health of the mother and the unborn child. While studies have been done, it has shown that adherence during pregnancy is a challenge Virological and clinical success depend critically on high adherence to ART because with low adherence. The success of expanded ART coverage in improving health outcomes depends on adherence to treatment. During pregnancy, a compromised Virological response to ART also increases risk of mother-to-child transmission (MTCT) of HIV. This study was carried out to determine factors that influence adherence to antiretroviral therapy among HIV positive pregnant women in Lusaka district of Zambia. Methodology This was a qualitative study which used a case study approach. Data was collected through in-depth interviews. The collected data was analysed using a thematic analytical approach. Results 17 pregnant women living with HIV /AIDS in Lusaka had Challenges with adherence to ART. The study explored factors related to adherence to ART among pregnant women living with HIV/AIDS. ART adherence was found to be low. The findings call for the need to reduce on social stigma. The results confirmed that there is low adherence to ART among pregnant women living with HIV /AIDS in Lusaka. Conclusion Adherence to ART among pregnant women living with HIV/AIDS is a challenge for Zambian pregnant women. Improved levels of adherence to ART is hampered by fear of social stigma, and fear of being blamed by partners if they disclosed their status. Stigmatisation needs to be addressed because nearly all the participants expressed this factor. There is need to address the HIV/AIDS stigma very seriously in order for society to look at HIV/AIDS like any other illness.
Aug 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2202
Background: Ideally, disclosure of HIV status to infected children and adolescents should involve both health care workers and parents/caregivers. Most studies on disclosure in children have focus mainly on parents/caregivers with little information on health care workers. We conduct this study to evaluate the practice, perception of the healthcare workers in our health facility on disclosure to infected children and adolescents. It is envisaged that such information will help in the design of better strategies on disclosure in our environment. Methods: A cross sectional hospital based study was conducted among health care workers at the special treatment clinic, and heart to heart unit of the University of Abuja Teaching Hospital, Gwagwalada from January to March 2017 for the above objective. A structured questionnaire was used to collect information on disclosure among the healthcare workers, which include among others: their bio-data, knowledge, perception, and practice on disclosure in the two service areas of the hospital. Results: Of the 80 health care workers interviewed, 60(75.0%) were females, 11(13.8%) were doctors, 9(11.3%) nurses, 17(21.3%) monitoring/evaluation/record clerks, and 16(20.0%) were either voluntary counseling and testing counselors or adherence counselors. Their mean age and duration in service in the two areas were 39.70±7.10 and 7.93±4.99 years respectively. Over half 48(60.0%) of the health care workers were unaware of the hospital having guideline on disclosure, 64(80.0%) have not been trained, and 68(85.0%) does not know any key information on disclosure. While all 80(100%) felt that disclosure was a good practice for better adherence, only 16(20.0%) had actually disclosed, with 6(37.5%) not seeking any formal permission from parent/caregivers before disclosing. Ages 8-16 years was recommended by 60(75%) as the appropriate age to disclose, however 28(35.0%) recommended age 14-16 years. Over half of the respondents 58(72.5%) admitted that disclosure should be a shared responsibility between themselves and the caregivers, most however perceive their role as only preparing the parents/caregivers for disclosure, and providing ongoing counseling to both the parents/caregivers and the children and adolescents. Lack of training on disclosure, and none availability of guideline in the health institution were major setback on the ability of the healthcare providers to fully participate in disclosure process. Conclusion: While healthcare providers support the idea of disclosing at mid and late adolescent, their perceived role was that of support and provision of ongoing counseling. Lack of training and none availability of disclosure guideline affects their perceived role. There is need to train and retrain healthcare workers on disclosure guideline, and making such guideline available in the health facilities.
Aug 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2263
Nigeria is one of the high-burden countries in sub-Saharan Africa for HIV/AIDS and contributes to reproductive health morbidities and mortalities. This study was aimed at determining the prevalence of HIV-discordant rate among pregnant women in Plateau state Nigeria. The study sought to determine the prevalence and trend of HIV sero-discordance among pregnant women in Plateau state, Nigeria. The study was a 5-year descriptive analysis of HIV sero-discordance among pregnant women accessing prenatal care and their partners in Plateau state, Nigeria based on data generated between January 2012 and December 2016. The data was disaggregated by year, HIV concordant negative, HIV concordant positive, and HIV sero-discordant prevalence in the software and analysis were done using excel to obtained the proportions and trend of HIV sero-discordant prevalence among the antenatal population. Out of a total of 7,851 partners of pregnant women studied, 969 (16.3%) were HIV sero-discordant, 5,795 (73.8%) were HIV concordant negative, and 773 (9.9%) were HIV concordant positive. HIV sero-discordant positive males accounted for 12.3% while females were 4.0%. The prevalence of HIV sero-discordance was low with a high proportion of HIV positive male partners in Plateau state with grave public health implications for new HIV infections among partners and eroding the gains made in the Prevention of mother-to-child transmission of HIV.
Aug 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2236
Nigeria is one of the high-burden countries in sub-Saharan Africa for HIV/AIDS and contributes to reproductive health morbidities and mortalities. This study was aimed at determining the prevalence of HIV-discordant rate among pregnant women in Plateau state Nigeria. The study sought to determine the prevalence and trend of HIV sero-discordance among pregnant women in Plateau state, Nigeria. The study was a 5-year descriptive analysis of HIV sero-discordance among pregnant women accessing prenatal care and their partners in Plateau state, Nigeria based on data generated between January 2012 and December 2016. The data was disaggregated by year, HIV concordant negative, HIV concordant positive, and HIV sero-discordant prevalence in the software and analysis were done using excel to obtained the proportions and trend of HIV sero-discordant prevalence among the antenatal population. Out of a total of 7,851 partners of pregnant women studied, 969 (16.3%) were HIV sero-discordant, 5,795 (73.8%) were HIV concordant negative, and 773 (9.9%) were HIV concordant positive. HIV sero-discordant positive males accounted for 12.3% while females were 4.0%. The prevalence of HIV sero-discordance was low with a high proportion of HIV positive male partners in Plateau state with grave public health implications for new HIV infections among partners and eroding the gains made in the Prevention of mother-to-child transmission of HIV.
Jul 2018 DOI 10.14302/issn.2690-4837.ijip-18-2238
Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an association towards development of infections that may cause of morbidity among people living with Human Immunodeficiency Virus (PLWHIV). We report on the prevalence, antibiotic susceptibility pattern and risk factors associated with MRSA carriage among PLWHIV at Nyenga hospital, Buikwe district in central Uganda. Materials and Methods We conducted a cross-sectional study among PLWHIV attending Nyenga hospital anti-retroviral therapy (ART) clinic. Nasopharyngeal swab was collected from each participant, cultured to isolate Staphylococcus aureus, and drug susceptibility testing (DST) performed. Sociodemographic data and medical history was recorded. Results We enrolled 219 PLWHIV; of these, 58.4% (N=128) were females. The majority of participants (95.0%) were on ART. Ninety-eight (44.75%) of the nasopharyngeal swabs had growth, of which 41 (41.84%) were S. aureus. Of these, 11 (5.02%, 95% confidence interval: 3.67-7.02) were MRSA. Of 41 isolated S. aureus strains, only 8 (19.51%) were susceptible to all antibiotics tested. A total of three (7.32%) were multi-drug resistant (MDR), while one1 (2.43%) was a possible extensively drug resistant (XDR) strain. Deteriorating immunologic state as indicated by a low CD4 count showed a significant association with the MRSA colonization. Conclusion These results are reassuring that MRSA colonization is high among PLWHIV. As most of the antibiotics in use were resistant, it raises concerns of intricate clinical management in a low resource set up.
Dec 2017 DOI 10.14302/issn.2576-6694.jbbs-17-1853
Objective: To determine the current prevalence of HBs Ag, Anti-HCV Ab and anti-HIV Abamong blood donors. Methods: This descriptive study was conducted in three blood banks centers in Sana'a city. During the study period from January to November 2016, 11374 blood donor specimens were subjected for detection anti-HBs Ag, anti-HCV and anti-HIV, by using Cobas e 411analyzer. Results: The overall prevalence of HBs Ag, HCV and HIV among blood donors was (1.9%), (1.0%) and (0.3%) respectively. Out of 11374 blood donors screened, 11249 (98.9%) were males and 125 (1.1%) were females with mean of age 30 years. While, (1.6%), (0.9) and (0.0%) of females were seropositve for HBs Ag, HCV and HIV respectively. High prevalence rate of HBs Ag and HCV found among the age group more than 55(5.7%, 2.0%) and 26-35 years old (1.9%, 1.1%) respectively. Conclusion: This study revealed less prevalence rate of HBs Ag, HCV and HIV among blood donors.
Nov 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1679
Background: Point-of-care diagnostic tests (POCTs) are increasingly used in both developing and developed countries. They allow same day testing and treatment at remote locations where no laboratory support is available. Quality control measures, which are routinely used in laboratories, have not been widely implemented for POCTs. This aimed to assess the integrity of the entire laboratory testing process, and aims to educate and improve performance in quality of HIV rapid testing. Methods: A health facility based cross section study was conducted from April to June 2016.Randomly selected health facilities were participated in the external quality assessment. Onsite evaluation and panel test were used to collect data using structured checklists and formats. Data was entered and analyzed using SPSS version 16. Results: Between April to June 2016, a total of 60 health facilities (145 testing points) from governmental health facilities (hospitals and health centers) were participated in the study. Among the participated testing points 41% have no designated area, 40% have no clean water for hand washing and 51% have no national test algorithm. The average performance of testing points was varies from 89.6% to 99.1% (Laboratory 99.1%, ANC 90.4%, TB clinic 91.4% and VCT 89.6%). In a multivariable logistic regression model, didn’t follow national testing algorithm to report client test results have statistical significance. Conclusions: High quality test results underpin accurate diagnosis and appropriate treatment for patients. But in the study area the score of proficiency testing result and coverage of training is slightly low comparing to other findings. Therefore following national testing algorithm to report client test results, training and monitoring are critical points to improve the proficiency testing score of testing points.
Sep 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1694
Introduction: Squamous cell carcinomas of the conjunctiva (SCC) are rare neoplasia but have a high rate of increase and a high rate of mortality, especially when they occur in the context of Human Immunodeficiency Virus (HIV) infection. The objective of this study was to establish an epidemiological and clinical profile of SCC in patients living with HIV and to assess its evolutionary characteristics. Patients and Methods: this was a descriptive cross-sectional study carried out over a period of 5 years in the ophthalmology department of the University Hospital of Treichville. The data collected focused on epidemiological, clinical, pathological, therapeutic and evolutionary elements. Twenty tree eyes of 23 patients were examined during this period. Results: The average age of our patients was 45 years with extremes ranging from 31 to 60 years. A female predominance was observed with a sex ratio of 0.92. The average consultation period was 18 months with extremes ranging from 6 to 60 months. Physically, 35% of our eyes (08 eyes) presented a functional loss of the eye. All our patients had a HIV positive status with 16 cases of HIV1 infection, 4 cases of HIV 2 infection and 3 cases of HIV 1 and 2 co-infection. Lymphocyte typing was performed for 15 patients out of the 23 With CD4 cell counts ˂ 200 in 30.43% of cases, between 200 and 500 in 34.78% of cases. All our tumors had had biopsy excision with pathological examination. A postoperative adjuvant topical chemotherapy in 6 cases. The average follow-up period of our patients was 29 months. In all cases, it was invasive differentiated squamous cell carcinoma. Discussion: HIV infection is a risk factor for the occurrence of conjunctival squamous cell carcinoma, but it is also an aggravating factor especially in the case of low CD4 cell count, particularly in sub-Saharan Africa, where the fight against infection, although boosted in these recent years, is far to achieve all objectives Conclusion: HIV seroprevalence is very often associated with opportunistic infections which include carcinogenic processes such as squamous cell carcinomas of the conjunctiva
Jun 2017 DOI 10.14302/issn.2690-4721.ijcm-17-1533
This essay draws on recent evidences from SIV vaccination studies in rhesus macaques to argue for the potential importance of HIV-1-specific CD8+ T cells restricted by the non-classical major histocompatibility complex, HLA-E, in controlling HIV-1 replication. It then seeks to present a possible method of inducing such responses through the procedure of T cell vaccination using activated autoimmune CD4+ T lymphocytes ‘infected’ with inactivated replication-incompetent structurally intact HIV-1 particles. It is hoped that the argument presented here will interest many of those involved in HIV/AIDS research and others in the general scientific community.
Nov 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1271
Introduction The cardiovascular complications have became the 3rd cause of death and the 4th reason for hospitalization of the patients infected by the HIV. The objective of this work was to determine the frequency of asymptomatic myocardial ischemia among patients infected by the HIV receiving antiretroviral therapy. Patients and Methods It was a descriptive cross-sectional study which was conducted in November 2015. The patients infected by HIV1 receiving antiretroviral treatment, with asymptomatic myocardial ischemia were included in the study and they were followed up in the HIV clinic of the in Infectious diseases service of the University Hospital Souro Sanou of Bobo-Dioulasso(CHUSS).. The includes patients benefited from a collection of cardiovascular risk factors, and of two measurements of the blood pressure in a sitting position after 10 minutes of rest and an electrocardiogram 12 derivations after rest. Results A total sample of 123 patients infected by HIV1 was selected, with a median age of 42 years (IQR: 36-50). It was composed of 79% of female. The cardiovascular risk factors found were distributed as follows: HTA (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%), diabetes (0.8%). All the known hypertensive cases (5.7%) were insufficiently treated. The median duration of exposure to the antiretroviral therapy was 5.3 years (IIQ: 3-7.7). The disorders of the repolarization were observed in 26 cases (21.13%). They were divided into under epicardic ischemia in 20 cases (16.26%), under endocardic lesion in 2 cases (1.63%) and after-effect of necrosis in 4 cases (3.25%). The Left ventricular hypertrophywas observed in 12 cases (9.76%) and all of them were hypertensive patients. QTc was lengthened among 7 patients (5.69%) independently of the class of antiretroviral therapy administrated. Conclusion In this study about patients infected by HIV1, it emerges that asymptomatic myocardial ischemia is frequent. It would be advisable to reinforce its tracking by using more powerful tests of ischemia, in order to better specify its gravity in this population with an increased cardiovascular risk.
Nov 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1198
Spain is one of the countries with the highest incidence of HIV within the European Union. Multiple and complex factors influence HIV infection in young people. This study aims to determine the influence of sexual sensation seeking, sexual compulsivity and perceived sexual pleasure variables in condom use. A total of 424 heterosexual youth were evaluated (M age = 20.62; SD = 2.62) distributed into a risk group (60.7%) and a no-risk group (39.3%). Sexual Sensation Seeking Scale, AIDS Prevention Questionnaire, Sexual Compulsivity Scale, and Sexual Pleasure Perceived Scale were administered. Results indicate statistically significant differences in sexual sensation seeking (p=.001), failure to control sexual impulses (p=.030), perceived sexual pleasure with a condom (p=.027) and without a condom (p=.001). The regression analysis revealed that three factors explained about 14% of the variance in condom use: sexual sensation seeking and sexual pleasure perceived without a condom (risk factors), and sexual pleasure perceived with a condom (protective factor). It is necessary to incorporate these variables into HIV prevention programs to reduce the number of infections in young people.
Sep 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-1227
Introduction: Human Immuno-deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) constitute public health challenge in Nigeria and adolescents are increasingly becoming vulnerable. It is necessary to provide adolescents in schools with risk-reduction educational interventions so as to expose them on the need to protect themselves from getting infected. This study used risk-reduction interventions (Class-room Instruction and Drama) to encourage risk-reduction practices among in-school adolescents. Materials and Method: Quasi-experimental design using 165 students randomly selected from three convenient co-educational secondary schools in the rural areas was adopted. Two experimental groups, class room instruction (CI) and drama (DR) were used. Baseline data using semi-structured questionnaire with 27- point risk reduction practices were collected. Data were analysed with descriptive statistics, t-test and ANOVA at p =0.05. Result: Scores for HIV risk reduction practices among the adolescents at baseline, classroom instruction (CI), drama (DR) and control respectively were 18.5±4.6, 19.8 ± 5.8 and 17.0 ± 4.8 . The mid-term scores obtained were 23.8 ± 3.4, 23.6 ± 3.4 and 17.7 ± 5.1. The scores obtained for CI, DR and control groups at follow-up were 24.9 ± 2.6, 26.7 ± 1.1 and 17.0 ± 5.3 respectively. The results showed more effective risk reduction practices among the intervention groups than control group. Conclusion Drama intervention yielded more positive outcomes in risk-reduction practices than others. Drama is therefore recommended as the best HIV and AIDS intervention programme for in- school adolescents.
May 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-944
Pulmonary hypertension may occur as a co-morbid disease in HIV. We examined the characteristics of our HIV infected veterans with pulmonary hypertension and compared them with a control group of HIV infected patients without pulmonary hypertension. Among our cohort, patients were diagnosed with pulmonary hypertension at a mean age of 49.8 y ± 11.0y. This diagnosis came about 8.1y ± 6.7y after the diagnosis of HIV. Our pulmonary hypertension patients lived for about 3.4 ± 3.0y after their pulmonary hypertension diagnosis. The presence of pulmonary hypertension in HIV infection confers an increased risk of mortality. Mortality in our pulmonary hypertension cohort was 73%.
Feb 2016 DOI 10.14302/issn.2324-7339.jcrhap-15-828
Introduction Working with people who are HIV positive is a herculean task and relevant theories to assist them medically, psychologically, economically, socially and otherwise are necessary. People who are living positively with HIV and AIDS are usually ridiculed, discriminated against, rejected and isolated. Using theories to work with them will help to cushion the negative impacts of HIV and AIDS, especially stigma which has been identified as a major barrier to health care and quality of life in illness management. The fundamental human rights of people living positively with HIV and AIDS should be protected since majority of such rights are usually trampled upon. The review aimed at discussing the potential benefits of using theories to assist people living positively with HIV and AIDS to cope with their various and varying situations in life. Materials and Method: Information for this study was collected by extensive review of recent literature on theories for assisting people living positively with HIV and AIDS. The paper reviews theories that influence long-term behaviour change among people living positively with HIV and AIDS. It assesses the need for using these theories to improve HIV and AIDS intervention in developing countries including Nigeria. In this study, eleven behaviour theories were reviewed. Result It was noted that some of the theories promoted adherence as well as helped to explain the benefits of adherence to HIV and AIDS medication. Also a good number of the theories assisted researchers in designing effective intervention strategies. Conclusion: Further research is needed to determine the effective theories that will increase adherence to long-term treatment regimens of HIV and AIDS. Such theories can be used to alleviate the potential burnout of Caregivers and people living positively with HIV and AIDS who travel long distances for diagnostic procedures and work long hours without adequate remuneration, support and supervision.
Feb 2016 DOI 10.14302/issn.2324-7339.jcrhap-13-255
People living with HIV (PLWH) are at risk of developing chronic lifestyle diseases such as ischaemic heart disease (IHD). Physical inactivity is a modifiable risk factor for IHD. The level of ambulation physical activity in individuals living with HIV in a South African context is unknown. The aim of this study was to assess the physical activity levels and other risk factors for IHD in PLWH on antiretroviral therapy (ARV). An observational study was conducted from October 2010 to June 2012 at an outpatient clinic in Johannesburg, South Africa. Two hundred and five individuals who were on ARV for 6-12 months were screened. Physical activity was measured with the Yamax SW200 pedometer over a seven day period. Physical activity of the sample was reduced at 7673.2 (±4017.7) steps/ day with women walking less than men 6993.3 (±3462.6) and 10076.3 (±4885.6)respectively. Body mass index was increased to 25.6 (±5.4) kg/m2 with women noted to be overweight [26.6 (±5.5) kg/m2]. Independent predictors of being overweight were systolic blood pressure, waist and hip circumference, CD4 count and daily fruit and vegetable intake. Smoking was less common in the study population with 16.1% of the sample being current smokers and 25.9% former smokers. Individuals’ mean perceived stress levels were 19.9 (±7.8) on the Cohen’s Perceived Stress Scale. The ambulation physical activity level of individuals living with HIV requires modification to assist with reducing risk factors of IHD.
Jan 2016 DOI 10.14302/issn.2324-7339.jcrhap-13-180
Perception of Human Immunodeficiency Virus has been topical due to its central place in determining attitudes and care for people living with HIV/AIDS and having implications for the containment of the epidemic. People living with HIV/AIDS face social stigmatization due partly to misconception in the perception of the disease and people living with it and students are not left out in this stigmatization and discrimination. This study aimed at exploring the perception of HIV/AIDS by the students of Obafemi Awolowo University. The study utilized quantitative methodology –questionnaires to elicit information from 160 students on their perception of the disease. The sampling technique was quota sampling technique in which 40 students were randomly selected from each hostel out of the 4 selected hostels. The findings were that majority of the respondents view the disease and people living with it negatively (53.9) and dangerous (30.9) and 66.4 percent of the respondents did not see themselves being vualnerable to contracting the virus. The result further showed a significant association between knowledge and perception of the disease. It was also revealed that there was no significant relationship between perception of the disease and socio-economic status of students. This negative perception has serious implications for students living with HIV/AIDS in the University. In conclusion, the negative students’ perception of the disease and people living with it has serious implications for the containment of the epidemic in that people living with HIV/AIDS would hide their sero-positive status to avoid stigma and would in turn infect others. There is therefore need for intervention to change student perception to positive in the university.
Dec 2015 DOI 10.14302/issn.2324-7339.jcrhap-13-264
Phytochemicals (PHT) are a large group of biologically active plant chemicals that may have positive effects on human health such as immune system stimulation, down regulation of inflammatory responses, radical scavenging activities, cell repair function, and antibacterial and antiviral activity. In this proof of principle 6 months study, the effects of supplementing a PHT mix, Phyto V7, to HIV-1 seropositive individuals and AIDS patients were examined. Individuals with CD4+ T-cells below 350 counts/mm3were assigned to one of the following treatments: CG1 - no treatment, CG2 - only highly active antiretroviral treatment (HAART), TG1 - only Phyto V7, and TG2- both Phyto V7 and HAART. After 3 months of treatment there were approximately (-)1%, 1%, 2% and 4% increase in the mean weight of the CG1, CG2, TG1 and TG2 groups, respectively. The tendency for the body mass index (BMI) was similar. The CD4+ counts increased by 13%, 39%, 53% and 35%, respectively. Similar trends were noted after 6 months with 2%, 79%, 53% and 69% increases in the CD4+ counts, respectively. There was a significant reduction in viremia only in groups receiving HAART. Overall better results were obtained in the group of patients receiving both HAART and Phyto V7, in which the mean weight increased by 5.7% and the CD4+ T-cell counts increased by 69% after 6 months. This study indicates that providing Phyto V7 to HIV-1 seropositive individuals and AIDS patients, receiving or not receiving HAART, improves their physical wellbeing and CD4+ counts, enabling them to cope better with the viral infection.
Jun 2015 DOI 10.14302/issn.2324-7339.jcrhap-15-648
HIV/AIDS has become a global scourge affecting mainly young people. Sexual behavior change remains the most effective way of preventing further spread. The aim of this study is to assess the knowledge, perception and practice of safe lifestyles towards prevention of HIV infection among students of a tertiary educational institution in Abakaliki, south eastern, Nigeria. A cross sectional descriptive study was carried out, and participants were selected using multistage sampling technique. Data was collected using a pretested, self administered questionnaire and analyzed using SPSS software, version 20. Three hundred and eighty seven participants were recruited for the study, including 199 (51.4%) males and 188 (48.6%) females. Mean age of participants was 23.6 ±2years. All (100%) of the participants were aware of the existence of HIV/AIDS, with the commonest source of information being electronic media (81.1%). Their knowledge of the routes of transmission and modes of prevention of HIV infection was high, though few of them have some misconceptions. Poor practice of safe lifestyles towards prevention of HIV infection as well as low perception of self-vulnerability to the risk of HIV infection was also found. There was poor practice of preventive lifestyles among the participants despite high knowledge of HIV transmission and preventive measures probably due to low perception of self-vulnerability to the risk of HIV infection. Health education should be intensified to impact sufficient comprehensive knowledge to change low perception of self-vulnerability among the students.
May 2015 DOI 10.14302/issn.2324-7339.jcrhap-13-235
A clinical case of painful mucocutaneous lesions in an HIV‑1 seropositive woman is presented. The report discusses differential diagnosis, diagnostic work‑up in resource‑limited settings, and targeted therapy considerations.
May 2015 DOI 10.14302/issn.2324-7339.jcrhap-14-416
Objective: Human immunodeficiency virus (HIV) /acquired immune deficiency syndrome (AIDS) affect all levels of society and drivers are considered as vectors of HIV transmission because of the mobility of their work. The aim of this study was to assess struck drivers’ knowledge, attitudes and practices on HIV and AIDS in Burkina Faso. Methods: Quantitative method and cross-sectional survey using questionnaire with Cronbach’s alpha 0.76 were used in this study. SPSS, version 18.0 was used for analysis. P-values ≤ 0.05 were considered statistically significant. Results: 150 truck drivers participated in the study with a mean age of 38.71 years (SD=8.87), and ranged from 25 to 68 years old. It was observed that misconceptions about HIV transmission are quite prevalent among truck drivers. About 61 (40.7%) felt that AIDS can be transmitted by sharing meals, 35 (23.3%) stated that it can be spread by mosquito bite and 65 (43.3%) were of the opinion that AIDS can be transmitted by using same toilet and cloths. High-risk behavior was established in the study. 78% have other sexual partners besides their wives and 34% often visit sex workers in which 26 % had unprotected sex with sex workers. Alcohol seems to have a big role in their sexual behavior; thus 22 % of truck drivers declare drink alcohol before sex. There were significant association in demographic factors and knowledge, attitude and practice. Conclusion: The study findings underline the negative risk behaviors of truck drivers. Safe sex and use of condom have to be promoted through education program among truck drivers in Burkina Faso.
Oct 2014 DOI 10.14302/issn.2324-7339.jcrhap-14-541
A 25 year old, single, active duty soldier presented to a clinic in Afghanistan complaining of malaise, fatigue, acholic stools, and mild jaundice over a 5- to 7-day period. He had significantly elevated liver transaminase levels approaching 5000 U/L and a positive rapid human immunodeficiency (HIV) 1 antibody test. Ultimately, the patient was found to have a false positive rapid HIV-1 antibody test due to acute hepatitis A virus infection. This case report describes his evaluation and outcome, in addition to exploring possible causes of false positive HIV screening.
Jul 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-168
This paper examines the association between intimate partner violence and the consistency of condom use in a US urban cohort of HIV-serodiscordant couples. It uses both male and female data from the California Partners Study II of a lower-income ethnically mixed cohort of 145 such couples in the San Francisco Bay Area. We observed a significant association between inconsistent condom use and physical abuse: the risk of inconsistent condom use was double for those experiencing physical abuse (OR, 2.2; 95% CI, 1.1, 4.1). Injection drug use and a history of bisexual behavior were also associated with inconsistent condom use. Physical abuse tended to be reciprocal between partners (OR, 3.2; 95% CI, 1.9, 5.6). Our findings suggest that interventions effective in reducing intimate partner violence, and/or reducing the use of injection drugs in HIV-serodiscordant couples could lead to less transmission of HIV.
Jul 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-321
Background: The use of condoms in marriages is a complex decision. It however plays a role in prevention of HIV and other sexually transmitted infections (STIs). The problem is, what factors and conditions determine consistent condom use among HIV positive women? This study aimed at identifying determinants of consistent condom use among HIV positive women cohabiting with their partners and attending ‘Heart to Heart’ treatment centre in Abia State University Teaching Hospital. Materials and Method: This longitudinal descriptive study was conducted among 248 married HIV positive women who attended ‘Heart to Heart’ treatment centre in the Abia State University Teaching Hospital from December 2012 to February 2013 and are cohabiting with their partners. Interviewer administered semi-structured questionnaire was used to obtain data from the respondents. Data were analysed using SPSS version 17 software. Results: A total of 73(29.4%) of the respondents used condom consistently. Age, level of education, and desire for more children influenced condom use (OR 7.023., CI 2.050 – 24.047, P<0.001). The older the respondents, the more condom they used (OR 164.474, CI 21.477 – 1260.2, P<0.001). Also the more educated the respondents were, (tertiary, secondary) the more likely they used condom. Women who did not desire more children used condom more than those who desired more children (OR 13.612, CI 0.043-26.311, P<0.001). Women who had disclosed their HIV status to their spouses, used condom more than those who had not (OR 13.072, CI 5.836 – 29.253, P<0.001). Conclusion The fact thatonly 29.4% of the respondents used condom consistently with their spouses shows lack of awareness of the benefits of condom use. Health education which will stress the importance of using condom in preventing HIV transmission and other sexually transmitted infections (STIs) is recommended for HIV positive women and their spouses.
Jun 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-158
It is important to measure depressive symptoms in HIV-infected individuals because depressive symptoms have been found to be correlated with faster progression to AIDS. Worldwide, the CES-D has been used to assess depressive symptoms and examined for its construct validity. However, no previous studies have investigated the CES-D’s construct validity among HIV-infected perinatal women. Therefore, the objective of this study was to examine the construct validity of the CES-D using both explanatory and confirmatory factor analysis among HIV-positive perinatal women in Thailand. Results showed that, overall, the CES-D is a 4-factor instrument with good construct validity and can be used to evaluate depressive symptoms among HIV-positive perinatal Thai women. However, some items from our study loaded differently on the 4 factors from Radloff’s model. Finally, the CES-D can be used as a general-factor scale without being compromised.
Jun 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-239
As advances in treatment and prevention are starting to decrease the magnitude of the Acquired Immunodeficiency Syndrome (AIDS) epidemic in Sub-Saharan Africa, the number of orphans and children surviving Human Immunodeficiency Virus (HIV) infection is growing. To date, little research has been conducted in the care of HIV-infected children in orphanages in Sub-Saharan Africa. In this qualitative study, managing personnel in 10 programs caring for HIV-infected children were interviewed to ascertain perceived barriers to care of these children. While all programs commented on medical infrastructure barriers, respondents felt sociocultural issues were more pressing. After analysis of transcribed interviews, three major themes of poverty, denial/stigma, and cultural differences with outsiders emerged. These findings have implications for international programs that both serve and seek to serve the needs of HIV-infected children and orphans in Africa. Outside funding organizations will need to address local poverty, stigma, and African “ownership” of HIV-positive orphans to ultimately ensure the best care of these vulnerable children.
May 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-147
Evidence shows that depressive symptoms are associated with faster progression to AIDS in HIV-infected populations. Physical symptoms, self-esteem, and emotional support have been reported to play a major role in contributing to depressive symptoms. However, comparisons of different sources of support—specifically family vs. friends— have only been made in a few previous HIV studies. Therefore, the objectives of this study among HIV-positive perinatal Thai women were to examine: 1) both the direct and indirect effects of physical symptoms and emotional support on depressive symptoms; 2) which source of support is more significant, family or friends; and 3) the direct effect of self-esteem on depressive symptoms. Results revealed that half of the participants experienced major depressive symptoms. Physical symptoms and self-esteem both had direct effects on depressive symptoms. Emotional support, from friends and family, had an indirect effect on depressive symptoms. Treating physical symptoms and increasing self-esteem through emotional support, could help decrease depressive symptoms in the target population. Finally, it is crucial that routine screening for depressive symptoms is established at all HIV clinics for perinatal women in Thailand.
May 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-128
This commentary argues for incorporating secondary prevention into the HIV care continuum for patients retained in care. It outlines opportunities to reduce transmission through viral suppression, risk reduction counseling, and supportive services within routine visits.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-191
Objective: This cross-sectional study examined cognitive subtypes and influential factors in HIV-positive (HIV+) adults. Method: Two-step cluster analysis was conducted on a neurocognitive test battery in a sample (N = 78) of adults and older adults with HIV (Mage = 46.1). Next, cognitive, functional, and mental and physical health differences were compared between the HIV+ clusters and an HIV- reference group (N = 84; Mage = 47.9). Results: A two-cluster solution emerged, with a lower performing cluster exhibiting poorer performance across all domains except psychomotor speed, and a “normal” cluster displaying similar performance as the HIV- group. The most influential factors to classification in the lower performing cluster were older age and presence of stroke and hypertension. There were trends for longer duration of HIV-infection, higher unemployment rates, and greater prevalence of Hepatitis C co-infection in the lower performing cluster. Conclusions: These findings suggest that there are not unique cognitive subtypes in HIV, but rather a subset of individuals who exhibit globally normal performance and those with below average performance. Older age and the related cardiovascular comorbidities of both aging and HIV medications may be key influential factors to variability in neurocognitive functioning in this population and thus should be considered in future studies. Implications for research and practice are provided.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-211
Recruitment of couples is important for study success. The multi-centered HPTN 052 clinical trial was designed to evaluate whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners. The objective of this study was to retrospectively compare several approaches for community recruitment at our site in Kisumu, Kenya based on a) feedback from recruitment staff, b) associated cost, and c) number of eligible couples enrolled. A secondary objective was to assess the discordant couples’ acceptability of the community recruitment approaches relative to the a) main recruitment venues, b) educational materials, and c) local language best suited for explaining the trial. 241 couples were screened for eligibility using nine recruitment approaches. We compared the approaches used for the 60 couples found to be eligible to those used for the 56 ineligible couples for whom that information was available. Analyses for association were carried out. In-depth interviews were conducted with 20 staff and 29 discordant couples. Records were kept of the costs associated with each approach. Overall, staff interviews revealed that acceptability of the approaches was high. Challenges were present with all approaches ranging from one member of the couple not wanting to reveal their positive HIV status to their partner (Patient Support Center or PSC approach), to not finding people at home (home based counseling and testing or HBCT approach). The PSC and the HBCT recruitment approaches were the most effective in terms of recruiting eligible participants. There was an overall significant difference between the proportion of eligible and ineligible participants among the 9 approaches (χ2 (8) =33.5; p<0.0001). Analyses for association showed that the PSC approach resulted in attracting a greater proportion of couples who were eligible than ineligible (χ2 (1) =6.6; p=0.016). The cost for the PSC approach was less than one-third that of the HBCT approach. All discordant couples interviewed found the two main recruitment venues (PSC and their home) acceptable. Among couples who saw the educational materials, the majority found them useful (poster 72.7%; pamphlet 90.9%; flyer 88.9%). All couples found the language they were told about the study acceptable. The evaluation of recruitment approaches indicated that working with local partners, specifically the PSC staff and HBCT staff, was the most effective way to recruit eligible discordant couples. A focus on collaborations and partnerships between research and clinical organizations will help study recruitment efforts. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of their respective institutions. Funding for this substudy was provided by the Kenya Medical Research Institute (KEMRI) through a cooperative agreement with the U.S. Centers for Disease Control and Prevention.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-157
Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity 34.6% 95% Confidence Interval (CI): 25.3% to 43.9%, chronic kidney disease {20.7% (95% CI: 11.6% to 29.7%)} and tachycardia {20.6% (95% CI: 12.7% to 28.5%)}. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked {65% (95% CI: 57%-72.3%)}, used tobacco products {66% (95% CI: 56.4%-74.4%)} or drugs (53.8% of the men) and consumed alcohol {60.2% (95% CI: 50.5%-69.1%)}. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region.
Jan 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-187
Retention of sufficient numbers of participants in longitudinal research studies is a serious methodological concern, as retention influences the validity of the research findings. An assessment of participant retention or attending all study visits was made quarterly during a 12 month follow-up of an HIV incident cohort in Kisumu, Kenya. The study objectives were to determine 1) the proportion of participants attending all study visits and 2) demographic and behavioral factors associated with missing ≥ 1 visit. The Kisumu Incidence Cohort Study (KICoS) was initiated in January 2007 (N=831). Detailed contact information was collected from each participant to enhance retention. Bivariate and multivariable analyses were used to determine factors associated with missing ≥ 1 visit. Overall retention was 90%. Of those enrolled, 46.4% were females. The adjusted odds of missing ≥ 1 study visit were greater for participants who were female (AOR=2.85; CI=1.90-4.28) and who had technical training (AOR=2.51; CI=1.20-5.25) or college/university education (AOR=1.89; CI=1.10-3.24) compared to having no or only primary education. Retention was high in this HIV prevention cohort study. However, studies could benefit by tailoring retention strategies for women. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of their respective institutions.
Jan 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-edt.1.3
This hypothesis‑driven review considers phytochemicals with putative anti‑HIV activity. It summarizes proposed mechanisms, in vitro evidence, and formulation issues, and calls for standardized assays and clinical trials to determine real‑world efficacy and safety.
Nov 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-200
Various sporting activities are being used as vehicles for HIV/AIDS education and prevention within the field of sport-for-development (SFD). Kicking AIDS Out! is one SFD program that aims to promote protective attitudes regarding HIV/AIDS amongst youth. This study explored organizers’ perspectives of the use of sporting activities in the Kicking AIDS Out! program in Trinidad and Tobago. Qualitative case study methodology was used to examine the case. Data was generated through semi-structured interviews with seven organizers who were Kicking AIDS Out! staff or volunteer members. Thematic analysis guided data analysis. Generated themes include: Sport to Draw, There’s Something for Everyone, the Emotional Wow, and Beyond Sports. These themes illuminate the idea that sport captivates and attracts youth, and illustrate the use of sport activities to promote engagement in the program as they are tailored to the skills and interests of youth. Sport activities may challenge values and beliefs regarding HIV/AIDS and may promote engagement in new roles, such as those as advocate or caregiver for individuals with HIV/AIDS, and engagement in healthy lifestyle behaviours, such as safe sexual encounters. The findings of this study offer an opportunity for HIV/AIDS prevention programs to consider their use of sporting activities in a manner that achieves these SFD characteristics.
Nov 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-266
Objective: Toanalyze the socio-economic pattern amongst HIV patients in eastern and north-eastern India as measured by different parameters such as educational status, wealth, marital status, sexual behaviour. Methods: This study involved 650 HIV seropositive individuals enrolled in a HIV Apex Clinic in a tertiary care hospital in Kolkata, India during 2006 to 2011. Socio-demographic data were obtained while keeping the names of HIV seropositive individual’s names confidential. HIV testing was done according to the guidelines of NACO, India. Diagnoses of different common opportunistic infections were also done. Results: Out of the 650 individuals, 53% reported to have presenting symptoms of low grade fever, 21% had weight loss, general weakness and malaise. 13% reported to have frequent skin rashes, 13% ported to severe seizures and lack of coordination. 41.07 % of them had an income ranging from Rs1000 - 1500 per month. These individuals mainly were daily workers, labourers who work in per day income basis. 44.13% (89 out of 202) of the females were married at a young age, 65 (32.17%) were widowed whose husbands succumbed to HIV. Assessment of the educational qualifications reveals that those individuals affected reveals that 65% of the males received education till standard VIII, 25% received elementary education till standard IV. Conclusion: The study highlights the sectors of the socio-economic class who need more attention to tackle the HIV burden. The analysis of the socio-economic status reveals the low income and lack of education are main contributing factors towards the spread of this disease in this region.
Nov 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-227
Background: In Nigeria HIV infection is transmitted mainly through heterosexual route, affecting mostly individuals within reproductive age groups. As a result, HIV/AIDS education is advocated as a strong component of family and reproductive health education in the school curriculum which should emphasize responsible sexual behavior, premarital chastity and protective sexual practice. Aims/ Objectives: To evaluate student’s knowledge of HIV/AIDS, premarital HCT, and reactions to possible discordant HCT results. Methods: Cross sectional questionnaire-based study of 600 students in 6 schools in Zaria/Sabon Gari LGAs. Exclusion criteria: students aged ≤13 years, married, in JSS 1-3, SS1. Results: 550 students completed questionnaire (92% response rate). 54.5% females (ᾱ age =17.5 ±2.7 years) versus 45.5% males (16.5 ±2.7 years), Muslims (53%) and Christians (47%) respectively. 76%, 57%, and 38% knew the meaning of AIDS, HIV and VCT respectively; while all knew both the routes of HIV transmission and preventive measures. More than two-third supported voluntary, free and self initiated premarital HCT, preferably in a private and confidential setting. None would marry a discordant HIV positive partner, while 61% would marry themselves if both have positive HIV results. Conclusion: Many students would shun marriage with discordant HIV+ partner.
Nov 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-304
Antiretrovirals have traditionally been associated with much toxicity. Newer antiretrovirals are considered much less toxic relative to older antiretrovirals. Upon its FDA-approval in 2009, raltegravir’s adverse drug reaction profile was found to be similar to placebo. However, recently there have been reports of increased creatine kinase and rhabdomyolysis following the initiation of raltegravir. We describe a 52-year-old, African-American man who developed rhabdomyolysis after starting raltegravir for HIV. Rhabdomyolysis resolved upon discontinuation of raltegravir. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6). Although raltegravir is a well-tolerated antiretroviral, clinicians should be aware of the possibility of rhabdomyolysis when prescribing this medication.
Sep 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-268
Established in 1996 with funding from CDC and NIH, the HIV/AIDS Prevention Program Archive (HAPPA) is now the biggest private sector collection of HIV-related evidence-based behavioral interventions (EBIs). Each EBI in HAPPA has been determined by a distinguished Scientist Expert Panel to have demonstrated efficacy in preventing HIV or its risk-related behaviors in the United States. The multimedia replications kits contain everything that a new site would need to implement an EBI such as a user guide that gives an overview of the program and the evidence of its effectiveness; a facilitator’s manual that gives step-by-step implementation protocols for each session; and session implementation materials referenced in the facilitator's manual such as slides, video clips, participant handouts, activity masters, checklists, and homework assignments for the next session. The program packages also contain evaluation materials such as surveys and questionnaires that were used in the original demonstration of effectiveness and that may be used to re-evaluate the program as implemented in a new setting. Recently, we have expanded HAPPA’s scope to include HIV EBIs developed globally and to include evidence-based structural interventions (effective in modifying the physical, social, cultural, political, economic, legal, and/or policy aspects of the HIV risk environment). This paper describes HAPPA’s procedures for identifying, selecting, acquiring and packaging HIV EBIs. It also provides comprehensive lists of evidence-based HIV behavioral and structural interventions and gives information on how to access EBI program packages for implementation in new settings.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-74
HIV infected children who started antiretroviral therapy (ART) in public health facilities in South Africa have survived to older age and disclosure has become an essential part of their care. Available data on HIV disclosure to children were collected much earlier in the provision of ART in South Africa. The aim of the study was to (a) determine the characteristics of caregivers of pediatric HIV patients in Gauteng, South Africa, (b) estimate the prevalence and timing of HIV disclosure among these patients, and (c) assess the factors associated with disclosure status. A cross-sectional study was conducted among 286 caregivers of paediatric ART children aged 4–17 in two centres in Gauteng, South Africa. Bivariate and multivariate logistic regression analyses were carried out. The highest proportion of care givers were biological mothers (n=140, 49.3%). The mean age of the children was 8.5 years, (range 4-17 years). More than a third (n=99, 34%) were disclosed their HIV status, and the mean age at disclosure was 9.3 years, (SD = 2.7). Child’s age older than 10 years (OR =1.63; 95% CI: 1.44–1.85), having a nonbiological caregiver (OR=1.75; 95% CI: 1.06-2.89), caregiver educational level (OR =0.64; 95% CI: 0.47–0.87), and caregiver’s age older than 60 years (OR=1.02; 95% CI: 1.01-1.04), were significantly associated with HIV disclosure to infected children. The relatively higher prevalence of disclosure is attributed to increasing access to paediatric ART. Training healthcare providers to support caregivers in disclosure will increase the rate of disclosure to HIV infected children receiving ART in public health facilities.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-140
Analyzing SNPs linked to fatty liver disease, this study finds no association with HAART‑related hepatic steatosis in HIV patients. The work underscores the multifactorial nature of antiretroviral toxicity and points to metabolic and pharmacologic contributors beyond common variants.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Background: HAART has resulted in significant decline in morbidity and mortality from HIV. However, it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV and their clinical and demographic profile years after the introduction of HAART. Methods: A retrospective audit of the HIV admissions from July 2009 through June 2010. The case notes of all the adult admissions where one of the discharge diagnoses was HIV infection was reviewed. Data including the demographics, date of diagnosis, treatment and the follow up details, admission outcome and the final diagnosis were extracted from the case notes. Results: Over the 12 months period there were 154 admissions where one of the discharge diagnosis was HIV infection, and this accounted for 2.9% of all medical admissions in adults. 103(67%) admissions were in persons who were known to be HIV infected prior to the current admission. HIV infection was diagnosed for the first time during the current admission in 51(33%) cases. Nearly two-thirds of those hospitalized, had a CD 4 cell counts of < 200/µL and 63 (66%) had a viral load greater than 50,000 copies/ml. Over all, opportunistic infection was the commonest (47%) discharge diagnosis, followed by serious bacterial infections and HIV nephropathy. The median duration of hospitalization was 6 days (Range 2 to 71 days). There were 49 (32%) deaths. Conclusions: A significant proportion of patients admitted with HIV infection were still diagnosed on admission and were found to be severely immunosuppressed. An opportunistic infection continues to be the commonest discharge diagnosis in HIV infected patients.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-68
New research suggests that people living with HIV have the potential to be strong advocates for HIV prevention by passing on HIV prevention messages within their social networks. However, there is a paucity of research into the nature and prevalence of HIV prevention behaviours engaged in by HIV clients, and the psychosocial correlates of such advocacy, which are the goals of this analysis. We examined engagement in HIV prevention advocacy among 602 new HIV clients at two clinics in Uganda. Eighty nine percent reported encouraging others to get tested for HIV, 79% told people they know to use condoms when they have sex, and 61% reported discussing HIV more generally with friends and family. A client was classified as fully engaged in HIV prevention advocacy if they reported engaging in all three of the measured HIV prevention advocacy behaviors. In the bivariate analysis, being from the rural study site (p<0.001), higher levels of HIV disclosure to friends (p<0.001), greater hopefulness (p<0.001), and lower levels of depression (p<0.001) and internalized HIV stigma (p<0.001) were associated with full engagement in HIV prevention advocacy. In the multivariate analysis, being from the rural study site (OR=5.461, 95% CI=3.11-9.61), lower levels of internalized HIV stigma (OR=0.524, 95% CI=0.39-0.70) and higher levels of HIV status disclosure to friends (OR=2.040, 95% CI=1.23-3.38) remained significantly associated with full engagement in prevention advocacy. These data suggest that psychosocial adjustment and functioning may play a key role in empowering HIV clients to be advocates for prevention.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-edt.1.1
This editorial discusses combination strategies that concurrently target viral replication and host factors in HIV therapy. It surveys candidate mechanisms, potential benefits, and safety considerations, advocating rigorous trials to balance efficacy with tolerability in diverse patient populations.
Dec 2024 DOI 10.14302/issn.2642-9241.jrd-24-5320
Introduction Mortality is one of the most important demographic phenomena in public health, and its rate is the primary indicator of a population's state of health. The aim of this study was to describe the profile of patients in the pneumo-phthisiology department of the Hospital National Ignace Deen CHU in Conakry. Methodology This was a retrospective descriptive study lasting one year, from 01 January to 31 December 2023, on 176 records of hospitalized patients who died in the pneumophthisiology department of the Ignace Deen National Hospital. Results A total of 1043 patients were hospitalized during our study period, 176 of whom died, giving a mortality rate of 16.87%. The mean age of the deceased patients was 49.57±18.8 years, with a male predominance (sex ratio=1.93). Clinical signs on admission were dominated by dyspnoea (70.45%) and chest pain (61.36%). Tuberculosis was the most common diagnosis with a frequency of 42.61%, followed by TB/HIV co-infection with a frequency of 22.16%. The average length of hospitalization was 8.79 days. Probable cause of death was dominated by respiratory distress (54.44%) and decompensated anaemia (32.95%). Conclusion Mortality in the pneumo-phthisiology department of the Ignace Deen National Hospital remains high. Anemia and respiratory distress were the most common diagnoses of severity, hence the need to improve management of these probable causes of death.
Sep 2024 DOI 10.14302/issn.2474-7785.jarh-24-5212
From an academic and clinical point of view, stem cell therapy represents one of the most promising advances in modern medicine, with the ability to partially induce the regeneration of acutely injured or chronically damaged tissues. Stem cell research provides new opportunities for the treatment of various conditions, among them diabetes mellitus, HIV, cardiovascular diseases, and neurodegenerative illnesses. Stem cell therapy is currently not FDA-approved in the US (except for certain blood cancers). While bioethics and religion have mostly discussed the source of cells, i.e., embryonic cells that require the destruction of embryos versus adult tissue for research purposes, we also discuss the controversies with regard to currently offered therapies, and marketing of unapproved procedures from a scientific, clinical, and religious viewpoint.
Apr 2024 DOI 10.14302/issn.2994-6743.ijstd-24-5006
Objectives This study explores the clinical characteristics, associated infections, and management outcomes of syphilis within a specific population over the years 2018 to 2022. With a focus on the frequency, clinical manifestations, and co-infections of syphilis, the research addresses a critical gap in understanding the nuanced dynamics of this sexually transmitted infection and its impact on public health. Methods The study employs a retrospective analysis of data collected from 2018 to 2022, utilizing three key serological tests (Syphilis AB, RPR/VDRL, and TPHA) to characterize syphilis infections within the population. Clinical manifestations and associated infections, including HIV, HBV, HCV, Chlamydia, Gonorrhea, and HPV, are systematically assessed. Treatment rates and re-infection patterns are also analyzed, providing a comprehensive overview of syphilis epidemiology within the studied timeframe. Results The frequency of syphilis, particularly indicated by the Syphilis AB test, exhibited a marked increase in 2020, reaching 96%, suggesting a heightened frequency within the population. RPR/VDRL test results demonstrated consistent frequency, emphasizing the persistent presence of active syphilis infections. Clinical manifestations, such as chancre, skin rashes, alopecia syphilitica, and lymphadenopathy, displayed dynamic patterns over the study years. Co-infection rates varied, with fluctuations observed in HIV, Chlamydia, Gonorrhea, and HPV, while HBV and HCV showed infrequent but stable frequency. The management of syphilis cases demonstrated commendable treatment rates, but an increase in re-infection rates in 2021 highlights the need for continued vigilance. Conclusion This study provides a comprehensive evaluation of syphilis epidemiology, clinical characteristics, and associated infections within the studied population. The results offer valuable insights into the dynamic nature of syphilis and its co-infections, informing public health initiatives and interventions. The findings contribute to our understanding of the epidemiological landscape and underscore the importance of sustained efforts in both prevention and treatment to curb the transmission of syphilis and its associated infections. The study, however, calls for continued vigilance and research to address the evolving trends and challenges in syphilis management within the specified population.
Jan 2024
Drug-resistant tuberculosis (DR-TB) is the most urgent public health problem to solve in Peru, according to the Ministry of Health 1. In the WHO Global TB Report 2021, Peru has the highest burden of DR-TB in the Americas (Table 1), with 38% of TB cases either RR or MDR. In addition, the Ministry reports an estimated prevalence rate of DR-TB of 5.7% in new cases and 24.2% in previously treated cases. A total of 2493 new cases of DR-TB were reported in 2022, with 18.5% treatment dropout in 2019 believed to have increased by at least 52% in 2022 1. The post-pandemic context has created additional challenges for the control of DR-TB in Peru. A complex multiplicity of factors connects this disease to groups with high vulnerability, such as populations in extreme poverty and overcrowding or deprived of freedom; those who have immune system disorders, such as HIV and diabetes; and isolated indigenous populations.
Dec 2022 DOI 10.14302/issn.2324-7339.jcrhap-22-4371
Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.
Nov 2022 DOI 10.14302/issn.2641-4538.jphi-22-4332
Introduction Physical, psychological, and emotional growth are among the changes that define the adolescent stage. As compared to other age groups, adolescents are more vulnerable to sexual and reproductive health issues. Parents can become protective and influencing factors for their children to prevent risky sexual behavior. This study aims to assess adolescent-parent communication on sexual and reproductive health and its associated factors. Methods A descriptive cross-sectional study was conducted among 212 adolescents aged 15–19 in higher secondary schools of Tokha Municipality. A self-administered structured modified questionnaire to assess the communication used the Weighted Topics Measure of Family Sexual Communication (WTM) tool with a simple random sampling technique of data collection. We performed descriptive statistical analysis and chi-square tests to analyze data and assess the association between variables. Data quality was assured through careful questionnaire design, pretesting, and training. Results The study found that about 75.9% of adolescents had communicated on SRH topics with their parents. Only 56.1%, 50.1%, 55.2%, and 50.5% of adolescents communicated about choosing a life partner, menstruation, physical and psychological changes during adolescence, and the physical growth and development of reproductive organs, respectively, while topics like using birth controls, when to start having sex, pregnancy, how to handle sexual pressure from a partner, STI and HIV/AIDs, about condoms, and abortion had never communicated by 61.3%, 86.6%, 69.3%, 85.8%, 72.2%, 78.8%, and 82.5% of adolescents, respectively. Adolescent-parent communication on sexual and reproductive health was significantly associated with the level of knowledge regarding sexual and reproductive health (X2 = 5.809, p = 0.01, df = 1). Similarly, there was a significant association with the perceived parenting style (X2 =3.932, p =0.04, df =1), living arrangements (X2 =6.376, p=0.01, df =1), and adolescent-parent communication. Conclusion It concluded that adolescent-parent communication on SRH issues is not satisfactory. Creating an adolescent-friendly environment at home and conducting awareness programs with the help of the local government of the respective schools would help to increase adolescent-parent communication.
Jul 2022 DOI 10.14302/issn.2324-7339.jcrhap-22-4204
Introduction Pre-exposure prophylaxis (PrEP) is an element of the biomedical interventions of Human Immunodeficiency virus (HIV) prevention. The level of protection is strongly correlated to PrEP drug adherence. In Nigeria, the prevalence of HIV among female sex workers (FSW) is 15.5%. The 2020 integrated biological and behavioral surveillance survey did not report on PrEP adherence among FSW. This study therefore assessed the level of adherence to PrEP and its predictors among FSW in South-Western Nigeria. Methodology This cross-sectional analytical study was conducted in 2021. Study population were brothel-based FSW at Gambari Ogbomoso and Lagos, Nigeria. A total of 156 FSW participated in the study. Data was collected using interviewer-administered semi-structured questionnaire and analyzed using IBM SPSS Version 25. Results One hundred and forty-nine properly completed questionnaires were analyzed. Ninety-nine respondents (66.4%) have been working for more than 5years as a FSW and 65(43.6%) had initiation of sex work before 18 years of age. Respondents’ sexual behavior showed that 55 (36.9%) of total respondents had consistent use of condom. One hundred and thirty-four respondents (89.9%) had good knowledge of PrEP, 97 (65.1%) had good attitude towards PrEP while 111 (74.5%) had good perception of risk of HIV infection. One hundred and thirty-two (88.6%) reported to be taking PrEP and 119 (79.9%) had good adherence to PrEP. Predictors of adherence to PrEP were educational status, age of commencement of sex work and monthly income. It was found that educated sex workers were 2.67 times more likely to adhere to PrEP (OR=2.67, 95% CI=1.280-5.591, p=0.019). Those who commenced sex work after clocking 18 years of age were 75% times less likely to adhere to PrEP (OR=0.251, 95% CI=0.106-0.597, p=0.001) while those with average monthly income more than #10,000 were 1.65 times more likely to adhere to PrEP (OR=1.65, 95% CI=0.674-4.042, p=0.0275. Discussion and Recommendation The level of adherence to PrEP is considerably high and underscores a positive effect of the efforts of the Government of Nigeria in controlling HIV as a threat by 2030. Further studies would be useful to understand the behavioral factors associated with low adherence to PrEP among FSW who have spent more than 5 years in sex work.
Mar 2022
Dolutegravir suppresses this integration enzyme, so human immune virus can’t create every greater copies of itself, thus ‘’integrase inhibitor.’’ Dolutegravir is hastily absorbed pursuing oral administration. The median maximum plasma concentration is reached 1.5–2.5 hours after oral uptake with a mean half-life of 12–15 hours, rendering feasible for once-daily dosing without the need for pharmacological boosting. The terminal half-life is about 14 hours. The apparent oral clearance is about 1 liter/hour. Fifty three percent of the total oral dose of dolutegravir is excreted unchanged in the feces, thirty two percent through urine as glucuronide (eighteen percent) or alkylated product (three point five percent), and other organic conjugated products sequencing from phase II liver metabolisms. Dolutegravir’s categorized as pregnancy category B (no confirmation of pitfall in humans) means either animal-reproduction inquests have not substantiated a fetal peril but there are no restrained inquests in pregnant women or animal-reproduction inquests have reveal an adverse effect (distinctive than a de-escalate in fertility) that was not inveterate in restrained inquests in women in the first trimester (and there is no confirmation of a pitfall in later trimesters) or there is survey in animal that revealed the medication is safe in pregnant animal, but there is no fetal pitfall confirmation in pregnant women.Antiviral Pregnancy Registry (APR) revealed that as of January 2017, pregnancy outcomes and birth defects were analyzed from 142 pregnancies with reported exposure to DTG during pregnancy. There were 128 live births reported (3 terminations, 11 miscarriages, no stillbirths). Only 4 (3.0%) reported birth defects, which is similar to the expected rate of birth defects in the general population. European Pregnancy and Paediatric HIV Cohort Collaboration (EPPIC) displayed that as of July 2017, 101 pregnancies with exposure to DTG had been identified with 84 birth outcomes. Rates of preterm delivery and “small for gestational age” were identical to outcomes reported from women on alternative regimens (standard of care in the United Kingdom of Great Britain and Northern Ireland).
Apr 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3741
Background Ethiopia confirmed its 1st case of COVID-19 on Friday 13th February 2020. The burden increased dramatically by August/2020. The conditions that led to this rise were not reviewed. Objective To exploreCOVID-19 related phenomena in Ethiopia during 2019-2020. Materials and Methods Review of journals, books, and letters to editors, e-sources, news, personal experiences, observations, and communications. Results The zoonotic source of SARS- CoV-2 (Severe Acute Respiratory Distress Syndrome- Coronavirus-2) is not confirmed. The precedent events; and exact mechanism of COVID-19 is not clear. Dynamic models were required on the time line of dynamics of COVID-19; dynamics of infectiousness of COVID-19, and mechanism of transmission of COVID-19. Incubatory carriers might have been missed. Screening based on temperature had been problematic. The time spent in the development of diagnostic test for COVID-19 might have contributed to the early spread. Uninterrupted flights to China during the epidemic by Ethiopian Airlines as well as uninterrupted domestic flights; IDP (Internally Displaced People); and others put Ethiopia (and other countries) at great risk. Demographic adjustment may not be applicable for Ethiopia due to lack of census which had to be conducted every 10 year, was conducted only in 2007. This adds to the problem of error projection. The impact of HIV (Human Immuno-Deficiency Virus Disease) and war in Ethiopia before 2000 might have had affected people who would be now old age and who would be at the most risk of death. This made the impact of COVID-19 to appear low as revealed by the lower number of COVID-related deaths in Ethiopia. There were also hesitations inconsistencies in case definitions; implementations of quarantine; and burial regulations. Conclusion Even though uninhibited foreign flight to China as well as domestic flights; inconsistencies in the implementation of regulations pertaining to COVID-19 have contributed to COVID- 19 emergence in Ethiopia, the absence of census; the demographic impact of HIV and war before 2000 might have made the impact of COVID-19 to appear low as revealed by the lower number of COVID-related deaths in Ethiopia. Recommendation Accurate and current evaluation of the impact of COVID-19 in Ethiopia may require the absence of census; demographic consequences of HIV; and war before 2000 into consideration.
Feb 2021
Introduction Risk reduction intervention is meant to provide enhanced and desirable interventions for HIV prevention among adolescents especially the in-school. Adolescents have been identified as the most vulnerable groups that can easily acquire human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). Therefore, adolescents are the appropriate target for HIV prevention efforts. Most interventions for adolescents focus on providing AIDS-related education with the assumption that improving knowledge would enable adolescents to protect themselves from sexually transmitted infections. Numerous studies have shown that using class-room education alone is insufficient in reducing adolescents’ risky sexual behaviours. Therefore, this study used role-plays and peer facilitation for the study. Materials and Method The study used role-play and peer facilitation for the intervention strategy. The theme of the role-play was ‘My Future is My Choice’ (MFMC) intervention which was aimed to reduce HIV risk behaviours among sexually inexperienced adolescents. The role-play was carried out by 4 peer leaders who were trained in the theoretical framework of role-plays and peer facilitation by a consultant. With mastery and experience they carried out the role play in a regular classroom section for over 3 class periods, co-facilitated with the assistance of a volunteer teacher. A unique feature of this intervention was the dual focus on strategies that influenced both individual risk factors (i.e., attitudes, behavioural skills) and social environments (e.g., peer resources). A school was chosen by simple random sampling for the intervention. In the school chosen, a total sample of 65 students in senior secondary classes 2&3 ( SS2&3) were included in the study. These were the students considered to be sexually active who can respond to the questions in the questionnaire. Self-administered pre-and post-questionnaire were completed by the students. The results were analysed using frequency tables, descriptive and inferential statistics. Results The students studied were between the ages of 13-18 years. There was evidence that the role play ‘My Future is My Choice’ (MFMC) intervention created positive effects on reduction of HIV risk behaviours among the sexually inexperienced participants aged 13–18. Perceptions on methods of preventing risk reduction behaviours were also positively impacted by the intervention as 12(18.5%) and 34(52.3 %) of the respondents realized after post- intervention that having sex with someone outside marriage and being transfused with infected blood respectively Will constitute risk to HIV infection. Conclusion The role play which used the theme ‘My Future is My Choice’ (MFMC) intervention provided safer choices for reducing one or more measures of sexual risk behaviours among the sexual inexperienced respondents. It created the opportunity for the students to recognize that engaging in unprotected sex constitutes high risk for HIV, other sexually transmitted infections and pregnancy.
Feb 2021 DOI 10.14302/issn.2641-4538.jphi-21-3725
This brief report article is a retrospective, descriptive, first-person account of following-up on a difficult-to-find client of an HIV/AIDS community-based pre-post intervention and disease prevention Research and Demonstration project in Houston, TX. Through the story about the personal journey of searching for the client, the author experiences an epiphany, especially in light of current events. Specifically, as opposed to social distancing and disconnection, public health disease prevention probably would be better served through leveraging the powerful and positive natural human features of social connectivity and closeness.
Nov 2019 DOI 10.14302/issn.2324-7339.jcrhap-19-3070
The telomeres existing at the end of the eukaryotic chromosome, play an important role in localization, pairing of homologous chromosomes during cell division and synapsis formation, while telomerase is involved in maintenance of the telomere length. The application of antiHIV-1 molecules particularly NRTIs have been shown to interfere with telomerase function thereby inducing aging processes. Since the application of these molecules has already indicated production of oxidative stress and toxicity in AIDS patients, their adverse impact on telomerase function may further worsen the situation. In addition, the negative influence of antiHIV-1 regimens on certain host factors involved in telomerase function may enhance aging. HAART changes the landscape of the disease by progressively decreasing the progression of HIV-1, but exerts prolonged adverse effects on the telomerase function. Though there is no exact information available on this issue, intensive efforts are needed to explore regulation of telomerase expression in HIV infected individuals and particularly those receiving antiretrovirals.
Dec 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2333
Introduction: The introduction of preexposure prophylaxis (PrEP) against incident HIV infection has changed the epidemiology of disease as continuous treatment with tenofovir and emtricitabine among high risk groups can reduce the relative risk for incident HIV infection by over 90%.However,despite the approved use of TDF+FTC, as a fixed dose combination of emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg, for oral PrEP since 2012 , it does not appear to have become widely accepted and in use among healthcare workers especially those in low income countries. Researches are therefore needed to consider the awareness and practice of health workers towards the availability of PrEP services in this part of the world. Healthcare workers are expected to be promoters of the use of PrEP services. Method: A cross sectional questionnaire-based study conducted in southern Nigerian over a 6 months period. Data were collected from 250 healthcare workers using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: A high proportion of the respondents(>60%) were highly educated healthcare workers(majorly Nurses and medical doctors) and about half (55%) having at least 10yrs working experience in the health sector with most especially on the HIV program(>90%), majority (94%) of the health workers were aware about ARV pre-exposure prophylaxis but very few ( 6% )could give the standard definition for PrEP as the use of ARV drugs by HIV negative persons to prevent the acquisition of HIV.Most(67%) of them gave wrong definition for PrEP and worse still about one fifth (20%) had no idea what PrEP was all about. Most (70%) could not correctly identify all the ARV drugs in a standard PrEP regimen while about 35% had no idea at all of the approved ARVs used for PrEP. Though PrEP services was not available at any of the facilities where the respondents were working ,the approved drugs(TDF+FTC) for PrEP were available at about 40% of the health facilities(public and private) and 15% community pharmacies in the vicinity of the respondents . Only 60% of the respondents were willing to access PrEP service for themselves if indicated while 35% would not use such services even if it is indicated for reasons which include concern about adverse effects and safety.Awareness of PrEP was significantly associated with the ability of the healthcare workers to identify the correct ARV regimen, ARV dosages and also correct indication for PrEP. Awareness was also associated with the knowledge of the correct proven efficacy for PrEP(>95%) and high likelihood of seeing a patient placed on PrEP and willingness to use PrEP based on personal indication Conclusion: The level of awareness of PrEP among healthcare workers was very high at about 90% yet many(60%) could not give correct standard definitions of PrEP, PrEP ARV regimen, dosages and level of efficacy of PrEP. Also none of the respondent had PrEP services available either at their center or any known referral centers. This is unacceptable in a country with second highest HIV burden in the world and has adopted PrEP in her national HIV guideline with ongoing PrEP demonstration studies. The few healthcare workers who were able to mentioned this information were more likely to have seen a patient placed on PrEP and were more willing to use PrEP based on personal indication. Recommendations: There is need to deepen the and knowledge of PrEP among healthcare workers especially those in poor resource settings by engaging them through update courses outreach, educational resources, campaigns/seminars and workshops and various job aids. All healthcare service providers should be very comfortable to carry out HIV risk assessment of their clients and provide PrEP to those indicated directly or indirectly through referral
Dec 2018 DOI 10.14302/issn.2641-4538.jphi-18-2464
Background Nicaragua has the highest prevalence of teenage pregnancies in Latin America. Knowledge regarding sexual and reproductive health plays an integral part in sexual behavior. The objective was to assess school going adolescents' knowledge about sexual and reproductive health and possible factors affecting it in the semi-rural community of Tololar, Nicaragua. Methods A cross-sectional study with a self-administered questionnaire on tablets was used for data collection. All 253 registered students at the school present at the time of fieldwork who gave written informed consent were deemed eligible for the study. A total of 225 participants in the ages of 11-19 years were included. Simple linear regression and multiple linear regression were performed analyzing the outcome knowledge. A p-value <0.05 was considered significant. Results The general knowledge about sexual and reproductive health was moderate; however, knowledge gaps were found such as prevailing myths and poor knowledge regarding human immunodeficiency virus (hiv) transmission and contraceptive methods. Being female and single were significant negative determinants of knowledge (p-value < 0.01) and knowledge increased significantly with age (p-value < 0.05). School teachers, websites, social networks, and TV were the most frequently chosen sources of information on the topic. Conclusions Increased education on sexual and reproductive health with new interventions particularly for young females is recommended. Using IT-based materials as a complement may be an effective way to reach out to adolescents.
Nov 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2291
In The Gambia like all nations, drug abuse is seen as a social and health problem that has many serious implications for the physical, social, psychological and intellectual development of the victims more especially, the children. Therefore, it continues to be a concern to families, community leaders, educators, social workers, health care professionals, academics, government and its development partners. Though there are some studies on drug abuse, there is none on children and drug abuse focusing on the street children the most vulnerable category. Street children are hypothesized to be more at risk of any epidemic including drug abuse. This study sought to determine the risk and prevalence of drug abuse among street children focusing on those in the car parks. The research was focused on six critical areas: level of knowledge of drug abuse, perception towards it, level of knowledge of the causes of it in the community and among street children, level of knowledge of negative impacts of it, level of knowledge of the preventive methods; and level of knowledge of the support services and treatments needed by victims. A structured questionnaire was used to collect the data from thirty five participants (i.e. one driver and six casual apprentices from each of the five car parks) were interviewed. The data was presented and analyzed using tables and percentage. The findings revealed among other things, that there is high level of awareness of drug abuse but the feelings towards it are mixed. Like other children, street children are abusing drugs mainly due to peer influence with the ultimate objective of getting high to relief stress, group recognition, desire to be trusted by peers, etc. Similarly, participants are highly aware of the negative impacts encompassing fighting, stealing, mental illness, etc. To finance the behavior, victims are engaged in all types of dangerous antisocial behavior including romantic ones exposing them to a range of diseases including STIs and HIV/AIDS. Marijuana is the most commonly abused drug. Though in the minority, some have started experimenting cocaine/coke, hashish; and heroin. While participants have good knowledge of the critical methods to fight drug abuse, the support services needed by victims, victims are mostly reluctant to seek the services not only because they are hard to find but fear societal stigmatization, exclusion and discrimination and professionals’ maltreatments.
Apr 2018 DOI 10.14302/issn.2578-8590.ipj-18-2078
Background: The core interthreshold zone (CIZ) is defined as the range between core temperature (Tc) at the onset of shivering and the Tc at the onset of sweating under consistent mean skin temperatures of 28°C to 30°C. A previous study demonstrated a diurnal change in the CIZ for male subjects and its relationship to the cutaneous sensation threshold zone (CSZ). In the present study, diurnal changes in the CIZ and the CSZ for young Japanese female subjects were investigated using the same experimental protocol from the study of male subjects and the sex differences in these responses were then examined. Methods: The CIZ and the CSZ were measured in 10 female subjects who participated in three experiments in a single day during the morning, afternoon, and evening in the summer of 2014 (single-day experiment), and six female subjects who participated in the same experiments on the morning of day 1, the afternoon of day 2, and the evening of day 3 during the summer of 2016 (multiple-day experiment). Air temperature was controlled at 25°C. Each subject wore a suit perfused with 25°C water at a rate of 600 cc/min, and exercised at 50% of their maximum work rate on an ergometer for 10–15 min until their sweating rate increased. They then remained seated, without exercising, until their oxygen uptake increased. Rectal temperature, skin temperature at seven sites, the forehead-sweating rate, and oxygen uptake were continuously monitored throughout the experiment. Cutaneous warm and cold sensation thresholds were measured at three sites using 1-cm2 and 2-cm2 probes. Results: The results from the single-day experiment demonstrated that the CIZ was proportional to core temperature prior to exercise (Tc-init) whereas the results from the multiple-day experiment demonstrated that the CIZ increased continuously from morning to evening despite almost a constant Tc-init. The CIZ appeared to be proportional to the CSZ measured with the 2-cm2 probe. When compared with the results from the previous study of men, no significant sex difference was observed between the CIZ of 0.25±0.07°C for female subjects and 0.21±0.05°C for male subjects. Conclusion: No significant sex difference or diurnal variation in the CIZ was confirmed. Continuous increase in the CIZ from morning until evening is expected in both men and women under a normal Tc circadian rhythm.
Feb 2018 DOI 10.14302/issn.2576-6694.jbbs-18-1887
The application of bilateral alternating stimulation in tactile (BLAST) form technology, a non-invasive, somatosensory-based method, has been shown to modulate the electrical activity of brain networks that mediate the stress response, resulting in a stress-reducing effect in individuals with high reported levels of anxiety, such as post-traumatic stress disorder (PTSD). In this study, we examined archival data from a heterogeneous group of users (n = 1109) of BLAST technology via Touchpoints, a novel BLAST-based treatment modality, all of whom had high self-reported levels of stress and anxiety. Ratings of levels of emotional stress and bodily distress on a scale of 0 (no stress/distress) to 10 (worst stress/distress of one's life) before and after the application of Touchpoints for 30 seconds were entered into an app. Results showed a statistically significant reduction in the levels of both emotional stress and bodily distress, 62.26% and 50.502%, respectively, after 30 seconds of BLAST technology was applied. This demonstrates a clear benefit of BLAST on the stress response, reducing both emotional stress and disturbing body sensations. Recent work examining EEG changes after BLAST technology is applied suggests that BLAST may reduce sympathetic activation by reducing the electrical activity of key areas of the salience network. Further work will more precisely characterize the effects of BLAST, its potential clinical uses, and the mechanisms of actions behind it’s apparent stress-reducing effects.
Feb 2018 DOI 10.14302/issn.2324-7339.jcrhap-17-1908
Introduction The practices of having extreme and permanent body modifications as in tattoos and scarifications are gaining popularity among youths especially those in the universities. Not minding the unbearable and painful pressure of sharp objects on the tissues and the risk of being infected with blood transmitted infections including HIV, youths still engage in these practices. This study aimed to examine the extent to which university students are aware of the risks of using improperly sterilized and disinfected sharp objects. Materials and Method First year students in three universities, Federal, State and Private Universities were used for the study. A random sample of ninety (90) students made up of 30 students from each of the three universities studied was used. Drama was used as an intervention that will create awareness on risks of utilizing sharp objects in making scarifications. The completed copies of self-administered pre- and post-drama questionnaire were collected and analyzed quantitatively using Tables and percentages. Results Results showed that a good number of students 29 (97%) in Michael Okpara University of Agriculture (MOUA) , 28(93%) in Abia State University (ABSU) and 27( 90%) in Rhema University viewed sharing sharp objects like razor blades and syringes as risk to blood transmitted infections especially HIV. A total of 28(31%) of students both males and females in MOUA, ABSU, and Rhema had marks (scarification and/ or tattoos) on the body. The main reason for having the marks was for traditional identification and this was more among students in MOUA than in others. Conclusion Based on the results of the study, drama proved to be a valuable and timely intervention strategy that created awareness among university students on the risks of using sharp objects to make marks on the body.
Dec 2017
This paper aims to examine the challenges and implications of the Village and Commune Safety Policy (VCSP) on harm-reduction programs and describe lessons learned from a harm-reduction program within the context of the VCSP in Cambodia. Data were collected from a monitoring and evaluation database and reports of a drop-in center that provides a wide range of harm-reduction services. In addition, qualitative data were collected through key informant interviews and focus group discussions with 38 participants including people who use drugs (PWUD) and people who inject drugs (PWID). Desk reviews and consultative meetings with key stakeholders were also conducted. In total, 496 PWUD were registered into the program between 2010 and 2012, of which 22.4% were PWID, and 15.0% were women. The mean age of participants was 26 years old. HIV prevalence among PWUD was 1.0% compared to 16.2% among PWID. Remarkable achievements were observed such as high uptake of services by PWUD and PWID with active referrals to methadone maintenance treatment (MMT) and voluntary HIV confidential counseling and testing (VCCT). However, distribution of clean needles and syringes in communities was limited. Also, the newly initiated needle and syringe program (NSP) based in pharmacies failed to reach PWUD and PWID. Appropriate coordination and collaboration with law enforcement and authorities were observed given the complexity of the VCSP. However, the implementation of the VCSP poses challenges including NSP and accessibility to harm reduction services. For future successes of harm-reduction programs, it is important to maintain close coordination and collaboration between program implementers and local authorities with mutual understanding and flexibility.
Aug 2017 DOI 10.14302/issn.2578-2371.jslr-17-1669
Aims: To describe the clinical, biological and evolutionary features of mono infected patients treated with tenofovir in Togo. Method: It is a descriptive, prospective study. Patients were treated with Tenofovir Disoproxil Fumarate (TDF). The inclusion criteria were: active chronic HBV (HBs Ag-positive for more than 6 months, high aminotransferases, the HBV –DNA ≥ 2000 IU / ml for HBeAg negative or ≥ 20 000 IU / ml for HBeAg positive and significant fibrosis) and absence of HCV, HDV, or co-infection HIV. Results: Among patients with HBV in our department, only 10.68% were treated with TDF. The mean age of patients was 33.01±9.81years. There was male predominance (68%). The circumstances of discovery were mainly during blood donation (65.3%) and a routine checkup (14.7%). Clinical examination was normal in most of cases (86.7%) apart from hepatomegaly (9.3%) and icterus (4%).) The HBeAg was negative in 89.3%; the average DNA was 7.56 ±8.01 log10 IU/ml. Abdominal ultrasonography was performed in all patients and we found hepatomegaly (18.67%), splenomegaly (10.67%), and ascites (5.3%). The assessment of fibrosis and activity had enabled to find a fibrosis higher or equal to 2 in 12 cases (48%) and an activity higher or equal to 2 in 9 cases (36%). The clinical and virologic outcome was marked by an undetectable viral load (HBV-DNA˂10 IU/l) in 89.3% of the patients after 1 year of treatment. Conclusion: TDF had helped to find out an undetectable viral load in in 89.3% of the patients after one year of treatment.
Aug 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1430
HIV and AIDS remains a major health problem in South Africa even after two decades since the introduction of antiretroviral therapy. Long term survival with HIV is associated with new health related issues and a risk of functional limitation/disability. The aim of this study was to assess the impact and predictors of functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province South Africa. Questionnaires that were interview administered were used to collect information on demographics, disability, mental and physical health state, adherence and livelihood. A total of 1044 participants with an average age of 42±12 years, were included in the study and 51.9% of the participants reported functional limitation (WHODAS ≥ 2). These were reported mainly in the participation (40.2%) and mobility domains (38.7%). In addition, adherence to ARV, physical health symptoms and depression were strongly associated with functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not addressed and pose a risk of long term disability and negative adherence outcomes. Therefore, wellness for people living with HIV/AIDS (PLHIV) needs to include interventions that can prevent and manage disability.
Aug 2017 DOI 10.14302/issn.2324-7339.jcrhap-16-1316
The socio-cultural context of illness has become a major research area, and it has made significant contributions to our understanding of the socio-cultural dimensions of illness. In this article, we briefly trace the roots of a socio-cultural approach to illness, and we present some of the key findings of socio-cultural organized under main themes. Adherence to antiretroviral therapy drugs in the treatment of HIV infection is complicated because of many psychosocial factors. The aim of the study was to investigate the psychosocial factors involved in non-compliance with ART among people infected with HIV in Alert Hospital in Ethiopia. To achieve its objective, the study utilized a qualitative method to gather direct, inductive and wealthy information from the participants. The study covered interviews with twenty participants. The participants were selected using purposive sampling technique. The collected data was categorized and analyzed thematically based on the research objective. The results of the study indicated that the major psychological and social factors such as stigma and discrimination, social support, substance abuse, subjective norms, belief system and perceived behavioral control, and various cultural factors may uniquely contribute to deeper and potential barriers to ART adherence. Evaluating changes in the level of knowledge health workers trained in adherence measurements and concerned bodies work for providing relevant and updated information about ART issues for the followers in a convincing way. Therefore, the study has concluded that health workers in all facilities that provide ART would be trained in adherence counseling through formal training.
Aug 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1686
Background: In the absence of a cure for HIV and AIDS, prevention remains the most effective strategy to eliminate the pandemic. Abstinence from sexual intercourse is, therefore, the primary prevention weapon among unmarried adolescents and young adults, especially the school-going ones. This study uses the main constructs of the Health Belief Model (HBM), as the theoretical framework to investigate the psychosocial predictors of sexual abstinence among senior secondary school students in an urban setting in the Southwest region of Cameroon Methods: This study adopted a cross-sectional design, collecting data from a stratified random sample of 420 students in November 2016, using a pretested structured questionnaire, and analyzing them using SPSS version 20 software programme, using binomial logistic regressions at the level 0.05. Results: Only 194 (46.2%) were abstaining from sex. Perceived susceptibility to HIV, perceived severity of HIV/AIDS, perceived benefits of sexual abstinence and perceived self-efficacy for sexual abstinence were not that high, 79.8%, 71.0%, 86.4% and 68.3% respectively. None of the above constructs of the HBM was a significant predictor of sexual abstinence. However, increasing age was significantly associated with an increased likelihood of sexual abstinence, OR=1.6 (95% CI 1.20-2.24, p=0.002). Conclusions: Senior secondary school students in urban Cameroon were not practicing sexual abstinence. Interventions and strategies to increase sexual abstinence are highly recommended and should focus on increasing the perception of risk of contracting HIV, which is assumed to be the immediate antecedent of sexual abstinence, on overcoming barriers to sexual abstinence and on sexual abstinence negotiating skills, and should target adolescent students (10-19 years old).
Mar 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1468
Successful viral load programs rely on the presence of data systems and high quality of patient data. Using a cohort of 49 patients at Partners in Hope, a large, urban HIV clinic in Malawi, we performed a quality improvement assessment of a new viral load program with a focus on accuracy of data collected from patients as well as adherence to Malawi HIV Guidelines in regard to response to elevated viral loads (≥1,000 copies/mL). Data were obtained from three parallel medical record systems to investigate the proportion of patients with a repeat viral load and whether the three data systems agreed in regard to sociodemographic and clinical data. Fewer than 30% of patients had a repeat viral load within six months, as recommended in the Malawi HIV Guidelines. There were significant problems with data agreement across the three parallel databases used for care. Date of birth was consistent for 55.1% (N=27) of patients, while a different date of birth was noted in all three sources for 10.2% of patients (N=5). Viral load data from all three sources agreed for only 2.0% of patients (N=1). For 65.3% (N=32), the viral load from the laboratory did not match the recorded viral load in the electronic or paper record. Scale-up of viral load monitoring must be accompanied by the development of data systems that support workflow from sample collection to lab and back to provider. Education of providers and strategies for data collection with minimal errors can facilitate scale-up of high quality programs.
Feb 2017 DOI 10.14302/issn.2372-6601.jhor-16-1402
Background Blood donation is a common practice in many countries of the world and it benefits many of the people suffering from conditions which require blood transfusions. The blood donated should be appropriately screened for certain infectious diseases such as HIV/AIDS, Hepatitis B, Syphilis and Gonorrhea through serological tests. Materials and Methods This cross sectional study was conducted from January 2014 to August 2014, Data was collected from eight dental hospitals in four provinces of Pakistan. Attendants of the patients admitted in the surgical ward with age more than 16 years were included. Knowledge and practices of the participants were evaluated through a self-administered questionnaire. Ethical consent was obtained from the ethical committee or concerned authority of all eight hospitals. Results Response rate was 84 %. In total 55% male and 45 % female participated with 15.5% of the total sample population was under the age of 20 years. The age group with the maximum number of participant was between 20 to 39 years of age. 26% and 22.5% of the males and female participants respectively had knowledge. About blood donation, lesser percentage of attendants, 7.2% of the males and 4.6% declared that they had donated blood in the past. Based on education levels, it was highest among graduates (3.5%) and less in primary educated (2.2%) and uneducated respondents was 0.7%. 18% of the males and 17% females asserted that they hold some kind of fear of blood donation. Conclusion The population is not adequately knowledgeable regarding blood donation. There is a need for proper campaign to educate masses at national level within Pakistan to promote more people to become regular volunteers.
Mar 2016 DOI 10.14302/issn.2324-7339.jcrhap-16-925
Objectives Antiretroviral pre-exposure prophylaxis (PrEP) against HIV acquisition has been shown to be safe and effective in populations at risk of HIV acquisition. We examined PrEP awareness, experience and acceptance among men who have sex with men (MSM) in southwest Switzerland. Methods Between 1st June 2011 and 31st August 2012, individuals attending 1) MSM screening clinics (Checkpoint Geneva) and 2) meeting areas were invited to complete an anonymous questionnaire covering sexual practices and PrEP awareness, experience and interest in participating in future PrEP trials. Results Of 918 men approached, 654 (71%) agreed to participate, the majority (536/654, 82%) enrolled via Checkpoint. Most participants (512/654, 78%) were homosexual; 21/654 (3.2%) disclosed being HIV-positive; 140/654 (21%) had unknown HIV status. Unprotected anal intercourse (UAI) with a partner of different or unknown HIV status (non-serosorting) was practised by 49% of participants during the preceding year, more by participants of positive / unknown HIV status than by those negative / undisclosed status (68% vs 43%, P<0.001). Awareness of PrEP was reported in 42% (very aware in 17% and slightly aware in 25%); Checkpoint participants were more aware than those from other venues (47% versus 16%, P<0.001). PrEP experience was low (1.5%); 20% expressed interest in participating in future PrEP trials. Conclusions This is the first study exploring MSM PrEP awareness in Switzerland. Although overall awareness was 42%, interest in participating in future PrEP trials was low, against high frequencies of UAI and non-serosorting. If interest in using PrEP in practice is similar, alternative measures to curb HIV transmission are required in this population.
Mar 2016 DOI 10.14302/issn.2471-7061.jcrc-15-899
Missed cancers have been reported at higher frequencies in the right colon despite optical colonoscopy screening. The purpose of this study was to determine if there are regional differences in haustral fold height between the ascending, transverse, and descending colon using CT colonography (CTC). 50 supine CTC datasets from 50 asymptomatic, adult patients were analyzed (NCI-CBIIT instance of the National Biomedical Imaging Archive). At least 5 consecutive, pairs of unobscured haustral folds in each colonic segment were necessary to be included in this study. Of an initial 201 patients, 151 were excluded due to suboptimal colonic distension, retained fluid, tortuosity, and diverticulosis. For each dataset, the heights of the non-dependent haustral folds were measured in the ascending, transverse, and descending colon on 2D multiplanar reformations. Differences in mean HFHs were assessed using a hierarchical generalized linear mixed model. A total of 2079 colonic folds were measured: 625 in the ascending colon (including the cecum), 687 in the transverse colon, and 767 in the descending colon. The mean number of folds measured per segment was 6.87 ± 2.11. Mean HFHs were significantly taller in the ascending colon (14.62 ± 5.47 mm) than in the transverse (9.49 ± 3.65mm) or descending (6.53 ± 3.12mm) colon; mean HFHs were also significantly taller in the transverse than the descending colon, (P<0.0001, for all comparisons). In conclusion, taller colonic haustral folds are present in the proximal colon and may contribute to more frequently missed lesions (e.g. polyps) in the right colon by conventional, optical colonoscopy.
Mar 2016 DOI 10.14302/issn.2572-5424.jgm-16-1353
The possible interrelation of ethanol and the membrane protein molecules such as TRP ion channels in the whole living organism has not been studied. In the present research we study the influence of ethanol (50%) and agonist of TRPM8 ion channel L-menthol (1% in 50% ethanol) application to abdominal skin on the thermoregulatory response to cooling in rats. We used two types of cooling with the different rates of skin temperature decrease - 0.1 °C/sec for rapid and 0.005°C/s for slow cooling. It was shown, that the effects of ethanol and activation of the cold-sensitive TRPM8 ion channel are mainly directed at different components of thermoregulatory metabolic response to cold. Menthol, as an agonist of the TRPM8 ion channel, besides the constrictor vascular response stimulates predominantly the emergency first phase of metabolic response which appears only at rapid cooling without any effect on the second phase of metabolic response to cooling. Ethanol inhibits the most powerful second phase of metabolic response to cold which is manifested at decreased deep body temperature and is associated with the development of not only non-shivering but also shivering thermogenesis. Effect of ethanol is accompanied by the acceleration of the deep body temperature fall. Ethanol does not prevent the effect of menthol on thermoregulatory blood vessel and emergency phase of metabolic response, and the activation of the cold-sensitive TRPM8 ion channel by menthol has no obvious influence on the effects of ethanol – inhibition being the most powerful thermogenic component of the metabolic response to cold.
Jul 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-150
Aims and Objectives: The incidence of cryptococcal meningitis caused by Cryptococcus neoformans has risen markedly over the past 20 years as a result of theHIV epidemic and increasing use of immunosuppressive therapies. The objectives of this study were to isolate and identify Cryptococcus neoformans from clinically suspected cases of fungal meningitis by conventional techniques and evaluate the role of C-reactive protein (CRP) as a serum or urine biomarker for the diagnosis and monitoring of patients with cryptococcal meningitis. Materials and Methods: Direct microscopic examination of the CSF samples from clinically suspected cases of fungal meningitis was done by India Ink staining for the capsule demonstration and isolation of the Cryptococcus neoformans was done by inoculation of the sample on Sabourauds dextrose agar. Latex agglutination test for the presence of cryptococcal antigen was done on sera, CSF and urine samples. C Reactive Protein levels were estimated in sera and urine. Result: Cryptococcal meningitis was diagnosed in 12 cases by culture and/or India Ink staining and/or latex agglutination assay for antigen detection in CSF. Only 8 (66.67%) and 1 (8.33 %) out of 12 samples were positive for cryptococcal antigen in sera and urine respectively. Whereas all the 12 patients were positive in the sera for CRP above the detection threshold limit, only 1 (8.33 %) patient had raised CRP in urine. CRP was raised two weeks after initiation of antifungal therapy in 3 of the above 12 sera and all these 3 cases turned out to be recurrent cases of cryptococcal meningitis. Conclusion Given the high incidence, morbidity and mortality associated with cryptococcal meningitis, it would be ideal if a screening test could be used to exclude this diagnosis based on the presence of biomarkers in serum or urine which would mean less discomfort for the patient in addition to decreased laboratory examination costs.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-174
Background: In India, Human immunodeficiency (HIV) infected patients with highly active antiretroviral therapy (HAART) are at higher risk of developing adverse drug reactions (ADRs). Objectives: The aim of this study was to characterize the pattern of use of HAART, occurrence, incidence, severity and causality of ADRs to HAART in Indian HIV positive patients. Methods: This was a prospective observational study conducted between August 2009 and May 2012. Enrolled HIV positive patients were intensively monitored for ADRs with fixed dose antiretroviral therapy as per National AIDS Control organization (NACO).World Health Organization (WHO) definition of ADR was adopted to detect ADRs to HAART and classified based on WHO adverse reaction terminologies. Naranjo’s scale was used for causality assessment of ADRs. Preventability was assessed using Thornton and Schuman criteria and severity was assessed using the modified Hart wig and Siegel scale. Pattern of ADRs was assessed with patient demographics, ADRs characteristics, and pattern of drug and reaction characteristics. P-value <0.05 was considered as statistically significant. Results: A total of 426 ADRs to HAART were evaluated from 1982 HIV positive patients during the study period. The overall incidence of ADRs to HAART was 21.4%. Significant difference was seen in the incidence of ADRs in the age group of 41-60 years (p <0.001), CD4+T-cell counts of 350-500 cells/µl (p <0.001), females (p <0.001). Three fatal ADRs of with cutaneous drug eruptions of Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) was 1.1%. Anemia (31.7%) accounted for majority of the reports followed by vomiting (15.5%), skin rash (12.9%) and peripheral neuropathy (10.7%). The suspected drug was withdrawn for the management of the ADRs in majority (27.9%) of the reports. Higher incidence rate of ADRs was noted with lamivudine (3TC) + nevirapine (NVP) + stavudine (D4T) (22.9%). In, naranjo's causality assessment, majority of the ADR reports were rated as possible (69%). Symptomatic treatment for ADRs was given in 91.8% of the reports and 86.4% of the reports the patient recovered from the suspected adverse reaction at the time of evaluation. Conclusion: In India, occurrence of ADRs to HAART in HIV infected patients was found to be higher with zidovudine induced anemia (31.7%). The higher percentage of ADRs to HAART was seen with female patients, age 41-60 years; CD4+ T-cell counts 350-500 cells/µl. Physician must focus for monitoring all lab investigations for early detection and prevention of adverse effects associated with HAART.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-13-edt.1.2
This perspective reviews practical approaches to measuring ART adherence in resource‑limited settings. It weighs self‑report, pill counts, pharmacy refill data, and biologic measures, emphasizing feasibility, bias, and programmatic integration to support sustainable HIV care.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-71
In India, interruptions to highly active antiretroviral therapy (HAART) are due to adverse drug reactions (ADRs) and no reports on the direct cost incurred in the management of ADRs to HAART are available. There is a need to study direct cost incurred with ADRs to HAART to explore the high economic cost burden imposed by ADRs to HAART in HIV/AIDS patients. This study was aimed to evaluate the direct cost incurred in the management of ADRs to HAART in Indian HIV positive patients. This prospective study was conducted at a Medicine department in a South Indian tertiary care teaching hospitals were ADRs reporting system exist. HIV-positive hospitalized in-patients were identified and intensively monitored for ADRs to HAART. The World Health Organization (WHO) probability scale was used for causality assessment of ADRs. Modified Hart wig and Siegel scale was used for severity assessment of ADRs.Pearson chi-square test identified association of mean direct cost between ADRs and without ADRs by investigating total mean direct cost. The overall direct cost per ADRs to HAART was found to be higher in the context of expenditure on health care cost in India.