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Is it Feasible to Use an Oral-Fluid Based Rapid Test Facilitated by Frontline Workers to Improve HIV Screening of Pregnant Women in Indian Rural Settings?

Objectives: The importance of knowing HIV status is a key strategy for HIV response and effective treatment services. The present study aimed to assess feasibility of using oral- fluid based rapid HIV test aided by FrontlineHealth workers (FLWs) of pregnant women in rural districts of India. Methods: A feasibility study, using cross sectional design was carried-out in two rural districts of India. Overall, 900 pregnant women were screened using OraQuick® test, an oral-fluid based rapid HIV test facilitated by trained FLWs and subsequently, all participants were tested at in existing government center for confirmatory HIV testing. The data were collected from three aspects: i) the results of OraQuick® HIV test and confirmatory test ii) the perspectives of FLWs through in-depth interviews and iii) information on the acceptability of oral-fluid based HIV testing from 479 pregnant women, through a structured questionnaire. The descriptive statistics was used to analyse the quantitative data and thematic content analysis to analyse the qualitative in-depth interviews. Results: Of the 947 pregnant women who were offered HIV screening using OraQuick® saliva based test, 95% (n=900) accepted to undergo the test. Of the total 479 pregnant women interviewed, 91.2% liked the OraQuick® kit for HIV screening. The key motivators of accepting the test are easy procedure (43%), non-invasiveness (29%) and quick access to results (18%). Out of 900 pregnant women screened by OraQuick®, nine women were found to be HIV positive, which corresponded with confirmatory test results. Qualitative data provided insights into FLWs to understand their views regarding current situation on HIV testing and services available to the pregnant women. Conclusion: With an urgent need to improve access to HIV screening at the grass root level, an oral based HIV rapid testing mechanism can provide a plausible solution for improving early detection of HIV among pregnant women.

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Open Access
A Review on Various Aspects of HIV Infection

Many people are affected by HIV infection worldwide, lack of ability of modern medication in developing an active vaccine against HIV is a global public health importance. Various aspects such as diseases associated with HIV infection, role of immune cells in diagnosis and treatment, significance of molecular changes during infection, complications in infants, impact of gender and social behaviour and diagnosis of disorders associated with HIV infection were discussed in this review. Affected patients would be associated with acute kidney injury, arterial stiffness, cardiovascular disease, Tuberculosis, intestinal parasite carriage and disruptive sleep apnea. Immune cells like CD4, CD8, CD38 T cells and natural killer cells have a vital role in diagnosis and treatment. DNA vaccines could play a major role to prevent or treat infectious diseases including HIV and would elicit T cell immunity, protective antibody responses and local mucosal immunity protective vaccine against HIV infection. Health professionals are responsible for diagnosis of disorders associated with HIV infection and follow-up of HIV-infected paediatric patients. There is a crucial need to improve and evaluate novel interventions that are tailored for this helpless population. Several factors such as income deficit, Pre-college residence, pornographic film viewing and believe in sexual abstinence for HIV prevention were found to be significant predictors of initiating premarital sex. Younger generations could be advised to maintain the virginity as cultural norm. Incorporation of socio-structural elements and geospatial techniques in analytical approaches would lead to better understanding of local dynamics and develop mediations that increase our facility of targeted HIV prevention services.

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Nf-κb-Dependent Inhibition of HIV-1 Transcription by Withaferin A

Despite the remarkable progress made in suppressing HIV-1 infection, antiretroviral drugs are still often inaccessible in developing countries, and there is an urgent need for cheaper and alternative drugs. HIV-1 replication is triggered by the activation of the long terminal repeat (LTR) promoter, which contains two binding sites for the transcription factor nuclear factor κB (NF-κB). Withaferin A (WA), a steroidal lactone isolated from the Indian medicinal plant Withania somnifera, has been found to have significant pharmacological effects on the regulation of immune response. Recent studies have demonstrated that the anti-inflammatory properties of WA are mainly due to its inhibition of the NF-κB pathway. In the present study, we demonstrate that WA represses HIV-1 LTR transcription and viral replication through NF-κB inhibition. The human lymphocyte T cell line Jurkat E6.1 was treated with WA and infected with wild-type pseudotyped HIV- 1 particles or mutant viruses containing inactive κB sites. Then, the effect of WA on HIV-1 replication was evaluated by the measurement of reporter activity. Electrophoretic mobility shift assays and Western blots analysis were also performed to study the impact of WA on NF-κB. We found that WA inhibited the transcription of wild-type pseudotyped viruses in single-round infection assays, whereas mutant viruses containing inactive κB sites showed a reduced response to WA. Moreover, we found that WA directly or indirectly inhibits NF-κB nuclear translocation, including RelA and p50 subunits. However, the degradation of inhibitory protein IκB-α was not prevented by WA. Taken together, our results suggest that WA inhibits HIV-1 transcription in human Jurkat E6.1 lymphocyte T cells through the NF-κB pathway.

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Open Access
Evaluation of Pill Counts Adherence with Self-Reported Adherence in Assessing Antiretroviral Therapy Behavior of Women living with HIV at a Faith-based Clinic in Malawi

Background: Antiretroviral treatment is imperative for increasing survival among HIV positive individuals. Treatment success is assured by strict adherence to antiretroviral therapy (ART) resulting in improved quality and quantity of life. Aim: To compare visual analogue scale (VAS) (self-report) adherence with pill counts adherence reports of individuals receiving HIV treatment in a rural faith-based clinic while evaluating the relationships between those two adherence measures with medication side effects, food insecurity, demographic characteristics, and socialpsychological constructs. Methods: This is a non-experimental cross-sectional study of a convenience sample of 200 reproductive age HIV positive women on ART at a faith-based clinic in Makwasa, Thyolo District, Malawi. Pill counts, VAS adherence, and other constructs measurements were taken from November to December 2013. Bivariate analysis was used to test the association between the two adherence outcomes and background factors and univariate logistic regression (ULR) models were used to explore the association of each variable to the two adherence outcomes; and multivariate logistic regression (MLR) was used to examine the association between outcome variables and adherence determinants. Results: Mean pill count adherence was 79.00 ± 29.66 compared to 96.55 ± 14.21 for VAS adherence. Household food insecurity (OR=1.40; P=0.01), individual food insecurity (OR=1.54; P=0.00), and self-efficacy (OR=2.93; P≤0.00) were significantly associated with pill count in the ULR. Household (OR=0.44; P=0.00) and individual food insecurity (OR=0.38; P=0.003), self-efficacy (OR=0.35; P=0.04), subjective norms (OR=0.24; P=0.02), and attitude (OR=0.34; P=0.04) were associated with VAS adherence in the ULR. In the multivariate, self-efficacy (adjusted) was associated with pill count, while attitude (adjusted) was associated with VAS adherence. Conclusions: The study showed that a gap existed between VAS adherence and pill counts adherence indicating the participants verbally overestimated their adherence. Additionally, intervention focusing on food supplements would be useful for improving poor adherence associated with food insecurity.

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Open Access