Antiretroviral Therapy Clinic Research Articles

Insecticide Treated Net Usage and Its Predictors among HIV Patients Attending an Antiretroviral Therapy Clinic in Ebonyi State, Nigeria.

Malaria prevention is important among HIV patients to mitigate its associated complications. This study explored the predictors of insecticide-treated net (ITN) usage among HIV patients attending an antiretroviral therapy (ART) clinic in Ebonyi state, Nigeria. It was a cross-sectional study that involved 297 patients who attended an ART clinic in Ebonyi State. An interviewer-administered questionnaire was used to collect relevant data which included perception of malaria prevention, ownership of ITN, condition of ITN, duration of use and ITN usage. The relationship between ITN usage and other variables was assessed using bivariate analysis and the predictors were determined using multivariate logistic regression. There were 64 (21.5%) males and 233(78.5%) females. Knowledge of the use of ITN (mean= 4.24 ±0.93) was rated better than knowledge of the use of mosquito repellent (mean = 3.79 ± 1.21) and knowledge of the use of protective clothes (mean= 3.86 ±1.26). 246 (83%) of the study population owned ITN. Only 48% (118) of those who had ITNs reported having optimal nets (nets without holes). 135 (45.5%) of the participants reported sleeping under the net every day in the past week. There was a significant relationship between ITN usage and knowledge of the use of ITN, ownership of ITN, duration of use and condition of nets. Predictors of usage of ITN were duration of use (AOR=0.386, 95%C.I for AOR=0.224-0.665) and condition of the nets (AOR=0.399, 95%C.I for AOR=0.226-0.706). Perception of malaria prevention was high among the study group. Ownership of ITN was high although many of the ITNs were not in good condition. Usage of ITN was largely determined by duration of use and good condition of nets. Yearly assessment of the condition of ITNs and replacement exercise of ITNs (2-3 years) at ART clinics to replace old and worn-out nets among HIV patients are recommended.

Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar city, Northwest Ethiopia

IntroductionIntimate partner violence against women is a behavior within an intimate relationship that causes sexual, physical, or psychological harm to the women. It occurs among all socioeconomic, religious, and cultural groups in all settings, and affects the health of women, families, and the community at large. Determining the magnitude and determinants of intimate partner violence against HIV positive women could help to design preventive and control strategies. However, there is a dearth of information regarding the magnitude and determinants of intimate partner violence against HIV positive women in Ethiopia. Thus, this study aimed to assess the magnitude and associated factors of intimate partner violence against HIV positive women in Gondar city, Northwest Ethiopia.MethodA facility-based cross-sectional study was carried out from February to May 2021 in selected public health facilities of Gondar city among 626 HIV positive women. A systematic random sampling technique was used to select study participants. Data were analyzed using Statistical Package of Social Science (SPSS) version 20 software. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify determinants of intimate partner violence. Statistical significance was considered at a p value < 0.05.ResultsThe overall prevalence of intimate partner violence against HIV positive women within the last 12 months was 64.2% (95% CI 60.4, 68.2). Physical violence was the most common type (54.8%), followed by sexual (51.1%) and emotional (48.9%) violence. Intimate partner violence among HIV positive women was associated with women’s age 19–24 (AOR = 0.13, 95% CI 0.02, 0.79), monthly income of 500–2500 (AOR = 6.5, 95% CI 1.72, 25.0), urban residence (AOR = 0.35, 95% CI 0.13, 0.91), partner drink alcohol (AOR = 2.14, 95% CI 1.42, 4.06), and a husband with no multiple sexual partners (AOR = 0.75, 95% CI 0.34, 0.94).ConclusionThe result of this study revealed that intimate partner violence against HIV positive women was found to be high. Thus, protective measures that could increase the community’s and women’s awareness about the consequences of various forms of violence, and women empowerment are paramount. Priorities in programs of gender-based violence prevention should involve women from rural residences, older age, and males who consume alcohol.

Enrollment and retention of female sex workers in HIV care in health facilities in Mbarara city.

Sex work is a global driver of the HIV epidemic, and the risk of acquiring HIV is 13 times higher for female sex workers (FSWs) compared to the general population. The enrollment and retention of FSWs in HIV care is a challenge and has been a major contributing factor to increased new HIV infections. We conducted a qualitative study among 30 FSWs and 21 healthcare workers (HCWs) working in antiretroviral therapy (ART) clinics at the selected three primary health facilities in Mbarara City, Southwestern Uganda. The study participants were enrolled by both purposive and snowball sampling techniques. We obtained informed consent from all the participants, and data were collected using in-depth interviews and thematically analyzed. Three themes emerged as facilitators toward enrollment and retention of FSWs into HIV care, namely, (1) good health living, (2) receptive HCWs and availability of health services, and (3) community outreach services and peer support. The barriers are summarized into four major themes: (1) stigma, community discrimination, and beliefs; (2) social obstacles; (3) adverse effects of ART; and (4) inadequate services at the health facilities. FSWs are challenged by unsupportive environments and communities where they live and work, which hinders their enrollment and retention in HIV care. Creating awareness of the utilization of HIV care services and extending such services to hotspot communities could enhance the response of HIV-positive FSWs to ART.

Prevalence and Determinants of HIV Related Eye in Patients Attending Anti-retroviral Therapy Clinic in Katsina State, Nigeria

Background: HIV and its complication AIDS was a source of serious public health concern that greeted the end of the 20th century. Being a multi-systemic disease, it was also associated with different forms of ocular morbidities of interest. &#x0D; Purpose: To determine the prevalence, patterns and determinants of HIV related eye diseases in patients attending anti-retroviral clinics in Katsina state, Nigeria.&#x0D; Methods: Two hundred and twenty subjects met the inclusion criteria over a six month period. A questionnaire was administered for socio-demographic data, patients’ history, record review and a detailed ophthalmic examination. Data was analysed using SPSS version 20. Parametric and non-parametric assessments were used to assess the relationship of various factors with manifestation of HIV associated eye diseases.&#x0D; Results: Out of 220 respondents, 164 were females. The Male: Female was 1:2.9. The mean age was 28.5 years ± 14.83 SD. About 65.5% of respondents had eye diseases while 46.4% had HIV associated eye diseases. Prevalence of HIV associated eye diseases was found to be 46.4%. The most common types of eye diseases found were Kerato-conjunctivitis Sicca (KCS) 25.5%, conjunctivitis 5.5%, herpes zoster ophthalmicus 3.2%, anterior uveitis 2.7% and molluscum contagiosum 2.3%. Factors found to affect the manifestation of these eye diseases were CD4 cell count, WHO Clinical Stage of the disease and the Presence of eye symptoms.&#x0D; Conclusion: The study showed a high prevalence of HIV associated eye disease. The Patient’s clinical/WHO stage, CD4 cell count and presence of ocular symptoms were shown to have significant association with the ocular manifestation.

Perspectives on long-acting injectable HIV antiretroviral therapy at an alternative care site: a qualitative study of people with HIV experiencing substance use and/or housing instability

IntroductionAdherence to daily oral antiretroviral therapy (ART) and regular clinic appointments can be challenging for individuals who experience adverse social determinants of health. Long-acting injectable ART administered outside of traditional clinic settings may be a promising solution to adherence barriers, but additional research is needed to assess patients’ perspectives. This study assessed perspectives of people living with HIV (PLWH) who had difficulty with adherence to traditional HIV care models and evaluated feasibility and acceptability of receiving a long-acting ART injection at a location outside of a traditional HIV clinic to address barriers to HIV care.MethodsQualitative interviews (n = 26) were conducted with PLWH who had experienced barriers to adherence. Participants were referred to the study by staff from Project Trust, a drop in harm reduction and sexually transmitted infection/HIV clinic. The interviews were conducted between May and November 2021. Interviews were recorded, professionally transcribed, coded, and analyzed qualitatively using the integrated-Promoting Action on Research Implementation in Health Services framework.ResultsWe identified 6 main themes regarding the acceptability of receiving a long-acting injection to treat HIV, and the acceptability and feasibility of receiving injections at an alternative care site. Participants specified that they: (1) have a general understanding about their HIV care and the importance of ART adherence, (2) prefer a long-acting injection over a daily pill regimen, (3) expressed concerns about injection safety and efficacy, (4) had specific logistical aspects around the delivery of long-acting injections, including location of injection administration, that they believed would improve their ability to adhere, (5) have confidence that they can become undetectable and then complete the oral lead-in required to begin receiving the injection, and (6) see potential barriers that remain a concern for successful adherence to long-acting injections.ConclusionTo better treat HIV among people who are living with challenging social determinants of health, interventions that include a long-acting injection in a non-traditional care setting may prove to be a promising treatment option.

Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries

ObjectivesTo demonstrate acceptability and operational feasibility of introducing human papillomavirus (HPV) testing as a principal cervical cancer screening method in public health programmes in sub-Saharan Africa.Setting45 primary and secondary health...

A qualitative analysis of factors influencing healthcare providers’ behaviour toward persons living with HIV in Ghana

BackgroundA positive relationship between a healthcare provider (HCP) and a patient is likely to build trust and improve care for People Living with HIV (PLWH). The study explored the individual and external factors influencing HCP behaviour towards PLWH and compares HCP in antiretroviral therapy clinics (AHCP) with general health care settings HCP (GHCP). MethodsThis qualitative study used a semi-structured interview protocol to guide individual in-depth interviews among 33 HCPs. The interview protocol was informed by empirical literature and included topics such as perceptions and experiences working with PLWH, HIV-related training received, knowledge about HIV, emotions towards PLWH and support related to patient care. The interview data were thematically analysed. ResultsBoth AHCP and GHCP claimed that their thoughts and judgments never influenced the way they managed PLWH, but there appears to be reflections of either sympathy or positive discrimination, especially for AHCP, or stigmatizing behaviours such as using gloves for PLWH-only among GHCP. The findings from this study suggest that individual factors such as perceptions about HIV, attitude towards HIV patients, different emotions, HIV-related training received and external factors such as availability of guidelines, logistics, infrastructural and reimbursement challenges influenced HCP behaviour towards PLWH. ConclusionThe study suggests that individual and external factors influence AHCP and GHCP behaviour towards PLWH. We recommend the use of Intervention Mapping to develop and evaluate interventions addressing the behaviour and emotions of AHCPs and GHCPs to reduce stigmatization of PLWH in the healthcare sector, hence improving hospital visits and medication adherence.

Non-adherence to antiretroviral therapy and associated factors among adult HIV patients in Somali region public Hospitals, eastern Ethiopia

BackgroundAntiretroviral adherence is defined as an individual's behaviors such as taking medications, following a diet, and/or making lifestyle changes that are consistent with agreed-upon recommendations from a health care provider. For antiretroviral therapy (ART), a high level of consistent adherence is required to suppress viral replication, improve immunological and medical outcomes, reduce the threat of emerging antiretroviral drug resistance, and reduce the risk of HIV transmission. ObjectiveTo assess non-adherence to antiretroviral therapy and associated factors among adult HIV patients in Somali region public hospitals, eastern Ethiopia. Methods and materialsResearch participants of 405 were studied in Jigjiga and Godey public hospitals at ART clinics from January 1st to June 30th, 2022, and interviewed consecutively until the set proportion was met in each hospital, using a facility-based cross-sectional study design. A pretested, semi-structured English questionnaire was used to collect data on socio-demographic variables, while a card review of the patient's medications, clinical stage, viral load, and CD4 count was performed. The information was coded and entered into Epidata version 3.1, then exported and analyzed with SPSS v20. To determine the relationship between the outcome variable and the independent factors, bivariate logistic regression was used, with a value of < 0.25 regarded as a candidate for multivariate logistic regression. Using multivariable logistic regression analysis, odds ratios with 95 percent confidence intervals were calculated to discover characteristics related to study participants' antiretroviral therapy (ART) non-adherence. A p-value of less than 0.05 was considered statistically significant. ResultThe non-adherence rate was 19.3 % with a (95 % CI (15, 23.6), current CD4 count of 200–499 cells/mm3 [AOR = 2.007, CI = 1.051, 3.831], alcohol drinking [AOR = 2.613, CI = 1.105, 6.181], merchants [AOR = 4.726, CI = 1.249, 17.877], medication side effects [AOR = 5.817, CI = 2.858, 11.840], and age category of 25–44 years [AOR = 2.752, CI = 1.020, 7.426] were independent predictors of non-adherence to antiretroviral therapy. ConclusionThe outcome of non-adherence is high, and the factors associated with it are age, occupation, CD4 count, alcohol consumption, and medication side effects.

Antiretroviral therapy programme outcomes at Senkatana antiretroviral therapy clinic, Lesotho: a four-year retrospective cohort study.

sub-Saharan Africa, home to over 10% of the world´s population, is the worst Human Immunodeficiency Virus (HIV)-affected region in the world. HIV/AIDS is a major public health challenge in Lesotho, with an HIV prevalence of 25.6% in 2018. The aim of this study was to evaluate the treatment outcomes of people living with HIV (PLHIV) on antiretroviral therapy (ART) after 48 months of initiation. we conducted a register-based retrospective cohort study for all patients registered at the Senkatana ART Clinic from January to December 2014 and followed them for 48 months until 2018. The ART treatment register and treatment cards were the primary source of data. Data were captured and cleaned in Epi info version 7 and exported into Stata version 14 for analysis. Descriptive statistics were used to describe participant characteristics. Due to the lack of incident data, the factors associated with treatment outcomes were determined using Chi-square tests and logistic regression. in 2014, 604 patients were enrolled on ART, of which the majority were female (59.4%) and married (54.8%). The mean age (standard deviation (SD)) at which ART was started was 36 years (10.5) years. After 48 months of initiation, the cohort consisted of 387 patients of which 365 (94.3%) were retained on treatment. In the multivariable logistic regression model, neither demographic characteristics nor clinical factors were associated with ART treatment outcome (viral load suppression, adherence, or ART retention), however, the univariable analysis showed that higher CD4 count at initiation was associated with viral load suppression. retention, viral load suppression, and adherence were generally good in this cohort after 48 months of initiation. CD4 at initiation was a significant predictor of viral load suppression at 48 months. The ART programme has managed to maintain high viral load suppression and improve immunity in patients who are immunocompromised. Proper data quality management is required for adequate patient monitoring to enable clinical personnel to record and use individual patient data for guiding the clinical management of such patients. Strengthening patient support and tracing will help to reduce the number of patients lost to follow-up.

Fertility desire among HIV-positive individuals in the Chinese sociocultural context: A qualitative study.

China's recent change from a one-child policy to a two-child policy has urged many couples/families to consider having a child or an additional child. However, little is known about such fertility desire among heterosexual couples with at least one human immunodeficiency virus (HIV)-positive partner. The objective of this qualitative study was to describe fertility desire and its motivating factors and barriers among people living with HIV (PLHIV). We conducted in-depth semi-structured interviews in 31 patients at an antiretroviral therapy (ART) clinic in Kunming, China, from October to December 2020. We included only patients in a sexually active heterosexual relationship with no more than one child. Participants gave verbal informed consent before participation. Interview recordings were transcribed verbatim, translated into English, and then analyzed using thematic analysis. Participants who reported fertility desire were mostly male, while participants who reported no fertility desire were mostly female. Study participants reported motivating factors and barriers that were identical to HIV-negative persons such as 1) social norms, 2) Chinese sociocultural factors, 3) the government's two-child policy, and 4) the financial burden of having children. However, study participants also reported motivating factors and barriers unique to human immunodeficiency virus (HIV)-positive individuals that included 1) the availability of ART and prevention of mother-to-child HIV transmission services, 2) health-related concerns, 3) stigma and discrimination against PLHIV, and 4) the additional cost of child-rearing when HIV-positive. The study findings highlighted major areas of concern for relevant stakeholders. The development of PLHIV-specific health policy should consider the PLHIV-specific motivating factors and barriers reported in this study. However, social desirability and lack of generalizability should also be considered in the interpretation of this study's findings.

To explore patients’ perceptions about motivators and barriers of adherence to highly active antiretroviral therapy among people living with HIV: A qualitative study

ABSTRACT Objective: For people living with HIV (PLHIV), strict adherence to highly active antiretroviral therapy (HAART) is the key to effective treatment and retention in human immunodeficiency virus (HIV) care. There are many factors which promote or halt the antiretroviral therapy (ART) adherence practices. Therefore, the present study aimed to examine the HAART adherence levels and to explore patients’ views about barriers and facilitators to HIV treatment adherence. Methods: Semi-structured interviews were conducted among 15 PLHIV at the ART clinic of Dr. Ram Manohar Lohia Hospital, New Delhi. Interviews were audio-recorded in the local Hindi language, and bilingual experts (English and Hindi) transcribed verbatim. Qualitative data were coded for themes and subthemes and analyzed using a phenomenological approach as per thematic content analysis. Results: Feeling of hopelessness, delayed ART initiation, difficult initial phase of ART, forget to take ART on time, fear of disclosure of HIV diagnosis, lack of privacy and negative social support, and impact of lockdown due to COVID-19 were revealed as significant barriers to ART adherence. At the same time, commitment to raise and educate children, ART to increase life span, maintain oneself to be physically fit and healthy, only a single pill per day, very supportive counselors and health-care professionals, and hope to give birth to a healthy child were identified as facilitators of HIV retention. Conclusion: Understanding patient’s perception about ART adherence, its motivational and barrier factors which are directly affecting ART adherence and retention of PLHIV in HIV treatment and follow-ups are of utmost importance to improve ART adherence during HIV patient care services.

Children's Adherence to Antiretroviral Therapy and Associated Factors: Multicenter Cross-Sectional Study.

Poor adherence to antiretroviral therapy (ART) causes drug resistance, treatment failure and death. Studies conducted among children below 15 years were limited in Ethiopia in general and in the study area. Therefore, this study aimed to assess the status of children's adherence to ART and associated factors in the study area. We conducted a facility-based cross-sectional study from April 1 to May 10, 2020 by including 282 children <15 years. All children who received ART for at least one month and attend ART clinic during data collection period were consecutively recruited. Face-to-face interview was conducted using a standardized questionnaire. Both bivariate and multivariate logistic regression were performed. Adherence and exposure variables (i.e., sociodemographic and reason for missing) were measured by the caregivers/children's report of a one-month recall of missed doses. Among 282 caregivers included with their children, 226 (80.2%) were females (mean age = 38.6 and SD = 12.35) and half (50%) of children were females. Two hundred forty six (87.2%) children were aged between 5-14 years (mean age = 8.5 and SD = 2.64), and 87.2% were adhered (≥95%) to ART in the month prior to the interview. Children whose caregivers were residing in urban were 3.3 (95% CI: 1.17, 9.63) times more adherent to ART than their counterparties. Children whose caregivers were biological parents were 2.37 (95% CI: 1.59, 3.3) times more adherent than children with non-biological parents. Children with knowledgeable caregivers about ART were 4.5 (95% CI: 1.79, 9.8) times more adherent to ART. Children's adherence to ART in our study area was sub optimal. Biological caregivers, residing in urban and being knowledgeable about ART facilitate adherence to ART. Adherence counseling targeting non-biological parents and for those who come from rural areas were recommended.

Virologic Response Following a Switch to Dolutegravir-based Regimen in People Living with HIV/AIDS at a Tertiary Care Center in Nepal

Background The dolutegravir-based antiretroviral regimen is the preferred first-line regimen for the management of people living with human immunodeficiency virus in Nepal recently. It is considered safe to transition to a dolutegravir-based regimen for children and adults on Nevirapine and Efavirenz-based regimens.&#x0D; Objective To determine the virologic response following the transition to a Dolutegravir-based regimen in people living with human immunodeficiency virus previously taking Nevirapine and Efavirenz-based regimen.&#x0D; Method This is a retrospective cohort study including people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) who were transitioned to Tenofovir/Lamivudine/Dolutegravir previously on other antiretroviral therapy regimens for at least 6 months and who had their viral load test done before transition. The medical records of patients were reviewed from records available at the antiretroviral therapy clinic of Dhulikhel Hospital. The viral load done at least 3 months after switching to the Dolutegravir-based regimen was recorded. Descriptive analysis of socio-demographic and clinical characteristics data was done.&#x0D; Result Fifty-seven people living with human immunodeficiency virus/ acquired immunodeficiency syndrome who transitioned to a Dolutegravir-based regimen previously on other antiretroviral therapy regimens for at least 6 months were included in this study. Tenofovir/Lamivudine/Efavirenz (47.4%), Zidovudine/ Lamivudine/Nevirapine (22.8%) and Zidovudine/Lamivudine/Efavirenz (17.5%) were the most common antiretroviral regimens before transition. The majority of the patients (86%) had suppressed viral load of fewer than 40 copies/mL before the switch. Following the transition, 96.5% of the patients had suppressed viral load of fewer than 40 copies/mL.&#x0D; Conclusion Dolutegravir-based antiretroviral regimen led to untransmittable viral load following a switch from Nevirapine and Efavirenz-based regimen.

Prevalence of Comorbidities and Associated Factors among HIV Patients Attending Antiretroviral Clinics in the Tamale Metropolis, Ghana

Human Immunodeficiency Virus (HIV) is a chronic infectious disease, and without antiretroviral therapy (ART), it is associated with comorbidities. The prevalence of comorbidities, adherence to ART and quality of life (QoL) of HIV patients were studied. A cross-sectional study design involving 360 HIV patients from two ART clinics across the Tamale metropolis was employed. Socio-demography, adherence to therapy, and QoL data were taken with the help of a questionnaire and analyzed using SPSS version 24. The prevalence of comorbidities was 30.3% (109), with Hepatitis B infection (73, 20.3%) being the most prevalent. Adherence levels were high (192, 53.3%), moderate (108, 30.0%) and low (60, 16.7%). Overall, QoL was excellent amongst 149 (41.4%), good in 169 (46.7%), and poor in 42 (11.7%) respondents. Marital status, presence or absence of HIV symptoms, adherence level to ART and overall QoL, especially Physical, Psychological, and independence domains (p &lt; 0.05), were factors associated with the presence of comorbidities. There is a high level of comorbidities among persons living with HIV (PLWH) in the Tamale metropolis influenced by QoL and adherence to ART. We recommend a multifaceted approach to the management of PLWH.

Nevirapine plasma concentration is associated with virologic failure and the emergence of drug-resistant mutations among HIV patients in Kenya: A cross sectional study

This study aimed to determine the association between the plasma concentration of nevirapine (NVP) and clinical outcomes. In this cross-sectional study, sociodemographic and clinical data were collected from 233 HIV patients receiving NVP-based first-line antiretroviral therapy (ART) regimens in Nairobi, Kenya. The mean age was 41.2 (SD ± 11.9) years. Fifty-four (23.2%) patients had virological failure (>1000 copies/mL), whereas 23 (9.9%) were infected with drug-resistant HIV strains. Eleven patients had nucleoside reverse transcriptase inhibitor resistance mutations, including M184V and T215Y, whereas 22 had non-nucleoside reverse transcriptase inhibitor resistance mutations, including G190A, K103N, V106A, Y181C, A98G, and Y188L. The median NVP plasma concentration was 6180 ng/mL (IQR 4444-8843 ng/mL), with 38 (16.3%) patients having suboptimal NVP plasma levels of <3400 ng/mL. The majority 23 of the 38 (60.5%) patients with NVP Cmin < 3400 ng/mL were significantly infected with drug-resistant HIV virus (P = .001). In the multivariate analysis, the time taken to arrive at the ART clinic (β -11.1, 95% CI -21.2 to -1.1; P = .031), higher HIV viral load (β -2008, 95% CI -3370.7 to -645.3; P = .004), and the presence of HIV drug resistance mutation (β 3559, 95% CI 2580.8-4537.2; P = .0001) were associated with NVP plasma concentration. A significant proportion of patients receiving the NVP-based regimen had supra- and sub-therapeutic plasma concentrations. Higher HIV viral load and the presence of HIV drug-resistant mutations are important factors associated with NVP plasma concentrations.

Symptoms Experience among People Living with Human Immunodeficiency Virus in a Clinic

Introduction: Symptoms assessment is the foremost and first step of health care management. People living with Human Immunodeficiency Virus (HIV) experience various physical and psychological symptoms throughout the disease. Adherence to antiretroviral therapy (ART) and an individual’s quality of life is adversely affected by poorly managed severe symptoms. This study aimed to assess the prevalence of symptoms among people living with HIV who attended an Antiretroviral Therapy (ART) clinic. &#x0D; Methods: A descriptive cross-sectional study was carried out among consecutively selected 208 people with HIV who attended an ART clinic. Memorial Symptoms Assessment Scale (MSAS) was used to assess the symptoms. Data were collected through the interview method. Descriptive (Mean, SD), independent t-test, and one-way ANOVA were used for data analysis. &#x0D; Results: Among 208 respondents, the most prevalent symptoms in people with HIV receiving ART were numbness and tingling sensation in hands and feet (37.5%), followed by lack of energy (33.7%), pain (29.8%) and weight loss (25.5%). Likewise, the most distressing symptoms were: numbness and tingling sensation in hands and feet (20.2%), lack of energy (19.8%), pain (18.3%), and feeling sad (4.3%). Total symptoms score and physical symptoms occurrence were significantly different according to age, CD4 count, duration of taking ART, and presence of comorbidities. &#x0D; Conclusions: People living with HIV are experiencing various physical and psychological symptoms despite receiving antiretroviral therapy. These distressing symptoms need to be acknowledged and managed holistically. &#x0D; Keywords: ART center, Distressing symptoms, Experience, People living with HIV &#x0D;

Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium.

Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels. Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.

Evaluation of referral letters to the antiretroviral therapy outpatient specialist clinic of the tertiary health facility in Ilorin, Nigeria.

Human immunodeficiency virus (HIV) disease is a chronic medical condition that requires lifelong treatment. Specialist care is of importance in its management and referral process to a specialist is mostly initiated through a referral letter. The ability to design a good management plan during consultation depends on the quality of clinical information in the referral. This study was designed to assess the information provided in referral letters presented to Antiretroviral Therapy (ART) outpatient specialist clinic in a tertiary hospital in Nigeria&#x0D; It was a retrospective study conducted between January and June 2022. All referral presented to ART clinic on clinic days were reviewed for information provided using a data capture form.&#x0D; A total of 142 referrals were analyzed. The majority of the referral provided information on patient identifiers. Information on clinical parameters considered important for quality review and management were generally unsatisfactory. Less than a quarter of the referral provided information on laboratory investigations like cluster of differentiation 4 count. Majority (97.9%) of the referrals stated the reason for the referral but physical examination findings and medication history were only reported in 38.7% and 43% respectively.&#x0D; Referral letters to ART clinic were deficient in the information needed for quality review. The deficiencies delayed patient management. Institution of measures to address the deficiencies will help to improve HIV care. The use of a structured referral form and training of doctors on the required information in a referral letter will also impact positively on HIV care.

Effects of HIV-related worries on fertility motivation moderated by living children among couples living with HIV: A dyadic analysis

HIV-related worries are a major barrier to achieving fertility goals for couples living with HIV (CLWH). We examined the moderating role of living children in the association between HIV-related worries and fertility motivation in CLWH including happiness, well-being, identity, and continuity. The data of 322 reproductive-aged CLWH were collected for this cross-sectional study from a referral antiretroviral therapy clinic in Kunming, China between October and December 2020. Intra- and interpersonal mechanisms of association between HIV-related worries and fertility motivation moderated by the number of living children in husband-wife dyads were analyzed by the actor-partner interdependence moderation model. The high-level HIV-related worries of the wives and husbands were associated with the spouses' fertility motivation. Having at least one child helped to ameliorate the negative association between one's own HIV-related worries and fertility motivation. However, there was no evidence of such moderation in the spouse. Whether the CLWH has at least one living child should be taken into account in counseling. Childless families should be counseled on HIV-related worries as those worries have a greater negative effect on fertility motivation than couples who have a child.

Impact of COVID-19 on HIV services and anticipated benefits of vaccination in restoring HIV services in Ethiopia: A qualitative assessment.

HIV services were inevitably disrupted and affected due to COVID-19. There are many challenges in implementing appropriate HIV services, particularly in the provision of health care and the link between people living with HIV/AIDS and retention in care. The study investigated the impact of COVID-19 on HIV services and the anticipated benefit of the COVID-19 vaccination on HIV service restoration in North Shewa, Oromia, Ethiopia. A qualitative descriptive study approach was used to explore how healthcare delivery evolved during the outbreak of COVID-19 in Ethiopia. Sixteen antiretroviral therapy (ART) clinics were selected from 13 districts and one administrative town in Ethiopia. From them, 32 ART providers were purposively selected based on their experience in ART provision. Data were collected from June to July 2021 using in-depth interviews. A thematic analysis approach was used to analyze the data, based on themes and subthemes emerging from the data. ATLAS.ti software was used for coding. Healthcare for people living with HIV was interrupted due to the COVID-19 pandemic. Medical appointments, HIV testing and counseling services, opportunistic infection treatment, medicine supply, and routine viral load and CD4 T-cell count tests were interrupted. Due to a shortage of healthcare staff, outreach testing services and home index testing were discontinued and HIV testing was limited only to hospitals and health centers. This has substantially affected accessibility to HIV testing and reduced the quality of HIV service delivery. Telehealth and less frequent visits to health facilities were used as alternative ways of delivering HIV services. The COVID-19 vaccination campaign is expected to restore healthcare services. Vaccination may also increase the confidence of healthcare providers by changing their attitudes toward COVID-19. The COVID-19 pandemic has substantially impacted HIV services and reduced the quality of HIV care in Ethiopia. Health facilities could not provide routine HIV services as they prioritize the fight against COVID-19, leading to an increase in service discontinuation and poor adherence.