Antiretroviral Therapy Center Research Articles

Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh

Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence. Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospital. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and adherence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS. Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found significant were sex of the patient, the education, the socioeconomic status, financial constraints, family support, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors namely having less than college education, WHO stage at diagnosis, alcohol intake and lack of family support were found to predictors of non-adherence. Conclusions: Family support, treatment of alcohol addiction will improve adherence in HIV positive patients.

Building communities of practice through case-based e-learning to prevent and manage TB among people living with HIV–India

BackgroundCo-management of HIV-TB coinfection remains a challenge globally. Addressing TB among people living with HIV (PLHIV) is a key priority for the Government of India (GoI). In 2016, GoI implemented single-window services to prevent and manage TB in PLHIV. To strengthen HIV-TB service delivery, case-based e-learning was introduced to health care providers at Antiretroviral Therapy centres (ARTc).MethodsWe implemented a hub and spoke model to deliver biweekly, virtual, case-based e-learning at select ARTc (n = 115), from four states of India–Delhi, Uttar Pradesh, Andhra Pradesh and Tamil Nadu. We evaluated feasibility and acceptability of case-based e-learning and its impact on professional satisfaction, self-efficacy, knowledge retention using baseline and completion surveys, session feedback, pre-and post-session assessments. We reviewed routine programmatic data and patient outcomes to assess practices among participating ARTc.ResultsBetween May 2018 and September 2020, 59 sessions were conducted with mean participation of 55 spokes and 152 participants. For 95% and 88% of sessions ≥ 80% of respondents agreed that topics were clear and relevant to practice, and duration of session was appropriate, respectively. Session participants significantly improved in perceived knowledge, skills and competencies (+ 8.6%; p = 0.025), and technical knowledge (+ 18.3%; p = 0.04) from baseline. Participating ARTc increased TB screening (+ 4.2%, p < 0.0001), TB diagnosis (+ 2.7%, p < 0.0001), ART initiation (+ 4.3%, p < 0.0001) and TB preventive treatment completion (+ 5.2%, p < 0.0001).ConclusionCase-based e-learning is an acceptable and effective modus of capacity building and developing communities of practice to strengthen integrated care. E-learning could address demand for accessible and sustainable continuing professional education to manage complex diseases, and thereby enhance health equity. We recommend expansion of this initiative across the country for management of co-morbidities as well as other communicable and non-communicable diseases to augment the existing capacity building interventions by provide continued learning and routine mentorship through communities of practice.

Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India

BackgroundThe number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited.MethodsWe conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL).ResultsAmong 400 participants, median age was 40 years (IQR 34–44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77–13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98–8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33–5.34).ConclusionsWe found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.

Effect of Antiretroviral Therapy on CD 4 cell count and WHO Staging among PLHIV Accessing Services at Tertiary care Hospital, Coastal Karnataka

Background: Human immunodeficiency virus attacks CD4 cells primarily. Current CD4 count is a strong predictor of the immediate risk of acquired immune deficiency syndrome or death. Antiretroviral therapy results in an improvement in immunologic status, one feature of which is an increase in the CD4 cell count.Objectives: To study the effect of Antiretroviral therapy on CD4 cell count &amp; WHO staging among people living with HIV/AIDS.Methodology: A retrospective cross-sectional descriptive study was conducted using data available from Antiretroviral therapy centre attached to Teaching Hospital of Karwar Institute of Medical Sciences, Karwar.Conclusion: Antiretroviral therapy among People Living with HIV was significantly associated with the increase in their CD4 cell count. The mean difference of the CD4 count increase in patients obtained was of 451 and is statistically significant (P &lt; 0.01). There is improvement in the WHO staging of the disease after the start of Antiretroviral therapy

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;

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Clinicodemographic profile and outcome of tuberculosis treatment in TB-HIV co-infected patients receiving daily ATT under a single window TB/HIV services delivery initiative.

The risk of death in HIV-TB coinfected individuals is far greater than in HIV-only patients. It is critical to provide timely and appropriate therapy in HIV-TB coinfected patients in order to reduce morbidity and mortality. The purpose of this study was to evaluate the clinical presentation and outcome of TB treatment in HIV-TB co-infected patients receiving daily anti-tubercular therapy (ATT) and concurrent antiretroviral therapy (ART) at a tertiary respiratory care centre in New Delhi, India. The research was cross-sectional, observational, and hospital-based A. From September 2018 to August 2019, a total of 53 patients with HIV-TB coinfection were enrolled at the Institute's ART centre. Patients were evaluated with a structured proforma. Data were evaluated using SPSS version 23.0 and p-value of less than 0.05 was considered statistically significant. Among the patients enrolled, the mean age was 35.98 years. Among the patients enrolled, 56.6% patients had EPTB, 32% had PTB and 11.3% had both PTB and EPTB. The majority of the enrolled patients (n=46, 86.7%) had favourable TB treatment outcomes, while 13.3% (n=7) had unfavourable outcome [including death (n=5) and loss to follow up (n=2)]. During the study and follow-up period, no patients transferred out or relapsed. In univariate analysis, low SES, bedridden functional status, low BMI, anaemia, hypoalbuminemia, and a low CD-4 cell count (<100 cells/mm3 were significantly associated with an unfavourable outcome. Bedridden functional status (p=0.002), anaemia (p=0.040), and low BMI (p<0.001) were independently associated with a poor outcome. Adequate disease knowledge and health education can be very beneficial in reducing morbidity and mortality. Early ART in combination with ATT can reduce mortality in TB-HIV co-infected patients.

Utility of the lateral flow urine lipoarabinomannan tuberculosis assay in patients with advanced HIV disease at antiretroviral therapy centres in Mumbai, India.

BackgroundPeople with Advanced HIV Disease (AHD) are at higher risk of TB coinfection and mortality. However, there are challenges in TB diagnosis with the currently recommended diagnostic tools. WHO recommends lateral flow urine lipoarabinomannan (LF-LAM) assay to assist TB diagnosis among AHD patients. We assessed the utility and acceptability of using urine LF-LAM assay for TB diagnosis among patients at public Antiretroviral Therapy (ART) Centres in Mumbai.MethodsThe cross-sectional study was conducted among adult AHD patients accessing care from 17 ART centres during November,2020-June, 2021. Urine LF-LAM was offered as routine care for eligible patients in combination with standard diagnostic tests. We calculated the proportion of positive LF-LAM results by CD4 categories and TB symptoms and performed multivariable logistic regression to determine the factors associated with LF-LAM positivity.ResultsAmong 2,390 patients, the majority (74.5%) had CD4 between 101–200 cells/mm3. The mean age was 43.7 years (SD:10.6), 68.6% were male, 8.4% had TB symptoms and 88.0% were on ART. The overall proportion of patients with urine LF-LAM positive results was 6.4%. Among PLHIV with CD4≤100 cells/mm3, the positivity was 43.0% and 7.7% in symptomatic and asymptomatic patients, respectively. Among PLHIV with a CD4>100 cells/mm3, the positivity was 26.7% and 2.7% in symptomatic and asymptomatic patients respectively. Urine LF-LAM positivity was higher among inpatients, ART naïve, patients on treatment for <6 months, symptomatic and in WHO clinical stage III/IV of HIV disease as compared to the reference categories. We detected an additional 131 TB cases with urine LF-LAM in combination with the standard diagnostic tests.ConclusionThe study demonstrated the utility of urine LF-LAM for TB diagnosis among AHD patients and the simple, user-friendly test was acceptable as part of routine care. Inclusion of urine LF-LAM test in the current diagnostic algorithm may facilitate early TB diagnosis among AHD patients.

Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India

People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) in a cohort of PLHIV in Bihar, India. We hoped to evaluate optimal diagnostic algorithms to detect ALI in PLHIV. We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or post kala-azar dermal leishmaniasis (PKDL) at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 enzyme-linked immunosorbent assay (ELISA), rK39 rapid diagnostic test (RDT) and/or quantitative polymerase chain reaction (qPCR). Additionally, the urinary Leishmania antigen ELISA was evaluated. Determinants for ALI were established using logistic regression and agreement between diagnostic tests calculated using Cohen’s Kappa. A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (interquartile range 33–46), were included in the analysis. Baseline prevalence of ALI was 7.4% (n = 96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n = 6) and 0.4% (n = 5) were positive by qPCR and rK39 RDT, respectively. Negligible or weak agreement was seen between assays. Independent risk factors for ALI were CD4 counts <100 (OR 3.1; 95% CI 1.2–7.6) and CD4 counts 100–199 (OR = 2.1;95% CI:1.1–4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR = 1.9;95% CI:1.1–3.1). A total of 2.2% (n = 28) participants were positive by Leishmania antigen ELISA, detecting 20 additional participants to the asymptomatic cohort. Prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. Using the Leishmania antigen ELISA, prevalence increased to 9.0%. Patients with low CD4 counts and larger household size were found to have significantly higher risk of ALI.Trial Registration: Clinical Trial Registration CTRI/2017/03/008120.

Cardiovascular Risk Factors amongst the Patient Living with HIV Attending at Anti-Retroviral Therapy Center of Bangladesh

Human immunodeficiency Virus (HIV) seropositive individual is at risk of developing disease of cardiovascular system (CVD). There are scarce of research work regarding this field in Bangladesh. Considering scarcity, this study was conducted at anti-retroviral therapy (ART) center of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh to find out the frequency of the CVD and their common risk factors in HIV seropositive patients from March 2017 to September 2019. Different CVD risk factors were assessed in this study. The demographic data were assessed and World Health Organization STEPS questionnaire were used to collect demographic data. The 10-year CVD risk was calculated by using the Framingham coronary risk score (FRS). Mean age of study population was 38, SD= 9.8. Among them sixty-five (65%) were men and thirty-five (35%) were women. About one third were overweight followed by 5% were obese. High cholesterolemia, high triglyceridemia, high low-density lipoprotein (LDL) and low high-density lipoprotein (HDL) were found in 23%, 58%, 14%. and 63% of the HIV patent, respectively. Hypertension was present in 19% and diabetes in 15% of the patients. In Framingham risk score, 19% of the participants had intermediate to high risk of cardiovascular disease within 10 years. The cardiovascular risk factors were common in HIV patients attending ART center of BSMMU, where base line 10-years CVD risk was low. People living with HIV appear to be an imminent risk to develop CVD. Bangladesh Med J. 2021 May; 50(2) : 40-44

Cardiac Abnormalities in People Living with HIV visiting ART Center of a Tertiary Hospital in Kaski, Nepal: A CrossSectional Study

Introduction: Anti-Retroviral Therapy (ART) by virtue of immune boost up has increased life span of People Living with Human Immunodeficiency Virus infection (PLHIV) and thus they are prone for late cardiovascular manifestations of infection. Age related atherosclerotic cardiovascular risks also accumulate on them. Therefore, this study aimed to assess cardiac abnormalities in those PLHIV taking ART.&#x0D; Methods: It was a single center descriptive cross-sectional study conducted on those ART taking PLHIV who underwent extensive cardiac evaluation by a meticulous clinical examination and investigation with Chest X-Ray (CXR), Electrocardiogram (ECG) and echocardiography. Excluded were those with past history of heart disease, cardiac surgery and chronic systemic disease before the diagnosis of PLHIV and pregnant women.&#x0D; Results: There were total of 381 PLHIV. There was male predominance (54.33%) with mean age of 44.7 years and average duration of ART was 7.8 years. Hypertension (18.9%) was the predominant co-morbid factor. Cardiovascular abnormalities detected by CXR, ECG and echocardiography were 39.3%, 64.6% and 48.8% respectively.&#x0D; Conclusions: Cardiac abnormalities are common in ART taking PLHIV; hence comprehensive cardiovascular evaluation is need of the hour.

Prevalence of Psychological Distress and Quality of Life among People Living with HIV/Acquired Immunodeficiency Syndrome at Tertiary Health-care Center in Coastal Karnataka, Institutional-Based Cross-sectional Study

Background: With increase in cases of HIV, in addition to the direct effect of HIV, the social stigma causes psychological distress in people living with HIV/AIDS (PLWHA). With improvements in antiretroviral therapy (ART), HIV has become a chronic disease, which increases the incidence of other psychiatric comorbidities. Objectives: To assess the predisposing factors causing psychological distress and to assess the quality of life (QOL) in people living with HIV. Materials and Methods: A total of 380 patients who visited ART center in a Coastal Karnataka tertiary health-care center were included in this study. They were given questionnaires, which included World Health Organization-QOL-Bref, HAM-Depression, MOS-social support survey, perceived stress scale (PSS), and substance abuse. Result: Out of 380, the prevalence of psychological distress in patients with HIV/acquired immunodeficiency syndrome (AIDS) was 30.5%. The mean of the total QOL scores was 78. Prevalence of poor QOL in patients with HIV/AIDS was 1.58%. About 5.8% were mild or moderately depressed. Only 0.5% were found to be with severe depression. There was no statistically significant substance abuse among PLWHA. Conclusion: PLWHA who were in the age group of 30–60 years, illiterate, those with history of alcohol abuse, and having lower QOL scores and high scores in PSS had increased odds of psychological distress. Thus, concerned medical fraternity should collaborate on integrating HIV/AIDS treatment services with mental health services. Future interventions are needed to improve the level of social support and psychological support to the people living with chronic illnesses like HIV/AIDS.

High Prevalence of Cervical High-Grade Lesions and High-Risk Human Papillomavirus Infections in Women Living with HIV: A Case for Prioritizing Cervical Screening in This Vulnerable Group

Introduction: Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors. Methods: A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs. Results: The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03). Conclusion: Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.

C-Reactive Protein as a Screening Test for Tuberculosis in People Living with HIV in Southern India: A Cross-Sectional, Observational Study.

Background: Tuberculosis is the leading cause of mortality in people living with HIV(PLHIV). We assessed the utility of C-reactive protein (CRP) as a screening test for tuberculosis (TB) in PLHIV. Methods: We performed a cross-sectional, observational study on 150 HIV patients visiting the Anti-Retroviral Therapy (ART) center for the follow up of their ART treatment. Patients who screened positive on the WHO symptom screen were included in the study. C-reactive protein levels in the blood were measured, and the patients were followed up with for a confirmatory diagnosis of tuberculosis. Results: The ideal cut-off for CRP was found to be 8.25. There was a statistically significant relationship between the CRP value and tuberculosis positivity (p value < 0.001). The CRP value had a sensitivity of 70.13%, a specificity of 69.86%, a positive predictive value of 71.05%, a negative predictive value of 68.92%, and a total diagnostic accuracy of 70% in patients who screened positive on the WHO symptom screen. Conclusion: CRP is a valuable screening tool and should be added to the tuberculosis screening algorithm to improve the diagnostic accuracy of screening for tuberculosis in people living with HIV.

Factors associated with antiretroviral therapy adherence among adolescents living with HIV in the era of isoniazid preventive therapy as part of HIV care.

High levels of adherence to antiretroviral therapy (ART) are essential to promoting viral suppression and consequential good treatment outcomes. Adolescents living with HIV (ALHIV) in sub-Saharan Africa are less adherent to ART compared to adults, leading to lower rates of viral suppression and immunological recovery. We conducted a mixed-method study utilizing a convergent parallel approach to explore factors associated with ART adherence among ALHIV in the era of isoniazid preventive therapy (IPT) as part of HIV care. The quantitative data were collected from patient records from the period between 1 February 2017 and 31 January 2018 (6 months before and after IPT introduction), while qualitative data was collected from purposively selected patients and healthcare workers by in-depth interviews through a pretested interview guide. A total of 385 patient records (age 10-19 years) were analyzed in the two time periods, while 16 ALHIV (age 10-19 years) and three healthcare workers directly involved in adolescent care were interviewed. Quantitative data utilized logistic regression to measure the strength of association between IPT addition and ART adherence, whereas, qualitative data were analyzed using a thematic analysis approach. The mean age of participants in the quantitative section was 14.3 years (SD 2.7) and 178 were females, while the median age for adolescents interviewed was 14 (IQR 12-17) and 8 were females. Overall, we found an interaction of factors that influenced ART adherence. Added pill burden, on its own, did not affect ART adherence. Commonly reported factors that led to poor adherence were lack of status disclosure within the family, school pressure, and inadequate support from guardians and parents. According to retrospective patient records, complex ART regimens also worsened adherence (p = 0.0462). ART regimen was independently associated with adherence (OR 2.11 95% CI 0.97-4.53). Being on ART for a longer duration, enrolment into teen clubs, clinical psychosocial support, and self-reinforcement techniques were suggested to improve ART adherence. The interplay of multiple factors leads to poor rates of adherence. The introduction of IPT to ART packages may not independently affect ART adherence. Readily available psychosocial services and the presence of peer and guardian support is critical to optimal ART adherence. There is a need for ART centers that provide HIV care to adolescents to consider integrating psychosocial and other youth-friendly services into day-to-day clinic operations.

Attitudes and acceptability of children, caregivers, and healthcare providers about using telemedicine for pediatric HIV care in a resource-limited setting.

BackgroundThe Pediatric HIV Telemedicine Initiative is a video-linked delivery of expert services, designed to reach those previously unable to access expert HIV care. The present qualitative study was designed to understand the acceptability of telemedicine [TM] by patients, their caregivers and health care providers in the anti-retroviral therapy (ART) centers in Maharashtra.MethodsWe conducted focus group discussions with caregivers at six ART centres (three linked with TM facilities and three not linked with TM). We also conducted in-depth interviews with medical officers, counselors, and pharmacists at each centre. The data from the interviews were transcribed and translated into English for analysis. The qualitative data were analyzed using thematic framework approach.ResultsChildren and caregivers who had participated in telemedicine consultation through video conference found the process acceptable, were comfortable communicating during these sessions, and did not have any specific problem to report. The advantages of TM were: consultation without having to travel to other cities; economic advantage; and prompt consultation. The total time spent during the process and technical difficulties during the TM sessions were some of the challenges. The medical officers had the opportunity to discuss difficult cases with the expert during the TM session. Some sessions were also considered a ’group counseling’ session, wherein several children and caregivers were able to interact and learn from each other and motivate each other. The health care providers at the three centers that did not currently have TM facilities expressed a desire to have these services at their centers as well. According to them, these facilities will help them address complicated and difficult pediatric HIV cases. Currently, they send their patients to referral centers or other hospitals. Since, many of these referral hospitals are situated in bigger cities, less than 50% of patients access care at these centers This is mostly due to the time constraints and finances (travel/stay) required for accessing these centres.DiscussionTM was a feasible, acceptable, and desired approach for care of children living with HIV/AIDS. It provides support to their caregivers as well as their care providers. The ART staff from the telemedicine-linked peripheral centers were supportive of the use of TM and wanted these services to be initiated in the non-linked centers.

Quality of life of people living with HIV/AIDS before and after receiving antiretroviral therapy

Background- HIV/AIDS is a chronic illness. Besides having serious morbidities, opportunistic infections, it also adversely affects quality of life of People Living with HIV/AIDS (QOL- PLHIV). Early and prompt initiation of antiretroviral therapy (ART) might improve quality of life of PLHIV in various domains like psychological, physical, environment level of independence, social relationship and spirituality/religion/personal beliefs. Material and methods- The study was conducted at a medical institute of North India. Patients attending ART centre of the institute for the treatment of HIV/AIDS were interviewed on WHOQOL-HIV questionnaire. Aim and objectives- To assess and compare quality of life of people living with HIV/AIDS at initiation and after 6 months of receiving antiretroviral therapy. Result- QOL-PLHIV was improved in various domains when assessed after six months of receiving ART. For physical domain mean score increased from 12.83 to 13.85, for psychological domain from 12.54 to 14.31, for level of independence from 12.95 to 13.21, for social relationship from 12.46 to 14.15, for environment domain from 11.98 to 13.15 and for spirituality/religion/personal belief mean score increased from 11.41 to 11.96. Respective standard deviation was decreased when compared from before initiation of ART to six months after receiving ART. Conclusion – Quality of life of people living with HIV/AIDS was improved significantly after receiving ART.

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan.

Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

A comparative study on early treatment outcome and adverse drug reaction profile of two protease inhibitor-based antiretroviral regimens in human immunodeficiency virus patients at a tertiary care teaching hospital, Rajasthan

Introduction: Second-line antiretroviral therapy (ART) regimens are used when patients develop treatment failure from first-line drug regimens. The present study is aimed to compare treatment outcome in terms of clinical, virological, and immunological effectiveness over 1 year of follow-up in human immunodeficiency virus (HIV) patients, switched to various second-line ART regimens and to assess adverse drug reactions (ADRs). Materials and Methods: A longitudinal observational study was conducted at ART center, SMS Hospital, Jaipur, after approval from Institutional Research Review Board. One hundred HIV positive patients, resistant to first line ART, switched to either of the 2 s line ART regimens were followed for 1 year for early treatment outcomes and any ADRs. Results: Out of 97 patients enrolled 65 patients received Tenofovir and 32 patients received Zidovudine (ZDV) along with lamivudine and Atazanavir/ritonavir. There was significant increment in CD4 count from the baseline value (202.51–438.52 cells/mm3) after 12 months of therapy. On comparison, CD4 cell rise was not significantly different between the two groups. However, Plasma viral load suppression was achieved insignificantly more number of patients in ZDV group than in tenofovir group: 31 (96.9%) versus 57 (87.7%), respectively. Opportunistic infections (OI) were seen in 21.5% and 28.1% patients respectively at the time of switching of second-line ART. Out of 59 ADRs reported, nausea, vomiting, diarrhea, hyperbilirubinemia, dyslipidemia, and anemia were most common. Conclusion: Nonadherence, drug resistance, and treatment failure are the major challenges in controlling HIV disease. Our study shows that both the second-line regimens were comparable in improvement in CD4 count and viral load suppression with 1 year success rate of 90.7%.