Antiretroviral Therapy Clinic Research Articles

Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

BackgroundSub-Saharan Africa suffers from a high burden of undernutrition, affecting 23.2% of its population, and in 2015 constituted 69% of the estimated people living with Human Immunodeficiency Virus (HIV) globally. Zimbabwe, in Southern African has a HIV prevalence of 14.7%, but malnutrition (under- and over-nutrition) in this population has not been characterized. A nationally representative survey was therefore conducted to determine malnutrition prevalence and associated factors among HIV-positive adults (≥15 years) enrolled at antiretroviral therapy (ART) clinics in Zimbabwe.MethodsHeight and weight measurements were taken for all enrolled participants who had attended their scheduled clinic review visits. Malnutrition was determined using body mass index (BMI) calculations and classified as undernutrition (<18.5 kg/m2), normal (18.5–24.9 kg/m2) or over-nutrition (≥25 kg/m2). Multivariate-adjusted odds ratios (aOR) were used to assess factors associated with undernutrition and over-nutrition.ResultsOf 1,242 HIV-positive adults interviewed, 849 (69%) were female and median age was 41 years (IQR, 34–49). The majority (93%) were on ART with a median treatment duration of 3 years (IQR, 1.1–4.3) and 581 (56%) had advanced HIV disease and a median CD4 cell count of 348 cells/uL (IQR, 174–510) at their last scheduled visit. There were 776 (63.6%) who had a normal BMI, 122 (10%) who had under-nutrition (1.4%-severe; 1.5%-moderate; 7.1%-mild) and 322 (26.4%) who had over-nutrition (18.4%-overweight; 8%-obesity). Females and those of older age (35-44 years and ≥45 years) versus 15–24 years were less likely to have undernutrition. Those reporting difficulty in accessing food in the past month [aOR = 1.67 (95%CI, 1.10–2.55)] and who had advanced HIV disease [aOR = 2.25 (95% CI, 1.34–3.77)] were more likely to have undernutrition. Being overweight or obese was more likely in females [aOR = 3.86 (95% CI, 2.72–5.48)], in those age ≥45 years [aOR = 2.24 (95% CI,1.01–5.04)], those with higher wealth quintile and those with CD4 > 350 cells/mL[aOR = 4.85 (95% CI, 1.03–22.77)].ConclusionZimbabwe faces two types of nutritional disorders; undernutrition and overweight / obesity, in its HIV-infected population, both of which are associated with increased morbidity and mortality. This may reflect a shift in the pattern of HIV/AIDS from being a highly fatal infectious disease to a chronic manageable condition.

Renal safety of lithium in HIV-infected patients established on tenofovir disoproxil fumarate containing antiretroviral therapy: analysis from a randomized placebo-controlled trial

BackgroundThe prevalence of bipolar disorder in HIV-infected patients is higher than the general population. Lithium is the most effective mood stabiliser, while tenofovir disoproxil fumarate (TDF) is frequently used as part of combination antiretroviral therapy (ART). Both TDF and lithium are associated with renal tubular toxicity, which could be additive, or a pharmacokinetic interaction may occur at renal transporters with a decrease in TDF elimination.ObjectiveWe report on the change in estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease formula in participants who received ART including TDF and were enrolled in a 24 week randomised trial of lithium versus placebo in patients with HIV-associated neurocognitive impairment.MethodsWe included HIV-infected adults with cognitive impairment established on ART for at least 6 months with a suppressed viral load attending public sector ART clinics in Cape Town, South Africa. We excluded participants with an eGFR <60 mL/min and treated with medications predisposing to lithium toxicity. We reviewed participants weekly for the first month for adverse events followed by 4 weekly visits for renal function assessment, adverse event monitoring and adherence. Lithium dose was titrated to achieve the maintenance target plasma concentration of between 0.6 and 1.0 mmol/L. Sham lithium concentrations were generated for participants receiving placebo.ResultsWe included 23 participants allocated to the lithium arm and 30 participants allocated to the placebo arm. Baseline characteristics were not statistically different with a mean age of 37.7 and 40.8 years, a median time on ART of 33 and 40 months and an eGFR of 139.3 and 131.0 mL/min in the lithium and placebo arms respectively. There was no statistical significant difference in the reduction in eGFR or increase in potassium between the two arms during the 24 weeks.ConclusionsWe found that 24-week treatment of HIV-infected patients with lithium and TDF did not result in increased nephrotoxicity.Trial registration The study was registered on the Pan African Clinical Trials Registry (PACTR) with the identifier number PACTR201310000635418. Registered 11 October 2013 before the first participant was enrolled

Caretakers' barriers to pediatric antiretroviral therapy adherence in Vietnam – A qualitative and quantitative study

BackgroundPoor antiretroviral therapy (ART) adherence leads to drug resistance and treatment failures. The options for second and third line ART regimens, particularly for pediatric patients, are very limited in low and middle-income countries. HIV-infected children are mostly passive drug-takers, thus caretakers play a very important role in assuring ART adherence. Pediatric ART adherence is still a challenging problem in Vietnam since non-adherence is the major risk factor for treatment failure. Our study explores and measures caretakers' barriers in order to improve pediatric ART adherence in future. MethodsExploring caretakers' barriers was conducted through a qualitative study with Focus Group Discussion (FGD) on two topics: 1. Current society – family support and difficulties in taking care children under ART; 2. Stigma experience. Based on the finding from the qualitative study a quantitative study measuring caretakers' barriers was conducted through a designed questionnaire. Study methods strictly followed the consolidated criteria with 32-item checklist for interviews and focus groups. ResultsIn total eight FGDs with 53 participants were conducted. Common caretakers' barriers to children's ART adherence, were financial burden, lack of ART KP (Knowledge-Practice), stigma, depression, shifting caretaker, drug taste and side effects, lack of family support, fixed health check-up schedule and HIV non-disclosure. In the questionnaire study a total of 209 caretakers participated. The most commonly reported caretakers' barriers were: financial burden (144; 69%), KP burden (143; 68%), depression (85; 41%) and stigma (30; 14.8%). Some caretakers' characteristics that significantly associated with reported barriers (p<0.05). Rural caretakers reported significantly more financial burden (OR=2.26) and stigma (OR=3.53) than urban. Caretakers with under high school level education reported significantly more financial burdens (OR=2.08) and stigma (OR=4.15) compared to caretakers with high school education or over. ConclusionFinancial burden, KP burden, depression and stigma were common reported caretakers' barriers to pediatric ART adherence. Family residence, caretaker's education level and job were considered as the key factors determining caretakers' barriers related to financial burden and stigma. These findings may be important for policy makers and researchers in order to develop effective interventions regarding to caretakers' burdens and associated factors. Furthermore, a tool for nurses in monitoring caretakers' barriers to pediatric ART adherence was developed first with FDG, and then interview questionnaire. This tool could be applied and modified easily in any pediatric ART clinic settings in accordance to economic, social and cultural circumstances.

Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach

BackgroundSub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility.MethodsA mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis.ResultsMultiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types.ConclusionOver the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.

The perceptions of patients on antiretroviral therapy (ART) and treatment supporters with regard to their role towards ART adherence, at ART clinics in the intermediate hospital Oshakati, Namibia

Background: The benefits of antiretroviral therapy (ART) are undeniable: decreased morbidity and mortality, improved clinical outcomes, and decreased HIV transmission. In recent years, there have been remarkable efforts to roll out HIV support and treatment programs, resulting in ART access to nearly 4 million people in sub-Saharan Africa. However, a decisive step in improving outcomes of these programs relies on ART adherence. This study was conducted by aiming at exploring and describing the perceptions of patients on ART and treatment supporters about their roles in ART adherence. It was carried out at Oshakati ART clinic in the Intermediate Hospital Oshakati in Oshana region, Northern Namibia.Methods: The qualitative investigation was carried out on patients on ART and treatment supporters by means of unstructured interviews through convenient sampling technique. The data were analysed by content analytical method.Results: The study results from all respondents were consolidated, which gave a clear understanding regarding adherence at the ART clinic in Intermediate Hospital Oshakati. The perceptions of patients on ART and treatment supporters with regard to their role towards ART adherence were classified based on participants’ experiences into two main themes and sub-themes, including: 1) ART patients’ perceptions around their current roles in ART adherence comprise of four sub-themes of ART patients’ perceptions about taking medication daily, perceptions about collection of medicine supply and follow-up visits, perceptions about food and medication and perceptions about support in ART treatment; 2) Treatment supporters’ perceptions about their role in ART adherence consist of four sub-themes of perceptions about follow-up visits and collection of medicine, perceptions about psychosocial and emotional support, perceptions about giving food and medication and perceptions about encouraging personal hygiene.Conclusion: Patients and treatment supporters perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients understanding of treatment, traditional and religious beliefs were among other factors perceived by treatment supporters to be impacting on ART adherence.

Malaria parasitemia in HIV-infected children attending antiretroviral therapy clinic in a teaching hospital

Background: Malaria and HIV are important health problems in developing countries. They cause more than 4 million deaths a year globally. The interaction of these two infections is both synergistic and bidirectional. We determined the prevalence of malaria coinfection in HIV-infected children attending antiretroviral therapy (ART) clinic. Materials and Methods: A prospective study of all HIV-infected children attending the ART clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, over a 5-year period was carried out. Malaria parasite was identified by Giemsa-stained blood films using a light microscopy. Statistical analysis was carried out using SPSS version 20.0. Results: The total numbers of children screened were 236. Of those, 73 (31%) had malaria/HIV coinfection. One hundred and twenty-one (51.3%) were males and 115 (48.7%) were females. The mean age of the children was 8.63 ± standard deviation 3.76 years (range of 1–17 years). Conclusions: The study shows that the rate of malaria and HIV coinfection is high. Prompt treatment of malaria and malaria disease prevention are recommended for children.

Occurrence, patterns & predictors of hypogonadism in patients with HIV infection in India.

Background & objectives:Data on hypogonadism among human immunodeficiency virus (HIV)-infected Indians are not available. This study was aimed to evaluate the occurrence, pattern and predictors of hypogonadism in HIV-infected Indians.Methods:Consecutive stable HIV-infected patients, 18-70 yr age, without any severe comorbid state, having at least one year follow up data at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays.Results:From initially screened 527 patients, 359 patients (225 males; 134 females), having disease duration of 61.44±39.42 months, 88.58 per cent on highly active antiretroviral therapy (HAART), 40.67 per cent having tuberculosis history and 89.69 per cent with vitamin D insufficiency were analyzed. Testosterone <300 ng/dl was documented in 39.11 per cent males. Primary, hypogonadotropic hypogonadism (HypoH) and compensated hypogonadism were observed in 7.56, 31.56 and 12.44 per cent males, respectively. Males with hypogonadism were significantly older (P=0.009), and had higher opportunistic infections (P<0.001) with longer disease duration (P=0.05). Menstrual abnormalities were observed in 40.3 per cent females, who were significantly older (P<0.001), had lower CD4 count (P=0.038) and higher tuberculosis history (P=0.005). Nearly 46.3, 16.2 and 13 per cent women with menstrual abnormalities were in peri-/post-menopausal state, premature ovarian insufficiency (POI) and HypoH, respectively. Age, CD4 count at diagnosis and 25(OH)D were best predictors of male hypogonadism. Age and CD4 count increment in first 6-12 months following HAART were the best predictors of POI.Interpretation & conclusions:Hypogonadism was observed to be a significant problem in HIV-infected men and women in India, affecting 39 and 29 per cent patients, respectively. HypoH was the most common form in males whereas ovarian failure being the most common cause in females.

Utility of Brief Versions of the Alcohol Use Disorders Identification Test (AUDIT) to Identify Excessive Drinking Among Patients in HIV Care in South Africa.

In sub-Saharan Africa, large proportions of patients who are on antiretroviral therapy (ART) engage in excessive alcohol use, which may lead to adverse health consequences and may go undetected. Consequently, health care workers need brief screening tools to be able to routinely identify and manage excessive alcohol use among their patients. Various brief versions of the valid and reliable 10-item Alcohol Use Disorders Identification Test (AUDIT) (i.e., the AUDIT-C, AUDIT-3, AUDIT-QF, AUDIT-PC, AUDIT-4, and m-FAST) may potentially replace the full AUDIT in busy HIV care settings. This study aims to assess the utility of these six brief versions of the AUDIT relative to the full AUDIT for identifying excessive alcohol use among patients in HIV care settings in South Africa. Participants were 188 (95 women) patients from three ART clinics within district hospitals in the City of Tshwane Metropolitan Municipality who reported past-12-month alcohol use. Performance of each brief AUDIT measure for identifying excessive alcohol use was evaluated against that of the full AUDIT (with a cutoff score of ≥6 for women and ≥8 for men) as the gold standard. We used receiver-operating characteristic (ROC) analysis. Most brief AUDIT measures had an area under the receiver operating curve (AUROC) above .90 when compared with the full AUDIT (five of six for women and three of six for men). The AUDIT-PC, AUDIT-4, and m-FAST had the highest AUROCs, whereas the three brief measures comprising only consumption items had low specificities at the most optimal cutoff levels. Various brief versions of the AUDIT may be appropriate substitutes for the full AUDIT for screening for excessive alcohol use in HIV clinics in sub-Saharan Africa.

Skin Manifestation among HIV Patients and Its Correlation with CD4 Count and WHO Clinical Staging in Jimma University Specialized Hospital, Southwest Ethiopia

Background: More than 90% of human immunodeficiency virus (HIV+) infected patients develop skin lesions at some time throughout the course of the disease. Several skin diseases have proved to be sensitive and useful indicators of progression of HIV+ infection. Although these conditions may be seen in general healthy population, their occurrence in patients with acquired immunodeficiency syndrome is often atypical, more severe and explosive. Objective: The aim of the study was to assess the magnitude and prevalence of skin manifestation among HIV patients in JUSH ART Clinic. Methods: A retrospective study was conducted among HIV patients in JUSH ART Clinic using a structured data collection format and the data was collected from patient’s record (card) and was analyzed by using SPSS version 20. The result was presented using numbers, ratios and tables. Results: Of 268 HIV/AIDS, patients who have follow-up in Jimma University Specialized Hospital (JUSH) Antiretroviral therapy (ART) clinic 137 (51.1%) were having skin manifestations. The commonest type of skin lesion identified was Herpes Zoster, 74 (54%). This study showed that HIV positive (HIV+) patients with advanced stages of skin disorders had relatively lower CD4+ cell counts. Skin manifestation was significantly associated with WHO clinical stage with P=0.019 and CD4+ cell count with a P-value 0.0001. Conclusion: Skin diseases are highly prevalent among HIV- Positive patients and the frequency and number of these manifestations are well correlated to the patient’s immune status and World Health Organization (WHO) staging. Therefore, examination of skin disorders, as early diagnosis and management of skin problems will improve the quality of life in HIV positive patients.

Awareness and management of elevated blood pressure among human immunodeficiency virus–infected adults receiving antiretroviral therapy in urban Zambia: a call to action

ABSTRACT The prevalence of high blood pressure (HBP) and hypertension (HTN), awareness of the diagnoses, and use of anti-hypertensive drugs were examined among human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy (ART) in Zambia’s capital Lusaka. Within a prospective cohort based at two public sector ART clinics, BP was measured at ART initiation and every 6 months thereafter as a routine clinic procedure. Predictors of HBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) during one year on ART were analyzed using logistic regression, and the proportion with HTN (2+ episodes of HBP >3 months apart) described. A phone survey was used to understand patient awareness of HBP, use of anti-hypertensive drugs, and history of cardiovascular events (CVE; myocardial infarction or stroke). Among 896 cohort participants, 887 (99.0%) had at least one BP measurement, 98 (10.9%) had HBP, and 57 (6.4%) had HTN. Increasing age (10-year increase in age: adjusted odds ratio [AOR] = 1.50; 95% confidence interval [CI] 1.20–1.93), male sex (AOR = 2.33, 95% CI 1.43–3.80), and overweight/obesity (AOR = 4.07; 95% CI 1.94–8.53) were associated with HBP. Among 66 patients with HBP, 35 (53.0%) reported awareness of the condition, and nine (25.7%) of these reported having had a CVE. Only 14 (21.2%) of those reached reported ever taking an anti-hypertensive drug, and one (1.5%) was currently on treatment. These data suggest that major improvements are needed in the management of HBP among HIV-infected individuals in settings such as Zambia.

Occurrence of Bacteria and Yeast in Urinary Tract of HIV/AIDS Patients Attending Antiretroviral Therapy (ART) Clinic at University of Jos Teaching Hospital, Nigeria

Urinary tract infection is one of the infections observed among HIV patients and the cause of morbidity and hospitalisation in HIV positive individuals. The study aimed at determining the prevalence of Urinary tract pathogenic bacteria and yeast among HIV-infected individuals attending Anti-retroviral therapy (ART) clinic in Jos,Nigeria. Mid-stream urine samples collected from 240 HIV seropositive patients were cultured, isolates identified and antibiotic susceptibility profile determined using agar disk diffusion technique (Kirby-Baeur). Out of the 240 samples screened, 39(16.25%) had urinary tract infections (UTIs) and 33(16.20%) had yeast infection. The distribution of the isolates were as follows: Escherichia coli 12(30.77%), Staphylococcus aureus 10(25.64%), Klebsiella pneumonia 4(10.26%), Enterobacter sp. 4(10.26%), Staphylococcus saprophyticus 3(7.69%), Citrobacter freundii 2(5.13%), Pseudomonas aeruginosa 2(5.13%) and Proteus mirabilis 1(2.567%).Among the yeasts, Candida albicans showed the highest prevalence with 21(63.64%) while non-albican Candida sp had 12(36.36%). Age group 20-24 years with 1(33.3%) cases had the highest prevalence while bacterial infection was not detected among &lt;19, 55-59 and ≥60 years. Females had a higher prevalence of 36(17.60%) compared to the males 3(8.33%).The antibiotic susceptibility patterns showed that gentamicin (10µg), augmentin (20µg), chloramphenicol (30µg), ciprofloxacin (5µg) and ofloxacin (5µg) were more active. The study revealed that uropathogenic bacteria and yeast were prevalent among HIV/AIDS patients. Routine screening of uropathogens should be incorporated in the management and care of HIV/AIDS patients in Nigeria.

Experiences of alcohol consumption and taking antiretroviral medication among men living with HIV in Tshwane, South Africa

Hazardous alcohol consumption may compromise optimal antiretroviral therapy (ART) adherence among patients. Adoption of hegemonic notions of masculinity may encourage health-risk behaviours, such as alcohol consumption, and discourage health-enhancing behaviours, such as ART adherence among men. This study aimed to explore linkages between masculinity, alcohol consumption, and taking ART medication among male ART recipients in South Africa. Male facilitators conducted five focus group discussions with 27 black male ART recipients aged between 28 and 65 years at five ART clinics. Eligibility criteria were: 18 years or older, at least three months on ART, and alcohol consumption in the past three months. Data were analysed inductively using thematic content analysis. The men demonstrated a masculinity that fostered commitment to taking ART. However, normative notions of masculinity in the men’s social circles often compromised their timeous taking of medication. Fears of alcohol-ART interactions often led to intentional non-adherence to ART when drinking. Finally, healthcare provider-patient power dynamics seemed to prevent the men from discussing their challenges regarding alcohol use and ART adherence with their healthcare providers. Interventions that focus on addressing harmful hegemonic notions of masculinity among men are needed in community settings such as drinking establishments where men tend to socialise. Patient-centred approaches which enhance men’s sense of involvement in their treatment are needed in healthcare settings.

Integrated intervention for mental health co-morbidity in HIV-positive individuals: A public health assessment

In South Africa, where it is estimated that more people have HIV than anywhere else in the world, HIV/AIDS and psychological disorder co-morbidity have been shown both to exacerbate the late diagnosis and treatment of psychological disorders and to affect adherence to ARVs. Targeted, affordable and evidence-based strategies to reach these populations are essential. Against this backdrop, a pilot project and situational assessment aimed at determining the context of psychological care and HIV treatment services in South Africa was undertaken. The situational analysis consisted of individual interviews, a patient survey, and a retrospective medical record data review. Training and mentorship were conducted from 2011 to 2013 by the Foundation for Professional Development (FPD) in five anti-retroviral therapy (ART) clinics in the Tshwane-Metsweding area. Data were both descriptively and inferentially analysed. Outcomes indicate that the general structure of HIV services is well organised and well run in the sampled clinics. However, mental healthcare and HIV services need to be integrated further. There is also a need to develop and pilot-test appropriate materials and models for the delivery of mental healthcare within the parameters of affordability, acceptability and availability further, and to advocate the advancement of mental health and HIV treatment and policy integration.

Fertility intention and use of contraception among women living with the human immunodeficiency virus in Oromia Region, Ethiopia

Background: The human immunodeficiency virus (HIV) epidemic resulted in decreased fertility among HIV-positive women, who did not want to transmit the virus to their unborn children. With the availability of antiretroviral therapy that suppresses viral load, HIV-infected women live normal lives and even acknowledge the desire and intention to have children, a factor that is rarely acknowledged in antiretroviral therapy (ART) clinic services. This study examined fertility intentions and contraception use among a sample of women attending an ART clinic in Oromia Region, Ethiopia.Methods: A quantitative, cross-sectional and descriptive design was used on a sample of 362 HIV-positive women. Data were collected using a researcher-administered questionnaire.Results: The ages of the participants ranged from 18 to 49 years and most were between the ages of 23 and 32. A desire and intention to fall pregnant was reported by 46.6% (n = 158) of the participants. A total of 114 (35.5%) had given birth after they were ...

Predictors of poor retention on antiretroviral therapy as a major HIV drug resistance early warning indicator in Cameroon: results from a nationwide systematic random sampling

BackgroundRetention on lifelong antiretroviral therapy (ART) is essential in sustaining treatment success while preventing HIV drug resistance (HIVDR), especially in resource-limited settings (RLS). In an era of rising numbers of patients on ART, mastering patients in care is becoming more strategic for programmatic interventions. Due to lapses and uncertainty with the current WHO sampling approach in Cameroon, we thus aimed to ascertain the national performance of, and determinants in, retention on ART at 12 months.MethodsUsing a systematic random sampling, a survey was conducted in the ten regions (56 sites) of Cameroon, within the “reporting period” of October 2013–November 2014, enrolling 5005 eligible adults and children. Performance in retention on ART at 12 months was interpreted following the definition of HIVDR early warning indicator: excellent (>85%), fair (85–75%), poor (<75); and factors with p-value < 0.01 were considered statistically significant.ResultsMajority (74.4%) of patients were in urban settings, and 50.9% were managed in reference treatment centres. Nationwide, retention on ART at 12 months was 60.4% (2023/3349); only six sites and one region achieved acceptable performances. Retention performance varied in reference treatment centres (54.2%) vs. management units (66.8%), p < 0.0001; male (57.1%) vs. women (62.0%), p = 0.007; and with WHO clinical stage I (63.3%) vs. other stages (55.6%), p = 0.007; but neither for age (adults [60.3%] vs. children [58.8%], p = 0.730) nor for immune status (CD4351–500 [65.9%] vs. other CD4-staging [59.86%], p = 0.077).ConclusionsPoor retention in care, within 12 months of ART initiation, urges active search for lost-to-follow-up targeting preferentially male and symptomatic patients, especially within reference ART clinics. Such sampling strategy could be further strengthened for informed ART monitoring and HIVDR prevention perspectives.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1991-3) contains supplementary material, which is available to authorized users.

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

ABSTRACTTo achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child’s treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR = 0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR = 5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR = 12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child’s medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings.

Screening HIV-associated neurocognitive disorders (HAND) among HIV positive patients attending antiretroviral therapy in South Wollo, Ethiopia

BackgroundThe vast majority of people living with HIV/AIDS reside in low and middle income countries, particularly in Sub-Saharan Africa, including Ethiopia. Despite the huge number of service users in the local area, cognitive disorder among HIV patients has not been extensively studied and there is a dearth of knowledge on the subject. The objective of this study was to assess the prevalence and associated factors of HIV-associated neurocognitive disorder among people living with HIV/AIDS in antiretroviral therapy (ART) clinics. MethodsInstitution based cross sectional study was conducted from April to May, 2015 at Dessie Referral Hospital & Kombolcha Health Center. International HIV Dementia Scale was used to screen HIV associated neurocognitive deficits. Logistic regression analysis was used to assess predictors of neurocognitive disorders. ResultThe risk of HIV associated neurocognitive disorder was 36.4%. Those who had CD4 count of 500 cells/dl or less (AOR = 2.368 (1.524, 3.680)), no formal education (AOR = 4.287 (2.619, 7.016)), poor medication adherence (AOR = 1.487 (1.010, 2.180)) and older age (AOR = 3.309 (1.259, 8.701)) were found to be significantly associated with HIV associated neurocognitive disorders. ConclusionThe risk of HIV-associated neurocognitive disorder was found to be high among people living with HIV/AIDS. This emphasizes the need of regular cognitive screening for early identification and appropriate intervention.

One-Stop Shop: A Community-Based Antiretroviral Therapy (ART) Clinic Model to Improve Human Immunodeficiency Virus (HIV) Prevention and Treatment Cascade for Key Populations in Nigeria

One-Stop Shop: A Community-Based Antiretroviral Therapy (ART) Clinic Model to Improve Human Immunodeficiency Virus (HIV) Prevention and Treatment Cascade for Key Populations in Nigeria

Utilization of contraception among sexually active HIV positive women attending art clinic in University of Gondar Hospital: a hospital based cross-sectional study.

BackgroundContraception helps to prevent unplanned pregnancies among human immune virus positive women. The contraceptive utilization status and associated factors were not well addressed in the study area. Therefore, this study aimed to assess utilization of contraceptives and associated factors among human immune virus positive reproductive age group women appearing at anti-retroviral therapy clinic at the University of Gondar Hospital, North West Ethiopia.MethodAn institution based cross-sectional study was conducted among 397 systematically selected HIV positive reproductive age women who visited ART unit of the University of Gondar teaching referral hospital from January 8-20, 2014. The data were collected using pre tested and structured questionnaires through face-to-face interviews. The data were entered into Epi-Info version 3.5, and cleaned and analyzed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95 % confidence interval and P-value of 0.05.ResultsThe study revealed that the overall utilization of any type of contraception was 50 %. Of them, 4.1 % got contraception from anti-retroviral therapy unit. Fear of side effects was the most common (42 %) reason for not using contraception. Women who attended secondary education, married and who had 4-6 children were more likely to use contraception than their counterparts were; (AOR: 5.63; 95 % CI: 1.74–18.21), (AOR: 8.07; 95 % CI: 3.10–20.99) and (AOR: 3.61; 95 % CI: 1.16–11.26) respectively. However, Women between 35–49 years, had no intention to have another child and discordant couples were 83 %, 76 % and 65 % less likely to use contraception respectively than their counterparts.ConclusionsThe results of this study revealed that the utilization of contraception was low. Women between 35–49 years, those who had no intention to have another child and whose partner was HIV sero-negative and fear of side effect of the contraception played an important role for not using contraception. Therefore, there is a need to give attention about integration of family planning service with HIV care and support service.

Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

BackgroundHuman resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009.MethodsA two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis.ResultsThe identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment.ConclusionsFacility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.