Antiretroviral Therapy Users Research Articles

Protease inhibitor-based antiretroviral therapy in pregnancy: effects on hormones, placenta, and decidua.

The use of antiretroviral therapy (ART) in pregnancy is important for maternal health, and has been successful in reducing vertical transmission rates to almost zero in those taking effective ART regimens with good adherence. However, there are reports of higher rates of low birthweight and preterm births in women with HIV, which can be further exacerbated by ART usage in pregnancy. Protease inhibitors, and ritonavir-boosted lopinavir in particular, might directly contribute to placental and uteroplacental pathology in part by altering plasma concentrations of the essential steroid hormones of pregnancy, progesterone and oestradiol. In this Review, we collate the increasing evidence of dysregulated maternal endocrinology, reproductive physiology, and placental compromise associated with protease inhibitors. Based on findings of placental and decidual effects, we recommend that ritonavir-boosted lopinavir should be avoided in pregnancy, in line with US and European guidelines. Long-term follow-up of children exposed to protease inhibitors in utero is also recommended.

CD4 Count Progression of Adult HIV Patients Under Art Follow Up At Mekelle General Hospital, Tigray Region: A Longitudinal Data Analysis Approach


 Background: The number of people receiving antiretroviral therapy (ART) in low- and middle-income countries continues to show encouraging growth, indicating that the global effort to scale up HIV treatment has exceeded 15 million people by the end of 2015. 
 Methods: A retrospective cohort study, comprising of the quantitative method of data collection was conducted among randomly selected 210 adult ART users enrolled in the first 6 months of 2011 and followed up to mid-2016 which is a five year follow up. Data were analyzed using a linear mixed model to identify the determinant factors, which importantly incorporates the effect of factors over time. 
 Results: Ninety-five (45%) were males and 115 (55%) were females. Composition of patients’ WHO clinical stage were; stage I (25 (11.8%)), stage II (30 (14.2%)), stage III (102 (48.8%)), and stage IV (52 (24.6%)). The mean CD4+ count at baseline was 218 cells. The progression of CD4+ count for males is lower than that of female over time (coef. =-0.0779, p-value=0.0062). There was a direct relationship between time in month and CD4+ count progression i.e., the CD4+ count progression of the adult HIV patients was increasing during the subsequent number of times measured or followed up under the ART clinic (coef. = 0.0435, p-value=0.0000). Patients with WHO stage II (coef. = -0.0982, p-value=0.0109) , stage III (coef. = -0.0884, p-value = 0.0010) and stage IV (coef. = 0.0859, p-value = 0.0095) had lower CD4+ count than the reference category WHO clinical stage I over time. 
 Conclusion: In conclusion, we found that the WHO clinical stage, Time, Weight, Gender and the Interaction effects of Weight with Time were significantly associated with the progression of CD4+ counts over time. 

Risk Factors for Viral Non-Suppression among People Living with HIV and Major Depressive Disorder in Uganda

Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder; we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (<1000 viral copies/mL) and non-suppressed (≥1000 viral copies/mL). We used generalized linear regression models to evaluate the factors associated with non-viral suppression. Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.

Motor Control Alterations and the Perception of Postural Instability in non-Fallers Latinx-Hispanic Adults Living with HIV

People who have advanced HIV can display inadequate postural control because of the virus affecting the brain. Antiretroviral therapy (ART) mitigates some repercussions of the disease, maintaining a healthy immune system. The issue is that prolonged usage of ART may affect balance at a slower pace. Purpose: Assess postural control and balance perception in Latinx-Hispanic people living with HIV with a stable immune system. Methods: 42 (30 men and 12women) subjects took part in the investigation (57.2± 8.7 years old). Participants had to be diagnosed with HIV to enroll in the study with a CD4 count of &gt; 500 cells/µL. The eight balance tasks (15 s each) were accomplished on a thick balance foam mat and further partitioned into two parts, four single and four dual cognitive tasks (subjects counting backward three numbers at a time). Results: We measured balance using body-worn accelerometers (ACC) and the ABC scale. There was a considerable increase in sway movements within the different tasks, χ2 (8) = 194.314, p = 0.00. This increment in postural movements was observed when single and dual tasks were contrasted for EO (Z=-2.169, p=005) and EOHUD (Z=-2.344, p 0.05). Related to the ABC scale, subjects scored lower, notably in tasks involving more balance demands. Conclusion: HIV-diagnosed individuals with a stable immune system exhibit increased postural alteration and perceive balance difficulties with activities requiring higher motor control demands. Clinicians should assess the balance in people living with HIV in all stages of the disease as a prevention tool.

Correlates of viral non-suppression among South African antiretroviral therapy users: comorbidity of major depression, posttraumatic stress, and alcohol use disorders

ABSTRACT Antiretroviral therapy (ART) users at two public health facilities in South Africa were assessed for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), using the Structured Clinical Interview for the DSM5 (n = 688). Multivariate regression analysis was used to identify associations between mental disorders and unsuppressed viral load (VL), controlling for sociodemographic factors. All main effects and two-way interaction effects between mental disorders were explored. Prevalence estimates for MDD, PTSD and AUD were 24.9%, 14.7% and 22.1%, respectively, and 22.0% had unsuppressed VL. In multivariate regression models, unsuppressed VL was associated with being unemployed (aOR = 2.23) and AUD (aOR = 1.78). MDD, PTSD and comorbid mental disorders did not increase risk of unsuppressed VL. Population Attributable Risk analysis indicated that treating AUD could yield a 2% absolute reduction in prevalence of unsuppressed VL (equivalent to 9.3% proportional reduction), highlighting the importance of screening and treating AUD among persons receiving ART.

Special features of interferonlambda contents in blood serum of the patients with HIV infection

Studies in HIV infection remain an important issue for modern medicine, which, becomes controlled due to widespread usage of antiretroviral therapy. At the same time, however, it cannot be cured completely, and there is a number of “white spots” in understanding immunopathogenesis of disorders complicating this disease. The in-depth studies of interferon system, in particular from the lambda family, are desirable, because of their antiviral activity in HIV-infected patients. The aim of our study was to evaluate the content of interferons-lambda: IFNλ1 (IL-29) and IFNλ3 (IL-28B) in patients with HIV infection.Blood serum of 120 patients with HIV infection (average age 49.7±6.2 years) who were treated in the outpatient setting at the Center for AIDS Prevention and Control of Regional Clinical Hospital No. 2 in Vladivostok was subjected to laboratory testing. HIV infection 4A was the main clinical diagnosis in all the patients, i.e., the stage of secondary diseases, remission phase on the background of antiretroviral therapy (ARVT). In 52 patients, chronic viral hepatitis C was found as a concomitant disease. The content of IFNλ1 (IL-29) and IFNλ3 (IL-28B) in venous blood serum was determined by ELISA technique using a “Multiscan” analyzer. The ELISA reagents were from RD systems, catalog numbers DY5259; DY7246.In the groups of patients with HIV infection, both with and without viral hepatitis C, the levels of IFNλ1 (IL-29) and IFNλ3 (IL-28B) were significantly reduced in comparison with control group. When comparing the IFN values between the groups, a more pronounced decrease in IFNλ1 (IL-29) was revealed among the patients with viral hepatitis C. When analyzing the level of IFNλ3 (IL-28B), an opposite pattern was observed, i.e., its values in the patients with HIV infection and viral hepatitis C were higher than in the group without hepatitis, but still did not reach appropriate values of the control group. Based on the data on IFNλ3 (IL-28B) antiviral effect upon HIV transmission via macrophages One may assume that induction and maintenance of higher type 3 interferon levels can favorably affect the course of HIV infection. The registered changes in IFNλ1 (IL-29) and IFNλ3 (IL-28B) levels in the patients with HIV and HCV suggest some viral effect upon innate immunity characterized by multidirectional changes, depending on presence or absence of hepatitis C virus. The studies of changes in innate immunity and role of type 3 interferons may extend our knowledge on the interaction between the human body and HIV, and will promote preventive measures and rehabilitation in the patients with HIV infection.

Duration on ART, Alcohol Use and HIV Stage May Predict Risky Sexual Behavior in a Resource-limited Environment: A Cross-sectional Study.

The intention of antiretroviral therapy (ART) and regular clinic visits are to engender safe sex attitudes among HIV-infected individuals. However, this may not be the case due to the perceived therapeutic benefits of ART and may result in exposure to drug-resistant HIV strains. We aimed to determine the prevalence and predict the factors associated with risky sexual behaviors among ART users in a resource-limited environment. Two hundred and ninety-one sexually active ART-users aged 18-50 years and seeking care at the HIV clinic in Dodoma, Tanzania, participated in this study. The outcome variables modeled in a logistic regression were condom use, multiple sex partners, casual sex partners, and payment for sex. The predictors included in the models were the patients' socio-demographic characteristics. In addition, a new variable, sexual risk scores, was generated by culminating all the outcome variables. Finally, a multiple Poisson regression with the socio-demographic variables of the participants was used to model the sexual risk scores. Patients reported inconsistent/no condom use (44%), payment for sex (4%), casual sex encounters (13%), multiple sex partners (21%), and STD symptoms (15%). While having a casual sexual partner was significantly associated with age group in a Pearson Chi-square (p=0.0147), participants ≤35 years old were less likely to have single-sex partners than older participants (AOR: 0.188, 95 C.I: 0.042-0.849). Meanwhile, the likelihood of condom use was higher among participants with no HIV-infected family members (AOR= 2.409, 95% C.I:1.236,4.697) and among participants who had single-sex partners (AOR= 2.721, 95% C.I.: 1.115,6.640); these participants were less likely to report STD symptoms (AOR=0.265, 95% C.I.: 0.081-0.865). Adjusted analysis showed that estimated mean sexual risk scores significantly increased (mean, λ=1.61, 95% C.I:1.0817-2.4063) for recent ART recipients (within 1-3 years vs. ≥8 years). However, sexual risk scores of participants with HIV stage 3 were 38.8% lower than participants at stage 4 (95% C.I.: 0.3910-0.9558), and non-alcohol drinkers had an adjusted mean sexual risk score of 29% lower than participants who were alcohol drinkers (95% C.I.: 0.5102-0.9879). Researchers should prioritize patients at HIV CTC for education concerning safe sexual practices for those characterized by alcohol consumption, younger age (less than 35 years old), HIV stage 4, or commencement of ART within three years.

Depressive Symptoms, Gender, Disclosure, and HIV Care Stage Among People Living with HIV in Cameroon.

Depression is associated with suboptimal HIV care outcomes. Little is known about the extent to which the prevalence of depressive symptoms varies across the HIV care continuum. Also, the relationship among gender, HIV disclosure, HIV care stage, and depressive symptoms in PLWH remains poorly understood. We analyzed cross-sectional data from 12,507 PLWH at enrollment in International epidemiology Databases to Evaluate AIDS (IeDEA) Cameroon between 2016 and 2020. Recent depressive symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2). A score of three or greater on the PHQ-2 was considered indicative of likely major depressive disorder. We estimated the prevalence of depressive symptoms across three stages of HIV care: those not yet on antiretroviral therapy (ART), recent ART initiators (ART initiation ≤ 30days prior), and ART users (ART initiation > 30days prior). Adjusted prevalence differences (aPD) of depressive symptoms were estimated comparing recent ART initiators and ART users. Disclosure and gender were examined as effect measure modifiers of the relationship between HIV care stage and depressive symptoms. The prevalence of depressive symptoms was 11.9%, 22.0%, and 8.7% among PLWH not yet on ART, recent ART initiators, and ART users, respectively. ART users had significantly lower prevalence of depressive symptoms compared to recent ART initiators (aPD - 0.09 [95% CI - 0.11, - 0.08]). Neither gender nor HIV disclosure modified the effect measure of the relationship between HIV care stage and depressive symptoms. Depressive symptoms were commonly reported among this group of PLWH and were associated with recent ART initiation. Integration of screening and treatment of depression into HIV care should be prioritized and may be particularly relevant for PLWH initiating ART.

Changes in lipidomic profile by anti-retroviral treatment regimen: An ACTG 5257 ancillary study.

High cardiovascular disease risk in people living with HIV is partly attributed to antiretroviral therapy (ART). Lipid response to ART has been extensively studied, yet, little is known how small molecule lipids respond to Integrase inhibitor-based (INSTI-based) compared to Protease inhibitor-based (PI-based) ART regimens.Ancillary study to a phase 3, randomized, open-label trial [AIDS Clinical Trial Group A5257 Study] in treatment-naive HIV-infected patients randomized in a 1:1:1 ratio to receive ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r) (both PI-based), or raltegravir with Tenofovir Disoproxil Fumarate-TDF plus emtricitabine (RAL, INSTI-based).We examined small molecule lipid response in a subcohort of 75 participants. Lipidomic assays of plasma samples collected pre- and post-ART treatment (48 weeks) were conducted using ultra-performance liquid chromatography coupled to time-of-flight mass spectrometry. The effect of ART regimens was regressed on lipid species response adjusting for the baseline covariates (lipids, age, sex, race, CD4 level, BMI, and smoking). Results were validated in the Centers for AIDS Research Network of Integrated Clinical Systems study (N = 16).Out of 417 annotated lipids, glycerophospholipids (P = .007) and sphingolipids (P = .028) had a higher response to ATV/r and DRV/r compared to RAL. The lysophosphatidylcholine (LPCs(16:1),(17:1),(20:3)) and phosphophatidylcholine species (PCs(40:7),(38:4)) had an opposite response to RAL versus ATV/r in the discovery and validation cohort. The INSTI-based regimen had an opposite response of ceramide species ((d38:1), (d42:2)), PCs((35:2), (38:4)), phosphatidylethanolamines (PEs(38:4), (38:6)), and sphingomyelin(SMd38:1) species compared with the PI-based regimens. There were no differences observed between 2 PI-based regimens.We observed differences in response of small molecule lipid species by ART regimens in treatment-naive people living with HIV.

Improving Quality of Service Among Antiretroviral Therapy Users Through Strategic Problem-Solving Approach at Bure Primary Hospital, Northwest Ethiopia.

BackgroundGlobally, an estimated 1.7 million new human immunodeficiency virus (HIV) infections occurred in 2018. Although significant progress has been made still, it remained a public health threat. Thus, this capstone project aimed to improve the quality of services among anti-retroviral therapy (ART) users through a strategic problem-solving approach at Bure Primary Hospital, northwest Ethiopia, 2020.MethodsA before–after study design was employed among 357 people living with HIV (PLWH) clients on ART from December 2019 to January 2020 and from April to May 2020 pre and post capstone project. The capstone project involved regular internal mentorship, availing supplies, and providing refresher training. Data were entered using EPI data version 3.1 and exported to SPSS version 23 statistical for analysis. Paired t-test was used for comparing the mean scores before and after the capstone project. A mean score with 95% CI and a P-value <0.05 were used to determine the effect of the capstone project on the quality of the service.ResultsThe overall quality of ART service was improved as evidenced by the presence of a positive gap score (+0.0164) according to the SERVQAUL model. Receiving first CD4 count was improved from 65% to 85.1% and screening for TB from 90% to 97% with 95% CI at a p-value of 0.001. Whereas, viral load measurement at six months is 78% to 89.75% and IPT uptake is 62% to 71% with 95% CI at a p-value of 0.013 and 0.004, respectively.ConclusionEnsuring regular internal mentorship, availing supplies, and providing refresher training have a significant effect on the quality of ART service. Therefore, adhering to national guidelines and fulfilling the availability of the recommended infrastructures helps to improve the quality of ART service.

Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia

BackgroundPeople living with human immunodeficiency virus (HIV) with immuno-virological discordant responses are at an increased risk to develop acquired immunodeficiency syndrome (AIDS) and severe non AIDS events which are risk factors for death. This study was aimed to assess prevalence of immuno- virological discordant responses and associated risk factors among highly active antiretroviral therapy (HAART) users in Tigray, Northern Ethiopia.MethodsA cross sectional study was conducted from September to December 30, 2016 on 260 people living with HIV who started first line HAART from January 2008 to March 2016 at Mekelle hospital and Ayder comprehensive specialized hospital. Baseline and follow-up clinical data and CD4+ result were collected from patient charts. Besides, socio-demographic data and blood samples for CD4 + count and viral load measurement were collected during data collection period. Fisher’s exact test, bivariate and multivariate logistic regressions were used for data analysis. P-value < 0.05 with 95% CI was considered as statistically significant.ResultAmong the 260 study participants, 8.80% (95% Confidence Interval (CI) =8.77–8.84%) and 2.70% (95% CI = 2.68–2.72%) had virological and immunological discordant responses, respectively with an overall immuno-virological discordance response of 11.50% (95% CI = 11.46–11.54%). The median age of the study participants at HAART initiation was 35 (IQR: 28–44 years). More than half (58.1%) of the study participants were females. Age at or below 35 years old at HAART initiation (AOR ((95% CI) = 4.25(1.48–12.23), p = 0.007)), male gender ((Adjusted Odds Ratio (AOR) (95% CI) =1.71(1.13–1.10), p = 0.029)), type of regimen given ((AOR(95% CI) = 0.30 (0.10–0.88), p = 0.028)) and good treatment adherence ((AOR (95% CI) = 0.12 (0.030–0.0.48), p = 0.003)) were associated risk factors for virological discordant response. Likewise, immunological discordant response was associated with tuberculosis co-infections (p = 0.016), hepatitis B virus co-infections (p = 0.05) and low CD4+ count (≤100 cells/μl) at baseline (p = 0.026).ConclusionsOver all, immuno-virological discordance response was 11.5% in the study area. Males, low baseline CD4+ count, poor/fair treatment adherence, and TB and HBV co-infections were significantly associated with higher immuno-virological discordance. We recommend that decision of patient treatment outcome, regimen change and patient management response should be done using trends of both viral load and CD4+ count concurrently.

Unsuppressed Viral Load Level in Public Health Facilities: Nonvirological Predictors among Adult Antiretroviral Therapy Users in Southwestern Ethiopia.

BackgroundUnsuppressed viral load in patients on antiretroviral (ARV) therapy occurs when treatment fails to suppress a patient’s viral load, and is associated with decreased survival and increased HIV transmission. Identifying the level of unsuppressed viral load with its associated factors has benefits in controlling transmission and reducing burden. Therefore, this study aimed to assess unsuppressed viral load (>1,000 copies/mL) and associated factors among HIV patients taking first-line antiretroviral treatment at public health facilities in Jimma, Ethiopia.MethodsA facility-based cross-sectional study was conducted on 669 patients on first-line ARV therapy (at least 6 months) in public health facilities in Jimma. Sociodemographic, treatment, clinical, immunological, and viral load data were extracted from medical records, entered into EpiData 3.1, and analyzed with SPSS 20. Multivariate logistic regression analysis was performed to identify factors independently associated with viral nonsuppression, considering a 95% CI with P<0.05 statistically significant.ResultsAmong the participants, 258 (38.6%) were aged 25–34 years. Median age was 35 years. Prevalence of unsuppressed viral load was 20.3%. Risk of unsuppressed viral loads was 91% lower among ARV therapy patients who had been taking ARV therapy <2 years (AOR 0.09, 95% CI 0.01–0.83), lower baseline BMI (AOR 4.44, 95% CI 1.56–12.64), lower baseline CD4 (AOR 2.76, 95% CI 1.45–5.29), poor adherence to ARV therapy medication (AOR 3.19, 95% CI 1.29–7.89), and immunological failure (AOR 4.26, 95% CI 2.56–7.09) were the independent predictors of unsuppressed viral load.ConclusionThis study revealed that there is a high level of virological failure among adult HIV patients, and confirms the need to develop close follow-up strategies of targeted interventions for patients in care who are at high risk of unsuppressed viral load.

Modelling of HIV prevention and treatment progress in five South African metropolitan districts

Globally, large proportions of HIV-positive populations live in cities. The Fast-Track cities project aims to advance progress toward elimination of HIV as a public health threat by accelerating the response in cities across the world. This study applies a well-established HIV transmission model to provide key HIV estimates for the five largest metropolitan districts in South Africa (SA): Cape Town, Ekurhuleni, eThekwini, Johannesburg and Tshwane. We calibrate the model to metro-specific data sources and estimate progress toward the 90-90-90 targets set by UNAIDS (90% of people living with HIV (PLHIV) diagnosed, 90% of those diagnosed on antiretroviral therapy (ART) and viral suppression in 90% of those on ART). We use the model to predict progress towards similarly defined 95-95-95 targets in 2030. In SA, 90.5% of PLHIV were diagnosed in 2018, with metro estimates ranging from 86% in Johannesburg to 92% in eThekwini. However, only 68.4% of HIV-diagnosed individuals nationally were on ART in 2018, with the proportion ranging from 56% in Tshwane to 73% in eThekwini. Fractions of ART users who were virally suppressed ranged from 77% in Ekurhuleni to 91% in eThekwini, compared to 86% in the whole country. All five metros are making good progress to reach diagnosis targets and all (with the exception of Ekurhuleni) are expected to reach viral suppression targets in 2020. However, the metros and South Africa face severe challenges in reaching the 90% ART treatment target.

Health System Responsiveness for HIV/AIDS Treatment and Care Services in Shewarobit, North Shewa Zone, Ethiopia.

PurposeHealth System Responsiveness is the key objective of the health system used to fulfil patients’ universal legitimate expectations. However, the health system’s responsiveness to HIV/AIDS was not assessed in Ethiopia. Therefore, this study aimed at assessing the health system responsiveness of HIV/AIDS treatment and care services and associated factors in the public health facilities of Shewarobit town, Ethiopia.Patients and MethodsAn institution-based cross-sectional study was employed from 15 February to 15 April 2020 in the public health facilities of Shewarobit town. The data were collected among 416 randomly selected Anti-Retroviral Therapy (ART) users using an interviewer-administered questionnaire. Responsiveness was measured using 27 Likert scale questions across seven responsiveness domains. A binary logistic regression model was fitted. A p-value of less than 0.05 and AOR with a 95% confidence interval (CI) was used to declare the associated factors in the final multivariable logistic regression analysis.ResultsThe overall health system responsiveness was 55.3% (95% CI: 50.6–59.8). High performance of responsiveness was found on confidentiality, respect, and communication domains, whereas poor responsiveness was achieved in prompt attention and choice domains. Participants aged 50+ years (AOR:2.48, 95% CI, 1.12–5.54), perceived good health (AOR: 3.10, 95% CI: 1.75–5.48), patients’ satisfaction with care (AOR: 2.98, 95% CI: 1.35–6.54) and history of visiting traditional healers (AOR: 2.50, 95% CI:1.51–4.17) were factors associated with health system responsiveness of HIV/AIDS treatment and care services in the study area.ConclusionsUnacceptable responsive performance was found in choice and prompt attention domains. Participants’ age, perceived health status, history of visiting traditional healers, and patient satisfaction were factors that affect responsiveness in the study area. Thus, providing training, frequent supportive supervision, improving community awareness, and incorporating traditional healers in the modern health system would enhance the health system responsiveness in Ethiopia.

Predicting Posttraumatic Stress Disorder Caseness Using the PTSD Checklist for DSM‐5 Among Patients Receiving Care for HIV

This study assessed the ability of the Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) to distinguish between caseness and noncaseness for PTSD among South Africans receiving care for HIV. The PCL-5 and the Structured Clinical Interview for DSM-5-Research Version (SCID-RV) module for PTSD were administered to 688 patients receiving antiretroviral therapy (ART) at two HIV care clinics in the greater Cape Town (South Africa) area. In total, nearly half of the sample (n = 324, 47.1%) reported experiencing an index traumatic event, and 101 participants (14.74%, 95% CI [12.17%, 17.62%]) met the diagnostic criteria for PTSD as measured using the SCID-RV. An ROC curve analysis suggested that a PCL-5 cutoff score of 32 yielded optimal sensitivity (0.88) and specificity (0.88), indicating that the measure was successful in determining caseness for PTSD 88% of the time and noncaseness 88% of the time. The AUC was 94.3%, 95% CI [92.6% to 96.1%], indicating high accuracy. The positive predictive value and negative predictive values were 56.3% and 97.7%, respectively, which suggests that the PCL-5 is an effective screening instrument to determine the presence of PTSD among South African ART users. Undetected and, thus, untreated PTSD may reduce quality of life, impede optimal adherence to ART, and increase the likelihood of risk behaviors among individuals living with HIV, contributing to further infections. The PCL-5 may be used for detection, referral, and treatment of PTSD as a way to enhance its management among individuals receiving HIV care.

Prevention of Mother-To-Child Transmission of HIV - China, 2011-2020.

IntroductionPrevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) is a global health focus in most parts of the world. The World Health Organization (WHO) launched the dual Elimination of Mother-to-Child Transmission (EMTCT) of HIV and syphilis initiative and released global guidance on criteria and processes for validation of the EMTCT in 2014. The purpose of this report was to analyze the key validation indicators of EMTCT of HIV in China from 2011 to 2020 and to provide relevant basis information for the implementation of EMTCT action in China.MethodsThe report described the coverage of maternal HIV screening and antiretroviral therapy usage for HIV infected pregnant women and their infants in China using the data from the national information systems of PMTCT of HIV, syphilis, and HBV management from 2011 to 2020.ResultsThe rates of maternal HIV testing during pregnancy (predelivery and at labor) and predelivery increased from 92.9% (8,730,161/9,398,781) and 53.7% (5,050,569/9,398,781) to 99.9% (11,964,026/11,982,321) and 97.5% (11,679,924/11,982,321), respectively. The MTCT rate reduced from 7.4% to 3.6% between 2011 and 2020.ConclusionsThe data from the surveillance systems revealed that there was a marked increase in the coverage of HIV screening of pregnant women and antiretrovirals drugs use for HIV infected pregnant women and their infants in China from 2011 to 2020.

The Magnitude and Associated Factors of Consistent Condom Utilization Among ART Users in Hawassa City, Sidama, Ethiopia.

BackgroundAntiretroviral therapy (ART) introduction has sharply decreased mortality and morbidity rates among HIV-infected patients and resulted in longer and healthier lives among people living with HIV. Hence, the aim of this study is to determine the level of consistent condom use and associated factors among ART users in Hawassa City.MethodsCross-sectional study design triangulated with qualitative phenomenology was used. One hospital and one health center were selected by simple random sampling and proportional to size allocation was used to assign participants to each health facility. Accordingly, 358 study subjects were selected. Adjusted odds ratio (AOR) with 95% confidence interval was used to implicate significant factors. Thematic content analysis was used and narrative report writing with a quote was used to present qualitative data.ResultsThe prevalence of consistent condom utilization in this study was 51.4%. Sex (AOR= 4.20, 95% CI: 2.386, 7.41), residence (AOR=3.55, 95% CI: 1.81, 6.99) educational status (AOR=0.4, 95% CI: 0.196, 0.946), perception on ART’s does not reduction of HIV transmission (AOR=1.96, 95% CI: 1.12, 3.43), rate of counseling (AOR=0.37, 95% CI: 0.17, 0.84) and use condom to prevent pregnancy (AOR=4.53, 95% CI: 2.11, 9.73) were found to be independent predictors of consistent condom utilization among ART users. Refusal by husbands, decrement in satisfaction, gender difference with more women than men willing to use consistently and religious reasons were factors associated with inconsistent condom utilization in the qualitative study.Conclusion and RecommendationConsistent condom utilization among ART users was low. Sex, residence, educational status, perception towards ART were significantly associated with consistent condom utilization. Moreover, husband refusal, religious reason, decrement in satisfaction on the qualitative study were associated with non-consistent use of a condom. The importance of consistent condom use should be well addressed in HIV/AIDS patients, to prevent transmission and multiple infections of HIV.

Pathways for reduction of HIV-related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda.

IntroductionThe rollout of antiretroviral therapy (ART) has been associated with reductions in HIV‐related stigma, but pathways through which this reduction occurs are poorly understood. In the newer context of universal test and treat (UTT) interventions, where rapid diffusion of ART uptake takes place, there is an opportunity to understand the processes through which HIV‐related stigma can decline, and how UTT strategies may precipitate more rapid and widespread changes in stigma. This qualitative study sought to evaluate how a UTT intervention influenced changes in beliefs, attitudes and behaviours related to HIV.MethodsLongitudinal qualitative in‐depth semi‐structured interview data were collected within a community‐cluster randomized UTT trial, the Sustainable East Africa Research in Community Health (SEARCH) study, annually over three rounds (2014 to 2016) from two cohorts of adults (n = 32 community leaders, and n = 112 community members) in eight rural communities in Uganda and Kenya. Data were inductively analysed to develop new theory for understanding the pathways of stigma decline.ResultsWe present an emergent theoretical model of pathways through which HIV‐related stigma may decline: internalized stigma may be reduced by two processes accelerated through the uptake and successful usage of ART: first, a reduced fear of dying and increased optimism for prolonged and healthy years of life; second, a restoration of perceived social value and fulfilment of subjective role expectations via restored physical strength and productivity. Anticipated stigma may be reduced in response to widespread engagement in HIV testing, leading to an increasing number of HIV status disclosures in a community, “normalizing” disclosure and reducing fears. Improvements in the perceived quality of HIV care lead to people living with HIV (PLHIV) seeking care in nearby facilities, seeing other known community members living with HIV, reducing isolation and facilitating opportunities for social support and “solidarity.” Finally, enacted stigma may be reduced in response to the community viewing the healthy bodies of PLHIV successfully engaged in treatment, which lessens the fears that trigger enacted stigma; it becomes no longer socially normative to stigmatize PLHIV. This process may be reinforced through public health messaging and anti‐discrimination laws.ConclusionsDeclines in HIV‐related stigma appear to underway and explained by social processes accelerated by UTT efforts. Widespread implementation of UTT shows promise for reducing multiple dimensions of stigma, which is critical for improving health outcomes among PLHIV.

\u201cUniversal test and treat\u201d program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

BackgroundTuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment” programs, we aim to measure the effect of the UTT program on TB incidence.ObjectiveTo measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia.MethodsA retrospective cohort study was conducted through record review over 5 years (2014–2019) in public health facilities in Gurage Zone. Three hundred eighty-four records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi Info™ Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs.ResultsDuring the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR = 2.10/100 PY) in comparison to the differed program cohort (IR = 6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI = 0.08–0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR = 0.35 (95% CI = 0.22–0.48)), WHO Stage I and II (AIRR = 0.70 (95% CI = 0.61–0.94)) and higher base line CD4 count (AIRR = 0.96 (95% CI = .94–0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR = 5.8 (95% CI = 1.93–8.46)).ConclusionTB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

HIV Status and Antiretroviral Therapy as Predictors of Disability among Older South Africans: Overall Association and Moderation by Body Mass Index.

Objectives: Among older people living with HIV (PLWH) and comparable individuals without HIV, we evaluated whether associations of HIV and antiretroviral therapy (ART) with disability depend on body mass index (BMI). Methods: We analyzed 4552 participants in the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa." (HAALSI) We compared prevalence of disability (≥1 impairment in basic activities of daily living) by HIV status, ART use, and BMI category, adjusting for age, sex, education, father's occupation, country of origin, lifetime alcohol use, and primary health-care utilization. Results: Among PLWH, those underweight had 9.8% points (95% confidence interval (CI): 1.2 to 18.4) higher prevalence of disability than those with normal BMI. Among ART users, those underweight had 11.9% points (95% CI: 2.2 to 21.6) higher prevalence of disability than those with normal BMI. Conclusions: We found no evidence that weight improvement associated with ART use is likely to increase disability.