ART Initiation Research Articles

Serum Mature and Precursor Brain-Derived Neurotrophic Factors and Their Association with Neurocognitive Function in ART-Naïve Adults Living with HIV in Sub-Saharan Africa.

This study investigates the association between serum mature brain-derived neurotrophic factor (mBDNF), its precursor proBDNF, and neurocognitive function in ART-naïve adults with HIV in sub-Saharan Africa, exploring the distinct roles of these neurotrophic factors in cognitive health. This cross-sectional analysis utilized stored baseline serum samples and neuropsychological test data from participants in the AIDS Clinical Trials Group (ACTG) A5199 study in the Johannesburg and Harare sites. Serum concentrations of mBDNF and proBDNF were quantified using ELISA. Neurocognitive function was assessed via standardized tests, with results adjusted for site-specific demographics. Linear and quantile regression models examined the relationship of mBDNF and proBDNF with a composite cognitive score (NPZ-6), and structural equation modeling (SEM) explored their association with individual cognitive test outcomes. The analysis involved 157 ART-naïve adults with HIV. Increased serum mBDNF levels showed a significant positive association with cognitive performance (β = 1.30, p = 0.02), while elevated proBDNF levels were linked to poorer outcomes, particularly affecting fine motor skills and speed (β = - 0.29 to - 0.38, p ≤ 0.01). Quantile regression analysis highlighted mBDNF's stronger positive impact at higher cognitive performance percentiles (β = 1.04 (0.01, 2.06) at the 75th percentile), while proBDNF showed significant negative association at the 75th percentile (β = - 0.26 (- 0.47, - 0.06)). The study highlights the positive association of mature BDNF and the negative association of proBDNF with cognitive function in HIV. These findings emphasize the need for longitudinal research to understand the temporal dynamics of neurotrophic factors during ART initiation and their potential as targets for neurocognitive interventions in HIV.

Exploring Global Arts Movements and Their Impact on Health Education

This review investigates the intersection between global art movements and health education, exploring how art can play a transformative role in promoting health awareness and education, particularly in under-resourced communities. Drawing on philosophical theories of creativity, behavior change, and real-world case studies, this research highlights how arts initiatives have contributed to public health awareness and education. The paper addresses the integration of arts in health education, the challenges faced, and the opportunities for creating a more holistic approach to health promotion. The review concludes by emphasizing the importance of cross-disciplinary partnerships to further integrate arts into health education for a more profound global impact. Keywords: Global arts movements, Health education, Public health, Arts initiatives, Social change.

The Role of Art in Addressing Health Inequities

This paper examines the intersection of art and public health, focusing on the role of art in addressing health inequities driven by social determinants of health. Health disparities—disproportionate health outcomes influenced by socioeconomic, racial, geographic, and other systemic factors—are pervasive in many communities. Art, as both a therapeutic tool and a platform for social critique, holds unique potential to bridge these gaps. Through case studies of art initiatives, this paper investigates how collaborative art projects can foster community engagement, raise awareness, and influence policy changes to promote health equity. The paper also examines the challenges faced by art-health initiatives, offering practical strategies to overcome them. Ultimately, the integration of art into health interventions can foster emotional connections and inspire collective action toward more equitable health outcomes. Keywords: Health inequities, social determinants of health, art as social critique, public health, community.

The Role of Youth Groups in Community Peace Building: Case of Amani Kibra and Kibera Hamlets in Kibra Informal Settlements, Kenya

Purpose: The purpose of this study was to explore the role of youth groups in community peacebuilding, focusing on the Amani Kibera and Kibera Hamlets groups within Kibra's informal settlements in Kenya. Methodology: Anchored on Paul Lederach’s Conflict Transformation Framework, the study employed a mixed-methods approach, involving 40 respondents from Kibera Hamlets and 35 from Amani Kibera, selected through purposive and cluster sampling. Data collection included in-depth interviews, focus group discussions (FGDs), and structured questionnaires. Qualitative data were thematically analyzed, while quantitative data were processed using SPSS Version 28. Findings: Findings indicate that youth groups primarily focus on "Mentoring and Empowerment" (27.8%) and "Arts and Creative Expression" (26.9%), but encounter challenges such as resource limitations and socio-political instability, leading to ineffective support from religious institutions, government agencies, and NGOs. The study concludes that youth groups are essential for addressing community challenges and recommends expanding arts initiatives, improving resources, and using online platforms to enhance peacebuilding in Kibera. Unique Contribution to Theory, Policy and Practice: This study uniquely contributes to theory, policy, and practice in informal settlements by offering actionable, context-specific recommendations grounded in empirical evidence. It provides valuable insights into how innovative collaboration fosters trust and social capital, serving as an important resource for policymakers.

Early inflammation as a footprint of increased mortality risk in infants living with HIV from three African countries

In this work our aim was to identify early biomarkers in plasma samples associated with mortality in children with perinatal HIV treated early in life, to potentially inform early intervention targeting this vulnerable group. 20/215 children (9.3%) with perinatal HIV, enrolled within 3 months of age died prematurely within the first year of the study, despite early ART initiation. Using a propensity score, we selected 40 alive study participants having similar clinical and virological records compared to the deceased group. 13 HIV unexposed (HU) healthy children were additionally used as controls. Baseline plasma samples were analyzed using a targeted proteomic approach, and to assess pathogen-associated and damage-associated molecular patterns (PAMPs, DAMPs) levels. Data from deceased participants were compared to both control groups, with multivariate logistic regression models used to evaluate the association between mortality and plasma proteins. We developed a machine learning model to predict mortality risk, finding that IL-6 and CXCL11 not only were higher in deceased children than Matched-children with HIV (p < 0.001 and p = 0.0034) but also predictive of mortality (accuracy of 77%); levels of PAMPs were higher in deceased children (p = 0.0016). Thus, measuring early inflammatory biomarkers, particularly IL-6, could help mortality risk prediction and potentially guide targeted interventions.

Art and Science of Reinforcing Ceramics with Graphene via Ultrasonication Mixing.

This work presents an interdisciplinary approach combining materials science, ultrasonication, artistic expression, and curatorial practice to develop and investigate novel composites. The focus of the approach is incorporating graphene oxide (GO) into kaolin and exploring its effects on material properties. The composites were prepared with varying GO concentrations and sonication times, and their mechanical, thermal, and morphological characteristics were evaluated. The results reveal that the addition of 0.5 wt % GO, combined with a sonication time of 10 min, leads to the highest storage modulus and improved thermal stability. Ultrasonication proved to be an effective method for dispersing and distributing GO particles within the kaolin matrix, resulting in an enhanced material performance. Furthermore, the application of novel composites provided by Prvački adds a unique dimension to the study. Through the artistic interpretation, the tactile qualities and aesthetic potential of the composites are explored, shedding light on the transformative power of materials and cultural significance organized as part of an artist-in-residence commission, introduced in conjunction with the NUS Public Art Initiative. This interdisciplinary collaboration accompanied by an exhibition at the NUS Museum demonstrates the value of merging scientific research, technological advancements, and artistic exploration.

Experiences and challenges of nurses in initiating antiretroviral drugs among adolescents living with HIV and AIDS in Thaba-Tseka, Lesotho

Background: Lesotho has the second-highest HIV and AIDS prevalence globally and is the country’s second leading cause of death. Despite increasing ART coverage, adolescents remain left behind and face high mortality because of delayed ART initiation. This study aimed to explore the experiences and challenges of nurses when initiating adolescents living with HIV on ART in Thaba-Tseka, Lesotho. Methods: A qualitative descriptive research design and twelve in-depth interviews were conducted among nurses from a hospital in the Thaba-Tseka district. Participants were selected purposively until data saturation was reached. Data were transcribed verbatim and analysed manually using the thematic analysis approach. The findings were presented in themes and sub-themes. Individual face-to-face interviews were conducted in English and Sesotho from May to August 2021. Results: The key findings in this study involved adolescents’ attendance at the health care facility, ART initiation process, HIV stigma influencing the uptake of ART, poor ART follow-up and socio-economic factors affecting adherence to ART. Conclusion: The themes uncovered in this study provide valuable insights into the gaps in ART initiation, and highlight the challenges encountered by nurses during this process among adolescents in Lesotho. The experiences and obstacles shared by nurses during ART initiation cover a range of issues, collectively demonstrating their engagement in HIV and ART care. These findings emphasise the critical role of policymakers and health care providers in devising customised ART initiation interventions for adolescents. Addressing these challenges will be crucial for enhancing ART uptake and adherence among adolescents living with HIV in Lesotho.

Antiretroviral Therapy with Ritonavir-Boosted Atazanavir- and Lopinavir-Containing Regimens Correlates with Diminished HIV-1 Neutralization.

The impact of virion maturation on neutralizing antibody responses in HIV treatment is not fully understood. This study examines whether antiretroviral regimens (ART) with boosted protease inhibitors (b-PI), which increase exposure to immature virions, affect neutralization capacity compared to Non-b-PI regimens. Neutralization activity was assessed in 45 HIV-infected individuals on b-PI regimens and 56 on Non-b-PI regimens, adjusting for factors like infection duration, ART initiation, and immune markers. Individuals on b-PI regimens had significantly lower neutralization scores [mean: 6.1, 95% Confidence Interval (CI): 5.3-6.9] than those on Non-b-PI regimens (mean: 8.9, 95% CI: 8.0-9.9; p < 0.0001). This difference was not explained by infection duration or CD4+ counts. CD4+/CD8+ ratios were positively associated with neutralization, while b-PI use was negatively associated. A regression model indicated that b-PI use significantly predicted lower neutralization scores (beta = -0.30, p = 0.049). These findings suggest that exposure to immature virions via b-PI use reduces neutralizing antibody responses, highlighting the importance of virion maturation in antibody induction. ART regimens promoting exposure to mature virions may enhance neutralization, with potential implications for HIV vaccine design. Further research is needed to explore implications for HIV vaccine design, especially using virus-like particles.

Sub- and supratherapeutic efavirenz plasma concentrations with risk for HIV therapy failure are mainly genetically explained in Ugandan children: The prospective GENEFA cohort study.

Interindividual variations in efavirenz (EFV) plasma concentrations are extensive, but paediatric data on its consequences for viral control are scarce. The aim of this study was to explore the role of genetic variation in achieving therapeutic efavirenz plasma concentrations in a cohort of Ugandan children and the linkage between genetic CYP2B6 variants, EFV plasma variability, viral resistance and viral outcome. Ninety-nine treatment-naïve children, aged 3-12 years and living with HIV, were followed for 24 weeks after ART initiation assessing mid-dose efavirenz plasma concentrations, HIV RNA, HIV drug resistance and adherence. Polymorphisms in genes coding for drug-metabolizing enzymes were genotyped. Efavirenz concentrations were determined by liquid chromatography coupled with high-resolution tandem mass spectrometry. Metabolizer phenotype was predicted from composite genotypes of CYP2B6 (c.516G>T and c.983 T>C). A mixed effects restricted maximum likelihood regression model was used to identify important factors for efavirenz exposure. Efavirenz plasma concentrations were below the therapeutic interval (1000-4000 mg/mL) in 12-17% and above in 21-24% of measurements. Eight children had persisting subtherapeutic concentrations, five of which failed virologically and three acquired at least one new resistant mutation. Multivariate modelling explained 70% of interindividual variation in plasma concentration, with treatment duration, adherence, CYP2B6c.136A>G, and metabolizer phenotype as independent predictors of EFV concentration. In univariate analysis, metabolizer phenotype explained 50% of interindividual variation. Metabolizer phenotype explained 50% of interindividual variation in efavirenz plasma concentration. Autoinduction was not confirmed and >33% of the concentrations were outside the therapeutic interval. Subtherapeutic concentrations worsened virological resistance and outcomes. Genotype-based dosing may help avert both sub- and supratherapeutic efavirenz plasma concentrations in Ugandan children.

Changes in early HIV/AIDS mortality rates in people initiating antiretroviral treatment between 2013 and 2023: A 10-year multicenter survival study in Senegal

BackgroundHIV/AIDS-related early mortality has long been a significant challenge. Subsequent to recent policy changes and treatment advancements, we aimed to assess changes in early mortality rates in 2017–19 and 2020-23 compared to 2013–16. MethodsThis is a 10-year multicenter survival study in people living with human immunodeficiency virus having initiated ART between 2013 and 2023. We used frailty-based competing risk models to estimate adjusted early (6-month and one-year) mortality hazard ratios (HRs) in people living with HIV (PwHIV) having initiated ART in 2013–16 (comparator), 2017–19, and 2020–23. ResultsWe enrolled 4006 persons of whom 2281 (56.9 %) were female; median age was 40 years (IQR: 31–50); 635 (15.9 %) were at WHO clinical stage IV and 934 (23.3 %) had a CD4 count <200 cells/mm3. Median follow-up was 80.4 months (IQR: 48.6–106.7). All in all, 463 participants died (4.37 deaths per 100 person-years), including 296 at one year of follow-up (7.4 % [95 % CI: 6.6–8.2]). ART initiation in 2016–19 and 2020–23 was associated with 27 % (adjusted HR [aHR]: 0.73; 95 % CI: 0.55–0.98) and 63 % (aHR: 0.37; 95 % CI: 0.25–0.56) reductions in one-year mortality rates, respectively, compared to the 2013–16 period. ConclusionEarly mortality risk has significantly decreased over time in Senegal. However, the proportion of PwHIV with AIDS-defining conditions remains concerning. Continued efforts to ensure early diagnosis and prompt linkage to care are needed for more impact.

Contemporary Art in Public Spaces: Forms of Expression, Social Significance, and Revitalization

Introduction: This study examines the significance of contemporary art in public spaces, with a specific emphasis on its various manifestations, societal functions, and capacity to revitalize urban environments. It emphasizes the ways in which art enhances aesthetic enjoyment, enhances the overall quality of life, and contributes to economic growth. Methodology: A qualitative study examines the use of sculptures, installations, murals, performances, and digital artworks in urban settings. Illustrative instances of effective art initiatives demonstrate the positive impact of these interventions on public spaces. When considering a project, we carefully evaluate factors such as accessibility, interactivity, the differentiation between temporary and permanent installations, and the influence on community relations. Results: The study finds that contemporary art in public spaces expands cultural access, strengthens social bonds, and raises societal awareness. Interactive and temporary artworks particularly influence the use and perception of these spaces, promoting community identification with the environment. Discussions: Art projects like New York City's High Line and Copenhagen's Superkilen show how aesthetic improvements and cultural activities attract residents and tourists, driving economic benefits. Temporary installations and pop-up art actions offer dynamic experiences that continually draw visitors, aiding economic revitalization. Conclusions: Integrating contemporary art into urban development improves public spaces by fostering cultural experiences and contributing to social and economic growth. Cities should actively support such projects to enhance community sense and urban quality of life.

Exploring the Role of Art in Community Health Initiatives

This review investigates the intersection of art and community health initiatives, focusing on how art can serve as a tool for health promotion, disease prevention, and rehabilitation. It examines the historical and cultural significance of art in health practices, drawing on both active participatory and passive art experiences. By investigating the biopsychosocial model, the paper highlights how art contributes to individual and collective well-being, reducing stress, fostering social cohesion, and improving mental and physical health. Through case studies and evidence-based research, the paper argues that art plays a crucial role in community health strategies, advocating for greater integration of art into public health policy. Recommendations are offered for expanding interdisciplinary collaborations, increasing funding for arts-based health interventions, and exploring digital opportunities for art in healthcare. Keywords: Art in health, community health initiatives, public health, mental well-being, biopsychosocial model.

Timing of ART initiation associated with HIV-associated stroke.

Timing of ART initiation associated with HIV-associated stroke.

The risk of non-AIDS defining events is lower in ART-naive HIV controllers than in normal progressors on suppressive ART.

We aimed to compare the non-AIDS events (nADE) risk between normal progressors using ART (NP-ART) and people with HIV (PWH) that naturally control HIV infection (HIV controllers), as well as the outcomes after ART in HIV controllers on nADE. The primary endpoint was major nADE defined as the composite of cardiovascular disease, non-AIDS malignancy or all-cause mortality, whichever came first.. The role of ART in HIV controllers was assessed as a time-varying covariate. We included 1007 ART-naive HIV controllers (of which 60 elite controllers), 1510 Early-ART (<6 months after negative HIV test) and 15437 NP-ART (reference group), contributing 3813, 11,060 and 160,050 years of follow-up, respectively. HIV controllers had lower risk of the primary endpoint (HR 0.55, 95%CI 0.38-0.81, P = 0.0023), all-cause mortality (Adjusted Hazard ratio [aHR]: 0.45, 95% confidence interval [CI] 0.25-0.79, P = 0.0054), cardiovascular disease (aHR 0.47, 95%CI 0.22-0.99, P = 0.046) , but not non-AIDS malignancy (aHR 0.74, 95%CI 0.41-1.35, P = 0.33) than NP-ART. Among HIV controllers, each log10 lower baseline viral load further decreased the risk of nADE (aHR 0.54, 95% CI 0.29-0.99, P = 0.045). ART in HIV controllers did not reduce the risk of any nADE (aHR 1.22, 95% CI 0.66-2.29, P = 0.53). We found a lower risk of nADE in HIV controllers than NP-ART, especially in those with low plasma viral loads. Initiation of ART did not alter the nADE risk in HIV controllers. Our findings help clinicians to decide on prescribing ART in HIV controllers.

Randomized Controlled Trial of 60 minutes for Health With Rapid Antiretroviral Therapy to Reengage Persons With HIV Who Are Out of Care.

Many persons with HIV remain out of care (PWH-OOC). We evaluated InstaCare, a complex intervention integrating the brief behavioral intervention 60 minutes for Health with the rapid restart of antiretroviral therapy (rapid ART). Prospective open-label randomized controlled trial among PWH-OOC in San Diego, USA. PWH-OOC were randomized 1:1 to InstaCare or a time-and-attention control integrating a diet-and-nutrition behavioral intervention also with rapid ART initiation (restart ≤7 days from enrollment). All participants had access to support services (free transport, HIV peer navigation, adherence counseling, and linkage to care) and primary care services (mental health, case management, social work, medication-assisted treatment, and specialist pharmacy). The primary outcomes were viral suppression (<50 copies/mL) and re-engagement with care (≥2 HIV care visits >90 days apart) by 24 weeks. Outcomes were reported on an intention-to-treat basis. Between November 2020 and August 2022, 52 PWH-OOC were enrolled. Baseline substance use in the preceding month (49%), unstable housing (51%), moderate/severe depression (49%), and moderate/severe anxiety (41.7%) were prevalent. Rapid ART was provided for all participants. At week 24, the proportion with HIV viral load <50 copies/mL was 37.3% (19/51) (InstaCare 28.0%, control 46.2%, P = 0.25). Fourteen (27.5%) were engaged with care (InstaCare 7/25 [28.0%], control 7/26 [26.9%], P = 1.00). Most participants (94%) reported low or very low emotional distress associated with rapid ART. Study lost to follow-up by week 24 was high (23/51, 45%). The InstaCare complex intervention did not improve viral suppression or reengagement with care among PWH-OOC. Investigation of high-intensity, individually adapted interventions is needed among PWH-OOC.

Impact of enhanced adherence counselling on viral re-suppression among adolescents and young persons with persistent viremia.

Kenya ART guidelines recommend three sessions of enhanced adherence counselling (EAC) following detectable viral load. The objective of this study was to assess completion of EAC sessions and factors associated with viral re-suppression amongst adolescents and young persons (AYPs) with persistent viremia in Western Kenya. A retrospective analysis of routinely collected data abstracted from viral load registers was done. AYP with persistent viremia (consecutive viral load ≥1000 copies/ml) between October 2017 to September 2019 were followed for 12 months; those with more than one follow-up viral load results were analyzed. EAC was satisfactory if at least three sessions attended, barriers identified and addressed. Morisky scores 0 and at least 1 indicated optimal and sub-optimal adherence, respectively. Logistic regression models were used to assess predictors of viral load suppression (VLS). Of 124 AYPs with persistent viremia, 118 (95.2%) had documented follow-up viral load results and 119 (96%) completed three EAC sessions. Overall, 55 (47%) clients re-suppressed during the study period. AYPs who had satisfactory EAC sessions had higher odds of achieving VLS [odds ratio (OR) = 3.7, 95% confidence interval (CI): 1.6-8.1]. Similarly, AYPs with an optimal adherence had eight times (OR = 8.1, 95% CI: 3.5-18.5) higher odds of achieving VLS, and those who were suppressed at 6 months post-ART initiation had higher odds of achieving VLS at 12-months (OR = 2.5, 95% CI: 1.1-5.8). Satisfactory EAC sessions and optimal ART adherence was strongly associated with viral re-suppression among AYPs with persistent viremia. Continued support to EAC intervention is critical to improve treatment outcome among AYP living with HIV.

Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study.

Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy. An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906. We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high. BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented.

Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe

BackgroundMonitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression. MethodsThis was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods. ResultsPoor level of agreement was found between PC records and DBS tenofovir concentrations (k = −0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 – 16.5, p < 0.0001). ConclusionsSelf-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression. Trial identificationParticipants in the present study were a subset of those in the PESU intervention ClinicalTrials.gov Identifier: NCT02833441

Has COVID-19 Changed the Incidence and Profile of Late Presenters for HIV Infection in Lodz, Polish Reference Centre, Poland?

Objectives: The aim of this study was to compare the prevalence and characteristics of HIV late presenters (LPs) and advanced LPs (aLPs) registered in the Lodz HIV centre during the COVID-19 pandemic (2020-2021) with those of the pre-pandemic period (2017-2019). Methods: A retrospective analysis was performed of the predictive factors associated with HIV LPs and aLPs based on multivariable logistic regression. The patient entry into specialist HIV care after diagnosis during the pandemic was analysed. Results: Of 121 newly diagnosed HIV infections during the pandemic, 49.6% had late presentation and 36.4% had advanced HIV disease (AHD). In the pre-pandemic period, out of 154 newly diagnosed patients, 58.4% were LPs and 38.3% were aLPs. Independent risk factors for HIV late presentation were older age (OR: 1.04, 95% CI: 1.01-1.076; p = 0.008), diagnosis in hospital (OR: 5.63, 95% CI: 2.87-11.05; p < 0.001) and negative VDRL as compared to positive VDRL (OR: 2.48, 95% CI: 1.19-5.15; p = 0.015). The same predictive factors were associated with aLPs: older age (OR: 1.07, 95% Cl 1.04-1.11; p < 0.001), HIV diagnosis in hospital (OR: 4.25, 95% CI 2.17-8.29; p < 0.001) and negative VDRL as compared to positive VDRL (OR: 4.95, 95% CI 1.87-13.10; p = 0.001). HIV diagnosis during the pandemic was not a risk factor for late presentation nor for advanced late presentation. However, the time between HIV diagnosis and the first visit to an HIV centre was statistically lower in the pre-pandemic period (p = 0.0048); the median lengths of time between the date of HIV testing, the first visit to the centre and the initiation of ART did not differ between these two periods in LPs and aLPs (p > 0.05). Conclusions: The COVID-19 pandemic did not change the prevalence or characteristics of late presentation and aLPs among newly diagnosed patients, nor did it extend the time to enrolment in HIV care or ART introduction in these groups.

Investigating the Determinants of Mortality before CD4 Count Recovery in a Cohort of Patients Initiated on Antiretroviral Therapy in South Africa Using a Fine and Gray Competing Risks Model.

CD4 count recovery is the main goal for an HIV patient who initiated ART. Early ART initiation in HIV patients can help restore immune function more effectively, even when they have reached an advanced stage. Some patients may respond positively to ART and attain CD4 count recovery. Meanwhile, other patients failing to recover their CD4 count due to non-adherence, treatment resistance and virological failure might lead to HIV-related complications and death. The purpose of this study was to find the determinants of death in patients who failed to recover their CD4 count after initiating antiretroviral therapy. The data used in this study was obtained from KwaZulu-Natal, South Africa, where 2528 HIV-infected patients with a baseline CD4 count of <200 cells/mm3 were initiated on ART. We used a Fine-Gray sub-distribution hazard and cumulative incidence function to estimate potential confounding factors of death, where CD4 count recovery was a competing event for failure due to death. Patients who had no tuberculosis were 1.33 times at risk of dying before attaining CD4 count recovery [aSHR 1.33; 95% CI (0.96-1.85)] compared to those who had tuberculosis. Rural patients had a higher risk of not recovering and leading to death [aSHR 1.97; 95% CI (1.57-2.47)] than those from urban areas. The patient's tuberculosis status, viral load, regimen, baseline CD4 count, and location were significant contributors to death before CD4 count recovery. Intervention programs targeting HIV testing in rural areas for early ART initiation and promoting treatment adherence are recommended.