ARV Clinic Research Articles

Knowledge, attitude and practices on rabies prevention among the patient attending the antirabies vaccination clinics (ARV) in tertiary health care centre in central India

: We conducted KAP studies on Rabies Prevention among Patient attending ARV clinic of tertiary health care centre in central India. There is a paucity of published literature describing the public’s knowledge, attitude and practices of rabies prevention in central India, information that is critical to developing effective interventions and government policies. Hence the present study was conducted among 135 study participant who are attending ARV clinics of tertiary health care centre in central India. To assess the knowledge, attitude and practices on rabies prevention among the patient attending the ARV clinics. To assess the Proportion of animal exposure in the study area and to find out the association of socio-demographic factors with knowledge, attitude and practices (KAP) related to rabies. A cross-sectional study was conducted on 135 eligible participants in rabies vaccination clinics (ARV). We performed a face-to-face interview to investigate the rabies KAP of these participants using a self-designed questionnaire consulted with experts was done. Study was conducted from January to March 2022 by using consecutive sampling till the sample size was achieved. Factors associated with the KAP were evaluated using logistic regression models, 48.14 % participant aware regarding rabies disease, Younger age, and graduate and above had higher score compared to old age and less than high school, Participants who were younger (p < 0.000), who received better education (p < 0.000), and who reported good economic status (p = 0.05) were more likely to have higher scores of attitudes, participant who had older age (p<0.007).who had less education (p<0.00),who had poor socio-economic status (p<0.00) had lower score.: Lack of knowledge and attitude is suboptimal in study participant however practice regarding rabies vaccination is good in male and younger population.

Patient-centred care: reality or rhetoric—patients’ experiences at ARV clinics located in public hospitals in KwaZulu-Natal, South Africa

BackgroundThe South African public antiretroviral therapy (ART) programme is considered one of the largest and most successful ART programmes worldwide. Hence, a study exploring the patients’ experiences of the public antiretroviral therapy (ART) programme in the second decade of the programme is relevant as no study has been published on patients’ experiences at these sites.ObjectivesTo explore patients’ experiences of care in the public ART programme at four ARV clinics within the eThekwini District, KwaZulu-Natal.MethodA mixed-methods study design with 12 in-depth patient interviews, non-participatory observation, and a stratified random sample of 400 patients completed questionnaires. Qualitative data were thematically analysed. Quantitative data were analysed using a SPSS 24 package to determine frequencies and differences in patients’ responses (p < 0.05). The socio-ecological model framed the study.ResultsAll 412 patients reported valuing the provision of free ARVs. Patients’ positive experiences included: routine blood results mostly being available, most staff greeted patients, there were sufficient nurses, patients were satisfied with the time that they spent with doctors, clean clinics, and private and safe counselling areas. The negative experiences included: poor relationships with nurses, negative staff attitudes, disrespectful staff, information was lacking, inadequate counselling at times, varying and inflexible appointments, challenges with data capture and registration systems; varying ARV collection frequencies, routine health tests and processes per site, and the absence of patient committees and representatives.ConclusionThe results reflected positive and negative experiences which varied between the facilities, as processes and systems differed at each site. Innovative patient-centred processes and programmes could be implemented to ensure patients have mostly positive experiences. As part of continuous improvement, patients’ experiences should be regularly explored to ensure that the ART programme meets their needs and expectations.

Viral suppression among patients on antiretroviral therapy and the influence of demographic variables: Clinical evidence from a Nigerian tertiary hospital

Background: Antiretroviral therapy is aimed at suppressing viral replication to undetectable level in the blood. This helps to slow down disease progression, reduce incidence of opportunistic infections, lower the risk of transmission and improve quality of life of patients. Viral suppression is increasingly becoming a clinical challenge as evidence of non-suppression is becoming more common among patients on HAART. Objective: This study aims to determine the rate and factors associated with viral suppression among adult HIV/AIDS patients on highly active antiretroviral therapy Methods: This was a retrospective study involving 405 patients on four different HAART regimens. The study was carried out between 2016 and 2018 in ARV clinic of a tertiary care hospital using data obtained from medical records of patients. The primary outcome measure of viral load suppression is defined as &lt;1000 copies/ml. Analysis was carried out using descriptive and inferential statistics. P value &lt; 0.05 was considered significant Results: The proportion of patients who achieved viral suppression was 74.2% which is lower than 95% global target. The result showed no significant differences in the rate of viral suppression between the four HAART regimens in this study. There was also no significant association between demographic factors and viral suppression. Conclusion: The rate of viral suppression in this study was lower than the UNAIDS target of 95%. This finding makes a case for greater improvement and strengthening of existing programme interventions aimed at promoting long term suppression of viral replication.

Prevalence of diabetes mellitus and hypertension amongst the HIV-positive population at a district hospital in eThekwini, South Africa.

BackgroundLife expectancies of HIV-positive patients have been increasing with the rapid implementation of antiretroviral therapy (ART). This has led to an increase in comorbidities such as diabetes mellitus (DM) and hypertension (HT) amongst the HIV population. The burden of the non-communicable diseases (NCDs) such as DM and HT need to be quantified in order to ensure that patients receive optimal integrated care as patients often access care at different clinics compromising holistic care.AimThe aim of the study was to determine the prevalence of DM and HT amongst the HIV-positive population.SettingThe study was conducted at Wentworth Hospital, a district facility in South Durban, KwaZulu-Natal.MethodsThis cross-sectional study was undertaken to determine the prevalence of two NCDs, namely DM and HT in HIV-positive patients attending the ART clinic at a district hospital in the eThekwini district. We compared the socio-demographic and clinical profiles of those with and without comorbidities. A sample of 301 HIV-positive patients were administered a structured questionnaire.ResultsOf the 301 patients, 230 (76.41%) had HIV only (95% confidence interval [CI]: 71.25–80.89) and 71 (23.59%) had HIV and at least one comorbidity, namely DM and/or HT (95% CI: 19.11-28.75). Hypertension was the most prevalent comorbidity. This study revealed that there was no association between the duration of ART and comorbidities. Older age and body mass index (BMI) were associated with comorbidities, whilst gender and ethnicity were not associated.ConclusionNon-communicable diseases such as DM and HT do pose a burden for HIV-positive patients attending the ARV clinic at this district facility. This study highlights the definite need to plan for the increased burden of NCDs as HIV-positive patients live longer and gain weight.

Assessment of knowledge, attitude and practice of rabies prophylaxis among medical officers of anti-rabies vaccination clinics of Municipal Corporation of Greater Mumbai

Background: We conducted the present study to assess the knowledge, attitude and practice of rabies prophylaxis among medical officers of anti-rabies vaccination clinics of Municipal Corporation of Greater Mumbai (MCGM).Methods: We conducted a cross sectional study in 30 ARV clinics of MCGM. We collected data using pretested, structured, self-administered questionnaire and a facility survey check list. Questionnaire included questions pertaining to epidemiology of animal bite, biologicals supplied, protocols and guidelines for rabies prophylaxis, dosage and route of administration of ARV and training status. We analysed data using Microsoft Excel, 2007. Spearman’s rank correlation and Friedman test was used to examine the relationship between knowledge, attitude, and practice. The results were presented in the form of rates and ratios appropriately and p≤0.05 was considered statistically significant.Results: Mean knowledge, attitude and practice score of the study participants was 74.6%, 68.7% and 41% respectively. The difference between knowledge, attitude and practice was statistically significant (p&lt;0.01). Knowledge poorly correlated with attitude (r=0.18) and practice (r=0.13).Conclusions: In Mumbai ARV clinics are uniformly spread in the community. All the clinics are well equipped and staffed. There was no shortage of vaccine in any centre. Counselling of patients was done in all ARV clinics however there was lack of patient education materials. Knowledge of medical officers in respect of dose, route of administration, site of vaccination and schedule of vaccination of anti-rabies vaccine was good. The knowledge of immunoglobulins was poor. Knowledge poorly correlated with attitude and practice.

Menopause Symptom Experience and Perceived Well-Being Among HIV Positive and Negative Older Women in Ibadan, Nigeria

Globally, people are living longer with the Human Immunodeficiency Virus (HIV) and older individuals are becoming infected. Menopause symptoms affect women’s health and are associated with perceived declines in wellbeing. This study assessed and compared the menopause symptom experience and perceived wellbeing among HIV positive and negative older women in Ibadan Nigeria Focus group discussions were conducted among menopausal women attending the ARV and GOP clinics at the University College Hospital Ibadan. Opinions of discussants on knowledge and experience of menopausal symptoms, perceptions about the menopause and perceived health status were explored. A total of 90 HIV positive and 92 HIV negative women aged between 40 to 60 years were sampled. Knowledge of the cause of menopause was poor, with more HIV positive women opining that sexual promiscuity causes menopause. The majority of the discussants had adequate knowledge of menopausal symptoms with most of them reporting vasomotor and musculoskeletal symptoms. In both groups, perceptions about the menopause were generally positive as most of them opined that the menopause means freedom from sexual activity and child birth. More HIV negative women perceived themselves to be in good health compared to HIV positive women. Menopause induces many of the same metabolic changes that are being observed with HIV infection, and this may affect the health and quality of life of aging women with HIV infection. There’s a need for health education and health promoting interventions that will help these women in coping with the double burden of HIV infection and menopause.

\u201cKnowledge and practices of HIV infected patients regarding medicine disposal among patients attending public ARV clinics in KwaZulu Natal, South Africa\u201d

BackgroundRecent analysis of drinking water in South Africa found the presence of ARVs, other pharmaceutical and personal care products. The environmental and human health risk that this presents is daunting. The increased use of ARVs with poor disposal practices could be the reason for these substances being present in drinking water. Therefore, this study aimed to determine the knowledge and practices of HIV infected patients, regarding medicine disposal.MethodA descriptive, cross sectional, quantitative study that utilised a structured, self-administered, questionnaire was undertaken at 3 different public ARV clinics in the eThekwini Metro of KwaZulu Natal, SA. The variables included questions on demographics, knowledge and practices of medicine disposal of ARV and other medications. Data was captured using excel spreadsheets and analysed using SPSS version 25. Chi square tests were used to compare factors between correct and incorrect knowledge and practice groups.ResultsFour hundred and eighty four participants agreed to participate in this study, of which the majority (71.1%) were females. Over 87% of the participants knew that improper disposal of medicines were harmful to the environment with only 28.3% knowing that there were laws governing the way medicines should be disposed. Majority of participants that had unused and expired ARVs at home disposed of these medicines. The most common route of medicine disposal for ARVs was by throwing these medicines into the bin (56.4%). Only 24.2% of participants were informed by healthcare professionals about the proper method of medicine disposal. Participants who had secondary and tertiary level of education (p = 0.043) and the ability to speak English (p = 0.001) had appropriate knowledge on medicine disposal.ConclusionThis study identified that poor medicine disposal practices and lack of adequate information about the proper methods of medicine disposal were evident among the participant population. There is a need for patient education and healthcare professional intervention to ensure patients are aware of standard proper medicine disposal practices.

Patterns of detectable viral load in a cohort of HIV-positive adolescents on antiretroviral therapy in South Africa.

IntroductionDespite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load (VL) in a cohort of adolescents attending an ARV clinic in Cape Town, South Africa.MethodsWe conducted a retrospective cohort study of all patients on antiretroviral therapy aged 10 to 19 years.Participants were included if they underwent at least two VL measurements and remained in care at the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016.The primary outcome was two consecutive HIV VL >100 copies/mL, in line with the lower limit of detection of assays in use over the follow‐up period.Results and discussionOf the 482 screened participants, 327 met inclusion criteria. Most participants had perinatally acquired HIV (n = 314; 96%), and 170 (52%) were males. Overall, there were 203 episodes of confirmed detectable VL involving 159 (49% (95% CI 43% to 54%)) participants during the follow‐up period. Six participants had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens.Total follow‐up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 participants who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow‐up time, and 42% of the follow‐up time contributed by those who experienced detectable VL.The rate of detectable VL was 11.8 (95% CI 10.3 to 13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (Relative Risk 1.24 (95% CI 1.17 to 1.31); p < 0.0001).There was no sex difference with respect to duration (p = 0.4), prevalence (p = 0.46) and rate (p = 0.608) of detectable VL.ConclusionsClinicians need to be alert to the high prevalence of detectable VL during adolescence so as to pre‐empt it and act swiftly once it is diagnosed. This study helps to highlight the risk of detectable VL that is associated with increase in age as well the high proportion of time that poorly adherent adolescents spend in this state.

HIV Disclosure in Children in a Tertiary Hospital in Southern Nigeria–Child’s Perspective

Background: Disclosure of HIV status to children is essential for disease management. Studies on disclosure in children have largely described it from the health provider’s perspective or caregiver’s perspective. Caregivers’ and children’s reports about children’s feelings and distress can however differ. Understanding the disclosure process from the perspective of HIV-positive children will therefore better portray the impact it had on them.&#x0D; Aim: The aim of the study was to explore from the child’s perspective the process of disclosure, the impact it had on them, how they have coped and suggestions on how they think it could be done better.&#x0D; Methods: A cross-sectional study of HIV-infected children and adolescents aged 8–18 years who are aware of their status attending paediatric HIV clinic at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria from April 2015 to March 2016. Data were collected using an open-ended questionnaire administered by a Paediatric health care provider. Information sought included: Biodata (age, gender), educational levels of the child, family characteristics (primary caregiver, orphan status), age at disclosure, process of disclosure, the impact of the disclosure, how they have coped, what they did not like about the way they were told and suggested better ways of telling the children.&#x0D; Results: Seventy-eight HIV-positive children and adolescents were interviewed. Their ages ranged from 8 – 18 yrs with a mean age of 14.74±2.23 years. Forty (51.3%) were males, 50 (64.1%) were in secondary schools, 43 (55.1%) were orphans and the mode of transmission was vertical in 70 (89.7%). In majority 33 (42.3%), the biologic mother was the primary caregiver. Majority of the children 34 (43.6%) had their status disclosed to them between 13 and 14 years. The mother alone did the disclosure in 30 (38.5%). Thirty-six (46.2%) were already aware of their status before disclosure. Disclosure was a one-off event without discussions in 48 (61.5%). The commonest immediate reactions was depression 48 (61.5%). The majority 48(61.5%) became more prayerful as a coping strategy. All 78 (100%) agreed that disclosure has positively impacted on their taking their ARV drugs and clinic attendance.&#x0D; Concerning suggestions from the children, 36 (46.2%) said the most appropriate age for disclosure should be 12-13 years, 54 (69.2%) suggest that both parents should do the disclosure while 60 (76.9%) said that the children should be told how they got infected. Their major concern was having to take drugs for life 60 (76.9%).&#x0D; Conclusion: Disclosure process is suboptimal. Understanding the disclosure process from the perspective of HIV-infected children, therefore, is critical to developing interventions to improve disclosure. Most of the parent’s fears of negative impact of status disclosure may be exaggerated. There is need for health care providers to develop a plan with the caregivers of HIV-infected children on the optimal disclosure process and how to anticipate and resolve questions the children may have following disclosure.

Examining the effect of peer-support on self-stigma among persons living with HIV/AIDS.

IntroductionContrary to assertions that stigma may no longer be experienced due to substantial advancement in antiretroviral access and treatment, self-stigma still exists among people living with HIV/AIDS (PLWHA) in Nigeria. The use of peer health workers to improve care in underserviced settings has been implemented by a number of programs, but its effect has not been extensively assessed. This study compared the level of self-stigma among PLWHA in peer support and non-support groups in Enugu State Nigeria.MethodsA cross-sectional study using quantitative and qualitative instruments was conducted among PLWHA attending ARV clinics. Quantitative data was assessed using pre-tested structured interviewer-administered questionnaires. Chi-square test of statistical significance was used in the analysis. Four focus group discussions and eight key informant interviews were conducted among PLWHA and healthcare workers respectively. Manual content analysis was used to analyse the qualitative data.ResultsComparable proportions of respondents in peer support (31.4%) and non-peer support groups (30.2%) had self-stigma (p=0.709). Disclosure was higher among respondents in non-peer support groups (96%) against 94.5% in peer support groups (p=0.331). Health workers interviewed were of the opinion that self-stigma cuts across members of both groups. Participants in the FGD reported that the media and economic empowerment have helped reduce self-stigma among PLWHA.ConclusionThough peer support groups may be a starting place for the development of social support interventions for PLWHA, it might not be sufficient to combat self-stigma. Interventions aimed at economic empowerment of PLWHA and public enlightenment are essential for effective mitigation against self-stigma.

Prevalence of depression in people living with HIV and AIDS at the Kalafong Provincial Tertiary Hospital Antiretroviral Clinic.

BackgroundCompared to the general population, there is an increased prevalence of depression in people living with HIV and AIDS (PLWHA). The combination of these two common illnesses has profound consequences on the patient and on the healthcare system.ObjectiveThis study determined the prevalence of depressive symptomatology in PLWHA attending the Kalafong Hospital ARV Clinic. The study also established if the patients received definitive treatment for unipolar depression.MethodsA cross-sectional, descriptive study was carried out on 622 adult patients, aged 18 years or older. A brief rating scale for depression, the Centre for Epidemiological Study Depression Scale (CES-D) was administered to participants. The CES-D is a 20-item self-rating scale that assesses current levels of depression as per DSM-IV criteria. The traditional score of 16 and above was used to define a case of depression.ResultsThe prevalence of depression according to CES-D scale was 53.8%. The study found that none of the 622 patients ever received definitive treatment for depression. A lower CD4 count is associated with more depressive symptomatology, most significantly in patients with a CD4 count of 50 or less.ConclusionsDepressive symptomatology was highly prevalent in the study patients. Despite the high prevalence, none of the study sample patients were treated for clinical depression. The findings reflect the importance of evaluating for depression in PLWHA, especially in high-risk groups such as patients presenting for their initiation visit or patients with a CD4 count of 50 or less. Depression remains under-recognised and under-treated in PLWHA.

Unsilencing the silent South African HIV-positive RESEARCHER: An HIV-positive researcher’s reflection on negotiating insider- outsider positionalities whilst conducting a HIV study in eThekwini, KwaZulu-Natal, South Africa

The research study that informed this article’s discussion, critically interrogates an HIV-infected research team’s positionality whilst conducting a mixed-methods’ study on HIV-positive patients’ experiences of the public ART programme at four ARV clinics in KwaZulu-Natal, South Africa. It primarily utilises the principal investigator’s (PI) narrative to explore insider/outsider positionality, reflexivity, bracketing and participatory action research through exposure of feelings, emotions, challenges, engagements, relationships and observations. The fluid positionality of the HIV-positive research team presented both challenges and opportunities. However, the opportunities for more HIV-infected researchers to engage in HIV-related research to assist with destigmatising HIV, close research gaps and the creation of a trustworthy research environment to achieve an ethical and reliable health science study, far outweigh the challenges. Further, such research can improve patients’ support and healthcare, healthcare workers’ perceptions of patients, and provide a guide for policymakers to better understand the recipients of HIV policies. Lastly, the term ‘HIV reflexivity’ is coined as a result.

Implications of Mother to Child Transmission of HIV among Infected Pregnant Women and their Infants attending a PMTCT ARV Clinic in Ibadan, Nigeria

Background: Mother-to-child transmission (MTCT) is a major means through which HIV infected pregnant mothers pass the virus to their infants. This study aimed to assess the implications of MTCT of HIV among infected Pregnant Women and their Infants.Methods:60 consenting HIV infected pregnant women attending a PMTCT ARV clinic in Ibadan, were followed up for eighteen months. Data were captured using structured questionnaire and analyzed to identify associations. Results: The mother’s age range was 24-41 years with a mean of 32.9 years, while the infant’s median age was 35 days. 32 (72.7%) of them were females with mean birth weight of 3.10 Kg. MTCT of HIV was 4.5% (2/44). Majority of the respondents were of parity 1 (22.7%) and parity 2 (27.3%) and are in monogamous marriage (81.8%), while predominant religion and occupation were Christianity (59.1%) and Trading (56.8%). Viral load was negatively correlated with hemoglobin (r=-0.334), lymphocyte (r=-0.188), and neutrophil (- 0.151) but positively correlated with WBC count (r=0.141). However, between pregnancy and birth CD4 count increased from 503 to 716 (p<0.001). Viral load at birth was higher in positive babies (Mean=4.13, SD=0.06) than negative (mean=1.18, SD=0.71) with p=0.001. Conclusions: This study identified high risk as predictors of MTCT of HIV among exposed infants on follow up with severe implicating consequences. Therefore, testing for pregnant women for HIV should be a national priority, hence the need for more sensitization on the utilization of PMTCT program in Nigeria.

Anti-rabies prophylaxis among children attending ARV clinic in a tertiary care center, Solapur, India

Background: Children are more prone to dog bites and they are more likely to be injured by dog bites than adult. Although most of the bites are by pet animal and provoked, they may be more severe. The present study was conducted in tertiary care center to study the profile and pattern of dog bites cases in children. Objectives: The objective of this study was to study the profile of animal bites cases and observe different practice of wound washing after bite. Materials and Methods: A cross-sectional analytical study was conducted among

Patterns and predictors of disclosure of HIV positive status among youth living with HIV in Ibadan, Nigeria.

Background Information on disclosure of HIV status among youth is sparse in spite of the fact that they bear a significant burden of the HIV epidemic. Our objective was to determine the predictors of HIV disclosure among youth aged 18-35 years in Ibadan, Nigeria. Methods A cross-sectional study was conducted among youth with HIV attending two HIV support groups and one ARV clinic in Ibadan, Nigeria. Information was obtained with the aid of an interviewer-administered questionnaire. Descriptive and analytic statistics were conducted. Results There were 170 clients with a mean age of 29.6 ± 3.9 years; 140 (82.4%) were female and 139 (81.8%) had disclosed their status. Common people first informed included respondents' mother 49 (35.3%), spouse 39 (28.1%) or father, 38 (27.3%). Disclosure to an unmarried sexual partner was low as only six (12.0%) of the 50 single youth who had a current sexual partner had disclosed their status to him/her. Youth who were aware that their spouse/partner was HIV positive (OR = 9.87; CI = 1.09-88.83) or negative (OR = 9.98; CI = 1.18-84.70) were more likely to have disclosed their status than those unaware of their spouse/partners' status. Disclosure was also higher among members of an HIV support group (OR = 3.32; CI = 1.03-10.72). Conclusions Many respondents had disclosed their status although disclosure to an unmarried sexual partner was low. Interventions to improve HIV disclosure especially among unmarried sexually active youth could improve disclosure and overall management of HIV in our study area.

THE PREVALENCE LIVER FUNCTION AND IMMUNOLOGIC STATUS OF CHILDREN WITH HIV AND HEPATITIS B VIRUS COINFECTION IN ENUGU, NIGERIA.

Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders. Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and non- co-infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06). HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.

THE PREVALENCE LIVER FUNCTION AND IMMUNOLOGIC STATUS OF CHILDREN WITH HIV AND HEPATITIS B VIRUS COINFECTION IN ENUGU, NIGERIA

Background:Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts.Materials and Methods:A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients’ folders.Results:Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and non- co-infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06).Conclusion:HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.

Prevalence of chlamydia among HIV positive and HIV negative patients in the Vhembe District as detected by real time PCR from urine samples.

BackgroundChlamydia is a bacterial infection that has long plagued humanity as the most commonly contracted STD and is caused by Chlamydia trachomatis. With the emergence of HIV/AIDS, sexually transmitted diseases have also re-emerged as a grave public health problem, particularly in developing countries. Updated Information about the relative frequencies in developing countries is sparse. This study aims at establishing the relative occurrence of chlamydia using real time PCR technique in the Vhembe District of South Africa where reports on the prevalence of chlamydia are not available.MethodsA total of 243 Urine samples were collected from patients attending different ARV clinics in the Vhembe District and genomic DNA was purified using blood genomic DNA kit from Sigma-Aldrich. Real-Time PCR protocol targeting the 16S rRNA gene of C. trachomatis was used to confirm the presence of chlamydia among these patients. Demographic information as well as clinical data was collected as well.ResultsOf all the participants, 70.4 % were females. The age varied from 19 to 72 years. The overall prevalence of chlamydia was 32.1 %. The prevalence was significantly higher among females (39.2 %) compared to males (15.5 %) patients (P = 0.001) and was highest among pregnant women followed by patients who had reported any allergic reaction. Among the HIV positive patients, the prevalence was higher among those who were not taking ARV (38.1 %) compared to those who were taking them (28.5 %). The age group within which the highest prevalence was found was between 26–45 years.ConclusionsThe present study shows a high prevalence of chlamydia among HIV and AIDS patients in the Vhembe District emphasizing the need to enhance STI control and particularly chlamydia among all young people. The particularly high prevalence of chlamydia among pregnant women is of great concern as this predisposes them to complications, while allergy migh predispose people to chlamydia infections. Further studies are needed in the general population both HIV positive and HIV negative persons to further determine the impact of these infections in the community.

Compliance to rabies immunoglobulin in post-exposure prophylaxis of category III animal bite cases attending antirabies clinic of government tertiary care hospital, Solapur, Maharashtra, India

Background: In India since 1985, every year 25000-50000 human rabies deaths have been reported which accounted for 60% of global mortality. The rabies immunoglobulin (RIG) in particular are life-saving in severe (WHO category III) rabies exposures, Hence present study with objectives to assess treatment compliance of rabies immunoglobulin in animal bite cases and to study reason behind not taking RIG is undertaken. Methods: A cross sectional study was conducted among all 460 WHO category III animal bite cases attending ARV clinic at government tertiary care hospital, Solapur during the month of March 2016. After obtaining verbal informed consent, a predesigned questionnaire was used, the assessment of treatment compliance of RIG was considered by asking and confirming with hospital records, those couldn’t traced were contacted by using telephone survey method. Data was analysed by using statistical software SPSS 16.0 version. Results: A total 460 category III animal bite victims were interviewed from ARV clinic, 80.4% cases were completed rabies immunoglobulin treatment as compared to 19.6% defaulted RIG. The majority of cases were males 68.5%, children ≤15years were 33.5%, 75.0% from urban area, 77% cases belongs to below poverty line category, 35.9% had bite mark on left lower limb. The main animals responsible for bites were dogs (95.2%). The predominant reason behind not taking RIG was lack of money (67.7%). Conclusions: The present study showed maximum compliance to rabies immunoglobulin in Category III animal bite cases however economic constrain was prime hurdle followed by small injury in not taking RIG.

Understanding the Causes and Effects of Stigma and Discrimination in the Lives of HIV People Living with HIV/AIDS: Qualitative Study

Background: Globally HIV/AIDS is a disease of great public health importance, Nigeria has the second largest burden of the disease in the world and currently about 3.4% of the general population are HIV positive. Purpose of the study: The study aims to understand the causes of stigma and discrimination against people living with HIV/AIDS (PLWHA) and the effects of stigma and discrimination on the lives of PLWHA Methods: The study conducted using focused group discussions among people living with HIV/AIDS, who regularly attends ARV clinic, participants were selected based on the number of years of commencement of ARVs and those that have experienced one form of discrimination or the other. The interviews were transcribed verbatim and both manifest and latent content analysis was applied to analyze the texts. Findings: Following the analysis, two major themes emerged from the study: (1) Broken relationship and nondisclosure are consequences of stigma and discrimination, (2) Poor information strongly contributes to stigma and discrimination. These two themes were able to bring out the cause and effect of stigma and discrimination on the lives of PLWHA. Conclusion: Stigma and discrimination has contributed to broken relationship and promotes non-disclosure of HIV status to sexual partners, dissolution of families in Nigeria. Lack of proper information on the disease and poor education and information among the general public and especially health care workers (HCW) worsens stigma and discrimination.