Attending Antiretroviral Therapy Research Articles

IJCM_283A: Clinico-demographic profile of patients attending anti retroviral therapy centre in a tertiary care hospital: a cross -sectional study

Background: HIV is a major global public health issue, having claimed 40.4 million lives so far globally. In India the estimated number of people living with HIV (PLHIV) is 2.5 million (WHO, 2022). For planning targeted interventions, it is essential to know the socio-demographic and clinical profile of the HIV/AIDS patients in any particular area. Objectives: To study the socio-demographic and clinical profile of PLHIV attending anti-retroviral therapy (ART) centre of J.N. Medical College, A.M.U., Aligarh (U.P.). Methodology: This is a cross sectional study and data was accessed from routine records at ART centre, JNMCH, AMU, Aligarh. Records of 370 PLHIV aged =18 years attending the antiretroviral clinic were studied and analyzed. Socio-demographic characteristics, risk behaviours and laboratory investigations were studied. Anemia was defined according to WHO criteria. Data was analyzed using SPSS version 20.0. P value <0.05 was considered significant. Results: Mean age of the patients was 33.6 + 10.1 years and 60.8% of them were males. Majority of the patients belonged to rural areas (60.5%). Sexual route was the most common (69.5%) mode of transmission; among which heterosexual route was the commonest (96.1%). CD4 count was found to be less than 200 cells/mm3 in 22.2% of patients. Anemia was present in 67.3% of patients, among which moderate anemia was commonest (50.2%). Prevalence of anemia was significantly higher in females (83.4%) than males (56.9%) (p<0.001) and in rural population (71.9%) than urban population (60.3%) (p=0.02). Conclusion: Majority of patients were males and belonged to rural areas. Commonest mode of transmission was sexual route. Thus, IEC activities should be targeted to these particular groups and knowledge regarding safe sexual practices should be given particularly in rural areas. Prevalence of anemia is very high in PLHIV. Targeted interventions aiming to prevent anemia in PLHIV should be strengthened.

Mental health distress and associated factors among HIV- positive adolescents attending ART Clinics in Nigeria

BackgroundMental health disorders may have a negative influence on health outcomes in patients with HIV; however, these conditions are under-diagnosed among adolescents living with HIV. This study aimed to assess the prevalence of mental health distress and associated factors among adolescents living with HIV attending Antiretroviral Therapy clinics in Nigeria. MethodsThis was a cross-sectional study of 212 HIV-infected adolescents attending routine HIV clinic visits across five high patient-density clinics in southwestern Nigeria. Mental health distress was assessed using the General Health Questionnaire-12 (GHQ-12) and data was analyzed using IBM-SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA). ResultsThe prevalence of mental health distress among participants was 34.9 %. On bivariate analysis, respondents who consumed alcohol sometimes had significantly higher mental health scores than those who never took alcohol (t-test 2.738; P = 0.007). There were no significant differences in the mean mental health scores of respondents with regards to social factors (smoking, experience of rape, disability status, mode of payment for health services, and number of living companions) and clinical factors (duration of diagnosis and treatment of HIV, the type of HAART regimen, and whether there had been a change in regimen). On multivariate analysis no social or clinical factor was found to be independently associated with mental health distress. ConclusionsThe prevalence of mental health distress among adolescents living with HIV in southwestern Nigeria is high. Respondents who consumed alcohol had significantly higher mental health scores than those who never took alcohol. Future studies should explore psychosocial stressors that could be determinants of mental health distress among adolescents living with HIV in Nigeria.

Consumption and adverse reaction reporting of herbal medicines among people living with HIV at University teaching hospitals in Blantyre, Malawi and Ibadan, Nigeria

Background Consumption of herbal medicines among people living with HIV is a common practice in Sub-Saharan Africa. The utilization of herbal medicines was at 17.5% and 67.9% in Malawi and Nigeria, respectively. There is inadequate data on use and adverse reactions (ADRs) reporting of herbal medicines among people living with HIV (PLWHIV). This study was designed to investigate use and ADRs reporting of herbal medicines among PLWHIV at the University Teaching Hospitals in Blantyre, Malawi and Ibadan, Nigeria.MethodologyA cross-sectional study was conducted among PLWHIV attending Antiretroviral Therapy (ART) clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi and University College Hospital, Ibadan, Nigeria. A structured questionnaire was administered to 360 and 370 participants in Blantyre and Ibadan respectively, through face-to-face interviews after obtaining their informed consent. Results The prevalence of herbal medicines use among PLWHIV in Malawi and Nigeria was at 80.6% and 55.7% (p<0.001), respectively. The most frequently used herbal medicines in Malawi were Aloe vera (14.0%), Moringa oleifera (14.0%), Zingiber officinale (13.0%) and Allium sativum (7.0%). Likewise, in Nigeria, the most commonly used herbal medicines were Zingiber officinale (15.0%), Vernonia amygdalina (14.0%), Moringa oleifera (9.0%), and Allium sativum (11.0%). The major reason for herbal medicines’ use in Malawi was ready availability (42.1%) and perception that it boosts immunity (44.6%) in Nigeria. The PLWHIV reported experiencing suspected herbal medicine ADRs in Malawi (3.9%) and in Nigeria (8.0%).Conclusion A higher percentage of people living with HIV are using herbal medicines in Malawi as well as in Nigeria. In both countries, a few participants reported experiencing suspected ADRs related to herbal medicines.

Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial

ObjectiveIndividuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART).Materials and methodsThis randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants’ age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale.ResultsFindings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes.ConclusionsCognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS.Trial registrationThai clinical trial registry (i.e. TCTR = TCTR20210702002).

A protocol for feasibility of plasma based GeneXpert platform and Dried Blood Spot (DBS) based Abbott platform for HIV-1 viral load testing among the people living with HIV attending ART centers in India.

HIV-1 Viral load (VL) measures efficiency of the antiretroviral therapy (ART) after treatment initiation and helps to diagnose virological failures at an early stage. Current VL assays require sophisticated laboratory facilities. As well as there are other challenges pertaining to insufficient laboratory access, cold-chain management and sample transportation. Hence the number of HIV-1 VL testing laboratories is inadequate in the resource limited settings. The revised national tuberculosis elimination programme (NTEP) in India has developed a vast network of point of care (PoC) testing facilities for diagnosis of tuberculosis and several GeneXpert platforms are functional under this programme. Both the GeneXpert HIV-1 assay and HIV-1 Abbott real time assay are comparable and GeneXpert HIV-1 assay can be used as PoC for HIV-1 Viral load testing. Also, the dried blood spot (DBS) as a sample type has been considered as a good option for HIV-1 VL testing in hard to reach areas. This protocol is therefore developed to assess the feasibility of integrating HIV-1 VL testing among people living with HIV (PLHIV) attending ART centres using the two public health models under the current programme: 1. HIV-1 VL testing using GeneXpert platform and plasma as a sample type, and 2. HIV-1 VL testing using Abbott m2000 platform and DBS as a sample type. This ethically approved feasibility study will be implemented at two moderate to high burden ART centres where VL testing facility is not available in the town. Under Model-1, arrangements will be made to carry out VL testing on the adjacent GeneXpert facility and under Model-2, DBS will be prepared on site and couriered to identified viral load testing laboratories. In order to assess the feasibility, data will be collected on pretested questionnaire pertaining to number of samples tested for VL testing, number of samples tested for tuberculosis (TB) diagnosis and the turnaround time (TAT). In-depth interviews will be conducted among the service providers at ART centre and different laboratories for addressing any issues regarding the model implementation. The proportion of PLHIV tested for VL at ART centres, total TAT for both models including TAT for sample transportation, sample testing and receipt of results as well as proportion of sample rejections and reasons for the same, correlation coefficient between DBS based and plasma based VL testing will be estimated using various statistical tools. If found promising, these public health approaches will be helpful for the policy makers and program implementation in scaling up HIV-1 viral load testing within India.

Thyroid Function in Newly Diagnosed HIV-positive Patients.

As of 2019, the highest prevalence of human immunodeficiency virus (HIV) in India is seen in the Northeastern states. Endocrine and metabolic disturbances can occur in HIV infection. Thyroid dysfunction is one of the common endocrinopathies. In HIV infection, thyroid function abnormalities are seen in about 4-35% of adult patients. Thyroid function abnormalities range from overt hypothyroidism, subclinical hypothyroidism, and sick euthyroid syndrome to overt hyperthyroidism. Among them, subclinical hypothyroidism is the commonest abnormality. To our knowledge, there have been no studies from Northeastern India done in this regard. To study the thyroid function in newly diagnosed cases of HIV infection attending anti-retroviral therapy (ART) center, Assam Medical College. To estimate the prevalence and types of thyroid dysfunction in newly diagnosed HIV-infected individuals. To study thyroid dysfunctions with respect to age, sex, and cluster of differentiation (CD) 4 count. Hospital-based observational study was done at a tertiary care centre of upper Assam on newly diagnosed HIV-positive patients who were not started on antiretroviral therapy and who attended the ART centre, Assam Medical College during the period of our study. History, examinations and laboratory investigations, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), and CD4 count, are done in all such patients, and only those who fulfilled the inclusion and exclusion criteria of our study are taken as study participants, and their findings tabulated. A total of 95 newly diagnosed HIV-positive patients fulfilling the inclusion and exclusion criteria of our study were taken. In our study, a total of 36.84% of the patients had thyroid dysfunction. We got subclinical hypothyroidism, overt hypothyroidism, sick euthyroid syndrome, and overt hyperthyroidism as the types of thyroid dysfunction. Among all the types of thyroid dysfunction, subclinical hypothyroidism was the commonest abnormality in our study. Under sick euthyroid syndrome, we got only low FT3 as the biochemical abnormality. Thyroid dysfunctions were more common in females (42.3%) than males (35.8%) and were more common in the age group of 30-39 years. In the present study, among patients with thyroid dysfunction, it was seen that 51.43% of the patients had a CD4 cell count in the range 101-200 cells/mm3, whereas only 11.43% of patients had a CD4 cell count in the range &lt;50 cells/mm3 and no patient had a CD4 cell count &gt;500 cells/mm3 . In our study, we found that thyroid dysfunctions were common in newly diagnosed HIV-positive patients, the prevalence of which was much higher in the general population. Thyroid dysfunction was present in all the stages of the HIV disease.

Predictors of suicidal ideation, attempts among adults living with HIV attending ART follow-ups at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia: a cross-sectional study

ObjectiveTo assess the magnitude of suicidal ideation, attempts and associated factors among adults living with HIV attending antiretroviral therapy follow-ups at Tirunesh Beijing General Hospital, Addis Ababa.DesignHospital-based observational, descriptive, cross-sectional...

Dual Contraceptive Method Utilization and Associated Factors Among HIV Positive Women Attending ART Clinic in Finote-Selam Hospital: Cross-Sectional Study

Worldwide, the human immune deficiency virus is the leading cause of death for women of childbearing age. Around two-thirds of all pregnant women living with the human immune deficiency virus experience an unintended pregnancy. The correct and consistent use of dual contraceptive methods is important to prevent unintended pregnancy and transmission of sexually transmitted infections. However, little is known about the utilization of dual contraceptive methods among HIV-infected women. Thus, this study aimed to assess dual contraceptive utilization and associated factors among HIV-positive women attending antiretroviral therapy (ART) in Finote Selam Hospital, Northwest Ethiopia. Facility-based cross-sectional study design was conducted from September 1 to October 30, 2019, in Finote Selam Hospital among HIV-positive women. A systematic random sampling technique was used to select study participants and the data were gathered by an interviewer-administered structured pretested questionnaire. Factors associated with dual contraceptive use were identified through binary logistic regression. Finally, a p-value < 0.05 was taken as a cutoff point to declare a significant association, and the direction and strength of the association were determined by the adjusted odds ratio. The study showed that 21.8% of HIV-positive women attending ART care in Finote Selam Hospital utilize dual contraceptive methods. Dual contraceptive utilization was significantly associated with having a child (AOR: 3.29; CI 1.45, 7.47), having family support to use dual contraceptives (AOR: 3.02; CI 1.39, 6.54), having multiple sexual partners (AOR: 0.11; CI 0.05, 0.22), and urban residence (AOR: 3.64; 1.82, 7.3). The study revealed that low utilization of dual contraceptive methods. This will continue major public health problems in the study area unless future interventions conducted.

Awareness and Hesitancy of COVID-19 and other Vaccines among People Living with HIV/AIDS Attending Antiretroviral Therapy (ART) Center in North India.

Approximately 40 years have passed since we first learned about the human immunodeficiency virus (HIV), but several people living with HIV (PLHIV) in developing countries such as India cannot avail treatments. This makes preventive measures, such as vaccinations, critical in these persons to avoid vaccine preventable diseases (VPDs). However, little is known about the willingness and perceptions of PLHIV regarding these vaccines. Therefore, we explored vaccine awareness and hesitancy, especially during the recent COVID-19 pandemic. The primary objective was to determine the uptake of the Covid-19 vaccine and other VPD's among PLHIV and factors affecting the same in Antiretroviral therapy (ART) centers in a tertiary care hospital in North India. This was a cross-sectional study of HIV patients who attended our Antiretroviral Therapy center (ART). Clinical data were collected using a questionnaire on general profile, disease information, knowledge, attitude, and practice (KAP) regarding vaccinations, and vaccination status for different VPDs. We enrolled 300 subjects and found that 82% of the patients attending our ART center were aware of vaccinations, most of whom were aware of the polio vaccine (n=91, 30.33%), followed by tuberculosis (n=61, 20.33%), and the majority of them were not aware of vaccines indicated in PLHIV. We also found that the majority (n= 240, 80.23%) of patients had vaccine hesitancy, especially regarding the new COVID-19 vaccine. There is a need to create awareness among people about the benefits and uses of vaccination to achieve the greater goal of reduced morbidity and mortality among PLHIV. There is a need for free vaccination programs for VPDs in PLHIV patients.

Prevalence of depression and associated factors among adults on antiretroviral therapy in public hospitals of Kembata Tembaro Zone, South Ethiopia

Background Despite the commonness and its relationship with poor outcomes among Human Immunodeficiency Virus-infected adults, depression remains widely unrecognized, untreated, or undertreated in antiretroviral therapy clinic care. This study aimed to assess the prevalence and associated factors of depression among adult people living with HIV attending antiretroviral therapy clinics in public hospitals at Kembata Tembaro Zone, South Ethiopia, 2020. Method Multi centric facility based cross-sectional study was conducted on a sample of 393 HIV-infected adults in public Hospitals of Kembata-Tembaro Zone from March-April 2020. A simple random sampling technique was employed to select the study participants. Quantitative data were collected using a pretested and structured questionnaire. Multivariable logistic regression was used to assess factors associated with depression. P-value &lt;0.05 was considered statistically significant. Results Among the study participants, 217(56.2%) were females, 230(59.6%) were married, 190(49.2%) were between the ages of 29-39 years, and 198(51.3%) attended primary education. The prevalence of depression was 44.3% (95%CI: 39.4%-49.2%). Being female (AOR=2.03,95%CI:1.21,3.40), living alone (AOR=3.09,95%CI:1.68,5.68), Having HIV related stigma (AOR=2.85, 95%CI: 1.73,4.71), poor social support (AOR=2.55, 95% CI:1.48,4.78), CD4 count less than 350 cell/ul (AOR=2.66, 95% CI:1.48,4.58) and Poor medication adherence (AOR=2.19,95% CI:1.32,3.65) were factors significantly associated with depression. Conclusion The prevalence of depression was high. Being female, living alone, having HIV-related stigma, Poor social support, CD4 count less than 350cell/ul, and poor medication adherence was associated with depression. Depression should be included as part of the routine consultation of HIV patients to warrant early detection and treatment.

Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study

BackgroundIndex case HIV/AIDS testing (ICHT) is a good approach for addressing and improving the efficiency and yield of testing among high-risk populations. Partners and families of people living with HIV/AIDS are among the high-risk populations for contracting HIV/AIDS. However, there is limited study on index case HIV testing among HIV patients attending Anti-Retroviral Therapy (ART). Hence, this study was aimed at assessing the magnitude and factors associated with ICHT among HIV patients attending ART in Nekemte town public health facilities.MethodsAn institution-based cross-sectional study was conducted at Nekemte town public health facilities from May 20 to July 21, 2020. A systematic random sampling method was used to select the study participants. Multivariable logistic regression analysis was used to determine the predictors of acceptance of ICHT among HIV patients.ResultsThe ICHT acceptance was 85.2% (95% CI=84.9–91.1%). Disclosure of their HIV status (AOR=9.74, 95% CI=4.11–23.06), having good knowledge of ICHT (AOR=4.70, 95% CI=1.92–11.61), believing HIV index case testing has benefits (AOR=3.43, 95% CI=1.27–9.29), and being on ART for more than 1 year (AOR=4.78, 95% CI=2.13–10.76) were significantly associated with index case HIV test acceptance.Conclusion and RecommendationThis study revealed a significant proportion of index case HIV testing acceptance. HIV status disclosure of index cases, knowledge of ICHT, the perceived benefit of ICHT, and long duration on ART were found to be significantly associated with acceptance of ICHT. Hence, it is essential to give attention to counseling on the importance of ICHT, enhance people living with HIV (PLWHIV) to have positive belief on the advantage of ICHT, strengthen disclosure counseling, and assist HIV status disclosure in health facilities.

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study.

BackgroundThere has been promising progress toward screening, testing, and retaining patients with HIV in care in Ethiopia. Concern exists that possible disruptions in HIV programs due to coronavirus disease 2019 (COVID-19) could result in a more HIV-related mortality and new HIV infections. This study aimed to investigate the real-time burden of COVID-19 on patients with HIV attending antiretroviral therapy.MethodsWe conducted a facility-based, multicenter, and cross-sectional study among patients with HIV attending antiretroviral therapy in 10 healthcare facilities in Addis Ababa, Ethiopia, in the COVID-19 pandemic period. Data were collected using adapted, interviewer-based questionnaires, and entered into EpiInfo version 7 and exported to SPSS version 26 for analysis.ResultA total of 212 patients with HIV were included. The participants who missed visits for refill were 58 (27.4%). When the effects of other independent variables on appointments/visits for refill were controlled, the following characteristics were found to be the most important predictors of missed appointments (p< 0.05): age ≥ 55 [adjusted odds ratio (AOR) = 6.73, 95% CI (1.495–30.310)], fear of COVID-19 [AOR = 24.93, 95% CI (2.798–222.279)], transport disruption [AOR = 4.90, 95% CI (1.031–23.174)], reduced income for traveling to a health facility [AOR = 5.64, 95% CI (1.234-25.812)], limited access to masks [AOR = 7.67, 95% CI (1.303–45.174)], sanitizer [AOR = 0.07, 95% CI (0.007–0.729)], and non-medical support [AOR = 2.32, 95% CI (1.547–12.596)]. The participants were well aware of the COVID-19 preventive measures. The most costly COVID-19 preventive measures that cause financial burden to the patients were the costs for buying face masks (63.7%), disinfectants (55.2%), and soap for handwashing (22.2%). The participants who missed follow-up diagnostic tests were 56 (26.4%). Variables, which were found to be statistically significant, include the following: age ≥ 55 [AOR = 0.22, 95% CI (0.076–0.621)], partial lockdown [AOR = 0.10, 95% CI (0.011–0.833)], limited access to health services [AOR = 0.15, 95% CI (0.045–0.475)], reduced income for traveling to health facility [AOR = 0.18, 95% CI (0.039–0.784)], and unable to get masks [AOR = 0.12, 95% CI (0.026–0.543)]. The participants who missed counseling services were 55 (25.9%). In multivariate logistic regression, the following were statistically significant: age ≥ 55 [AOR = 0.21, 95% CI (0.078–0.570)], fear of COVID-19 [AOR = 0.11, 95% CI (0.013–0.912)], reduced income [AOR = 0.17, 95% CI (0.041–0.699)], unable to get face masks [AOR = 0.19, 95% CI (0.039–0.959)], and partial lockdown [AOR = 0.08, 95% CI (0.008–0.790)].ConclusionsThe COVID-19 had a significant burden on patients with HIV to attend their routine clinical care and treatment, which may lead to treatment failure and drug resistance. The impact was on their appointments for medication refills and clinical and laboratory follow-ups. Targeted initiatives are needed to sustain HIV clinical care and treatment services and improve the well-being of people living with HIV.

Prevalence and associated factors of intestinal parasitic infections among HIV clients attending Masaka Regional Referral Hospital, Uganda

infection with Human Immune deficiency Virus (HIV) increases the risk of opportunistic infections, which aggravates life-long complications. We report the prevalence and the associated factors of intestinal parasites among HIV infected clients attending anti-retroviral therapy (ART) clinic at Masaka Regional Referral Hospital, in Uganda. this was a cross-sectional study that purposefully enrolled 410 HIV infected clients. Stool samples were macroscopically assessed, and analyzed using wet preparations, Formol ether concentration and Modified Ziehl Neelsen (ZN) techniques to identify cysts and ova of intestinal parasites. Further, a questionnaire was used to obtain data on socio-demographic, hygiene and immunologic markers. Logistic regression analysis was used to determine the associated factors of intestinal parasitic infection. of the 410 adult HIV sero-positive clients enrolled, 58.0% (238/410) were females. Participants mean age was 26.8 years, (range of 18-59 years). The prevalence of intestinal parasites was 49/410 (11.95%; 95% confidence interval: 10.3 - 14.7). Intestinal parasites isolated were Giardia lamblia (N=10, 20.4%), strongloides stercolaris (N=4, 8.2%), and modified ZN showed Cryptosporidium species (N=35, 71.4%). Hand washing, history of not deworming in the previous 1 year, deteriorating HIV clinical stage and unprotected open water sources were the associated factors. this study reports a high prevalence of opportunistic intestinal parasites. As these are neglected tropical infections, early detection and exploration of the associated factors is key to their proper management.

Knowledge about vertical transmission of HIV and associated factors among women living with HIV or AIDS attending antiretroviral therapy clinic, Western Ethiopia.

Background:The United Nations Program on HIV or AIDS has committed to eliminating the vertical transmission of human immunodeficiency virus. However, significant number of newborn and children are acquiring HIV every year. Therefore, the aim of this study was to assess knowledge of mother on vertical transmission of HIV and associated factors among non-pregnant women receiving antiretroviral therapy in the West Wollega, Western Ethiopia.Methods:A facility-based cross-sectional study design was used on a sample of 422 non-pregnant women attending antiretroviral therapy clinic in West Wollega from 26 February to 26 March 2019. Systematic sampling was used to select the study participants. Pretested and structured interviewer-administered questionnaires and telephone interview were used to collect the data. Multivariable logistic regression model was used to identify factors associated with the knowledge of mother on vertical transmission of HIV. Odds ratio along with 95% confidence interval were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05.Result:Out of total participants, 94.1% (95% confidence interval: (91.7%, 96.2%)) of them were knowledgeable about vertical transmission of HIV. Urban resident (adjusted odds ratio: 2.36, 95% confidence interval: (1.27, 4.39)), primary school (adjusted odds ratio: 2.94, 95% confidence interval: (1.11, 7.83)), secondary school (adjusted odds ratio: 3.39, 95% confidence interval: (1.53, 7.55)), being on antiretroviral therapy for greater than 2 years (adjusted odds ratio: 2.67, 95% confidence interval: 1.02, 6.99)), and having child living with HIV (adjusted odds ratio: 1.54, 95% confidence interval: (1.07, 3 .83)) were significantly associated with the knowledge of mother on vertical transmission of HIV.Conclusion:The study indicated that 5.9% of the women lack knowledge about vertical transmission of HIV. This knowledge associated with sociodemographic factors, such as residence, educational status, experiences of having child living with HIV, and being on antiretroviral therapy for greater than 2 years. Thus, interventions toward the elimination of new newborn HIV infections should consider these factors.

Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study.

BackgroundHuman immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern EthiopiaMethodsThis retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection.ResultOne hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART).ConclusionThough the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.

Knowledge, attitude and practices towards visceral leishmaniasis among HIV patients: A cross-sectional study from Bihar, India.

BackgroundIn the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients living with HIV (PLHIV) is higher. It is important to investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.MethodsA questionnaire based cross-sectional study was performed among 120 HIV patients aged ≥18 years, to evaluate their KAP regarding visceral leishmaniasis. For the KAP indicators, each correct answer received a score of 1, while unsure and incorrect responses received a score of 0. Descriptive statistics and logistic regression were used for the analysis. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.ResultsThe study population had a male (68.30%) preponderance with a mean age of 37.03 years ± 9.80 years of standard deviation. The majority (93.30%) of the study participants had previously heard about VL. Only 32.10% of those who had heard about VL knew that the disease was transmitted by the sandfly. Most (80.40%) of the study respondents were ignorant of the sandfly breeding grounds. The vast majority (75.90%) had no idea how to recognize sandflies and were unaware of their biting time, leishmaniasis transmission season, and preventive practices. Although PLHIV are vulnerable to VL, only 27.70% of them agreed that VL is a fatal disease if untreated, and 42.90% believed they wear not at risk of developing the disease. Regarding the control methods of sandflies, 28.60% of participants did not use any methods to avoid sandfly bites. The multivariable analysis revealed that occupation and family history were the two independent predictor variables of the knowledge index. Age and gender were significantly associated with attitude towards VL. Participants working as laborers had significantly lesser odds (AOR: 0.248, 95% CI: 0.073–0.844) to follow good preventive practices. There were significantly higher odds of having good practice among participants aged 18–40 years (AOR: 6.866, 95% CI: 1.694–27.834) and those residing in urban areas (AOR: 4.159, 95% CI: 1.317–13.139) than their peers. Overall, 27.7% of respondents were knowledgeable, 41.1% had a positive mindset, and 33.9% had strong VL preventive habits, according to the study.ConclusionThe study determined a remarkable gap in the knowledge attitude and practices towards VL among PLHIV. This underscores the need of augmented health education initiatives for PLHIV in endemic areas for good VL awareness and preventive practices.

English

BACKGROUND Globally the number of people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) has been rising steadily since 2011 nearing more than 33 million whereas in developing countries like India it is 2.4 million with a prevalence of 0.3%. The purpose of this study was to assess the association of CD4 counts with cardiovascular dysfunction among HIV/AIDS patients. METHODS This was a hospital-based study conducted at the Vijayanagara Institute of Medical Sciences, Bellary. Convenience sampling was used and patients admitted to the wards of the internal medicine as well as those attending anti-retroviral therapy (ART) centre out-patient department (OPD) were included in the study. A total of 200 cases of seropositivity of HIV patient diagnosed by Elisa technique were assessed after obtaining informed consent. Clinical profile and laboratory investigations were carried out on the patients such as CD4 counts and analyzed with various cardiac dysfunction. RESULTS Commonest affected with HIV infection were young male (26 – 40 years) 77.5 % followed by young female 60 % Commonest symptoms were fever, cough 82 % each and breathlessness 44 %. Commonest clinical findings were pallor 80 %, pedal oedema 68 %, and lymphadenopathy 32 %. 26 % of patients had electrocardiography (ECG) abnormalities with commonest being sinus tachycardia 18 %, low voltage complex 4 %, IHD (ischemic heart disease) 2 %, LVH (left ventricular failure) 2 %. 34 % had chest x-ray abnormalities such as cardiomegaly 14 %, pleural effusion 12 % and PTB (pulmonary tuberculosis) 2 %. Abnormal CD4 counts were noted in 94 % of patients, with 12 % having very low CD4 counts that is less than 50. Statistically significant pericardial effusion was noted with low CD4 counts on 2D ECHO cardiography. CONCLUSIONS The study concludes that decrease in CD4 count is statistically associated with increased pericardial effusion among HIV/AIDS patients. KEYWORDS CD4 Counts, HIV/AIDS Patients, Cardiovascular Dysfunction, Pericardial Effusion

Hepatitis B and C infections in HIV-1 patients on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response to treatment, and hepatotoxicity

BackgroundViral hepatitis could have an impact on the treatment response in HIV patients. In this study, we sought to determine the prevalence of hepatitis B and C infections and examine the effect on the treatment response in HIV-1 patients attending antiretroviral therapy (ART) centers in the Volta and Oti Regions of Ghana. MethodA longitudinal study design was employed. A cohort of 200 newly diagnosed HIV-1 positive adults who met the inclusion criteria (CD4 count ≤350 cells/μl) were enrolled at three ART Centers and initiated on the combination Antiretroviral Therapy (cART) from January 2014 to December 2015. Blood samples obtained from each participant were subsequently screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody. Out of the 200 study respondents recruited, 93 HIV mono-infected were randomly selected plus all 17 HIV co-infected were prospectively followed for twelve months. Using standard methods, three consecutive measurements of CD4 cells, haemoglobin, and liver enzymes [(aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP)] as well as weight measurements were performed at baseline, six months and twelve months, respectively, after treatment initiation. ResultThe overall HIV-viral hepatitis sero-positivity was 8.5%. HBV and HCV co-infections were 7.0% and 1.5% respectively. Among HIV mono-infected CD4 cell count, haemoglobin, and weight significantly increased from baseline to the twelfth month while levels remained statistically comparable in the HIV co-infected patients. The levels of AST, ALT, and ALP were more pronounced (hepatotoxicity) in the HIV co-infected compared to the HIV mono-infected at various time points within the twelve month. ConclusionThe frequency of HIV-hepatitis co-infection was high. This correlates with poor immunological outcome, clinical response to treatment and pronounced hepatotoxicity. The findings, therefore, underscore the need for regular screening of HIV patients for early detection and appropriate management.

A Study on Hypertension among Persons Living with HIV attending ART Centers in TamilNadu- A Descriptive Cross-Sectional Study

People suffering from immunosuppressive conditions like Human Immunodeficiency Virus (HIV) are more prone to suffer from non-communicable diseases like hypertension, which is not identified and treated at an earlier stage, can lead to significant mortality and morbidity in them. The study design was a cross-sectional study done in select Anti-Retroviral Therapy (ART) centers in Government hospitals in Tamil Nadu during a period from 2017-2018. Data regarding their HIV status, treatment history and Body Mass Index (BMI) were recorded and Blood Pressure (BP) was recorded by using mercury sphygmomanometer using standard guidelines. Data was entered in Microsoft excel and analyzed by using SPSS version 22 software. The study population comprised of 75% males and 25% females. Mean age of study participants was 45+8.2 years and the mean BMI was 22+3.4. The prevalence of hypertension among HIV affected individuals was found to be 14.63%. According to JNC criteria, 34% were having Stage 1 hypertension and 33% had Stage 2 hypertension and only 23% were on treatment. Significant association was found between increasing age, gender, BMI and hypertension. Health education and awareness creation has to be created among HIV patients on maintaining a healthy diet and lifestyle so that, obesity can be prevented or reduced which could play an important role in NCD’s like hypertension and also hypertensive patients have to be identified and treated at early stage to reduce the morbidity and mortality.

Dietary Diversity and Associated Factors Among Adult HIV Positive Patients on Anti-Retroviral Therapy in Public Hospitals of Kembata Tembaro Zone, Southern Ethiopia.

BackgroundNutrition is a significant factor in all stages of HIV. Dietary management of HIV-positive patients is key to supporting their capacity to continue participating in the workforce and contributing to socio-economic growth. Few studies have been conducted regarding this important public health problem of dietary diversity throughout the developing countries including Ethiopia. Therefore, this study assesses the magnitude and factors associated with dietary diversity among HIV-positive patients attending antiretroviral therapy (ART) clinics at Public Hospitals in Kembata Tembaro Zoni, Southern Ethiopia.Methods and MaterialsAn institutional-based cross-sectional study was conducted from January 01/2019 to 30/2019 on 341 adult HIV-positive patients on ART at two randomly selected public hospitals in the study area. A systematic random sampling technique was applied to select study subjects from each facility proportionally. Bivariable and multivariable logistic regression analyses were done to identify factors associated with individual dietary diversity. Logistic regression analysis with 95% confidence interval (CI) was estimated to measure the strength of association. Level of significance for statistical tests was set at p <0.05.ResultsThis study shows 60.1% (95% CI: 55–65) of patients had inadequate dietary diversity. Average monthly income of less than 1000 Ethiopian Birr (AOR: 1.82, 95% CI: 1.04–3.17), being female (AOR = 2.99, 95% CI: 1.67–5.37), duration of ART less than 1 year (AOR = 3.77, 95% CI: 1.42–10.02) and lack of dietary counseling (AOR =0.54, 95% CI: 0.30–0.97) were factors associated with low dietary diversity.ConclusionLow dietary diversity was a major nutritional problem in HIV-positive patients. Low average monthly income, being female, duration of participants on ART, and lack of dietary counseling were the factors associated with low dietary diversity. To alleviate these problems, exceptional attention in nutritional care should be given to HIV-positive patients and they require appropriate counseling and support during early initiation of ART.