Availability Of Antiretroviral Treatment Research Articles

Depression and its role in adherence to anti-retroviral treatment in people living with HIV and AIDS in Chennai.

The AIDS epidemic has drastically reduced in India since it was first identified in 1986, largely due to the widespread availability of anti-retroviral treatment (ART). Management of HIV is currently more focussed on long term morbidities, including mental health. Depression is the most common co-morbidity seen in people living with HIV. Depression is found to negatively affect patient adherence to ART. Poor adherence to ART leads to drug resistance and susceptibility to opportunistic infections. The purpose of this study is to find the prevalence of depression among people living with HIV and to study the correlation between depression and adherence to ART. The study was conducted in the ART centre at Rajiv Gandhi Government General Hospital in Chennai, between August and October 2022. Patient health questionnaire-9 (PHQ-9) was used to identify depression, and the Adult AIDS clinical trials group (AACTG) questionnaire was used to identify adherence. Data were entered in MS Excel and were analysed using Statistical Package for Social Science (SPSS) Version 16. The association between categorical data were analysed using Chi-square and Fisher exact test. The correlation between adherence and depression was done using the Spearman correlation. The prevalence of depression was found to be 20.2%. A mild negative correlation was found between depression and adherence. Depression was found to have a significant correlation with women, unemployed, widowed, divorced individuals, and those with diabetes mellitus and tuberculosis. Depression is an important risk factor for adherence to ART. Though severe depression was not found in this study, mild and moderate depression was associated with reduced adherence to ART. Treating depression is likely to improve adherence and the overall wellbeing of patients with HIV and AIDS.

Impact of HIV on the Oral Microbiome of Children Living in Sub-Saharan Africa, Determined by Using an rpoC Gene Fragment Metataxonomic Approach.

Children living with HIV have a higher prevalence of oral diseases, including caries, but the mechanisms underlying this higher prevalence are not well understood. Here, we test the hypothesis that HIV infection is associated with a more cariogenic oral microbiome, characterized by an increase in bacteria involved in the pathogenesis of caries. We present data generated from supragingival plaques collected from 484 children representing three exposure groups: (i) children living with HIV (HI), (ii) children who were perinatally exposed but uninfected (HEU), and (iii) unexposed and therefore uninfected children (HUU). We found that the microbiome of HI children is distinct from those of HEU and HUU children and that this distinction is more pronounced in diseased teeth than healthy teeth, suggesting that the impact of HIV is more severe as caries progresses. Moreover, we report both an increase in bacterial diversity and a decrease in community similarity in our older HI cohort compared to our younger HI cohort, which may in part be a prolonged effect of HIV and/or its treatment. Finally, while Streptococcus mutans is often a dominant species in late-stage caries, it tended to be found at lower frequency in our HI cohort than in other groups. Our results highlight the taxonomic diversity of the supragingival plaque microbiome and suggest that broad and increasingly individualistic ecological shifts are responsible for the pathogenesis of caries in children living with HIV, coupled with a diverse and possibly severe impact on known cariogenic taxa that potentially exacerbates caries. IMPORTANCE Since its recognition as a global epidemic in the early 1980s, approximately 84.2 million people have been diagnosed with HIV and 40.1 million people have died from AIDS-related illnesses. The development and increased global availability of antiretroviral treatment (ART) regimens have dramatically reduced the mortality rate of HIV and AIDS, yet approximately 1.5 million new infections were reported in 2021, 51% of which are in sub-Saharan Africa. People living with HIV have a higher prevalence of caries and other chronic oral diseases, the mechanisms of which are not well understood. Here, we used a novel genetic approach to characterize the supragingival plaque microbiome of children living with HIV and compared it to the microbiomes of uninfected and perinatally exposed children to better understand the role of oral bacteria in the etiology of tooth decay in the context of HIV exposure and infection.

Biomedical bargains: Negotiating “safe sex” on antiretroviral treatment in rural South Africa

Wide-scale availability of antiretroviral treatment (ART) has transformed the global landscape for HIV prevention, shifting emphasis away from a strictly behavioral focus on changing sexual practices towards a biomedical approach. Successful ART management is measured by an undetectable viral load, which helps maintain overall health and prevent onward viral transmission. The latter utility of ART, however, must be understood in the context of its implementation. In South Africa, ART has become easily accessible – yet ART knowledge spreads unevenly, while counseling advice and normative expectations and experiences of gender and aging interact to inform sexual practices. As ART enters the sexual lives of middle-aged and older people living with HIV (MOPLH), a population growing rapidly, how has it informed sexual decisions and negotiations? Drawing on in-depth interviews with MOPLH on ART, corroborated with focus group discussions and national ART-related policies and guidelines, we find that for MOPLH, sexual decisions increasingly feature compliance with biomedical directives and concern for ART efficacy. Seeking consensus regarding the biological risks of sex on ART becomes an important feature of sexual negotiations, and anticipated disagreements can pre-empt sexual relationships altogether. We introduce the concept of biomedical bargains to explain what happens when disagreements arise, and the terms of sex are negotiated using competing interpretations of biomedical information. For both men and women, ostensibly gender-neutral biomedical discourses provide new discursive resources and strategies for sexual decisions and negotiations, yet biomedical bargains are still embedded in gender dynamics—women invoke the dangers of jeopardizing treatment efficacy and longevity to insist on condoms or justify abstinence, while men utilize biomedical arguments in an effort to render condomless sex safe. While the full therapeutic benefits of ART are critical for the efficacy and equity of HIV programs, they will nonetheless always affect, and be affected by, social life.

Advances in Chronic Kidney Disease in Africa

Africa, particularly sub-Sharan Africa (SSA), faces major challenges in respect to chronic kidney disease (CKD). There is a rising prevalence due to the combined effects of hypertension, diabetes, and human immunodeficiency virus (HIV) (and the interaction between them) and the effect of apolipoprotein L1 (APOL1) variants on the susceptibility to CKD. Epidemiological data on the prevalence of CKD are of low-to-medium quality, and reliable data are urgently needed for health planning. Furthermore, there are important deficiencies in creatinine-based equations in underestimating the prevalence of CKD in Africa, and evidence suggests that cystatin C based equations are more reliable. There is a changing spectrum of HIV related CKD with the greater availability of antiretroviral treatment. Major clinical trials using SGLT2 inhibitors have signalled a major advance in the treatment of CKD, especially in relation to type 2 diabetes, but the affordability, availability, and relevance to the African population is not established. The importance of the effects of hypertension in pregnancy and pregnancy related acute kidney injury on CKD and the newer concept of CKD of unknown cause (CKDu) are highlighted. Hypertension remains a dominant cause of CKD in Africa, and newer information suggests that the most appropriate treatment to control blood pressure and thus prevent CKD is the combination of either amlodipine plus a thiazide diuretic or angiotensin converting enzyme (ACE) inhibitor.

Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000–2015

ObjectivesThe structure and composition of the household has important influences on child mortality. However, little is known about these factors in HIV-endemic areas and how associations may change with the...

INSTIs for the management of HIV-associated TB (INSIGHT study): a phase 2b study to evaluate the efficacy, safety and pharmacokinetics of a combination of bictegravir, emtricitabine and tenofovir alafenamide fumarate for the treatment of HIV-1 infection in patients with drug-susceptible tuberculosis on a rifampicin-based treatment regimen: a phase 2b open-label randomised controlled trial

IntroductionCotreatment of HIV and tuberculosis (TB) reduces morbidity and mortality in coinfected patients. Availability of antiretroviral treatment (ART) drug options, including within drug classes, is important, particularly in high HIV/TB...

Factors associated with early biological aging in older people with HIV

ABSTRACT Advances and availability of antiretroviral treatment has enabled a longer life expectancy for HIV population. However, with its chronicity, premature aging challenges the management of people living with HIV. This study, conducted between 2018–2020, aimed to identify an association between risk factors and premature aging, using the biological age estimated by artificial intelligence (AI) based on deep learning (Aging 3.0). This was a cross-sectional, analytical study, involving older people living with HIV (OPLHIV), 66.1% of whom were men. Premature aging was identified in 67.8%. The presence of cannabis and diabetes were significant (p = 0.045 and p = 0.042, respectively). For current and nadir CD4 + cell counts, participants were divided into groups comparing biological age (BA) and chronological age (CA). Just one group presented no premature aging, whereas the group with premature aging was subdivided into BA > CA up to 4 years and BA > CA in 5 or more years. In conclusion, premature aging was present in most of the OPLHIV. The use of cannabis was self-reported in those with higher BAs and those with a lower BA presented a higher prevalence of diabetes. Factors directly linked to HIV infection, lower current and nadir CD4 + counts were associated with premature aging.

Viral Hepatitis Co-infection Impact on Response to Antiretroviral Therapy and HIV Disease Progression: Virologic and Immunological Indices Outlook

<i>Introduction</i>: Due to the availability of anti-retroviral treatment (ART), infected individuals with HIV in Sub-Sahara Africa live longer with reduced mortality and morbidity. But there’s rising cases of co-infection with viral hepatitis, reliable data on Hepatitis V virus (HBV) or Hepatitis C (HCV) co-infection prevalence among HIV infected adults in North Central Nigeria. <i>Methods</i>: A descriptive cross sectional study was carried out among 289 seropositive drug experienced HIV patients attending Federal Medical centre Keffi in Nasarawa State from December 2019 to march, 2020. The enrolled participants  18 years were tested for anti-HCV and HBsAg. Serological markers profile for Hepatitis B virus was performed on HBV positive samples. HBV DNA viral load and CD4+ T cells cunt were determined using BD faces analyser and CORBAS Tag-MAN Ampli-prep analyser (USA) respectively. <i>Results</i>: The HBV/HCV coinfection prevalence among sero-positive HIV drug experience patient was 5.1%. the prevalence of HBV-HIV and HCV- HIV coinfection were 9.5 and 9.3% respectively. Active viral carriers of HBeAg) were associated with HBV-HIV co-infected individuals was 8.6% and the HBeAg is associated with sever immune-suppression and decrease in CD4+ T cells and increase in viral load. Dependent risk factors for HCV-HBV-HIV infection are: CD4+ T cells OR; 0.4 (0.1-1.5), age 18-30years 2.1 (1.6-2.1), multiple sex partners 0.7 (0.1-2.3). Participants aged 18–30 years [OR=2.1 (1.6–2.1); p=0.046], male gender [OR=0.9 (0.3–1.4); p=0.034], CD4+ T cell count [OR=0.4 (0.1–1.5); p=0.045], History of Blood transfusion [OR=0.8 (0.2–4.0); p=0.012] and being married [OR=0.6 (0.2–4.3); p=0.039] were independent risk factors of HIV-HBV-HCV co-infections. <i>Conclusion</i>: Increase in viral load, severe immune suppression and decrease in CD4+ T Cells was predominant highlights in HBV, HCV coinfection amount HIV patients, increase HBV, HCV screening should be encouraged among seropositive HIV infected individuals.

Semi-parametric model for timing of first childbirth after HIV diagnosis among women of childbearing age in Ibadan, Nigeria.

HIV diagnosis is a watershed in women's childbearing experience. It is usually accompanied by the fear of death and stigmatisation. Women diagnosed of HIV are often sceptical about pregnancy. Meanwhile, availability of antiretroviral treatments has impacted positively on childbearing experience among women living with HIV. We therefore investigated the timing of first childbirth after HIV diagnosis and its determinants among women in Ibadan, Nigeria. We extracted and analysed data from a 2015 cross-sectional study on childbearing progression among 933 women living with HIV and receiving care at University College Hospital, Ibadan, Nigeria. Extended Cox proportional hazards regression, a semi-parametric event history model was used at 5% significance level. The women's mean age was 38.1 (± SD = 6.1) years and the median time to first birth after HIV diagnosis (FBI_HIV) was 8 years. The likelihood of first birth after HIV diagnosis was lower among women who desired more children (HR = 0.63, CI: 0.51-0.78). Women whose partners had primary and secondary education respectively were about 2.3 times more likely to shorten FBI_HIV compared to those whose partners had no formal education. Knowledge of partner's HIV-positive status (HR = 1.42, CI: 1.04,1.93) increased the likelihood of having a first birth after HIV diagnosis. Older age, longer duration on ART and a higher number of children at diagnosis were associated with a declined hazard of first birth after HIV diagnosis. The median time to first childbirth after HIV diagnosis was long. Partner's HIV-positive status and higher educational attainment were associated with early childbearing after HIV diagnosis.

Blessing’s (Life) Story: An Adolescent in Residential Care Living with HIV

The lifespan of perinatally HIV-infected children in South Africa has increased owing to the availability of antiretroviral treatment, allowing growth into adolescence and beyond. There is limited knowledge of the lived realities of adolescents with HIV. This paper, using life story methodology and based on Blessing’s narrative, provides an intersectional, complex view of the experience of one such teenager who is perinatally HIV-positive, was abandoned by his family and is living in a residential care facility. His story powerfully illuminates the specific construction of adolescence in this context, focusing on identity formation and the need for connection. The narrative also points to service providers’ practice when engaged with such youths.

HIV positive status disclosure and associated factor among HIV infected children in pediatric ART clinics in Gondar town public health facilities, North West Ethiopia, 2018

BackgroundDue to the increasing availability of antiretroviral treatment, HIV infected children are living longer which points out the necessity of disclosure. And which is important to support the uptake and adherence to treatment. Disclosure is an important measure to prevent secondary transmission when children are sexually active. ObjectiveThe aim of this study was to determine the prevalence of HIV positive status disclosure and associated factors among human immune virus-infected children in pediatric antiretroviral treatment clinics in Gondar town public health facilities. MethodAn institution based cross-sectional study was conducted among 449 primary caregivers of children aged 6–15years in regular follow-up at pediatric ART clinics in Gondar town public health facilities between March 3, 2018, to April 25, 2018. All subjects in the study area were included in the study. Data was collected in 5 pediatric ART clinics in Gondar town by structured questionnaires through face to face interview and supplemented by chart review to obtain some clinical factors. The variables which have an association with disclosure were identified on the basis of AOR, with 95%CI and p-value <0. 05. Model fitness was checked using Hosmer and Lemeshow goodness of fit test. ResultOut of 449 participants, 418 were interviewed with response rate of 93%. The prevalence of HIV positive status disclosure found to be 44%. Age of child >10years [AOR=5.88, (95% CI: 3.52, 9.81)], duration on ART [AOR=2.67 (95% CI: 1.59, 4.51)], place of follow-up [AOR=2.23 (95% CI: 1.27, 5.01)] and educational status of caregiver [AOR=3.00 (95% CI: 1.62, 5.56)] were identified variables. ConclusionThe prevalence of disclosure found to be low. Therefore appropriate measure should be taken to promote disclosure.

G-105 Academic institutional impact on global HIV pandemic response: A decade of Implementing PEPFAR programs by University of Maryland Baltimore

Background: The global HIV burden remains high with nearly 40 million persons living with HIV (PLWH) to date. Encouragingly HIV incidence and AIDS-related mortality have dropped significantly over the past 20 years due in part to availability of antiretroviral treatment in all parts of the world most especially in resource-limited countries. Global interventions such as U.S President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight TB, Malaria and AIDS (GFATM) are credited for this unprecedented response. As a result, to date more than 22 million are receiving antiretroviral treatment. The Center for International Health, Education and Biosecurity (CIHEB) and its predecessors within the Institute of Human Virology (IHV) at the University of Maryland Baltimore (UMB) has played a key role in the global HIV response since PEPFAR inception. Methods: Under PEPFAR 1.0 which focused on decreasing the high mortality rate due to HIV our interventions aimed at enhancing provider competencies and health facility care processes to deliver quality HIV services. PEPFAR 2.0 placed emphasis on transition of health programs to local ownership for sustainability, and we shifted our focus to building technical stewardship capacity to sustain key programmatic interventions. PEPFAR 3.0 has focused on achievement of epidemic control and likewise our strategies have evolved to implementation of targeted health-systems strengthening and community-owned innovations for achievement and sustenance of HIV epidemic control. Our approaches have included: using data and evidence to inform decisions, policy and practice; ensuring effectiveness and competence of highly trained multi-disciplinary teams; building robust data and information systems; modeling care delivery; and institutionalization of continuous quality improvement to enhance service delivery. It is imperative that we assess the impact of these interventions in order to optimize future academic institutions' engagement in global health. Results: From 2004 to 2018, our programs have implemented models of care for delivering HIV/AIDS and related services for rural, peri-urban and the urban poor in 10 countries. These programs have resulted in: (1) provision of antiretroviral treatment to over 1 million PLWH including 285,000 who are enrolled in current programs; (2) reduced mother-to-child HIV transmission from 7.8% in 2010 to less than 2.5% by September 2016 in Kenya; (3) increased access to prevention of mother-to-child transmission (PMTCT) interventions, (4) trained more than 50,000 healthcare providers in resource-limited settings; (5) increased comprehensive combined prevention services to key and priority populations; (6) implementation of novel electronic health records solutions; (7) led HIV and health policy and guidelines development; and 8) institutionalized data and evidence use as part of continuous quality improvement initiatives in more than 1500 health facilities. Significantly, these programs have improved key patient and population health outcomes including achieving more than 90% virologic suppression among PLHIV receiving antiretroviral treatment in CIHEB programs. Conclusions: Currently, CIHEB implements programs in 7 countries as a key partner to local government health authorities. Working through local systems and with national institutions has been critical to our achievements, while the application of academic principles of inquiry to program interventions and adaptation of innovations to new settings has provide a template for success. We present the CIHEB model as an optimal framework for global health involvement that allows for integration of global best practices and local knowledge throughout the implementation process.

Interventions Addressing Neurodevelopmental Delay in Young Children Infected With and Exposed to HIV: A Scoping Review

Background: Neurodevelopmental delays have been documented in children living with and infected by the human immunodeficiency virus (HIV). Early childhood stimulation programs can positively impact neurodevelopmental outcomes and have a far-reaching effect beyond childhood. Objective: To conduct a scoping review mapping evidence describing interventions aimed at mitigating or preventing neurodevelopmental delays resulting from exposure to or infection with HIV in preschool children. Methods: Electronic databases of PubMed, PsycINFO, CINAHL Plus, Google Scholar, and the Cochrane Library, reference lists of identified articles, and gray literature were searched. Title and abstract and full-text reviews were conducted independently by 2 reviewers. Study location, design, sample size, age of cohort, child's HIV serostatus, antiretroviral treatment availability for children or caregivers, neurodevelopmental assessment tool used, and details of the intervention and comparison groups were documented. Results: Ten studies meeting predetermined inclusion and exclusion criteria were identified. Six studies focused on training provided to the child's caregiver of which one offered an intervention focused specifically on stimulating child development through a home-based stimulation program. Four studies provided a child-directed intervention. Interventions ranged in duration from 10 days to 15 months. Intensity of the intervention varied from 3 times per day to biweekly. Interventions were aimed at children in the neonatal period throughout the preschool years. Conclusion: Many children are at risk of poor neurodevelopmental outcomes due to HIV infection. Few studies investigating interventions aimed at addressing this problem were identified. Further research into effective interventions aimed at improving childhood neurodevelopmental outcomes in the context of HIV is required.

The sex gap in neonatal mortality and the AIDS epidemic in sub-Saharan Africa

The sex gap in early-age death is one of the most important sources of child inequality in all societies, and it carries negative social consequences in the long run. In...

Excessive mortality and loss to follow-up among HIV-infected children in Guinea-Bissau, West Africa: a retrospective follow-up study.

To estimate the magnitude of mortality and loss to follow-up and describe predictors of mortality among HIV-infected children in Guinea-Bissau. Retrospective follow-up study among HIV-infected children under 15 years of age at the largest HIV-clinic in Guinea-Bissau from 2006-2016. A multivariate Cox proportional hazards model was used to identify predictors of mortality. Of 525 children were included in the analysis: 371 (70.7%) with HIV-1, 17 (3.2%) with HIV-2, 25 (4.8%) with HIV-1/2, and 112 (21.3%) with HIV of unknown type. At diagnosis, the median age was 3.5 years, 44.7% met the WHO criteria for severe immunodeficiency by age based on CD4 cell count, and 59.4% were underweight. The median follow-up time was 6 months. Despite the availability of antiretroviral treatment, the mortality rate was 10.4 deaths per 100 person-years of follow-up. Within the first year of follow-up, 11.0% died, 3.1% were transferred and 38.8% were lost to follow-up, leaving 47.1% in follow-up. Severe immunodeficiency (adjusted hazard ratio (aHR) = 2.52, 95% CI: 1.22-5.21) and underweight (aHR = 3.14, 95% CI: 1.40-7.02) were independent predictors of mortality. This study reveals a high rate of early mortality and loss to follow-up among HIV-infected children in Guinea-Bissau. Initiatives to improve patient retention are urgently needed.

Precarious transition: a mortality study of South African ex-miners

BackgroundDespite their burden of a triple epidemic of silicosis, tuberculosis and HIV infection, little is known about the mortality experience of miners from the South African mining industry once they leave employment. Such information is important because of the size and dispersion of this population across a number of countries and the progressive nature of these diseases.MethodsThis study included 306,297 South African miners who left the industry during 2001–2013. The study aimed to calculate crude and standardised mortality rates, identify secular trends in mortality and model demographic and occupational risk factors for mortality.ResultsCrude mortality rates peaked in the first year after exit (32.8/1000 person-years), decreasing with each year from exit. Overall mortality was 20% higher than in the general population. Adjusted annual mortality halved over the 12 year period. Mortality predictors were being a black miner [adjusted hazard ratio (aHR) 3.30; 95% confidence interval (CI) 3.15–3.46]; underground work (aHR 1.33; 95% CI 1.28–1.39); and gold aHR 1.15 (95% CI 1.12–1.19) or multiple commodity employment (aHR 1.15; 95% CI 1.11–1.19).ConclusionsThis is the first long-term mortality assessment in the large ex-miner population from the South African mining industry. Mortality patterns follow that of the national HIV-tuberculosis epidemic and antiretroviral treatment availability. However, ex-miners have further elevated mortality and a very high mortality risk in the year after leaving the workforce. Coordinated action between the mining industry, governments and non-governmental organisations is needed to reduce the impact of this precarious transition.

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.

Navigating Multiple Sources of Healing in the Context of HIV/AIDS and Wide Availability of Antiretroviral Treatment: A Qualitative Study of Community Participants' Perceptions and Experiences in Rural South Africa.

South Africa introduced the world's largest antiretroviral treatment (ART) program in 2004 and since 2016 the Department of Health implemented a universal Treatment as Prevention (TasP) strategy. However, some studies have shown that increasing the availability of ART is insufficient for the comprehensive treatment of HIV, since many people still use traditional health practitioners (THPs) to avoid being identified as HIV positive, and for reasons unrelated to HIV/AIDS. This qualitative study explored the factors influencing how both HIV-negative and HIV-positive people choose amongst multiple sources of healing and how they engage with them, in the context of HIV/AIDS and wide availability of ART. Data were collected as part of a larger TasP trial at the Africa Health Research Institute, KwaZulu-Natal. Repeat in-depth individual interviews were conducted with 10 participants. Repeat group discussions were conducted with 42 participants. Group discussion data were triangulated using community walks and photo-voice techniques to give more insight into the perceptions of community members. All data were collected over 18 months. Thematic analysis was used to analyze participants' narratives from both individual interviews and group discussions. In the context of HIV/AIDS and wide availability of ART, use of biomedical and traditional healing systems seemed to be common in this locality. People used THPs to meet family expectations, particularly those of authoritative heads of households such as parents or grandparents. Most participants believed that THPs could address specific types of illnesses, especially those understood to be spiritually caused and which could not be addressed or cured by biomedical practitioners. However, it was not easy for participants to separate some spiritually caused illnesses from biological illnesses in the context of HIV/AIDS. These data demonstrate that in this context, the use of THPs continues regardless of the wide availability of ART. To meet the health care needs of those patients requiring a health care system which combines biomedical and traditional approaches, collaboration and integration of biomedical and traditional health care should be considered.

'People say that we are already dead much as we can still walk': a qualitative investigation of community and couples' understanding of HIV serodiscordance in rural Uganda.

BackgroundStable, co-habiting HIV serodiscordant couples are a key population in terms of heterosexual transmission in sub-Saharan Africa. Despite the wide availability of antiretroviral treatment and HIV educational programs, heterosexual transmission continues to drive the HIV epidemic in Africa. To investigate some of the factors involved in transmission or maintenance of serodiscordant status, we designed a study to examine participants’ understanding of HIV serodiscordance and the implications this posed for their HIV prevention practices.MethodsIn-depth interviews were conducted with 28 serodiscordant couples enrolled in a treatment-as-prevention study in Jinja, Uganda. Participants were asked questions regarding sexual behaviour, beliefs in treatment and prevention, participants’ and communities’ understanding and context around HIV serodiscordance. Qualitative framework analysis capturing several main themes was carried out by a team of four members, and was cross-checked for consistency.ResultsIt was found that most couples had difficulty explaining the phenomenon of serodiscordance and tended to be confused regarding prevention. Many individuals still held beliefs in pseudoscientific explanations for HIV susceptibility such as blood type and blood “strength”. The participants’ trust of treatment and medical services were well established. However, the communities’ views of both serodiscordance and treatment were more pessimistic and wrought with mistrust. Stigmatization of serodiscordance and HIV-positive status were reported frequently.ConclusionsThe results indicate that despite years of treatment and prevention methods being available, stigmatization and mistrust persist in the communities of HIV-affected individuals and may directly contribute to new cases and seroconversion. We suggest that to optimize the effects of HIV treatment and prevention, clear education and support of such methods are sorely needed in sub-Saharan African communities.

Molecular epidemiology reveals genetic diversity among 363 isolates of the Cryptococcus neoformans and Cryptococcus gattii species complex in 61 Ivorian HIV-positive patients.

Cryptococcal meningitis is a severe opportunistic infection in HIV-infected patients. In Ivory Coast, despite the availability of antiretroviral treatment (ART), this infection is still prevalent. The study investigates the genetic diversity of 363 clinical isolates of Cryptococcus from 61 Ivorian HIV-positive patients, the occurrence of mixed infections and the in vitro antifungal susceptibility of the isolates. Serotyping was performed via LAC1 and CAP64 gene amplification. Genotyping was performed using the phage M13 core (GACA)4 and (GTG)5 primers and restriction fragment length polymorphism analysis of the URA5 gene. By PCR fingerprinting, the presence of the three serotypes were demonstrated among the 363 isolates in the population studied: A (n=318; 87.6%), AD (n=40; 11%) and B (n=4; 1.1%). Using PCR fingerprinting with primers M13 (GACA)4 and (GTG)5 , we grouped the isolates into 56 molecular subtypes. We observed a high frequency (39.3%) of mixed infections, with up to two different genotypes per sample. None of the isolates were resistant to amphotericin B. Only 0.3% and 1.1% of the isolates were resistant to fluconazole and flucytosine respectively. This study revealed the high genetic diversity among Cryptococcus isolates, the occurrence of mixed infections and a high antifungal susceptibility for the majority of Ivorian cryptococcal isolates.