Care For HIV Patients Research Articles

The Fundamental Role of Linkage Uncertainty in Epidemiological Analysis of Big Data

BackgroundEpidemiologists increasingly work with linked “big data”. Uncertainty in record linkage may lead to biased inferences but is often overlooked. We evaluate the impact of linkage uncertainty on statistical inference in linked big data. MethodsWe developed a graphical framework for describing linkage uncertainty when linking multiple representations of the same entity, applied to de-identified data from South Africa’s national laboratory database. Through simulation, we systematically introduced linkage errors and measured their impact on overall accuracy (sensitivity, positive predictive value (PPV)). We evaluate how linkage errors affect bias and variance in point estimates for a hypothetical parameter of interest in clinical epidemiology: 24-month retention in care for HIV patients. We compare the roles of sampling error vs. linkage error as fundamental sources of uncertainty in datasets of varying sizes. ResultsWe simulated a population of 14,393 HIV patients, with a “true” 24-month retention of 38.7%. There were 338,056 true links. Introducing 4,200 false links reduced PPV by 5%. Removing 21,500 existing links decreased sensitivity by 5%. From 10 simulation runs, a 95% sensitivity led, on average, to a 7.4% overestimate in entries to care and a 2.2% (range: 2.1-2.4%) underestimate in 24-month retention. A 95% PPV resulted, on average, in a 7.5% underestimate in entries to care and a 1.8% (range: 1.5-2.0%) overestimate in 24-month retention. ConclusionWe observe that in a large sample, linkage uncertainty minimally impacts variance in point estimates but has a potentially large influence on the magnitude and direction, distinguishing it from typical sampling errors.

COGNITIVE FUNCTION ASPECTS IN HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS: A CASE REPORT

HIV-associated cerebral toxoplasmosis may lead to cognitive function impairment through accumulation of β-amyloid plaques and Tau protein which cause damage, inflammatory and oxidative processes in the brain. A 40-year-old, Balinese, right-handed female patient, came with chief complaint of three times of seizure before admission. After the seizures stopped, the patient was fully conscious again. Since the last 2 months, the patient seemed more confused and spoke a little slower. The patient also often repeated a story about something and forgot that she had already told it. The patient has a known history of HIV infection in the past 3 months before admission, she had taken anti-retroviral agents but she stopped them by herself since last 1 month. Anti-Toxoplasma IgG antibody showed reactive results and CD-4 of 62 cells/µL. The results of the overall cognitive function examination found mild cognitive impairment with activities that required mild assistance. HIV-associated neurocognitive disorders (HAND) are still a challenge to study, and the importance of improving patient cognitive function to maintain or increase aspects of independence and quality of life is a target in the care of HIV patients, especially patients with HIV-associated cerebral toxoplasmosis infection.

Exploring patient-centered design solutions of a telehealth app for HIV − A qualitative study

BackgroundThe Communication and Tracing App HIV (COMTRAC-HIV) project is developing a mobile health (mHealth) app for integrated care of HIV patients in Germany. The complexity of HIV treatment and continuous care necessitates the need for tailored mHealth solutions. This qualitative study explores design solutions and a prototype to enhance the app's functionality and effectiveness. MethodsA total of eight HIV patients and pre-exposure prophylaxis (PrEP) users, recruited at the HIV Center Frankfurt, participated in focus groups and thinking-aloud tests (TA test). In the focus groups, design solutions were discussed for user-interface clarity, leading to the development of an interactive prototype, the usability of which was evaluated with a TA test. Data collection involved video/audio recordings. Qualitative analysis was conducted using a deductive category system, and focused on app design and usage in focus groups, and layout, navigation, interaction, terminology, comprehension, feedback, and level of satisfaction in TA tests. ResultsThe app was commended for its simple, clear design, especially its medication reminders and health tracking features. Opinions on the symptom diary varied however, respondents noting it more suitable for HIV users than PrEP users. Privacy concerns suggest avoiding display of HIV-specific information. Suggested improvements include e.g. image uploads, drug interaction checks and prescription tracking. A total of 25 usability issues were identified in the TA test, with most found in the layout (n = 6), navigation (n = 5), interaction (n = 5), and terminology (n = 5) categories. Two examples are non-intuitive controls and illogical button placement. Despite these disadvantages, participants noted positive impressions (n = 5) in the satisfaction category. ConclusionThe study emphasizes the need for patient-centered design in mobile HIV care solutions, highlighting to the app's user-friendliness and potential to enhance care. Further research is necessary to refine the app’s functionality and to align it with clinical and patients' privacy needs.

Exploring experiences of HIV care to optimize patient-centred care in Conakry, Guinea: a qualitative study.

Studies on the organisation of care and the power dynamic between providers and patients with HIV in sub-Saharan Africa are rare. This study aims to describe the patient-provider relationship and explore the challenges to optimal and patient-centred care for HIV patients. This was a qualitative exploratory descriptive study using in-depth individual interviews and focus group discussions. In total, 17 individual interviews and 5 focus group discussions were conducted. This was conducted in four urban health facilities in Conakry, the capital of Guinea. Three group of participants were included in this study namely patients with HIV; health providers including facilities and services managers; and psychosocial counsellors. Psychosocial counsellors provide emotional and psychosocial support to HIV patients. Their role in the organization care in Guinea is new and they contribute to strengthening adherence of patients with HIV to ARV treatment. Patients with HIV, health providers, and psychosocial counsellors have a positive perception of the patient-provider relationship. This relationship was characterized essentially by maintaining confidentiality of HIV status disclosure, caring attitudes towards patients (being available, adjusting locations for accessing ART, based on patients' preferences), and participating in HIV patient's social life. However, scolding and miscommunication about the interpretation of viral load tests were reported. The shortage of human resources, low salaries of health staff, poor infrastructure, and the financial burden borne by patients with HIV impede the implementation of optimal patient-centred care. Integrating psychosocial counsellors in HIV care organization, improving access to ARV, infrastructure, increasing human resources, and removing the financial burden for HIV patients are needed to optimal patient-centred care in Guinea.

Antiretroviral Therapy and Red Blood Cell Morphology: A Review in HIV Patients

Antiretroviral therapy (ART) has transformed the management of HIV, significantly improving the prognosis and quality of life for individuals living with the virus. While the primary focus of ART has traditionally been on viral suppression and immune restoration, emerging evidence suggests a potential impact on red blood cell (RBC) morphology. This paper explores the intricate relationship between antiretroviral therapy and red blood cell morphology in HIV patients, shedding light on the multifaceted effects of these medications beyond their antiviral properties. Moving beyond laboratory findings, the review investigates the clinical implications of alterations in red blood cell morphology in individuals undergoing antiretroviral therapy. This includes discussions on potential implications for oxygen-carrying capacity, hemoglobin levels, and overall hematological health, emphasizing the need for a holistic understanding of the hematopoietic consequences of ART. In conclusion, this paper consolidates existing knowledge, identifies gaps in understanding, and provides a comprehensive resource for researchers, clinicians, and healthcare professionals involved in the care of HIV patients. It contributes to the broader conversation on the holistic effects of antiretroviral therapy, paving the way for future investigations and improved clinical management.

Prevalence and risk factors associated with tuberculosis and HIV coinfection in Iran: A multivariate firth logistic regression for rare events.

Among the complications caused by HIV infection, tuberculosis (TB) is the most important challenge. The study aimed to determine the predictors of TB and HIV coinfection by using Firth logistic regression analysis. This cross-sectional study was conducted on 32,168 HIV-positive patients diagnosed in Iran. The required information was obtained from the national HIV/AIDS surveillance data. The prevalence of TB in HIV patients was 3.2%; the prevalence of TB in males and females was 944 (91.83%) and 84 (8.17%), respectively. Based on results of multivariate Firth logistic regression, male gender OR male/female = 1.91; injecting drug use (IDU) OR YES/NO = 1.46; illiterate or primary groups OR illiterate or primary /university = 2.23; high school group OR high school/ university = 2.24 all increased the risk of TB and HIV coinfection (p < 0.05). Also, having CD4 > 500 [OR CD4 > 500 / < 200 = 0.39], CD4 351-500 [OR351 / < 200 = 0.65], and CD4 200-350 [OR200-350 / < 200 = 0.64] decreased the risk of TB and HIV coinfection (p < 0.001). According to the results of this study, male gender, low education, injecting drug users, and low CD4 count at the time of diagnosis, were significant predictors of TB and HIV coinfection. Therefore, regular and periodic screening programs and linkage to the care and treatment of HIV patients need special attention.

Care of the HIV patient. A view from the Nursing Care Process

The Nursing Care Process (NCP) is a systematic methodology to guide nursing professionals in the planning and execution of care, especially relevant in the management of HIV due to the complexity of the disease. HIV weakens the immune system, predisposing to infections and complications. Nursing care of HIV patients requires a thorough understanding of the pathophysiology of the virus and its psychological and social implications. The ECP includes a thorough initial assessment to identify specific needs, diagnosis of health problems, planning of realistic goals, implementation of personalized interventions, and ongoing evaluation of their effectiveness. This ensures comprehensive and tailored care, improving the quality of life and adherence to treatment of HIV patients.

Interviews with HIV Experts for Development of a Mobile Health Application in HIV Care-A Qualitative Study.

The Communication and Tracing App HIV (COMTRAC-HIV) project aims to develop a mobile health application for integrated care of HIV patients due to the low availability of those apps in Germany. This study addressed organizational conditions and necessary app functionalities, especially for the care of late diagnosed individuals (late presenters) and those using pre-exposure prophylaxis. We followed a human-centered design approach and interviewed HIV experts in Germany to describe the context of use of the app. The interviews were paraphrased and analyzed with a qualitative content analysis. To define the context of use, user group profiles were defined and tasks derived, which will represent the functionalities of the app. A total of eight experts were included in the study. The results show that the app should include a symptom diary for entering symptoms, side effects, and their intensity. It offers chat/video call functionality for communication with an HIV expert, appointment organization, and sharing findings. The app should also provide medication overview and reminders for medications and appointments. This qualitative study is a first step towards the development of an app for HIV individuals in Germany. Further research includes involving patients in the initial app design and test design usability.

The recent natural history of human papillomavirus cervical infection in women living with HIV: A scoping review of meta-analyses and systematic reviews and the construction of a hypothetical model.

Women with HIV are more often infected with human papillomavirus (HPV) and are more prone to develop precancerous cervical lesions (squamous intraepithelial lesions, SIL) and invasive cervical cancer (ICC) than HIV-negative women. This scoping-review analyses the impact of HIV on HPV prevalence, incidence and evolution to SIL and ICC. We selected all PubMed systematic reviews and meta-analyses published between January 2000 and July 2021 reporting data about HPV, cervical intraepithelial neoplasia (CIN), SIL and ICC prevalence, incidence and evolution in women with HIV. A hypothetical model comparing the history of HPV infection in HIV-negative, combined antiretroviral therapy (cART)-treated and -untreated women with HIV was built. Data from 11 meta-analyses and 10 systematic reviews were selected, which included between 770 and 236 127 women with HIV. Women with HIV have a 3 to 6 times higher risk of being infected by HPV, of progression to high-grade SIL (HSIL) and to ICC. These risks are exacerbated when the CD4 cell counts are low and when they are not using cART, whereas these risks are reduced by 20%-30% when they are optimally treated with cART and have had a suppressed HIV viral load for at least 2 years. In our model, we illustrated that optimal HIV treatment and preventing HIV reduce the number of ICC cases by 2.5 and 6 times, respectively. Optimal treatment and care of HIV patients are essential to reduce their prevalence of ICC, as are preventive strategies which include HPV vaccination, cervical cancer screening strategies and treatment of HSIL.

Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda.

Health workers' failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (˃95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA-v15. The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.

Ethical reflections on the health care of HIV patients

Resumen Este trabajo propone analizar los aspectos éticos en el seguimiento terapéutico de pacientes con VIH a través de una revisión sistemática de la literatura en las bases de datos PubMed, LILACS y MEDLINE, utilizando descriptores en inglés y portugués, lo que resultó en 169 publicaciones entre 2011 y 2021. Para evitar sesgos se utilizó el método Prisma y, para clasificar el nivel de evidencia, se consideraron las recomendaciones establecidas por el sistema Grading of Recommendations Assessment, Development and Evaluation. El bienestar de los pacientes con VIH estuvo asociado al nivel de relaciones interpersonales, calidad del tratamiento y creencias personales. El estigma y el miedo a propagar la enfermedad en los grupos con los cuales conviven fueron los principales motivos de preocupación. Por lo tanto, es fundamental brindar un mayor apoyo a los pacientes durante el diagnóstico y tratamiento de la enfermedad para que puedan desarrollar mejor sus estrategias de afrontamiento.

Ethical reflections on the health care of HIV patients

Resumo Neste trabalho, pretendeu-se analisar aspectos éticos no seguimento terapêutico de pacientes com HIV mediante revisão sistemática de literatura, realizada por meio de pesquisas nas bases PubMed, LILACS e MEDLINE, usando descritores em inglês e português, com 169 publicações de 2011 a 2021. Para evitar viés, foi utilizado o método Prisma e consideradas as recomendações estabelecidas pelo sistema Grading of Recommendations Assessment, Development and Evaluation para classificação do nível de evidência. O bem-estar de pacientes com HIV está associado ao nível de relações interpessoais, qualidade do tratamento e crenças pessoais. A estigmatização e o medo da divulgação da doença nos grupos em que convivem são os principais motivos de aflição. Com isso, é fundamental um maior apoio aos pacientes durante o diagnóstico e tratamento da doença, para que possam elaborar melhor suas estratégias de enfrentamento.

Impact of the COVID-19 pandemic: Community and hospital shared pharmaceutical care model. Satisfaction and acceptability of patients with HIV infection on antiretroviral treatment.

BackgroundThe health crisis due to the COVID-19 pandemic is a challenge in the dispensing of outpatient hospital medication (OHM). Models of Antiretroviral Therapy (ART) based on community pharmacy support (ARTCP) have proven to be successful. The aim was to evaluate the degree of satisfaction, acceptability and limitations of the implementation of ARTCP, in the context of a pandemic, in our environment.MethodsDescriptive cross-sectional study carried out in a Barcelona hospital, during the months of July-November 2020. A telephone survey was carried out via a questionnaire on the quality dimensions of the model (degree of satisfaction, acceptability) and associated inconveniences. Data collected: demographics, antiretroviral treatment (ART), concomitant medication, drug interactions (DDIs), CD4 lymphocyte count and plasma viraemia. Data analysis included descriptive statistics.ResultsA total of 533 (78.0%) HIV patients receiving ART were included. 71.9% (383/533) of these patients were very satisfied and 76.2% preferred attending the community pharmacy rather than the hospital. The mean satisfaction rating was 9.3 (DS: 1.4). The benefits reported were: 1) proximity to home (406: 76.1%); 2) lower risk of contagion of COVID-19 (318: 59.7%); 3) shorter waiting time (201: 37.1%); 4) time flexibility (104: 19.5%); 5) reduction of financial expenses (35: 6.57%). A total of 11 (2%) patients reported no benefit. Only 22.9% reported disadvantages associated with ARTCP: 1) lack of privacy (65: 12.2%); 2) lack of coordination-organization (57: 10.7%).ConclusionThe COVID-19 pandemic has had an impact on the provision of pharmaceutical care for HIV patients. The ARTPC model has proved efficient, with patients reporting a high degree of satisfaction.

The cascade of care of HIV after one year of follow-up in a cohort of HIV-positive adult patients in three health settings of Morrumbene in rural Mozambique.

Objective: To assess the state of the retention in care of HIV patients in three health settings in Morrumbene, a rural district of Inhambane Province, Mozambique. We evaluated potential factors associated with early loss to follow‐up (LTFU), retention in care and ART adherence during the first year of follow‐up. Material and methods: Retrospective, cross‐sectional, observational study. We collected data on patients diagnosed with HIV infection in 2017 in two permanent clinics and one mobile clinic. Demographic, clinical, immunological and therapeutic data were retrieved up to December 31st, 2018. Data on follow‐up were collected at 6 and 12 months for medical visits and for ART adherence and analysed for factors associated with LTFU, retention in care and adherence to ART by Stata Version 14 and univariate and stepwise multiple unconditional logistic regression models. Results: In 2017, 960 patients were diagnosed with HIV infection. At 6‐month follow‐up, 49% attended the medical visit and 157 (25%) adhered to ART. After one year, 34% of patients were available for follow‐up, and only 72 patients adhered to ART. In multivariate analysis, factors associated with early LTFU were male sex (p = 0.036) and immediate prescription of ART (p = 0.064). Older age (p < 0.001) and being followed in the mobile clinic (p = 0.001) favoured retention in care. Advanced WHO status (p = 0.005) and being pregnant or breastfeeding showed a negative correlation with adherence to treatment (p = 0.068). Conclusions: Only one‐third of patients were available for follow‐up after one year, and only 13% adhered to ART. Young individuals, men and pregnant/breastfeeding women seem to be particularly at risk for LTFU and non‐adherence to treatment.

Institutional Factors Affecting Retention of HIV Patient on Treatment at Wuse General Hospital, Abuja, Nigeria

Retention On Treatment Is A Critical Factor In Reducing HIV-Related Morbidity And Mortality, The Incidence Of New Infections, And Development Of Drug Resistance Among Children And Adults. This Study Examined Institutional Factors Affecting Retention Of HIV Patients On Treatment, Care, And Support Services At Wuse General Hospital, Abuja. A Retrospective Cohort Study Was Used To Access Institutional Factors That Influence HIV Patient Retention On Treatment. About 4,564 HIV Patients Were Ever Enrolled On A Treatment Programme, And 2,791 Patients Are Currently Accessing Treatment. A Total Of 240 Clients Were Recruited For The Study, And A Pre-Tested Interviewer-Administered Semi-Structured Questionnaire Was Used For Data Collection. Data Were Entered Into Stata/MP 15.0 And Then Exported Into SPSS Version 23.0 For Statistical Analysis Of The 240 Respondents Interviewed, The Main Institutional Factor Affecting Retentions Were Long Waiting Time (61.7%), High Patient Load (46.9%), Inadequate Space For Clinics (48.3%), Poor Quality Of Services (40.8%), Difficulty In Accessing Health Facility (32.9%) And Inadequate Health Workers/Staff (31.3%). A Review Of Socio-Demographic Characteristics Of Respondents And Institutional Related Factors Affecting Retention In Treatment Showed An Association Between Marital Status (P=0.000), Religion (P=0.006), Employment Status (P=0.009), And Institutional Related Factors Affecting Retention In Care. Retention Of HIV Patients In Treatment And Care Support Services Is A Major Determinant In Achieving Sustained Viral Suppression And Reduced Community HIV Transmission. Therefore, Strategies To Mitigate Institutional Barriers To Treatment Retention Should Be Promoted To Optimize Retention Of HIV Patients In Care.

Short Communication: HIV Viral Load Trends During the Coronavirus Disease 2019 Pandemic in a Reference Center for HIV in Rome, Italy.

Coronavirus disease 2019 (COVID-19) pandemic has reduced the access of HIV patients to reference centers. However, retention-in-care is critical to maintain adherence to therapy and viral suppression. During lockdown in Italy, our center implemented several measures to ensure HIV-care continuum. To assess whether these efforts were successful, we investigated HIV viral load trend for a 1-year period (September 2019-August 2020), which included lockdown and partial lockdown months in our country. No significant changes overtime in the proportion of undetectable HIV-RNA were observed. Continuity of service made it possible to maintain viral suppression in our patients.

Applying a machine learning modelling framework to predict delayed linkage to care in patients newly diagnosed with HIV in Mecklenburg County, North Carolina, USA.

Machine learning has the potential to help researchers better understand and close the gap in HIV care delivery in large metropolitan regions such as Mecklenburg County, North Carolina, USA. We aim to identify important risk factors associated with delayed linkage to care for HIV patients with novel machine learning models and identify high-risk regions of the delay. Deidentified 2013-2017 Mecklenburg County surveillance data in eHARS format were requested. Both univariate analyses and machine learning random forest model (developed in R 3.5.0) were applied to quantify associations between delayed linkage to care (>30 days after diagnosis) and various risk factors for individual HIV patients. We also aggregated linkage to care by zip codes to identify high-risk communities within the county. Types of HIV-diagnosing facility significantly influenced time to linkage; first diagnosis in hospital was associated with the shortest time to linkage. HIV patients with lower CD4+ cell counts (<200/ml) were twice as likely to link to care within 30 days than those with higher CD4+ cell count. Random forest model achieved high accuracy (>80% without CD4+ cell count data and >95% with CD4+ cell count data) to predict risk of delay in linkage to care. In addition, we also identified top high-risk zip codes of delayed linkage. The findings helped public health teams identify high-risk communities of delayed HIV care continuum across Mecklenburg County. The methodology framework can be applied to other regions with HIV epidemic and challenge of delayed linkage to care.

Monitoring Recently Acquired HIV Infections in Amsterdam, The Netherlands: The Attribution of Test Locations.

Background: Surveillance of recent HIV infections (RHI) using an avidity assay has been implemented at Dutch sexual health centres (SHC) since 2014, but data on RHI diagnosed at other test locations is lacking.Setting: Implementation of the avidity assay in HIV treatment clinics for the purpose of studying RHI among HIV patients tested at different test locations.Methods: We retrospectively tested leftover specimens from newly diagnosed HIV patients in care in 2013–2015 in Amsterdam. Avidity Index (AI) values ≤0.80 indicated recent infection (acquired ≤6 months prior to diagnosis), and AI > 0.80 indicated established infection (acquired >6 months prior to diagnosis). An algorithm for RHI was applied to correct for false recency. Recency based on this algorithm was compared with recency based on epidemiological data only. Multivariable logistic regression analysis was used to identify factors associated with RHI among men who have sex with men (MSM).Results: We tested 447 specimens with avidity; 72% from MSM. Proportions of RHI were 20% among MSM and 10% among heterosexuals. SHC showed highest proportions of RHI (27%), followed by GPs (15%), hospitals (5%), and other/unknown locations (11%) (p < 0.001). Test location was the only factor associated with RHI among MSM. A higher proportion of RHI was found based on epidemiological data compared to avidity testing combined with the RHI algorithm.Conclusion: SHC identify more RHI infections compared to other test locations, as they serve high-risk populations and offer frequent HIV testing. Using avidity-testing for surveillance purposes may help targeting prevention programs, but the assay lacks robustness and its added value may decline with improved, repeat HIV testing and data collection.

The Importance of Considering Religious and Spiritual Ontologies in the Care of HIV Patients in Zimbabwe - A Scoping Literature Review

Background: HIV continues to have a major impact on morbidity and mortality in Zimbabwe. Religion/Spirituality (R/S) including traditional beliefs and practices (TP) play an important role for most people living with HIV (PLWHIV) in Zimbabwe. PLWHIV conceive and practice healing holistically, embracing not only the physical conditions, but also the spiritual, psycho-emotional, social, and ecological dimensions. Objective: This scoping review aims to systematically map the research done around R/S and TP and HIV in Zimbabwe. It intends to describe what is known about the role and influence of R/S on the experience of living with HIV in Zimbabwe in general and especially, to illustrate the influence of R/S and TP on the physical and psychological wellbeing of PLWHIV, and the access to HIV care. Design: This scoping review followed the Joanna Briggs Institute’s guidelines. The online databases Medline & ATLA were used to identify articles published between 2010–2021 about R/S and TP and HIV in Zimbabwe. The review includes textual papers, qualitative, quantitative, and mixed studies. Results: 638 records were found and screened for inclusion. 46 records were considered relevant for the qualitative and quantitative synthesis. Most articles (27) addressed the influence of traditional beliefs and practices on health and HIV and 16 records examined the influence of religious beliefs and religious groups’ attitude on HIV. The qualitative synthesis illustrates the influence of R/S and TP on physical and psychological wellbeing and on access to HIV care of PLWHIV in Zimbabwe, thus portraying the medical relevance of R/S issues and TP. Further synthesis identified three areas of conflict with biomedical practice: The bio-psycho-socio-spiritual understanding of health and illness, the notion of patriarchy, and the perception of sexuality and procreation. Here religious/spiritual ontologies may lead to compromised biomedical therapy outcomes. Conclusion: This scoping review includes papers of authors from different backgrounds (theology, medicine, sociology). The synthesis of the content of the records revealed a coherent picture of themes addressed and problems identified. Thus, this review is a fair description of the experience of living with HIV in Zimbabwe and the medical relevance of R/S and TP. The findings show that religious/spiritual ontologies need to be considered and integrated into the design of new health programs. It must be the aim to avoid compromised therapy outcome and to further a holistic support of PLWHIV. This is only possible in collaboration with religious stakeholders and traditional practitioners.

KNOWLEDGE LEVEL OF DENTISTS AND STUDENTS ON HIV PATIENT’S DENTAL TREATMENT IN BRAZIL: LITERATURE REVIEW

Background: Despite the low risk of contamination, fear and discrimination among dentists and students in relation to people infected with HIV could result in violation of some ethical precepts. Objective: The objective of this study was to review the knowledge level and attitudes of dentists and students in the dental care of patients with HIV. Methods: The last 20 years of specialized literature was consulted in the Virtual Health Libraries of Medline and Lilacs sources during the period between May 1999 and May 2019. A wide search strategy was used to avoid missing information: Dentistry and HIV, registered in the Descriptors in Health Sciences. Results: The search in the database resulted in 1058 articles. Screening of titles and abstracts resulted in 14 articles. After the complete reading, 12 articles fit the inclusion and exclusion criteria. Conclusion: Based on the methodology used, it was possible to conclude that the analysis of the selected articles showed that there is still much to be done in the training and in the performance of dentists and students regarding prejudice and willingness to offer dental care for HIV patients.