Comprehensive HIV Care Research Articles

Accelerated initiation of antiretroviral therapy by virtual health in service members newly diagnosed with HIV infection.

Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis. Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher's exact or Chi squared tests. Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15days vs 25days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05). The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.

Mortality Rates after Tuberculosis Treatment, Georgia, USA, 2008-2019.

Limited data exist on mortality rates after tuberculosis (TB) treatment in the United States. We analyzed mortality rates for all adults in Georgia, USA, who had a TB diagnosis and finished treatment during January 1, 2008-December 31, 2019. We obtained posttreatment mortality rate data from the National Death Index and calculated standardized mortality ratios (SMRs) for TB treatment survivors and the general Georgia population. Among 3,182 TB treatment survivors, 233 (7.3%) had died as of December 31, 2019. The overall TB cohort age- and sex-adjusted SMR was 0.89 (95% CI 0.73-1.05). The SMR among US-born TB treatment survivors was 1.56 (95% CI 1.36-1.77). In the TB cohort, US-born status, HIV co-infection, excess alcohol use, diabetes mellitus, and end-stage renal disease were associated with increased risk for death after TB treatment. TB treatment survivors could benefit from improved linkage to primary and HIV comprehensive care to prevent posttreatment death.

Sleep actigraphy results and HIV health outcomes in an urban HIV clinic sample

ABSTRACT Sleep disorders are prevalent and interfering conditions that affect people living with HIV (PLWH) at higher rates than the general population. Lower quality sleep has been associated with poorer health-related quality of life and immune function in PWH, though sleep is typically assessed subjectively. The current study aimed to examine the association between objective sleep/wake patterns measured via actigraphy with HIV outcomes. Participants (N = 87) were recruited from a public, urban HIV clinic located in the Southeastern United States. Participants were instructed to wear actigraphy monitors for one week (Range: 5–8 days). Log viral load and absolute CD4 were obtained via medical chart review. Linear regression analyses predicting HIV RNA Viral Load (log transformed) and CD4 Count were employed with three actigraphy sleep variables: sleep efficiency, wake after sleep onset (WASO), and sleep quantity. Backward entry regression with both significant actigraphy predictors, sleep efficiency and WASO, included as predictors resulted in sleep efficiency remaining in the model and WASO being removed. Separate models revealed that each one-unit increase in sleep efficiency was associated with a b = 0.032-point decrease in the log-transformed HIV RNA viral load (p = 0.03) and for each one-unit increase in wake after sleep onset (WASO) was associated with a b = 0.35-point increase in the log-transformed HIV RNA viral load (p = 0.04). Sleep quantity, however, was not, and none were associated with absolute CD4 count. The findings add to the evidence for an association of objectively measured poorer sleep efficiency being associated with higher HIV RNA viral load. Implications for clinical practice include assessing and addressing sleep efficiency as part of comprehensive clinical HIV care.

Improving Exercise Tolerance: Blood Transfusions and Physical Well-being in HIV Patients

Individuals living with HIV often experience reduced exercise tolerance due to anemia, fatigue, and muscle deconditioning, significantly impacting their quality of life. Blood transfusions emerge as a critical intervention to improve physical well-being by increasing hemoglobin levels and enhancing oxygen delivery to tissues. This review article explores the mechanisms by which blood transfusions positively influence exercise tolerance in HIV patients, highlighting the physiological benefits of improved oxygenation and energy levels, which facilitate greater participation in physical activities. In addition to the physiological benefits, enhanced exercise tolerance can lead to psychological improvements, reducing symptoms of anxiety and depression commonly faced by individuals with HIV. Engaging in physical activities fosters a sense of accomplishment and boosts self-esteem, creating a positive feedback loop that encourages a more active lifestyle. This multifaceted approach underscores the importance of integrating blood transfusion therapy into comprehensive HIV care to support both physical and mental health. Keywords: anemia, blood transfusions, exercise tolerance, HIV, physical well-being

Addressing Sleep Disturbances: Blood Transfusions and Improved Sleep Patterns in HIV Patients

Sleep disturbances are prevalent among individuals living with HIV, significantly impacting their quality of life and overall health. This review explores the relationship between anemia, fatigue, and sleep quality in HIV patients, highlighting the potential role of blood transfusions as an effective intervention for mitigating sleep disturbances. Blood transfusions improve hemoglobin levels, enhance oxygen delivery, and alleviate fatigue, which may contribute to better sleep patterns in this population. The mechanisms through which blood transfusions can improve sleep quality include enhanced oxygenation, reduction of inflammation, and modulation of immune responses. By addressing anemia and its associated symptoms, blood transfusions may foster an environment conducive to restful sleep, ultimately supporting the physical and mental well-being of individuals living with HIV. Integrating blood transfusions into comprehensive HIV care strategies is crucial for optimizing health outcomes. A multidisciplinary approach that includes ongoing assessment and tailored interventions can help manage anemia, improve sleep quality, and enhance overall quality of life for patients. Keywords: anemia, blood transfusions, fatigue, HIV, sleep disturbances,

Needs & networks: understanding the role and impact of social networks on HIV (self-)testing among GBMSM and trans people in England and Wales

BackgroundUnderstanding how HIV self-testing (HIVST) can meet the testing needs of gay, bisexual and other men who have sex with men (GBMSM) and trans people whose social networks vary is key to upscaling HIVST implementation. We aim to develop a contextual understanding of social networks and HIV testing needs among GBMSM (cis and transgender) and trans women in SELPHI (An HIV Self-testing Public Health Intervention), the UK’s largest randomised trial on HIVST.MethodsThis study re-analysed qualitative interviews conducted from 2015 to 2020. Forty-three in-person interviews were thematically analysed using the Framework Method. Our analytic matrix inductively categorised participants based on the unmet needs for HIV testing and the extent of social network support. The role of social networks on HIVST behaviour was explored based on individuals’ testing trajectories.ResultsFour distinct groups were identified based on their unmet testing needs and perceived support from social networks. Optimisation advocates (people with high unmet needs and with high network support, n = 17) strived to tackle their remaining barriers to HIV testing through timely support and empowerment from social networks. Privacy seekers (people with high unmet needs and with low network support, n = 6) prioritised privacy because of perceived stigma. Opportunistic adopters (people with low unmet needs and with high network support, n = 16) appreciated social network support and acknowledged socially privileged lives. Resilient testers (people with low unmet needs and with low network support, n = 4) might hold potentially disproportionate confidence in managing HIV risks without sustainable coping strategies for potential seroconversion. Supportive social networks can facilitate users’ uptake of HIVST by: (1) increasing awareness and positive attitudes towards HIVST, (2) facilitating users’ initiation into HIVST with timely support and (3) affording participants an inclusive space to share and discuss testing strategies.ConclusionsOur proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals’ unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care.

Abstract P148: Prevalence and Correlates of Overweight and Obesity Among Adults in an Urban HIV Clinic in Uganda

Background: Obesity has become a major comorbidity faced by people living with HIV (PLH). This study aimed to estimate the prevalence and correlates of overweight and obesity among PLH in Uganda. Methods: From June 2016 and February 2020, we conducted a cross-sectional analysis among PLH receiving comprehensive HIV care in a large urban clinic in Kampala, Uganda. We collected data on socio-demographic and behavioral anthropometry, and included variables such as age, marital status, occupation (farmer/other), migration history (rural to urban, urban to rural, consistently rural, consistently urban), contraceptive use history (pills, injections, implants), previous pregnancies (categorized as 0-2, 3-5, ≥6), and socioeconomic status (SES) index variable developed for Ugandan settings. Standardized weight and height assessments were performed with BMI categorization into normal, overweight and obese categories. We performed sex-stratified analysis employing multinomial logistic regression (Stata 18.0) to estimate adjusted relative risk ratios (aRRR) and 95% confidence intervals (CIs) for overweight and obesity compared to under or normal weight., focusing on correlates of overweight in males due to the limited number of obese male participants (n=15). Results: Of 1939 participants aged 18-80 years, 60.2% were female and the median age (IQR) was 43 (35-50) years for females and 47.5 (40-54) years for males. Median body mass index (BMI) was 24.27(21.09-27.99) kg/m2 for females and 21.63 (19.69-24.11) kg/m2 for males. 27.1% and 17.2% were overweight and 16.7% and 2% were obese among females and males, respectively. In adjusted analysis among females, factors positively associated with being overweight were older age (36-50 years: aRRR=1.84; 95% CI:1.26-2.68, &gt;50 years: aRRR=2.16; 95% CI:1.34-2.46), being married (aRRR=2.00; 95% CI:1.46-2.73), middle SES (aRRR=1.47; 95% CI:1.01-2.13), upper SES (aRRR=2.05; 95% CI:1.44-2.90), and rural-to-urban migration (aRRR=1.52; 95% CI:1.05-2.22). Being a farmer was negatively associated with overweight (aRRR=0.42; 95% CI:0.22-0.77). Similar associations were observed with obesity, with ever use of contraception and having had &gt;2pregnancies also significantly associated with increased risk of obesity. For males, being older (36-50 years: aRRR=2.09; 95% CI:1.06-4.11, &gt;50 years: aRRR=2.04; 95% CI:1.01-4.08) and having high SES (aRRR=2.38; 95% CI:1.53-3.70) were positively associated with overweight, while being a farmer was inversely associated (aRRR=0.43; 95% CI:0.20-0.93). Conclusions: High prevalence of overweight and obesity were observed among PLH in Uganda, notably among females. Migration, SES, and reproductive factors were strongly associated with higher BMI. Identified sociodemographic risk factors can guide targeted interventions in this region.

Process evaluation of the ‘Lafiyan Yara’ project on enhancing access to HIV testing services using existing community structures in Nigeria

BackgroundThe Lafiyan Yara Project aimed to increase demand for HIV counselling, testing, treatment, and prevention services among pregnant women and children in Taraba State, Nigeria. Implemented from 2019 to 2021, the project utilized existing community structures, including traditional birth attendants, village health workers, and patent and proprietary medicine vendors, for mobilization. This study assessed the project’s activities, contributors, relevance, effectiveness, and efficiency.MethodsThe process evaluation was conducted using focus group discussions and key informant interviews with beneficiaries, community leaders, project staff, health facility personnel, and government officials. Data analysis employed framework analysis.ResultsThe Lafiyan Yara project was reported to have achieved notable successes, including increased HIV testing rates among children and pregnant women, improved linkage to care services, reduced mother-to-child transmission of HIV, increased HIV/AIDS awareness and knowledge, and enhanced community engagement and support. Challenges identified included insufficient funding for community mobilizers, training needs for health workers, and inadequate availability of test kits at health facilities. Confidentiality and stigma issues arose during community mobilizations. A key lesson learned was the importance of a comprehensive HIV care approach, emphasizing testing and ensuring support for individuals testing positive.ConclusionsThe project’s approach of leveraging community structures to create demand for HIV services among women and children proved effective, provided proper linkage to care for those testing positive. Addressing stigma and involving husbands/fathers in the community approach are crucial for improving outcomes.Trial registrationIPHOAU/12/1384.

The Influence of HIV/AIDS Care and Support Services Accessibility on Utilization among HIV Infected Adults in Baringo County, Kenya

Context: Globally, efforts are being made to end the HIV/AIDS pandemic and improve the general health of people living with HIV/AIDS through continuous access to care and support services. However, the incidence of dropouts from utilization of HIV care and support services is rising among the HIV-positive clients enrolled in comprehensive care clinics in Baringo County for unidentified reasons. As a result, recognizing the opportunities and challenges in low-resourced communities that must be overcome to promote greater access to care and treatment will influence higher utilization.&#x0D; Aim: This study evaluates the influence of accessibility of HIV/AIDS care and support services on the utilization of HIV-infected adults in Baringo County.&#x0D; Methods: The study was conducted in Baringo County HIV comprehensive care centers. An analytical cross-sectional study design was used with 580 participants recruited. An interviewer-administered questionnaire was used to obtain data.&#x0D; Results: Support from social services (p&lt;0.0001), less frequent visits to clinics less than one month (p&lt;0.0001), access to treatment interventions (p&lt;0.0001), and easily accessible information (p &lt;0.0001) were among the factors associated with good accessibility to HIV services, according to bivariate analysis. Conversely, being an atheist (p&lt;0.006), residing in rural areas (p ≤0.0006), difficulty accessing services (p≤0.0001), and getting to another town (p &lt; 0.03) or getting to another county (p ≤0.0004) were linked to inadequate access to HIV/AIDS care and support services.&#x0D; Conclusion: The findings show that the efforts to support clients' access to HIV/AIDS care and support services should be made in response to their individual needs and consideration of geographical location. Besides, individualized HIV/AIDS services access depends on the support provided, where they are located, easily accessible information about the services, and how frequently they are provided. In contrast, living in rural areas, seeking services in a different town, feeling ashamed to visit clinics, and having a lower CD4 count were all associated with poor accessibility and utilization of HIV/AIDS care and support services. Consequently, it is necessary to establish support initiatives to address any of these access issues that particular clients might have.

Knowledge of Tuberculosis preventive treatment among people living with HIV: A cross-sectional survey in selected regions of Tanzania.

Tuberculosis remains a significant global health concern, especially for People Living with HIV, who are at an increased risk of severe TB disease. Despite the availability of TB Preventive Treatment, knowledge gaps persist among People Living with HIV regarding its importance, accessibility, and administration. The study aimed to assess TPT knowledge levels and determinants among People Living with HIV in Tanzania. A cross-sectional survey was conducted from April to May 2023 in 12 regions of mainland Tanzania. The study included PLHIV aged 18 years and above, receiving HIV care in selected Care and Treatment Centers. Data were collected through face-to-face interviews using a semi-structured questionnaire covering sociodemographic characteristics and Tuberculosis preventive treatment knowledge. Descriptive statistics, chi-square tests, and logistic regression analyses were employed for data analysis. Out of the 391 People Living with HIV interviewed, 71.4% demonstrated adequate Tuberculosis preventive treatment knowledge. Female participants, those attending urban health facilities, and individuals with longer durations of HIV care exhibited higher Tuberculosis preventive treatment knowledge levels. However, knowledge disparities persisted based on demographic characteristics such as gender and location of health facilities. While a considerable portion of People Living with HIV demonstrated adequate higher Tuberculosis preventive treatment knowledge, addressing gaps among those with lower understanding is crucial. Targeted education campaigns tailored to the needs of People Living with HIV, especially in rural areas and among male populations, are essential. Collaborative efforts between national health programs and community organizations are vital to integrate Tuberculosis preventive treatment awareness effectively into comprehensive HIV care programs, ultimately reducing the burden of Tuberculosis among People Living with HIV and the general population.

From disease specific to universal health coverage in Lesotho: successes and challenges encountered in Lesotho’s digital health journey

Abstract In Lesotho, the Ministry of Health and key donors have made significant advancements to develop digital health solutions specific to HIV services including an eRegister which is interoperable with the health management information system, pharmacy services and the laboratory information system. New investments from the Millennium Challenge Corporation will expand digital health services to all reported communicable and non-communicable disease areas at health facilities throughout the country. This paper explores how digital health interventions designed to support comprehensive HIV care can be leveraged to provide universal digital health coverage. Specifically, three priority areas will be addressed: (i) governance, security, and system architecture (ii) power, connectivity, and equipment (iii) human resources and change management.

Study of Utilization of ElectronicMedical Records in Health Service Provision at theHIV Comprehensive Care Centersin Kiambu County, Kenya

An electronic medical record system (EMR) is a digital record of health-related data for individual patients, maintained by authorized providers. Complete and timely information is crucial for informing public health decisions and improving health service delivery, particularly for HIV/AIDS. This study assessed the utilization of EMR systems in HIV comprehensive care centers in Kiambu County, Kenya. Specifically, it examined the association and predictive influence of infrastructure, technical factors, and perceived usefulness on EMR utilization. The research adopted a descriptive cross-sectional design and applied stratified random sampling to categorize 38 health facilities based on their level of care. A sample size of 186 participants was proportionally allocated to the various strata, and data was collected through questionnaires. Analysis using SPSS version 25.0 involved Chi-square tests to examine associations between variables and logistic regression analysis to assess predictive influences. The results revealed that infrastructure (χ²=24.23, p&lt;0.05), technical factors (χ²=62.93, p&lt;0.05), and perceived usefulness (χ²=38.55, p&lt;0.05) had significant associations with EMR utilization and had positive predictive influences. The study concluded that upscaling EMR utilization in HIV care clinics requires a multifaceted approach. It recommended that the County Government of Kiambu implement comprehensive training programs for EMR users, increase funding for EMR infrastructure, strengthen routine maintenance of ICT equipment, and engage ICT staff at the facility level to provide on-site support and troubleshoot the systems.

A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia.

HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.

Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection.

Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p < .001; Phi coefficient = 0.69, p < .001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p's < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.

High-risk human papillomavirus genotype distribution among women living with HIV; implication for cervical cancer prevention in a resource limited setting

BackgroundFor women living with HIV (WLHIV), the burden of persistent HPV infection, cervical pre-cancerous lesions and cancer have been demonstrated to be higher than among HIV-negative women. As Ghana and other lower-middle-income countries (LMIC) work toward developing national cervical cancer programmes, it is essential that local scientific evidence be provided to guide policy decisions, especially for such special populations. The objective of this study was to determine the distribution of high-risk HPV genotype and related factors among WLHIV and its implication for the prevention of cervical cancer prevention efforts.MethodsA cross-sectional study was conducted at the Cape Coast Teaching Hospital in Ghana. WLHIV, aged 25–65 years, who met the eligibility criteria were recruited through a simple random sampling method. An interviewer-administered questionnaire was used to gather socio-demographic, behavioural, clinical and other pertinent information. The AmpFire HPV detection system (Atila BioSystem, Mointain View, CA was used to detect 15 high-risk HPV genotypes from self-collected cervico-vaginal samples. The data collected were exported to STATA 16.0 for statistical analysis.ResultsIn all, 330 study participants, with mean age of 47.2 years (SD ± 10.7), were involved. Most (69.1%, n = 188/272) had HIV viral loads < 1000 copies/ml and 41.2% (n = 136) had ever heard of cervical screening. The overall hr-HPV prevalence was 42.7% (n = 141, 95% CI 37.4–48.1) and the five commonest hr-HPV types among screen positives were HPV59 (50.4%), HPV18 (30.5%), HPV35 (26.2%), HPV58 (17%) and HPV45 (14.9%). Most infected women (60.3%, n = 85) had multiple hr-HPV infections, with about 57.4% (n = 81) having 2–5 h-HPV types, while 2.8% (n = 4) had more than five hr-HPV types. A total of 37.6% (n = 53) had HPV16 and/or18, while 66.0% (n = 93) had the hr-HPV genotypes covered by the nonavalent vaccine. Women with HIV viral load ≥ 1000copies/ml (AOR = 5.58, 95% CI 2.89–10.78, p < 0.001) had a higher likelihood of being co-infected.ConclusionThis study found out that the prevalence of hr-HPV still remains high in women with HIV, with a notable occurrence of multiple infections and infection with genotypes 16 and/or18. Additionally, an association was established between hr-HPV and infection HIV viral load.. Therefore, comprehensive HIV care for these women should include awareness of cervical cancer, consideration of vaccination and implementation of screening and follow-up protocols. National programmes in LMIC, such as Ghana, should consider using HPV-based screen-triage-treat approach with partial genotyping.

Client satisfaction with antiretroviral treatment services in South Ethiopian public health facilities: an institution-based cross-sectional survey

ABSTRACT Background HIV/AIDS remains the leading cause of morbidity and mortality worldwide. Moreover, sub-Saharan countries, including Ethiopia, are highly affected by HIV/AIDS pandemic. Ethiopia’s government has been working on a comprehensive HIV care and treatment programme, including antiretroviral therapy. However, evaluating client satisfaction with antiretroviral treatment services is not well studied. Objectives This study aimed to assess client satisfaction and associated factors with antiretroviral treatment services provided at public health facilities of Wolaita zone, South Ethiopia. Methods A facility-based cross-sectional study involved 605 randomly selected clients using ART services from six public health facilities in Southern Ethiopia. A multivariate regression model was used to see an association between independent variables and the outcome variable. The odds ratio with 95% CI was computed to determine the presence and strength of the association. Results Four hundred twenty-eight (70.7%) clients were satisfied with an overall antiretroviral treatment service, which included significant variations ranging from 21.1% to 90.0% among health facilities. Sex [AOR = 1.91; 95% CI = 1.10–3.29], employment [AOR = 13.04; 95% CI = 4.34–39.22], clients’ perception of the availability of prescribed laboratory services [AOR = 2.56; 95% CI = 1.42–4.63], availability of prescribed drugs [AOR = 6.26; 95% CI = 3.40–11.52] and cleanliness of toilet in the facility [AOR = 2.83; 95% CI = 1.56–5.14] were factors associated with client satisfaction with antiretroviral treatment services. Conclusion The overall client satisfaction with antiretroviral treatment service was lower than the national target of 85%, with a marked difference among facilities. Sex, occupational status, availability of comprehensive laboratory services, standard drugs, and cleanliness toilets in the facility were factors associated with client satisfaction with antiretroviral treatment services. Sex-sensitive services needed to address and sustained availability of laboratory services and medicine recommended.

HIV-1 Transmission Cluster in Injection Drug Users in Nairobi City, Kenya.

While there is a striking increase in the prevalence of HIV in injection drug users, information on envelope-gene subtypes and transmission clusters in injection drug users is scarce. In a cross-sectional study, 247 injection drug users were recruited via out-rich method. Deoxyribonucleic acid was extracted from dry blood spot samples, amplified by Polymerase Chain Reaction and sequenced. Subtyping was performed using COntext-based Modeling for Expeditious Typing (COMET) and Recombinant Identification Program (RIP) tools. Phylogenetic diversity and Transmission clusters were identified using MEGA version 6.0 and TreeLink, respectively. Overall, 42 (17.0%) injection drug users were sero-positive for HIV-1. Of the 37 samples successfully sequenced, 29 (78.4%) sequences were identified as A1, 6 (16.2%) as AG while 1 (2.7%) as A1/G/AE and A1/C recombinants. The HIV subtypes formed clusters with little genetic diversity. The high HIV prevalence was associated with transmission clusters and diversity in subtypes indicating ongoing local transmission. Therefore, there is need for comprehensive HIV care tailored to this population.

Determinants of viral load suppression among orphaned and vulnerable children living with HIV on ART in Tanzania.

In Tanzania, only 66% children 0-14 years living with HIV know their HIV status, 66% are on treatment while 47% of children on ART are virally suppressed. Although retention on ART and poor adherence remain a challenge for children living with HIV, orphans and vulnerable children (OVC) face a greater limitation of access to and utilization of comprehensive HIV care and treatment. In response to this, the current study assessed the determinants of viral load suppression (VLS) among OVC aged 0-14 years living with HIV enrolled in HIV interventions. This was a cross-sectional study that used secondary data collected by the USAID Kizazi Kipya project in 81 district councils of Tanzania. Included in this study are 1,980 orphans and vulnerable children living with HIV (OVCLHIV) (0-14 years) enrolled and served by the project for 24 months. Data analysis involved multivariable logistic regression, with viral load suppression as the outcome of interest and HIV interventions as the main independent variables. The overall VLS rate among the OVCLHIV was 85.3%. This rate increased from 85.3, 89.9, 97.6 to 98.8% after 6, 12, 18, and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariable analysis, OVCLHIV attending people living with HIV (PLHIV) support groups were 411 times more likely to be virally suppressed than those not attending (aOR = 411.25, 95% CI 168.2-1,005.4). OVCLHIV with health insurance were 6 times more likely to achieve viral suppression than those without (aOR = 6.05, 95% CI 3.28-11.15). OVCLHIV with >95% adherence to ART were 149 times more likely to be virally suppressed than those not adherent to ART (aOR = 148.96, 95% CI 42.6-520.6, p < 0.001). Other significant factors included food security and family size. OVCLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not. To advance viral suppression, efforts should be made to ensure that all OVCLHIV are reached by community-based interventions as well as integrating food support in HIV treatment interventions.

Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

ObjectivesTo assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data...

Health workers' knowledge and practice of Isoniazid preventive treatment guidelines in health facilities in Ebonyi State, Nigeria.

Isoniazid preventive therapy is recommended as part of a comprehensive HIV and AIDS care strategy. IPT is used as prophylaxis to reduce the incidence of TB in HIV-infected persons. However, its implementation has been very slow and has been influenced by several factors. This study assessed health workers' knowledge and adherence to Isoniazid Preventive Therapy guidelines. This was a cross-sectional study in six health facilities providing HIV care in Ebonyi State using a semi-structured, self-administered questionnaire. Data were collected from 85 health workers working in the HIV clinics. Data were also extracted from 200 patient treatment cards. Data analysis was carried out using SPSS version 20 software. Chi-square statistics and logistic regression were carried out to determine the association between socio-demographic characteristics and knowledge as well as self-reported practice of the guideline. Slightly over half of the respondents (58.8%) had good knowledge of the guideline, and the majority (75.3%) self-reported that they practiced the guideline. Only 17% of the treatment cards had isoniazid prescribed and only 11% of these had patient adherence assessed. The most common challenges to implementation of the guideline cited by health workers were unavailability of isoniazid, poor awareness, patient non-adherence, poor resources, high pill burden, and lack of training. Being a doctor and more than 3 years duration of work in the clinic were predictors of good knowledge. There was no predictor of practice. There was good knowledge and practice of the guideline from health worker self-reports, however, review of treatment card showed prescription was low. Further studies to explore and understand why there is such low prescription of INH/IPT to HIV patients despite good knowledge of healthcare professionals are recommended.