Disclosure Of Status Research Articles

A qualitative analysis of self-management needs of adolescents and young adults living with perinatally acquired HIV in rural, southwestern Uganda.

The number of adolescents living with HIV remains high in sub-Saharan Africa with poorer HIV treatment outcomes among adolescents and young adults compared to individuals in other age groups. For adolescents and young adults living with perinatally acquired HIV (AYLPHIV), the transition from pediatric to adult HIV care is a particularly high-risk period. We conducted a qualitative study to understand self-management needs of AYLPHIV in rural, southwestern Uganda as they prepare to transition to adult HIV care in order to inform relevant interventions that can enable AYLPHIV acquire the necessary skills to manage their illness as they age into adulthood. We conducted 60 in-depth interviews with AYLPHIV (n = 30), caregivers (n = 20) and health care providers (n = 10) from the HIV clinic at Mbarara Regional Referral Hospital. We used an interview guide that focused on perceptions about transition to adult HIV care, challenges with transitioning, navigating HIV care, and self-management needs for AYLPHIV (from the perspectives of AYLPHIV, their caregivers, and health care providers). We used thematic analysis to identify themes related to AYLPHIV's self-management skills. We identified several self-management needs that we grouped under two major themes; social support and empowerment for AYLPHIV to assume responsibility for their own health and to navigate adult HIV care independently. The sub-themes under social support were information support, instrumental support, and emotional support as the sub themes while sub-themes under empowerment included self-advocacy skills, interpersonal skills, self-care skills, and disclosure skills. Taken together, these findings indicate that AYLPHIV need to be supported and empowered to maximize their chances of successfully transitioning to adult HIV care. Support comes from peers and caregivers. AYLPHIV require knowledge about their HIV status and empowerment with different skills including: self-advocacy skills, interpersonal skills, self-care skills, and HIV status disclosure skills, in order to assume responsibilities related to independent HIV care.

A Bayesian network analysis to examine the effects of HIV stigma processes on self-concept and depressive symptoms among persons living with HIV.

This study examines the relationships between HIV stigma dimensions, self-related mechanisms, and depressive symptoms among persons living with HIV. HIV stigma hinders the well-being of individuals living with HIV, which is linked to depressive symptoms and increased risk of poor clinical outcomes. However, the mechanisms underlying stigma's impact on depression are poorly understood. Psychosocial theories propose that experiencing HIV stigma leads to internalized stigma, impacting self-concept and mental health. Using Bayesian network analysis, we explored associations among HIV stigma processes (experienced, anticipated, internalized, perceived community stigma, and HIV status disclosure) and self-related mechanisms (self-esteem, fear of negative evaluation [FNE], self-blame coping, and social exclusion), and depressive symptoms. Our diverse sample of 204 individuals, primarily men, gay/bisexual, Black, and lower-middle SES, who experienced stigma showed increased anticipated, internalized, and perceived community stigma, FNE, and depressive symptoms. Internalized stigma contributed to self-blame coping and higher depressive symptoms. Anticipated and perceived community stigma and FNE correlated with increased social exclusion. This study investigates potential mechanisms through which HIV stigma may impact depression. Identifying these mechanisms establishes a foundation for future research to inform targeted interventions, enhancing mental health and HIV outcomes among individuals living with HIV, especially from minority backgrounds. Insights gained guide evidence-based interventions to mitigate HIV stigma's detrimental effects, ultimately improving overall well-being and health-related outcomes for people with HIV.

Mental Health Challenges Among Children and Adolescents Associated With HIV Status Disclosure: A Systematic Review and Meta-Analysis Protocol

BACKGROUND: Prenatally acquired HIV is highly prevalent among children and adolescents globally. HIV status disclosure to children is recommended to start from 8 years and older and has shown several benefits. However, HIV status disclosure is also associated with high risks of mental health challenges. This review and meta-analysis aim at describing the prevalence of mental health challenges and associated factors among children and adolescents living with HIV. METHODS: The study will involve conducting a systematic review and meta-analysis of the existing literature on the burden of mental health challenges including stigma, depression, anxiety and suicidality after HIV status disclosure among children and adolescents aged 8-17 years. Searches for both observational and interventional studies will be performed in PubMed, Medline, Embase, CINAHL and APA Psych Info from 2000 to the date of the review. Statistical heterogeneity will be assessed using I2 test and visual inspection of the forest plot. Data will be extracted using an investigator designed data extraction form by two independent people and any disagreements will be solved by involving a third person. Using the RevMan software, a random effects model will be applied to calculate a standardised mean estimate of the prevalence of mental health challenges. A narrative will be presented for the factors associated with the mental health challenges. Risk of bias will be assessed using the appropriate study design tool and results will be reported following the PRISMA 2015 guidelines. CONCLUSION: The review will provide valuable results that will shed light on the burden of mental health challenges associated with HIV status disclosure and the influencing factors among children and adolescents. This will inform clinical practice about the importance of assessing and managing the challenges according as well as designing health policies regarding the same.

Determinants of Family Support Among People Living With HIV Seeking Care in a Tertiary Hospital in Lagos State, Nigeria: A Cross-Sectional Study

Family support, as an aspect of social life, is crucial for individuals, including people living with HIV (PLWH). This study assessed the prevalence and determinants of family support among PLWH in Nigeria and tested the consequences of HIV disclosure. It adopted a cross-sectional study design, using systematic random sampling to select 404 PLWH. Most respondents were female (mean age: 42.65 [12.74] years). Strong family support was prevalent at 67.6%. Family support was positively correlated with disclosure of HIV status and social quality of life, while negatively correlated with adherence and independent quality of life. Our findings support the consequences theory of HIV disclosure. It implies that family members of PLWH must provide more support to improve their quality of life.

"Call 911 - That's my [Advance Care] Plan": Factors that Inform Advance Care Planning Conversation Readiness Among Aging Persons Living With HIV.

Antiretroviral therapy has dramatically increased the lifespan of people living with HIV (PLWH), but advance care planning (ACP) and hospice services are underutilized in this population. The purpose of this study was to understand barriers and facilitators to ACP among this group. PLWH (n = 25) were recruited from an HIV Clinic at a Veterans Affairs (VA) Medical Center in Atlanta, GA to represent a range of sociodemographic characteristics and experiences. Semi-structured interviews were analyzed using thematic analysis. More than half of participants (64%) indicated not engaging in ACP. We identified four key barriers to ACP: (1) a self-image among PLWH as "survivors" (and a reluctance to think about ACP); (2) a history of mistrust and mistreatment; (3) weak social ties and a desire to avoid disclosure of HIV status; and (4) a value for self-reliance. Findings have important implications for interventions to overcome these barriers.

Shifting Norms and Value Conflicts: Exploring the Effects of HIV Status Disclosure Fields in Sex-Social Apps

Sex-social applications used by men who have sex with men (MSM) often provide options to disclose HIV status to encourage more positive language and reduce stigma. Yet, little research has sought to understand how in-app disclosure fields impact on disclosure motivation. We interviewed MSM living with HIV and those who self-reported being HIV-negative (N=27\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$N=27$$\\end{document}) in the UK and applied a hierarchical model of motivation to interpret our data. We found conflicting motivations for disclosure and point to HIV status disclosure fields having shifted disclosure norms, limiting their perceived optionality. Moreover, the pairwise and location-aware nature of these apps fails to support narrative forms of disclosure, reducing motivation. We highlight an opportunity to support users in disclosing by linking apps more explicitly to the social narratives developed through public health campaigns. This could reduce the required effort to explain “the science" behind different treatment and prevention options and promote a more consistent narrative.

Magnitude and Factors Associated with Partner and Family-Based Index Case HIV Testing Among Clients on Anti-Retroviral Therapy Follow-ups at Holeta Health Centre, Oromia, Ethiopia

Background: Index clients are HIV-positive individuals at HIV Testing and Counselling Centres who were enrolled in treatment, care, and support services. Most of the index cases did not test hard-to-reach groups, including children and adult sexual partners. The aim of this study was to assess the magnitude and factors associated with partner and family-based index case HIV testing among HIV-positive clients who are on Anti-Retroviral Therapy and follow up at Holeta Health Centre, Ethiopia, 2022 G.C. Methods: A facility-based cross-sectional study was conducted on 316 selected individuals using simple random sampling techniques. The data was collected using structured questionnaires. The data were entered into EPI Info version 7.14 and then exported to SPSS version 24 for analysis. Bivariate logistic regression was used for each independent variable to check its association with the dependent variable. All variables with a P-value <0.25 in bivariate analysis were entered into a multivariate logistic regression analysis to identify factors independently associated with the dependent variables with a P value <0.05 were considered statistically significant factors and an adjusted odds ratio with a 95% confidence interval was used to measure the strength of the association. Result: This study showed that among the study participants, 86.8% had tested a partner and 92.9% had tested at least one child. Marital Status (AOR = 0.06 CI: 0.02-0.21), duration on ART (AOR = 2.71 CI: 1.17–6.25), and disclosure status (AOR = 4.26 CI: 1.21–15.05) were identified to be significantly associated with partner- and family-based index case HIV testing. Conclusion: This study showed that most of the study participants had tested with a partner and at least one child. Partner and family-based index case HIV testing has a significant association with marital status, duration on ART, and disclosure status of index cases.

Effect of Nurse-Led PMTCT Health Education on HIV Disclosure among HIV-Positive Women in Mombasa County: A quasi-experimental study

Background: This study investigated the impact of nurse-led PMTCT (Prevention of Mother-toChild Transmission) health education on enhancing HIV status disclosure among HIVpositive women in Mombasa County, Kenya. HIV status disclosure is crucial for the prevention of mother-to-child transmission and the overall well-being of affected individuals and their families.
 Methods: A quasi-experimental design was employed, with participants divided into an intervention group of 107 receiving nurse-led PMTCT health education and a control group of 107 receiving standard care. Demographic information, knowledge, attitudes, and practices related to HIV status disclosure were collected at baseline and post-intervention phases. Descriptive statistics were computed and a chi-square test was used to compare the level of self-disclosure of HIV status to sexual partners across the groups. Difference in differences (DID) analysis was used to evaluate the effectiveness of the intervention. Results: The study initially found that at baseline, 60.4% of HIV-positive women in the control group did not disclose their status to sexual partners, compared to 55.4% in the intervention group. However, there was no significant difference between the two groups at this stage. In the end-line survey, the control group had 64% non-disclosure, while the intervention group showed a significant improvement, with only 20% not disclosing. Chi-square analysis revealed a substantial difference (p < 0.001) in disclosure rates between the intervention and control groups. Additionally, a Difference-in-Differences (DID) analysis indicated a significant improvement in self-disclosure (23.1% net intervention effect, p < 0.0001). Overall, the nurse-led health education intervention notably increased HIV status disclosure among HIV-positive women in selected Mombasa County health facilities.
 Conclusion: Nurse-led PMTCT education enhances HIV disclosure in Mombasa County, improving PMTCT outcomes and curbing mother-to-child transmission. Tailored interventions are vital in addressing HIV challenges in diverse contexts.

Imprisonment for South Ethiopian people living with HIV presents a double health burden: lived experiences of prisoners.

Optimal adherence is crucial for ensuring both therapeutic and preventative benefits of antiretroviral therapy (ART). Sub-optimal adherence is common in prisoners and little information is available about its predisposing circumstances in resource-limited settings. We explored lived experiences of inmates living with HIV (ILWH) and experiential accounts of service providers in South Ethiopia to identify barriers to and facilitators of HIV care use in the prison context. We conducted qualitative in-depth interviewing with eleven ILWH and eleven service providers. Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging concepts. We employed a descriptive phenomenological approach to abstract meaning attributed to the prisoners' lived experiences in relation to HIV care use and service providers' experiential account regarding care provision as presented to our consciousness. Several concepts emerged as barriers to HIV care use amongst ILWH in South Ethiopia including: limited access to standard care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, and food supply insufficiency. In addition to a unique opportunity offered by an imprisonment for some ILWH to refrain from health damaging behaviours, the presence of social support in the prison system facilitated care use. This study identified important structural and social contexts that can both hinder and enhance HIV care use amongst ILWH in South Ethiopia. Given the disproportionate burden of HIV in prisoners and the potential of transmission to others during and after incarceration, development of contextually-responsive strategies is required to address the barriers and to also strengthen the enablers.

Reproductive and fertility-related challenges in female patients diagnosed with early-onset colorectal cancer.

57 Background: Incidence of early-onset colorectal cancer (EOCRC, defined as onset <50 years) is on the rise, with rates increasing by 51% from 2000-2015. Knowledge of fertility concerns in patients with EOCRC is important to provide the resources needed for this group. The aim of this study is to examine reproductive concerns after cancer diagnosis in female COLONTOWN patients with EOCRC using a validated and standardized questionnaire “Reproductive Concerns After Cancer” (RCAC). Methods: Female survivors (N=89, age at diagnosis 20 to 47 years) with EOCRC diagnosis were recruited from COLONTOWN. In order to capture the impact of EOCRC diagnosis on sexual health and fertility, a 51-question survey was created that included the RCAC scale as well as questions about pregnancy history, whether fertility preservation counselling occurred, self-reported demographics, and tumor and treatment. RCAC includes 6 subdomains on fertility preservation, partner disclosure of fertility status, child’s health, personal health, acceptance of possible infertility, and becoming pregnant, with total score being the sum of these domains. Data collected was analyzed using means, ranges, and standard deviations for continuous variables and frequencies and chi squared tests for categorical variables. Results: The mean age at diagnosis was 35 ± 5 years. 72% had discussions with a medical professional about fertility preservation after receiving their cancer diagnosis. Patients with rectal cancer were more likely to have this discussion compared to patients with colon cancer (p=0.04); tumor stage did not affect likelihood of having a fertility discussion (p>0.05). Seventeen (19%) underwent subsequent fertility preservation. Patients with stage IV cancer were less likely to undergo fertility preservation compared to those with stage I-III cancer (p=0.02); the decision to undergo fertility preservation was not affected by tumor site (p>0.05). 13% of all patients had insurance that would cover fertility preservation. Notably, 33 (37%) of patients said they would have considered fertility preservation if it were covered by insurance, and this was not impacted by tumor site or stage (p>0.05). RCAC subcategory scores were 3.47 for fertility preservation, 2.50 for partner disclosure of fertility status, 4.09 for child’s health, 3.88 for personal health, 2.27 for acceptance of possible infertility, and 3.49 for becoming pregnant. Conclusions: This study provides evidence that some patients with EOCRC experience concerns about fertility. Patients endorsed concern for child's health and personal health, followed by concerns about becoming pregnant and fertility potential. Interestingly, 37% would have considered fertility preservation had it been covered by insurance. This study provides characterization of the fertility-related concerns of EOCRC survivors and supports the future development of resources and policies to support these patients.

Experiences of adolescents and youth with HIV testing and linkage to care through the Red Carpet Program (RCP) in Kenya.

Adolescents and youth living with HIV (AYLHIV) experience worse health outcomes compared to adults. We aimed to understand the experiences of AYLHIV in care in the youth-focused Red-Carpet program in Kenya to assess the quality of service provision and identify programmatic areas for optimization. We conducted focus group discussions among 39 AYLHIV (15-24 years) and structured analysis into four thematic areas. Within the HIV testing theme, participants cited fear of positive results, confidentiality and stigma concerns, and suggested engaging the community and youth in HIV testing opportunities. Within the HIV treatment adherence theme, participants cited forgetfulness, stigma, adverse side effects, lack of family support, and treatment illiteracy as barriers to adherence. Most participants reported positive experiences with healthcare providers and peer support. In terms of the HIV status disclosure theme, AYLHIV cited concerns about their future capacity to conceive children and start families and discussed challenges with understanding HIV health implications and sharing their status with friends and partners. Youth voices informing service implementation are essential in strengthening our capacity to optimize the support for AYLHIV within the community, at schools and healthcare facilities.

Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement

BackgroundAboriginal and Torres Strait Islander Australians have amongst the highest incidence of sepsis globally. ObjectiveThe objective of this study was to describe the characteristics, short- and long-term outcomes of non-Indigenous, Aboriginal Australian and Torres Strait Islander Australians admitted with sepsis to an intensive care unit (ICU) to inform healthcare outcome improvement. MethodsA retrospective cohort study of 500 consecutive sepsis admissions to the Cairns Hospital ICU compared clinical characteristics, short-term (before ICU discharge) and long-term (2000 days posthospital discharge) outcomes. Cohort stratification was done by voluntary disclosure of Indigenous status. ResultsOf the 442 individual admissions, 145 (33%) identified as Indigenous Australian. Indigenous and non-Indigenous Australians had similar admission Acute Physiology and Chronic Health Evaluation-3 scores (median [interquartile range]: 70 [52–87] vs. 69 [53–87], P = 0.87), but Indigenous patients were younger (53 [43–60] vs. 62 [52–73] years, P < 0.001) and were more likely to have chronic comorbidities such as type 2 diabetes (58% vs. 23%, P < 0.001), cardiovascular disease (40% vs 28%, P = 0.01), and renal disease (39% vs. 10%, P < 0.001). They also had more hazardous healthcare behaviours such as smoking (61% vs. 45%, P = 0.002) and excess alcohol consumption (40% vs. 18%, P < 0.001). Despite this, the case-fatality rate of Indigenous and non-Indigenous Australians before ICU discharge (13% vs. 12%, P = 0.75) and 2000 days post hospital discharge (25 % vs. 28 %, P = 0.40) was similar. Crucially, however, Indigenous Australians died younger both in the ICU (median [interquartile range] 54 (50–60) vs. 70 [61–76], P < 0.0001) and 2000 days post hospital discharge (58 [53–63] vs. 70 [63–77] years, P < 0.0001). ConclusionsAlthough Indigenous Australians critically ill with sepsis have similar short and long-term mortality rates, they present to hospital, die in-hospital, and die post-discharge significantly younger. Unique cohort characteristics may explain these outcomes, and assist clinicians, researchers and policy-makers in targeting interventions to these characteristics to best reduce the burden of sepsis in this cohort and improve their healthcare outcomes.

Caregivers’ experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India

BackgroundIndia has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers’ perspectives on barriers and facilitators to access and utilize EID services.MethodsThe study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers’ of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers’ perspectives.ResultsThe stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.DiscussionThe study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers’ perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.ConclusionThe study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Magnitude of consistent condom use and associated factors among people living with HIV/AIDS in Ethiopia: Implication for reducing infections and re-infection. A systematic review and meta-analysis.

The human immune virus or acquired immune deficiency syndrome, is a major threat to the health of millions of people worldwide. In Ethiopia, there were more than a million people living with HIV/AIDS. The continuous and appropriate use of condoms, particularly among those who have HIV-positive clients, is essential to a comprehensive and long-term approach to avoiding HIV and other STIs as well as unintended pregnancy. But irregular condom use is regularly reported. There is inconsistent reports of the prevalence and correlates of frequent condom use in Ethiopia. This study's goal is to provide an overview of the most recent research on magnitude condom use among people living with HIV in Ethiopia. Four databases of PubMed, Science Direct, Scopus, and Google Scholar were used. Finally, 10 studies that satisfied the eligibility criteria were included in the systematic review and meta-analysis. The data were collected using a methodical checklist for data extraction, and STATA 14 was utilized for the analysis. The consistent condom use was reported as use of condom in every sexual encounter preceding the study. The prevalence of consistent condom usage among HIV/AIDS patients was calculated by dividing the total number of patients who regularly used condoms by the total number of HIV/AIDS patients and multiplying that result by 100. The factors associated with a consistent use of condom were described using the pooled odds ratio (OR) and calculated based on binary outcomes from the included primary studies. The statistical significance was determined based on the correlation factor as their confidence level should not include 1. Subgroup analyses by region and publication years were carried out by using a random-effects model. The STATA commands of metan magnitude semagnitude, random xlab(.1,5,10) lcols (authors) by (variables)texts(120) xsize(18) ysize (14) were used to carried out the subgroup analysis. To assess the presence of publication bias, funnel plot, Egger test and Begg's test at 5% significant level were computed. The asymmetry of funnel plot and the Egger test and Begg's test P value of 0 >0.5 showed the absence of publication bias. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. The pooled magnitude of consistent condom use was 50.56% (95%CI: 38.09-63.02). The predictors of consistent condom use includes urban residence (AOR = 3.46; 95% CI: 2.24-5.35), marital status (AOR = 0.33; 95% CI: 0.18-0.61), and HIV disclosure status (AOR = 5.61;95%CI: 2.29-13.73). Half of the HIV/AIDS patients in our study regularly used condoms. According to this study, urban residency, disclosure status, and marital status were all associated with consistent condom use among HIV/AIDS patients. Therefore, health education about condom use should be provided to married couples and people living in rural regions. In addition, disclosing HIV status and the necessity of constant condom usage would be crucial for consistent condom use.

Health-related quality of life and hypertension in people with HIV on long-term antiretroviral therapy in Uganda.

The presence of hypertension could reduce the health-related quality of life (HRQoL) of people with HIV (PWH). Yet, literature describing the HRQoL of PWH who have hypertension in Uganda is scarce making the design of locally adapted interventions cumbersome. In our study, we compared HRQoL scores of people with HIV with and without hypertension on long term antiretroviral therapy (ART) in Uganda. We recruited 149 PWH with hypertension and 159 PWH without hypertension in the long-term ART cohort at an urban clinic in Kampala, Uganda. Data on socio-demographics were collected using an interviewer designed questionnaire while data on the World Health Organisation clinical stage viral load and CD4 count as well as ART duration were extracted from clinic electronic database and a generic EuroQol -5D- 5L (EQ-5D- 5L) and Medical Outcome Study (MOS-HIV) questionnaire used to collect HRQoL data. Data were summarized using descriptive statistics while inferential statistics were used to determine associations between key variables and HRQoL. Mann-Whitney U tests were used to compare HRQoL between groups of interest. One hundred ninety (61.7%) participants were female. PWH who had hypertension were older (Mean ± SD: 53.7 ± 8.3 vs 49.9 ± 8.6, p value <0.001) than those without hypertension. Participants with hypertension had lower overall median health utility scores (0.71 (0.33-0.80) vs 0.80 (0.44-0.80), p value = 0.029) and mean physical health score (48.44 ± 10.17 vs 51.44 ± 9.65, p value < 0.001) as opposed to those without hypertension. Hypertension (p value = 0.023), high income status, >70,000 UGX, (p value = 0.044), disclosure of the HIV status of the participants to their partner (p value = 0.026), and current history of smoking (p value = 0.029) were associated with low HRQoL scores. Among people with HIV, those with hypertension had lower HRQoL compared to those without. This calls for inclusion of quality-of-life assessment in the management of PWH who have been diagnosed with hypertension to identify those at risk and plan early interventions.

Completion rate of tuberculosis preventive therapy and incidence of tuberculosis among people living with the Human Immunodeficiency Virus on antiretroviral therapy in Ekurhuleni East subdistrict, Gauteng province.

the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT. this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses. the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001. the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.

Assessing the Predictors of COVID-19 Vaccine Hesitancy Among People Living with HIV/AIDS: A Scoping Literature Review

Background: The administration of the COVID-19 vaccine at some points in the COVID-19 pandemic resulted in a significant reduction in the spread, risk of complications, and death from coronavirus infection. However, in the face of hesitancy against COVID-19 vaccination springing from the novelty of the vaccines and safety concerns, vulnerable population to COVID-19 infection such as people living with HIV/AIDS (PLWHA) were showing higher hesitancy to COVID-19 vaccines than the general population. This scoping review aims to identify factors COVID-19 vaccine hesitancy among PLWHA. Methods: A scoping review was conducted to identify and summarize studies from all over the world on COVID-19 vaccine uptake/hesitancy among people living with HIV/AIDS (PLWHA). The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Extension for scoping reviews was used. Articles written in English, peer-reviewed, published within the years 2021-2023, and conducted in any part of the world with sample population being PLWHA, and with an outcome of uptake/hesitancy towards the COVID-19 vaccine were included. Results: Fourteen articles met the inclusion criteria and were included in this review. The primary study settings were clinic and hospital-based and online self-reported. The prevalence of COVID-19 vaccine hesitancy was as high as 90.8% in an online survey done in the US and as low as 27.5% in a facility-based survey in China. The most common factors mentioned associated with COVID-19 vaccination were the fear of side effects of the COVID-19 vaccine, concerns about the safety of the vaccine, medical mistrust, vaccine novelty, disclosure of HIV status, and perceived interference with highly active antiretroviral therapy (HAART). Male gender, race, good knowledge of COVID-19 prevention practice, having a CD4 count &gt; 200 cells (p=0.032) and lower or undetectable viral load (p&lt;0.001) were identified as predictors of COVID-19 uptake.

Evaluating the implementation of weekly rifapentine-isoniazid (3HP) for tuberculosis prevention among people living with HIV in Uganda: A qualitative evaluation of the 3HP Options Trial.

Three months of isoniazid-rifapentine (3HP) is being scaled up for tuberculosis (TB) preventive treatment (TPT) among people living with HIV (PLHIV) in high-burden settings. More evidence is needed to identify factors influencing successful 3HP delivery. We conducted a qualitative assessment of 3HP delivery nested within the 3HP Options Trial, which compared three optimized strategies for delivering 3HP: facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), and patient choice between facilitated DOT and facilitated SAT at the Mulago HIV/AIDS clinic in Kampala, Uganda. We conducted 72 in-depth interviews among PLHIV purposively selected to investigate factors influencing 3HP acceptance and completion. We conducted ten key informant interviews with healthcare providers (HCPs) involved in 3HP delivery to identify facilitators and barriers at the clinic level. We used post-trial 3HP delivery data to assess sustainability. We used thematic analysis (inductive and deductive) to align the emergent themes with the RE-AIM framework dimensions to report implementation outcomes. Understanding the need for TPT, once-weekly dosing, shorter duration, and perceived 3HP safety enhanced acceptance overall. Treatment monitoring by HCPs and reduced risk of HIV status disclosure enabled DOT acceptance. Dosing autonomy enabled SAT acceptance. Switching between DOT and SAT as needed enabled acceptance of patient choice. Dosing reminders, reimbursement for clinical visits, and social support enabled 3HP completion; pill burden, side effects, and COVID-19-related treatment restrictions hindered completion. All HCPs were trained and participated in 3HP delivery with high fidelity. Training, care integration, prior TPT experience with daily isoniazid, and few 3HP-related serious adverse events enabled adoption, whereas initial concerns about 3HP safety among HCPs, and COVID-19 treatment disruptions delayed 3HP adoption. Refresher training and collaboration among HCPs enabled implementation whereas limited diagnostic facilities for adverse events at the clinic hindered implementation. SAT was modified post-trial; DOT was discontinued due to inadequate ongoing financial support beyond the study period. Facilitated delivery strategies made 3HP treatment convenient for PLHIV and were feasible and implemented with high fidelity by HCPs. However, the costs of 3HP facilitation may limit wider scale-up. Trial registration: ClinicalTrials.gov (NCT03934931); Registered 2nd May 2019; https://clinicaltrials.gov/study/NCT03934931?id = NCT03934931&rank = 1.

Index Case HIV Testing Uptake and its Associated Factors at Oromia, Ethiopia.

Lack of index case testing increased the risk of contracting HIV among the families of index clients, partners, and biological children. The aim of this study was to determine the prevalence of index case HIV testing uptake and its associated factors at Oromia, Ethiopia. An institutional-based cross-sectional study was conducted. A face-to-face interviewer administered structured questionnaire and chart review checklist were used to collect data. The data were analyzed using SPSS version 25. Logistic regressions were executed and statistical significance was declared at P < .05. The prevalence of index case testing was 80.2%. Factors associated with index case HIV testing uptake included HIV status disclosure (AOR = 5.4, 95% CI: 2.1, 14.0), discussed about HIV with family (AOR = 3.1, 95% CI: 1.2, 7.5), counseling of the index case (AOR = 3.3, 95% CI: 1.7, 10.6), perceived benefit of the index case tested (AOR = 3.2, 95% CI: 1.5, 8.7), being on ART 12 months or more (AOR = 2.6, 95% CI: 1.1, 6.1), and maintained privacy (AOR = 3.1, 95% CI: 1.3, 7.1). The uptake of index case HIV testing was moderately high. Additionally, factors such as HIV status disclosure, discussion of HIV with family, counseling of the index case, perception of the benefits of HIV testing for the index case, duration of clients on ART, and privacy maintenance during service delivery were significantly associated with index case HIV testing. To enhance index case testing, it is crucial to raise awareness and ensure client privacy during the initial HTC visit. Encouraging HIV status disclosure through discussion and promoting adherence to HIV medication is also recommended.

Evaluating Antiretroviral Therapy Service Delivery Models Through Lot Quality Assurance Sampling in Central Uganda.

This study evaluated the effectiveness and responsiveness of differentiated Human Immunodeficiency Virus (HIV)/Acquired Immuno-Deficiency Syndrome (AIDS) service delivery models (DSDMs) implemented to enhance antiretroviral therapy (ART) access and outcomes for patients while addressing Tuberculosis (TB)-HIV integration, focusing on four of the five DSDMs currently implemented in Uganda. A descriptive cross-sectional survey was conducted in eight districts of central Uganda using Lot Quality Assurance Sampling approach from 7th to 23rd March 2023. We randomly sampled 2668 patients who have been on ART for at least 1 year in a Facility-Based Individual Management (FBIM) model or in a non-FBIM DSDM for at least one year. Data were collected through patient interviews and review of records in ART and DSDM registers as well as ART cards. We analyzed the data in proportions, comparing the selected ART outcome and responsiveness indicators between Community Client Led ART Distribution (CCLAD), Community Drugs Distribution Point (CDDP) and Fast-Track Drug Refill (FTDR) DSDMs with the standard care (FBIM) model. The ART outcome variables include patients retained in the 1st line of the ART regimen, patients in World Health Organization clinical stage 1 during the last facility visit, patients who had no CD4 request during the past 12 months, viral load suppression, ART adherence, and patients who reported that they did not experience HIV/AIDS-related symptoms in the past 6 months. The variables on TB care include screening for TB using the intensified case finding form and patients tested positive for TB. Responsiveness variables include the perceived; travel time for ART refill, travel distance for ART refill, convenience and flexibility during ART refill, cost of travel for ART refill, fear of being seen at ART refill point, waiting time before service, adequacy of service time, crowding and risk of infections, social support, ability to address ART treatment challenges, HIV status disclosure and barriers to access. Non-overlap in 95% confidence interval in indicator proportion between non-FBIM DSDM and FBIM means a statistically significant difference in proportion, or otherwise non-significant. Higher proportions of ART patients in the CCLAD and CDDP DSDMs adhered to ART, had suppressed viral load, and a lower TB prevalence than those in FBIM model. Additionally, more CCLAD and CDDP clients reported shorter travel time and distance to access ART than their counterparts in the FBIM model. Compared to FBIM model, higher proportions of those in CCLAD and CDDP also reported flexibility in ART refill scheduling, reduced transport costs, fewer privacy concerns, less HIV/AIDS-related stigma, shorter waiting times, more efficient services, decreased congestion at ART pickup sites, enhanced peer support, improved problem-solving assistance, and increased HIV status disclosure. The FTDR model outperformed FBIM in proportions with fewer requests for CD4 testing, viral load suppression, as well as proportions of clients who reported; shorter travel time, lower transportation cost, decreased privacy concerns, shorter waiting time, and efficient service provision. Compared to both CDDP and FTDR, the FBIM had a higher proportion of clients remain on the first-line ART regimen. Community-based DSDMs show responsiveness to clients' needs without compromising the effectiveness of ART care for patients. Although FTDR also demonstrates high effectiveness and responsiveness for clients on ART, there is potential for further improvement. Planners and implementers of ART programs should consider both demand- and supply-side innovations to sustain the continuation of DSDMs.