High Prevalence Of HIV Infection Research Articles

A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations.

Currently, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) has become one of the major health problems worldwide, including Indonesia. East Java is one of the provinces in Indonesia with the highest prevalence of HIV infection. One of the causes of HIV infection transmission is lesbian, gay, bisexual, and transgender (LGBT) practice. Furthermore, the treatment using antiretroviral (ARV) drugs in HIV-1 patients can fail due to the presence of HIV drug resistance. The aim of this study is to identify the behavior at risk of HIV transmission among LGBT, patterns of genetic variation and antiretroviral (ARV) resistance. A systematic review and meta-analysis based on the PRISMA guidelines was conducted. We searched three databases including PubMed, ScienceDirect, and Google scholar for studies investigating the non-heterosexual behavior as risk factor of HIV infection and antiretroviral resistance. Only studies published in English are considered. The adjusted estimates of the risk were carried out using best-adjusted OR with 95% confidence interval (CI) and significant p value < 0.05. In the quantitative analysis of HIV infection risk factors, a total of 13 studies were included, which investigated non-heterosexual behavior as a potential factor. The studies involved a total of 37,129 participants, comprising 10,449 individuals in the non-heterosexual behavior group (LGBTQ+) and 26,680 individuals in the heterosexual group. The majority of the participants in this study were from the USA, Japan, China, and Brazil, and the main HIV subgenotypes were B and CRF. Additionally, the antiretroviral resistance of HIV patients was examined, involving a total of 3062 individuals, with 1296 individuals in the non-heterosexual behavior group and 1766 individuals in the heterosexual group. Our calculation showed that non-heterosexual behavior was significant as risk factor of HIV infection (OR = 2.17, 95% CI = 1.94-2.43, p < 0.001) and antiretroviral resistance (OR = 1.31, 95% CI = 1.00-1.71, p = 0.05). This study concludes that non heterosexual behavior is significant risk factor of HIV infection. A quite prevalent of antiretroviral resistance were found among non heterosexual behavior. The main subgenotype of HIV are B and CRF.

Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho

ABSTRACT Background A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. Objectives We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. Methods Secondary data from a prospective cohort of patients initiating a longer (18–20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. Results Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. Conclusions Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.

University students awareness about the problem of hiv infection (based on the example of Ural federal university named after the first president of Russia B.N. Yeltsin)

According to the Global Fund working group, both Russia and the Sverdlovsk Region are among the places with the highest prevalence of HIV infection. We conducted a study on the awareness of students about HIV infection as a result of the primary prevention process among students at the Federal State Educational Institution of Higher Education named after the First President of Russia B.N. Yeltsin (hereinafter referred to as UrFU). 336 students of different specialties and areas of training were interviewed (N=336). The data we obtained allowed us to reveal some results: the respondents mostly correctly indicated the ways of transmission of infection, the timing and places of examination, they know about the availability of treatment and the possibility of having healthy children, more than half of the students know the HIV status of the partner, while 70% do not know their current HIV status (more than 12 were examined for HIV infection months, the majority of respondents use preventive measures during sexual intercourse, the risk of infection in behavior has no gender characteristics, but is characteristic of young (21-25 years old) and more mature (40 and older) age and primarily for non-partners.

Prevalence of HIV in slums area: a systematic review and meta-analysis

BackgroundHuman Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations.MethodsA rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle–Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I2 test. Publication bias was also assessed using Egger's test. Additionally, subgroup analysis was performed to explore potential factors contributing to the observed heterogeneity.ResultsA systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI: 7–13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI: 8–19%, 18 studies: I2 = 98%), as opposed to men, where the prevalence was found to be 8% (95% CI: 6–12%, 16 studies: I2 = 95%). A geographical breakdown of the included studies revealed that Africa exhibited the highest prevalence, with a figure of 11% (95% CI: 9–13%, 18 studies: I2 = 98%). Subsequently, studies conducted in the American continent reported a prevalence of 9% (95% CI: 7–11%, 2 studies: I2 = 57%). The Asian continent, on the other hand, displayed the lowest prevalence of 1% (95% CI: 0–3%, 2 studies: I2 = 94%). Notably, studies employing rapid tests indicated a prevalence of 13% (95% CI: 9–17%, 6 studies: I2 = 94%), while those relying on self-reported data reported a lower prevalence of 8% (95% CI: 5–11%, 6 studies: I2 = 99%). Moreover, studies utilizing ELISA reported a prevalence of 9% (95% CI: 6–12%, 10 studies: I2 = 96%). Finally, it was determined that studies conducted in upper-middle-income countries reported a higher prevalence of 20% (95% CI: 16–24%, 5 studies: I2 = 45%), whereas studies conducted in lower- and middle-income countries reported a prevalence of 8% (95% CI: 6–10%, 12 studies: I2 = 98%).ConclusionThe current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.

Placental progesterone and its receptor in HIV-infected pre-eclamptic women

Given the high prevalence of HIV infection and pre-eclampsia (PE) in South Africa, this study evaluated and compared the placental immunostaining of progesterone (P) and progesterone receptors (PR) in the synergy of HIV-infected PE compared to normotensive pregnant women using immunohistochemistry interfaced with morphometric image analysis. Progesterone immunostaining was expressed widely across exchange and conducting villi within mesenchymal, endothelial, and trophoblast cells. In contrast, PR was expressed within syncytiotrophoblasts and was absent within endothelial cells. In exchange villi, P and PR immuno-expression was significantly lower in PE compared to the normotensive group (p = < 0.0001 and p = < 0.0001, respectively) and within the early-onset pre-eclampsia (EOPE) compared to the late-onset pre-eclampsia (LOPE) group (p = < 0.0001 and p = < 0.0001, respectively). Progesterone immuno-expression was significantly lower in the HIV+ compared to the HIV− group (p = < 0.0001), whilst PR was non-significant. In conducting villi, P and PR immuno-expression was significantly lower in the EOPE compared to the LOPE group (p = < 0.0001 and p = < 0.0001, respectively) and in the HIV+ compared to the HIV− group (p = < 0.0001 and p = 0.0009, respectively). Progesterone immuno-expression was slightly higher in the PE compared to normotensive group, and PR immuno-expression was non-significant. There was a significant difference between P and PR within exchange versus conducting villi regardless of pregnancy type, with villi type accounting for 34.47% and 15.28% of total variance for P and PR, respectively. Placental P and PR immuno-expression is downregulated in the duality of PE and HIV+ infection. The use of combined antiretroviral therapy (cART) may result in defective P synthesis, which causes insufficient binding to its receptors. Consequently, PI3K/AKT, JAK-STAT, and MAPK signalling pathways are affected, impairing trophoblast invasion and leading to pre-eclampsia development. Notably, the decrease in P and PR immuno-expression in EOPE validates their effect on placentation.

Forecasting trends in the tuberculosis epidemic situation using a simulation dynamic model

Introduction Sverdlovsk region still has a high prevalence of HIV infection and tuberculosis, which affects the effectiveness of anti-tuberculosis measures. The new coronavirus infection for a number of years makes it necessary to redistribute the limited health care resources of the subject of the Russian Federation. This determines the need to develop science-based methods for analyzing and forecasting the development of the epidemic process in tuberculosis infection in the region.The aim of the work is to scientifically substantiate the method of forecasting the epidemic situation of tuberculosis on the territory of the subject with a set of municipalities with the construction of mathematical models and application of artificial intelligence.Materials and methods The source material for the study was statistical data obtained in 2007–2012 from state statistical reporting forms: Form No. 8 “Information about diseases with active tuberculosis”, Form No. 33 “Information about tuberculosis patients”, Forms 089u/tub, data from the Federal Register of Tuberculosis Patients, police registers of tuberculosis patients in health care institutions of Sverdlovsk region. Information processing was carried out using MS Excel, complex analytical tables of absolute values and epidemiological coefficients were compiled. Using artificial intelligence technology, a mathematical simulation dynamic model of the tuberculosis epidemic situation at the regional level and in the context of 63 municipalities of the Sverdlovsk region was developed.Results Comparison of the forecast values made in 2017 with the actual values of 2018–2021 revealed a reliable coincidence of the trend of movement of tuberculosis epidemiological indicators in the region, the maximum deviation was no more than 14.8 %.Discussion The proposed dynamic model made it possible to identify, reliably calculate and graphically display trends in the movement of the values of the studied characteristics of the tuberculosis epidemic process, despite the insignificant discrepancy between actual and forecast values.Conclusion The forecast results obtained using the simulation dynamic model can be used in practice for operational resource planning of resources for the implementation of measures to counter the spread of tuberculosis at the regional level.

The structure of some blood-borne infections distribution among persons from penitentiary institutions the markers

The aim of the study was to assess the occurrence of serological and molecular genetic markers of HIV infection, viral hepatitis B and C among persons in pre-trial detention.Materials and methods. The material of the study identified 138 samples of blood sequences obtained from men in the pretrial detention center in St. Petersburg. Patients were examined by ELISA for the presence of serological markers of HIV infection (Ag/Ab HIV), HBV (HBsAg, antiHBs IgG, anti-HBcore IgG) and HCV (anti-HCV IgG). Determination of HIV and HCV RNA, as well as HBV DNA by PCR with hybridization-fluorescence detection in «real time» mode. HBV DNA with a low viral form was detected using a technique developed at the Saint-Petersburg Pasteur Institute.Results and discussion. With the prevalence of the general prevalence of serological markers, markers of HIV infection were detected in 55 (39.86%) patients, HBV — in 73 (52.90%), HCV — in 83 (60.14%). the same markers of HIV infection and HBV were detected in 6 (4.35%) examined, HIV infection and HCV in 17 (12.32%), HBV and HCV in 22 (15.94%) persons, to all three infections in 26 (18.84%) cases. In 22 (15.94%) people did not notice any of the analyzed markers. HIV RNA was found in 23.19%, HCV RNA — in 46.38%, HBV DNA — in 10.14% of the examined. At the same time, HBV DNA with a low viral form (less than 50 IU/ml) was detected in 7.97% of cases, including 6.52% of seronegative samples. Simultaneously, HIV and HCV RNA were detected in 6.52%, HCV RNA and HBV DNA in 2.17% of patients. Molecular biological markers of all three indicators were found in 1.45% of patients. The examined group was ranked by age into the following subgroups: 21– 30 years old (12.32%), 31–40 years old (34.78%), 41–50 years old (37.68%) and older than 51 years old (15.22%). Certain differences in the prevalence and distribution of the analysis of serological and molecular biological markers between age markers, the highest frequency was found for groups of 31–40 and 41–50 years.Conclusion. The results obtained indicate a high prevalence of HIV infections and parenteral viral hepatitis B and C among persons convicted and awaiting a stage in a pre-trial detention center. Careful attention must be paid to their admission to penitentiary institutions, since many convicts are not aware of their morbidity and may become infected. Regular conclusions, concluded in dynamics, including laboratory diagnostics using highly sensitive molecular biological methods, upon admission to a penitentiary institution, and then annually and upon release, should be taken into account as measures to prevent infection with HIV, HBV, HCV.

Tuberculosis Trends in the Sverdlovsk Region

Introduction: Medical and social importance of a continuous decrease in tuberculosis morbidity and mortality remains high implementation of tuberculosis control programs involves the analysis of current regional trends in the epidemic situation and interdepartmental cooperation in taking comprehensive measures to prevent the spread of this infectious disease. Objective: To analyze local trends and features of the spread of tuberculosis in the population of the Sverdlovsk Region. Materials and methods: Based on the results of a retrospective and prospective study for 2012–2022, we analyzed tuberculosis incidence, prevalence and mortality rates, bacterial carriage, drug resistance, combination with HIV infection, and the structure of clinical forms of tuberculosis in the Sverdlovsk Region. The data were retrieved from the reports of the Federal State Statistics Service, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), Ministries of Health of the Russian Federation and the Sverdlovsk Region, the Federal Register of Tuberculosis Patients, and departmental statistics of prison health care. Results: We observed a decline in the regional tuberculosis incidence, prevalence and death rates over the study period that were consistently higher than the national averages. The proportion of patients with bacterial excretion, multidrug resistance, and tuberculosis/HIV coinfection was increasing among the incident cases while the proportion of cases of disseminated and intrathoracic lymph node tuberculosis was rising in the structure of clinical forms. The main regional factors influencing the epidemiological situation of tuberculosis include a large number of prisoners and a higher prevalence of HIV infection among the general population. Conclusion: Based on the analysis of the situation, further implementation of a set of measures for interdepartmental cooperation for monitoring and combating tuberculosis is envisaged by the regional program.

Enhancement of Tuberculosis Detection and Prevention in HIV-Infected Patients

Tuberculosis incidence and HIV infection incidence in the regions of the Russian Federation are declining, but the proportion of HIV positive people among the entire cohort of tuberculosis patients is clearly growing.The objective: to determine causes for increasing proportion of HIV infected people among tuberculosis patients and to provide additional recommendations for enhancement of tuberculosis detection in HIV infected patients. as well as prevention of its transmission.Subjects and Methods. The cohort of new tuberculosis patients with concurrent HIV infection (TB/HIV coinfection) in the Russian Federation region with a high prevalence of HIV infection was studied based personal medical records of patients for the first 6 months of 2022 (682 cases totally).Results. The cohort of patients with TB/HIV co-infection belonged to socially vulnerable population. Among them, the parenteral route of HIV infection transmission still prevails, while in the whole country, among new HIV patients, the sexual (heterosexual) route of transmission already prevails. The majority of patients with TB/HIV co-infection, who had been infected with HIV for more than 5 years by the time tuberculosis was detected, were not registered with the Center for AIDS Prevention and Control and accordingly received no antiretroviral therapy. In most cases, HIV-infected patients sought medical care in general medical services when they developed symptoms of tuberculosis, however they referred for help when the disease was advanced. When assessing effectiveness of tuberculosis treatment, the specific parameters of tuberculosis course in HIV-infected patients with compromised immunity have not been taken into account.

Prevalence, drug-susceptibility pattern and associated factors of Mycobacterium tuberculosis infection among prisoners in western Arsi zonal prisons, Oromia, South West Ethiopia

ObjectivesEach year, tuberculosis (TB) in prisons is a major worldwide health concern that results in millions of diseases. It is particularly prevalent in low socio-economic countries like Ethiopia because of the poverty, overcrowding, starvation, lack of access to basic healthcare services, and high prevalence of HIV infection in these countries. MethodsA cross-sectional study with 259 prisoners was carried out in the western Arsi zonal prison from November to January 2021. The sputum samples were taken from suspected TB patients and evaluated using the Gene Xpert Mycobacterium tuberculosis/rifampcine test. Line probe assay was used to assess the molecular drug susceptibility of isolates from positive sputum. A bivariate and multivariate logistic regression was analyzed using SPSS version 24 packages. Odds ratio (OR) and corresponding 95% CI were used to quantify the degrees of association between target potential risk factors and Mycobacterium tuberculosis positivity. P-value of less than 0.05 was considered statistically significant. ResultsThe prevalence of undiagnosed pulmonary TB (PTB) verified positive cases was 5.4% (95% CI 2.7, 8.5) out of 259 research participants that were recruited in this study. One (0.38%) occurrence of mono-drug resistance to isoniazid was found among them. In this study, variables that were significantly linked with PTB positive were age ≥30 years, smoking (adjusted OR [AOR] = 0.087, 95% CI = 0.01-0.93, P = 0.043), body mass index 18.5 kg/m2, cough duration 4 weeks (AOR = 0.03, 95% CI = 0.1-0.13 P = 0.001), and coughing before incarceration (AOR = 6.2, 95% CI = 3.6-10.59, P = 0.004). ConclusionIn West Arsi zonal prisons, PTB and mono-drug resistance for isoniazid were found to be more common than in the general population.

Understanding the effect of gender-based violence on uptake and utilisation of HIV prevention, treatment, and care services among transgender women: a qualitative study in the greater Kampala metropolitan area, Uganda

BackgroundTranswomen (also known as transgender women) are disproportionately affected by all forms of gender-based violence (GBV). The high prevalence of physical, sexual and emotional violence not only predisposes transwomen to HIV infection but also limits the uptake/access to HIV prevention, care, and treatment services. Despite the high prevalence of HIV infection and GBV among transwomen, there is limited evidence on how GBV affects the uptake and utilisation of HIV prevention, care, and treatment services. Therefore, this qualitative study explored how GBV affects uptake and utilisation of HIV prevention, treatment, and care services among transwomen in the Greater Kampala Metropolitan Area (GKMA), Uganda.MethodsThis participatory qualitative study was conducted among transwomen in the GKMA. A total of 20 in-depth interviews, 6 focus group discussions, and 10 key informant interviews were conducted to explore how GBV affects the uptake and utilisation of HIV prevention, treatment, and care services among transwomen. Data were analysed using a thematic content analysis framework. Data were transcribed verbatim, and NVivo version 12 was used for coding.ResultsAt the individual level, emotional violence suffered by transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy (ART). Sexual violence compromised the ability of transwomen to negotiate condom use with intimate partners, clients, and employers. Physical and emotional violence at the community level led to fear among transwomen traveling to healthcare facilities. Emotional violence suffered by transwomen in healthcare settings led to the limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services, and delays in receiving appropriate care. The fear of emotional violence also made it difficult for transwomen to approach healthcare providers. Fear of physical violence such as being beaten while in healthcare settings made transwomen shun healthcare facilities.ConclusionThe effects of GBV on the uptake and utilisation of HIV prevention, care, and treatment services were observed in individual, community, and healthcare settings. Across all levels, physical, emotional, and sexual violence suffered by transwomen led to the shunning of healthcare facilities, denial of healthcare services, delays in receiving appropriate care, and the low utilisation of post-exposure prophylaxis, and HIV testing services. Given its effects on HIV transmission, there is a need to develop and implement strategies/ interventions targeting a reduction in GBV. Interventions should include strategies to sensitize communities to accept transwomen. Healthcare settings should provide an enabling environment for transwomen to approach any healthcare provider of their choice without fear of experiencing GBV.

Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa: Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation.

Peritoneal dialysis (PD) is a valuable means to increase access to kidney replacement therapy in South Africa (SA). An increased rate of modality discontinuation related to an increased risk of peritonitis in patients of black African ethnicity, in those with diabetes and in those living with HIV has previously been suggested, which may lead to hesitancy in adoption of 'PD first' programmes. To analyse the safety of a PD-first programme in terms of 5-year peritonitis risk and patient and modality survival at the outpatient PD unit at Helen Joseph Hospital, Johannesburg. After exclusions, clinical data from 120 patients were extracted for analysis. The effects of patient age at PD initiation, ethnicity, gender, diabetes mellitus and HIV infection on patient and modality survival and peritonitis risk were analysed using Cox proportional hazards modelling and logistic regression analysis. Five-year technique and patient Kaplan-Meier survival curves for peritonitis and comorbidity groups were compared using the Cox-Mantel test. The Mann-Whitney U-test and Fisher's exact test were used to compare continuous and categorical variables where appropriate. Five-year patient survival was 49.9%. Black African ethnicity was associated with reduced mortality hazard (hazard ratio (HR) 0.33; 95% confidence interval (CI) 0.15 - 0.71; p=0.004), and patients with diabetes had poorer 5-year survival (19.1%; p=0.097). Modality survival at 5 years was 48.1%. Neither Black African ethnicity nor HIV infection increased the risk of PD discontinuation. Peritonitis was associated with increased modality failure (HR 2.99; 95% CI 1.31 - 6.87; p=0.009). Black African ethnicity did not increase the risk of peritonitis. HIV was not independently associated with an increased risk of peritonitis. Patient and PD survival were generally similar to other contemporaneous cohorts, and the peritonitis rate in this study was within the International Society for Peritoneal Dialysis acceptable range. PD is a safe and appropriate therapy in a low socioeconomic setting with a high prevalence of HIV infection. Consideration of home circumstances and training in sterile technique reduce peritonitis risk and improve PD modality survival. Patients with diabetes may be at risk of poorer outcomes on PD.

ВЛИЯНИЕ ПАНДЕМИИ COVID-19 НА ЭПИДЕМИОЛОГИЧЕСКУЮ СИТУАЦИЮ ПО ТУБЕРКУЛЕЗУ В РЕГИОНЕ С ВЫСОКОЙ РАСПРОСТРАНЕННОСТЬЮ ВИЧ-ИНФЕКЦИИ

The aim of this study was to assess the epidemiological situation of tuberculosis during the COVID-19 pandemic (2020-2021) in comparison with the pre-pandemic period in a region with high prevalence of HIV infection. We studied the official statistical data on the major TB control indicators in Kemerovo region; we also studied the dynamics of the major epidemiological rates of TB and HIV infection in Kemerovo region (Kuzbass) in 2007–2021. We established a decrease in TB incidence by 24.8% in 2019–2021 along with a growing share of new TB cases with lung tissue destruction and sputum positivity, an increasing share of fibrocavernous pulmonary TB among new TB cases, and a decrease in TB detection by fluorography screening by 60% within 2 years (2019–2020). From 2019 through 2020 we observed a significant decrease (by 28.5%) in HIV infection incidence; in 2021 this tendency persisted (32.2%). TB/HIV incidence decreased by 22% in 2019–2020, and by additional 2.3% in 2021. Considering the significant decrease in TB and HIV infection incidence along with an increasing share of severe forms of TB/HIV among new cases, we believe that it is necessary to take complex measures to intensify screening of risk groups for TB/HIV in order to prevent negative consequences of restrictions related to COVID-19, which have resulted in lower coverage of the population by preventive screening in the region with tense epidemiological situation of TB/HIV infection.

Antepartum SARS-CoV-2 infection and adverse birth outcomes in South African women.

SARS-CoV-2 infection in pregnant women has been associated with severe illness in the women and higher rates of premature delivery. There is, however, paucity of data on the impact of the timing of SARS-CoV-2 infection and on symptomatic or asymptomatic infections on birth outcomes. Data from low-middle income settings is also lacking. We conducted a longitudinal study from April 2020 to March 2021, in South Africa, where symptomatic or asymptomatic pregnant women were investigated for SARS-CoV-2 infection during the antepartum period. We aimed to evaluate if there was an association between antepartum SARS-CoV-2 infection on birth outcomes. SARS-CoV-2 infection was investigated by nucleic acid amplification test (NAAT), histological examination was performed in a sub-set of placentas. Overall, 793 women were tested for SARS-CoV-2 antenatally, including 275 (35%) who were symptomatic. SARS-CoV-2 infection was identified in 138 (17%) women, of whom 119 had symptoms (COVID-19 group) and 19 were asymptomatic. The 493 women who were asymptomatic and had a negative SARS-CoV-2 NAAT were used as the referent comparator group for outcomes evaluation. Women with COVID-19 compared with the referent group were 1.66-times (95% confidence interval (CI) = 1.02-2.71) more likely to have a low-birthweight newborn (30% vs 21%) and 3.25-times more likely to deliver a very low-birthweight newborn (5% vs 2%). Similar results for low-birthweight were obtained comparing women with SARS-CoV-2 confirmed infection (30%) with those who had a negative NAAT result (22%) independent of symptoms presentation. The placentas from women with antenatal SARS-CoV-2 infection had higher percentage of chorangiosis (odds ratio (OR) = 3.40, 95% CI = 1.18-.84), while maternal vascular malperfusion was more frequently identified in women who tested negative for SARS-CoV-2 (aOR = 0.28, 95% CI = 0.09-0.89). Our study demonstrates that in a setting with high HIV infection prevalence and other comorbidities antenatal SARS-CoV-2 infection was associated with low-birthweight delivery.

Clinical Characteristics and Treatment Outcomes of HIV+ and HIV- Tuberculosis Patients Followed and Treated at the Regional Hospital of Oyem, Northern Gabon: A Two-Year Retrospective Study

Background: The objective of this study was to analyse the clinical characteristics of HIV+ and HIV- tuberculosis patients followed and  treated at the Oyem Regional Hospital Centre (ORHC).&#x0D; Materials and Methods: During this study conducted between January 2019 and December 2021, data collection was based on the exploitation of medical records and registers of results from the medical analysis laboratory of the regional hospital of Oyem, in which there were personal data (gender and age) of the patients, the status of HIV infection, clinical characteristics (pulmonary or extra pulmonary TB), and finally, the therapeutic outcomes of the patients after anti-tuberculosis and antiretroviral treatment. Binomial test following the Normal distribution was used to find an association between the percentages of extrapulmonary TB and TB+/HIV+ co-infection.&#x0D; Results: In this study, 128 confirmed TB cases were selected. While 54 (42.19%) were co-infected with TB+/HIV+, 74 patients (57.81%) were monoinfected with TB+/HIV+.  Among all these patients, 93 (72.66%) were reported to have extra pulmonary TB and 35 (27.34%) had pulmonary TB. A normal binomial test showed that TB+/HIV+ co-infection was significantly associated with extrapulmonary TB (p=0.04). Patients were put on anti-tuberculosis treatment according to the manufacturers' indications. Despite a total of 15 deaths (8.93%) in both mono- and co-infected patients, there was a favourable outcome, with 35 patients (27.34%) declared cured. With 8 deaths, mortality was higher in the co-infected than in the non-HIV infected TB patients who recorded 7 deaths.&#x0D; Conclusion: By indicating a relatively high prevalence of HIV infection in TB patients, this study showed that TB+/HIV+ co-infection was associated with extra pulmonary TB, the severe form of the disease, and increased mortality in patients, hence the need to strengthen joint activities to control this co-infection.

Lung Injury in COVID-19 and Pneumocystis Pneumonia. Similarities and Differences

In the regions with the high prevalence of HIV infection, it is necessary to perform differential diagnosis of lung injury caused by COVID-19 and pneumocystis pneumonia.The main complaints in COVID-19 and pneumocystis pneumonia are similar and include dyspnea, weakness, cough, fever, and ground glass radiographic syndrome. However, sputum production was more common in pneumocystis pneumonia. The most important differences were frequent anosmia in COVID-19 and its absence in pneumocystis pneumonia, frequent detection of oropharyngeal candidiasis in pneumocystis pneumonia which was not seen in COVID-19.Serum hepcidin concentration has a high diagnostic potential and indicates a greater likelihood of COVID-19 than pneumocystis pneumonia at values ≤ 768.044 pg/ml (ROC AUC 0.977; p &lt; 0.001).

The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence.

In Botswana, the prevalence of HIV-infection is high (20.1%). Literature on characteristics of appendicitis in a high HIV-infection prevalence is limited. A retrospective medical records review was conducted in patients admitted with a diagnosis of appendicitis and known HIV-infection status to adult surgical wards at Princess Marina Hospital from 2013 to 2019. Patients' demographics, clinical characteristics, laboratory data, management and outcomes were analysed. A total of 601 appendicitis patients with known HIV-infection status were identified. Males contributed 51.9%. The overall median age was 29-year: 25-year for HIV-negative patients (HIV-NP) and 36-year for HIV-positive patients. HIV-NP had significantly higher rate of WBC count >10,000/μL, p=0.034. Appendectomy was performed in 92.8% of the cases. Non-operative treatment failure rate in one year was 35.4%. A total of 58 complications were recorded including 20 surgical site infections (SSIs) and one mortality in HIV-NP and 11 SSIs and six mortalities in HIV-positive patients (HIV-PP). HIV-PP had significantly higher mortality than HIV-NP, p=0.010. The overall hospital stay between operated and non-operated patients, p=0.996 and hospital stay between HIV-NP and HIV-PP were not different, p=0.223. Female patients had a significantly higher normal appendix and chronic appendicitis rates than males, p=0.032 and p=0.018 respectively. Complex appendicitis was associated with longer pre-hospital symptom duration, p=0.008 and longer hospital stay, p= 0.001, but it was not related to mortality, p=1.000. Among operated HIV-PP, patients with CD4 count <200 had a significantly higher mortality rate than those with ≥200, p=0.043. In Botswana, the prevalence of HIV-infection in patients with appendicitis was higher than the rate in the general population. HIV-infection and low CD4 count had an adverse effect on the mortality of patients with appendicitis. The higher HIV-infection rate in appendicitis patients and the impact of antiretroviral drug and viral-load on the outcomes in HIV-PP worth investigating.

Prevalence and Spectrum of HIV-1 Resistance Mutations in the Siberian Federal District.

The Siberian Federal District is among the most affected regions with a high prevalence of HIV-infection and is characterized by high HIV-infection incidence rate and high mortality among the HIV-infected population. HIV drug resistance poses a major threat to public health and is associated with increased mortality, HIV incidence, and cost of epidemic control programs. A total of 1281 samples from HIV-infected patients were sequenced and analyzed with the DEONA and HIVdb Program to assess the prevalence of drug resistance mutations in patients in the Siberian Federal District in 2016–2018. The federal surveillance data obtained from 0.5% of HIV-infected patients during the long-term follow-up care in 2021 were also used. The incidence rate of HIV infection in the Siberian Federal District has declined since 2016: from 135.8 per 100 thousand population to 81.1 per 100 thousand population in 2021. Mutations associated with resistance to NRTI and NNRTI were found in 10.3% of the samples in 2016–2018 and in 28.4% of the samples in 2020. The rising prevalence of drug resistance in HIV-infected patients indicates that it is increasingly important to continuously monitor and improve the approaches to the use of effective treatment regimens.

Sexual vulnerability of migrant women in the multicultural context of French Guiana: A societal issue.

BackgroundFrench Guiana is a multicultural French territory in Amazonia with an old migration history and a high prevalence of HIV infection. The objective of this study was to evaluate situations of sexual vulnerability and their associated factors among migrant women in French Guiana.MethodsA cross-sectional epidemiological study was carried out in 2021 in the French Red Cross Prevention and Health Centers of the two main cities of French Guiana (Cayenne and Saint Laurent du Maroni). Analysis was performed with multivariate stepwise logistic regression using Stata 15.0 software.FindingsA total of 382 migrant women were included, with a median age of 31 years, mainly born in Haiti (80%), Suriname (9%), or Dominican Republic (6%), undocumented (71%), and with financial difficulties (77%). Among the 20% having casual partners, 57% reported unprotected sexual intercourse, more often the Haitian and Surinamese women. A history of rape was reported by 20% of women, most often in the country of origin (71%). Lifetime rape was associated with being threatened [aOR = 3.69 (1.96–6.96)] or being physically abused [aOR = 12.95 (6.51–25.75)] in the multivariate analysis. Among the women surveyed, 30% reported having ever exchanged sex for money, food, or shelter in their lifetime. Transactional sex is more common among Dominican women [aOR = 5.59 (1.84–16.95)] and women living in French Guiana for more than 2 years [aOR = 2.32 (1.38–3.92)]. Transactional sex is also associated with alcohol misuse [aOR = 2.57 (1.46–4.53)], history of threats [aOR = 2.03 (1.14–3.63)], history of rape [aOR = 1.92 (1.03–3.60)], and depressive disorders [aOR = 2.08 (1.21–3.60)].InterpretationMigrant women in French Guiana are in a situation of sexual vulnerability. An intervention focused on sexual education and the promotion of prevention tools among Haitian women is advisable. Better prevention and support for transactional sex are needed to prevent violence and its mental health and alcohol misuse consequences for all women, especially Dominican women.

Stratehichni prohramy hromadskoho zdorovia u sferi protydii VIL-infektsii/SNIDu na rehionalnomu rivni v Ukraini (na prykladi Sumskoi oblasti)

Today, according to WHO and UNAIDS, Ukraine remains a region with a high prevalence of HIV infection in Eastern Europe and Central Asia and is one of the leaders in the number of HIV-positive people. According to the Public Health Centre of the Ministry of Health of Ukraine, more than 350,000 cases of HIV infection were registered in Ukraine between 1987 and 2020, including almost 120,000 cases of AIDS and more than 50,000 deaths from diseases caused by AIDS. Almost 240,000 HIV-positive people are under medical supervision. In the country, the epidemic continues to spread among the general population due to the increasing epidemic importance of sexual transmission of HIV, which currently accounts for 65.6 % of first-time HIV patients, and the leading role of key at-risk groups (people who use drugs, people who provide sexual services for a fee, men who have sex with men, and their partners) in the spread of HIV. In the context of health care reform, the issue of achieving the Global Goal of Combating HIV/AIDS «95-95-95» remains extremely important, which is that by 2030 95 % of HIV-infected people should know their diagnosis, 95 % of them — receive treatment, and 95 % of these people have an indeterminate level of viral load. Also, the priority area of activity is to ensure equal access of the population to HIV treatment and prevention services, including representatives of key risk groups. Therefore, we consider the topic of our study relevant. The purpose of the study: is to develop strategic public health programs in the field of HIV/AIDS and to identify priority areas for further prevention of the spread of HIV/AIDS at the regional level. The scientific sources are analysed, different approaches to strategic public health management are studied, the directions of further research are chosen. General scientific theoretical methods are used to solve the outlined tasks and achieve the research goal: study and analysis of scientific sources on health care, HIV/AIDS, statistical and accounting documents, research data and assumptions. The results of the study allow to scientifically substantiate the priority areas of state policy in the field of combating the spread of HIV/AIDS and to determine the financial component of measures to combat the spread of HIV/AIDS. It is advisable for researchers to further focus on the study of strategic directions in the field of HIV/AIDS and their financial component in order to effectively implement management plans in this area.