HIV Mortality Research Articles

HIV, hypertension and diabetes care and all-cause mortality in rural South Africa in the HIV antiretroviral therapy era: a longitudinal cohort study

IntroductionSouth Africa is in the midst of rapid epidemiological transition from extremely high HIV and tuberculosis (TB) mortality to one characterised increasingly non-communicable disease-related deaths. However, longitudinal data linking modifiable...

Impact of Latent M. tuberculosis Infection Treatment on Time to CD4/CD8 Recovery in Acute, Recent, and Chronic HIV Infection.

In people living with HIV, active and latent tuberculosis (TB) coinfections are associated with immune activation that correlate with HIV progression and mortality. We investigated the effect of initiating antiretroviral therapy (ART) during acute (AHI), recent (RHI), or chronic HIV infection (CHI) on CD4/CD8 ratio normalization and associated factors, the impact of latent TB infection treatment, and prior/concomitant TB diagnosis at the time of ART initiation. We included sex with men and transgender women individuals initiating ART with AHI, RHI and CHI between 2013 and 2019, from a prospective cohort in Brazil. We compared time from ART initiation to the first normal CD4/CD8 ratio (CD4/CD8 ≥1) using Kaplan-Meier curves and multivariable Cox proportional hazards models. Sociodemographic and clinical variables were explored. Variables with P -values <0.20 in univariable analyses were included in multivariable analyses. Five hundred fifty participants were included, 11.8% classified as AHI and 6.4% as RHI, 46.7% with CHI-CD4 cell counts ≥350 cells/mm 3 and 35.1% with CHI-CD4 cell counts <350 cells/mm 3 . Time to normalization was shortest among AHI patients, followed by RHI and CHI individuals with higher baseline CD4. In the multivariable model, AHI was associated with a six-fold increased likelihood of achieving a CD4/CD8 ratio ≥1 (hazard ratio [HR]: 6.03; 95% confidence interval [CI]: 3.70 to 9.82; P < 0.001), RHI with HR: 4.47 (95% CI: 2.57 to 7.76; P < 0.001), and CHI CD4 ≥350 cells/mm 3 with HR: 1.87 (95% CI: 1.24 to 2.84; P = 0.003). Latent TB infection treatment was significantly associated with a higher likelihood of the outcome (HR: 1.79; 95% CI: 1.22 to 2.62; P = 0.003). Previous history or concomitant active TB at ART initiation was associated with a lower likelihood of the outcome (HR: 0.41; 95% CI: 0.16 to 1.02; P = 0.054). Initiating ART early during AHI may offer an opportunity to mitigate immune damage. Efforts to implement HIV diagnosis and ART initiation during AHI are critical to amplify ART benefits.

Incorporation of Nurse Initiated Management of Antiretroviral Treatment course within the undergraduate nursing programme North West province.

According to the 90-90-90 strategy, the focus is on 90% of people living with HIV and/or AIDS knowing their HIV status, initiated on antiretroviral treatment and achieving viral suppression. The challenge is that only 74% of people living with HIV and/or AIDS are on antiretroviral treatment, and HIV mortality still occurs. Literature recommends the incorporation of a Nurse Initiated Management of Antiretroviral Treatment (NIMART) course within the undergraduate nursing programme to capacitate new nurses to manage people living with HIV and/or AIDS immediately after completion of their training. However, the NIMART course is still not incorporated, and there is dearth of information on this topic in North West Province (NWP). To explore and describe nurse educators' perceptions regarding the incorporation of NIMART course within the undergraduate nursing programme in NWP. The setting of this research study was nursing education institutions of the NWP. Phenomenography qualitative research design was followed. Twelve nurse educators underwent purposive selection and unstructured individual interviews were conducted. The research co-coder verified the findings. There were ethical considerations and trustworthiness maintained throughout the study. Main themes that emerged in this study depicted benefits and challenges associated with NIMART course incorporation within the undergraduate nursing programme as stated in Table 1. This study concluded that NIMART course incorporation within the undergraduate nursing programme is a good and relevant idea, which requires human and non-human resources. The study contributed new knowledge on how nurse educators perceive the NIMART course incorporation within the undergraduate nursing programme in NWP.

Engaging Resource-Constrained Countries in Research Trials of HIV and Cancer: Lessons from Sub-Saharan Africa and the AIDS Malignancy Consortium

HIV contributes significantly to the global burden of cancer. In developing countries, AIDS-defining cancers predominate due to inconsistent access to antiretroviral therapy (ART). Even though AIDS-defining cancers are now less common in developed countries, the prevalence of non-AIDS-defining cancers (NADCs) has increased due to longer life expectancy in a milieu of chronic immune activation, exposure to oncogenic viruses, lifestyle factors, and environmental variables. In resource-constrained countries with inconsistent access to ART, Kaposi sarcoma, aggressive B-cell lymphomas, and cervical cancer continue to be a large problem. Not only do people living with HIV (PLWH) face higher cancer incidence and mortality, but they also encounter persistent stigmatization and barriers to equitable access to cancer treatment. To bridge this gap, the United States National Cancer Institute (NCI) established the AIDS Malignancy Consortium (AMC) to evaluate novel treatments, preventive strategies, and clinical guidelines for PLWH by conducting both domestic and international research. The AMC also emphasizes the development of robust research infrastructure in resource-limited countries, training of researchers, and fair management of clinical trial specimens. Despite various challenges, the AMC has contributed significant insights to international cancer trials among PLWH, thereby transforming clinical practice in low-resource areas. The high global burden of HIV-associated cancer underscores the need for comprehensive research, improved healthcare access, and greater inclusion of PLWH in cancer clinical trials.

Brief Report: Trends in HIV Mortality in the Context of the COVID-19 Pandemic.

The COVID-19 pandemic led to an increase in the number of deaths among all populations, including people with diagnosed HIV (PWDH). The aim of this study was to analyze the top causes of death (COD) among PWDH before the start of the COVID-19 pandemic, during the start of the COVID-19 pandemic, and a year later; to determine changes in the leading COD among PWDH; and to determine whether the historical trend of decreasing deaths related to HIV continued through the pandemic. To examine mortality among PWDH in New York State (NYS), records for PWDH who died from 2015 to 2021 were extracted from the NYS HIV registry and Vital Statistics Death Data. The number of deaths among PWDH in NYS increased 32% from 2019 to 2020 and continued in 2021. COVID-19 was one of the most common underlying COD among PWDH in 2020. In 2021, COVID-19-related deaths decreased while HIV and diseases of the circulatory system remained the top COD. HIV listed as either the underlying or contributing COD showed a consistent downward trend in the percentage of HIV-related deaths among PWDH, from 45% in 2015 to 32% in 2021. There was a large increase in deaths among PWDH in 2020, with a substantial percentage related to COVID-19. However, even with the introduction of COVID-19 in 2020, the percentage of deaths related to HIV-one of the goals of the Ending the Epidemic Initiative in NYS-continued to decrease.

Survival After Diagnosis of Esophageal Squamous Cell Carcinoma in Malawi.

Esophageal cancer (EC) is the second most common cancer in Malawi, with esophageal squamous cell carcinoma (ESCC) representing >90% of all ECs. Despite significant morbidity and mortality, little is known about disease outcomes. In this study, we assess survival after ESCC diagnosis in Malawi. We report on ESCC cases enrolled in a case-control study at Kamuzu Central Hospital in Lilongwe from August 2017 to April 2020. Suspected cases completed a questionnaire interview; provided blood, urine, and saliva specimens; and underwent a tumor biopsy for histologic confirmation. Cases were followed up by phone biweekly from enrollment to the study end date (December 31, 2020), date of death, or loss to follow-up. Survival was assessed using Kaplan-Meier analysis with the log-rank test. We also examined associations between treatment and ESCC mortality using Cox regression models. There were 300 patients with ESCC enrolled in this study, of whom 290 (97%) had known vital status at the end of follow-up and 10 (3%) were lost to follow-up. Among the 290 patients, 282 (97%) died during follow-up. The median age at enrollment was 55 years (IQR, 48-66), and the median time to death was 106 days (95% CI, 92 to 127). The 1-year, 2-year, and 3-year survival rates were 11% (95% CI, 8 to 15), 3% (95% CI, 1 to 6), and 0.9% (95% CI, 0.8 to 4), respectively. Palliative chemotherapy significantly improved the overall survival of patients with ESCC (Plog-rank = .038) and was significantly associated with reduced mortality (adjusted hazard ratio, 0.71 [95% CI, 0.51 to 0.99]). No significant association was observed between tobacco use, alcohol consumption, or HIV status and mortality. Survival after diagnosis of ESCC was poor in Malawi. Although palliative chemotherapy was associated with improved survival, prevention and earlier detection remain key priorities to improve ESCC mortality at a population level.

Trends and projection of incidence, mortality, and disability-adjusted life years of HIV in the Middle East and North Africa (1990–2030)

Evidence shows a growing trend of the HIV epidemic in the Middle East and North Africa (MENA). We aimed to project the incidence, mortality, and disability-adjusted life years (DALY) in the region from 1990 to 2019 and assess its trend by 2025, and 2030. We extracted the HIV incidence, mortality, and DALY data from the Global Burden of Disease (GBD) and UNAIDS databases. The joinpoint regression model was used to examine changes in HIV trends. The trend changes were estimated by average annual percent change (AAPC). In most countries, an increasing trend was observed in HIV incidence, mortality, and DALY. Specifically, the highest growth in the annual incidence rate was related to Egypt (AAPC = 14.4, GBD) and Iran (AAPC = 9.6, UNAIDS). Notably, Qatar (AAPC = − 5.6, GBD), Bahrain (AAPC = − 3.3, GBD), and Somalia (AAPC = − 4.2, UNAIDS) demonstrated a significant reduction in incidence. Regarding mortality rates, Djibouti (AAPC = 24.2, GBD) and Iran (AAPC = 16.2, UNAIDS) exhibited a significant increasing pattern. Furthermore, the estimated increase in incidence by 2030 was most marked in Djibouti (985%) and Iran (174%). Iran (422%) and Egypt (339%) showed a prominent rise in mortality rates. GBD data showed 16 countries had an increasing pattern in DALY in both genders. According to age and period effects, there was a significant upward trend in incidence, mortality rates, and DALY. Findings highlighted the urgent need for improved prevention and treatment services, including expanding access to HIV testing, promoting safe practices, increasing antiretroviral therapy coverage, and supporting targeted interventions for high-risk populations.

Prevalence and predictors of virologic failure among HIV patients on antiretroviral therapy in Makueni County: a cross-sectional study

Background: The growing number of people on antiretroviral therapy in Kenya has led to a decrease in HIV morbidity and mortality. However, virologic failure (VF) threatens to reverse these gains. In Makueni County, existing data indicate challenges in achieving viral load (VL) suppression among persons living with HIV (PLHIV). Few studies have been carried out investigating VF in the region despite its high incidence of HIV infections. Methods: An analytical cross-sectional study was conducted among PLHIV in Makueni County to investigate the determinants and estimate the prevalence of VF. The prevalence of VF and its associated 95% exact binomial confidence interval was estimated, and a mixed-effects logistic regression model used to evaluate the relationship between the predictors and VF. Results: The estimated period prevalence of VF between October 2018 and June 2019 was 13.2% (95% CI: 12.7%–13.8%). Being 15 years or older (aOR=0.53; 95% CI: 0.44 – 0.645) and having blood samples tested for reasons other than baseline VL measurement was associated with lower odds of VF: breastfeeding mothers (aOR=0.1; 95% CI: 0.01 – 0.97); clinical failure (aOR=0.08; 95% CI: 0.01 – 0.44); confirmation of VF (aOR=0.2; 95% CI: 0.07 – 0.62); no VL data (aOR=0.06; 95% CI: 0.01 – 0.31); routine VL (aOR=0.04; 95% CI: 0.01 – 0.12); drug substitution (aOR=0.03; 95% CI: 0.01 – 0.08). Taking ABC-based, AZT-based, or other non-TDF-Based regimens increased the odds of VF (aOR=1.61; 95% CI: 1.34 – 1.94), (aOR=1.75; 95% CI: 1.52 - 2.01), and (aOR=1.55; 95% CI: 0.99 - 2.44) respectively. Conclusion: This study showed that over 13% of HIV patients on ART in Makueni County had VF between October 2018 and June 2019. The significant risk factors associated with VF were found to be age lower than 15 years, taking a non-TDF-based ART regimen, and blood sampling for baseline VL measurements.

The global burden of HIV/AIDS in Russia in terms of public health. Part 1

Objective. Evaluation of the global HIV burden in Russia, identification of progress made and outstanding problems for 1987–2021.Materials and methods. The analysis of national and foreign publications, data obtained from Rosstat, from forms of federal statistical observation and the FNM of the AIDS Center of Rospotrebnadzor was carried out. The study used information-analytical, epidemiological and statistical methods. Mathematical calculations were performed using the SPSS-26 program.Results and discussion. In Russia, the target indicators of the state program of HIV/AIDS response strategy is being provided in different directions: the greatest success has been achieved in conducting chemoprevention of mother to child HIV transmission, somewhat less in the coverage of the population with HIV testing, which amounted to 26.1% versus the target indicator of 30.0% in 2021, the number of newly detected cases of HIV infection is decreasing (from 73.7 to 71.0 thousand people in 2020–2021, versus the target indicators of 76.1 and 72.3 thousand people, respectively), there is decreasing the HIV incidence (40.4 per 100 thousand. in 2021 versus 68.5 in 2015). Antiretroviral therapy (ART) coverage of patients registered in AIDS Centers went up from 12.4% to 78.9% in 2007–2021. Meanwhile, the determining factor in the HIV/AIDS epidemic progress in Russia is a heterosexual route (F=75.1, p&lt;0.0001) leading to the penetration of infection into all population segments. In addition, despite the increase in the coverage of ART for people living with HIV (PLWH), the HIV mortality rate is remaining high (11.6 per 100 thousand population in 2021, versus 7.9 in 2007).Conclusion. In recent years, there has been a positive trend in the coverage of three-stage HIV chemoprophylaxis in pregnant women, women in labor and newborns. The number of HIV population based screening tests is increasing annually. There is an increase in the ART coverage of patients and a decrease in the number of newly diagnosed cases of the disease. However, along with the observed increase in the HIV spread through heterosexual contacts, it is necessary to strengthen information and preventive measures, especially among the reproductive age group. The high HIV mortality rate is continuing to remain, despite the increase in ART coverage of PLWH. The identified problems need to be solved comprehensively based on the results of large-scale sociological research conducted in various regions of Russia.

Person-centred, integrated non-communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges.

Non-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person-centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre-exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person-centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility-based settings. South Africa'sCCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community-based pickup points, facility "fast lanes" and adherence clubs with public sector health facilities and private sector medication collection units. There are no out-of-pocket payments for medications or testing commodities. Wait-times for medication refills are lower at CCMDD sites than facility-based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Eswatini and South Africa demonstrate person-centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends.

Survival Patterns of Human Immunodeficieny Virus-Tuberculosis (HIV-TB) Co-Infected Patients in Selected Counties in Kenya`

One nation with a significant burden of tuberculosis and the human immunodeficiency virus is Kenya. Coinfection with tuberculosis and the human immunodeficiency virus/acquired immunodeficiency syndrome complicates infection control and lowers survival rates. While research on HIV/TB coinfection has been done in Kenya, little is known about the patterns in people's survival with Antiretroviral Therapy (ART) and T.B. therapy, particularly regarding the country's many Counties. This study used the Kaplan-Meier function to determine the trends in patient survival for those receiving ART and T.B. treatment in Kenya. A retrospective cohort research design was employed in the investigation. Patients receiving co-therapy for T.B. and ART management who visited the medical institutions between January 1, 2015, and December 31, 2019, were included in the target population. The National AIDS &amp; STIs Control Program (NASCOP) database (secondary data) records of all HIV-TB co-infected individuals from the chosen counties in Kenya were used to create the study's sample. The survival function was estimated using the Kaplan-Meier estimator. According to the study, the use of ART and T.B. treatment statistically affects the survival of patients co-infected with HIV and T.B. More persons with T.B. and HIV infections who received both ART and T.B. treatment survived longer than those who received only ART up to about the 750th day. The study also discovered that the mortality rates for HIV-TB patients between 2015 and 2019 differed from county to county. The study also showed that throughout five years, there were variations in the distribution of T.B. and HIV mortality among the 47 Counties. The overall number of T.B. and HIV deaths in the 47 countries was 1077 in 2015. This figure fell to 921 in 2016, 391 in 2017, 106 in 2018, and 60 in 2019. Conclusion: Starting treatment later in the course of the disease may have a bigger impact on lowering T.B./HIV-related mortality than focusing interventions in the first few months following ART initiation.

Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women

IntroductionWidowed women make up 18–40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya. MethodsWe implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models. ResultsThe trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (−3.13, 95%CI -4.42, −1.84 vs. −3.08, 95%CI -4.15, −2.02), depressive symptoms (−0.21, 95%CI -0.36, −0.07 vs. −0.19, 95%CI -0.29, −0.08), internalized stigma (−0.33, 95%CI -0.55, −0.11 vs. −0.38, 95%CI -0.57, −0.19), and anticipated stigma (−0.46 95%CI -0.65, −0.28 vs. −0.35, 95%CI -0.50, −0.21) was similar for both groups. In contrast, improvements in social support (−2.22, 95%CI -3.85, −0.59 vs. −4.00, 95%CI -5.16, −2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. −0.14, 95%CI -0.20, −0.09; p < 0.01) were weaker for widowed than married women. ConclusionsOur study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.

Dynamics of hospital admissions and all-cause mortality of HIV infected patients in Kazakhstan: data from unified nationwide electronic healthcare system 2014-2019.

Although global HIV pandemic has stabilized, it continues to rise in Eastern Europe and Central Asia due to exponential growth of newly acquired cases. Based on UNAIDS, there are currently 35,000 people living with HIV (PLWH) in Kazakhstan. This alarming HIV epidemiologic situation mandates urgent investigation of causes, routes of transmission and other characteristics in order to halt the epidemic. We aimed to analyze the data of all hospitalized patients for the period of 2014-2019 who tested positive for HIV from the Unified National Electronic Health System (UNEHS) of Kazakhstan. This cohort study extracted data for all HIV positive patients during 2014-2019 from UNEHS of Kazakhstan to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Crosscheck of the target population data was conducted with tuberculosis, viral hepatitis, alcohol abuse and intravenous drug user (IDU) cohorts in order to create a comprehensive database. All survival functions and factors associated with mortality were tested for significance. The cohort population (n = 2,213) mean age was 33.3 ± 13.3 years with 1,375 males (62.1%) and 838 females (37.9%). Incidence rate decreased from 2.05 in 2014 to 1.88 in 2019, however, prevalence and mortality continues to escalate every year, the mortality raised significantly from 0.39 in 2014 to 0.97 in 2019. People aged >50 years, males, retired people, patients from tuberculosis hospital profile had much lower survival probabilities than the corresponding groups. Adjusted Cox regression model death hazard showed strong association of HIV patients with tuberculosis coinfection (HR 1.4, 95% CI 1.1; 1.7, p < 0.001). The results of this study demonstrate high rates of HIV mortality, strong association of HIV with TB coinfection, regional, age specific, gender, hospital profile and social status differences that significantly affect HIV prevalence. Since the prevalence of HIV is continuing to increase, more information is necessary for evaluation and implementation of prevention procedures.

Effect of the "universal test and treat" policy on the characteristics of persons registering for HIV care and initiating antiretroviral therapy in Uganda.

We examined the effect of the Universal Test and Treat (UTT) policy on the characteristics of people living with HIV (PLHIV) at enrolment in HIV care and initiation of antiretroviral therapy (ART) in Uganda using data from 11 nationally representative clinics of The AIDS Support Organisation (TASO). We created two retrospective PLHIV cohorts: pre-UTT (2004-2016), where ART initiation was conditional on CD4 cell count and UTT (2017-2022), where ART was initiated regardless of World Health Organisation (WHO) clinical stage or CD4 cell count. We used a two-sample test of proportions and Wilcoxon rank-sum test to compare proportions and medians, respectively, between the cohorts. A total of 244,693 PLHIV were enrolled at the clinics [pre-UTT, 210,251 (85.9%); UTT, 34,442 (14.1%)]. Compared to the pre-UTT cohort, the UTT cohort had higher proportions of PLHIV that were male (p < 0.001), aged 18-29 years (p < 0.001), aged >69 years, never married (p < 0.001), and educated to primary (p < 0.001) and post-primary (p < 0.001) school level at enrolment in HIV care and ART initiation. Overall, 97.9% of UTT PLHIV initiated ART compared to 45.2% under pre-UTT. The median time from enrolment in HIV care to ART initiation decreased from 301 [interquartile range (IQR): 58-878] pre-UTT to 0 (IQR: 0-0) under UTT. The median CD4 count at ART initiation increased from 254 cells/μL pre-UTT to 482 cells/μL under UTT (p < 0.001). Compared to the pre-UTT cohort, the UTT cohort had higher proportions of PLHIV with a CD4 count >500 cells/μL (47.3% vs. 13.2%, p < 0.001) and WHO stage 1 (31.7% vs. 4.5%, p < 0.001) at ART initiation. Adoption of the UTT policy in Uganda was successful in enrolling previously unreached individuals, such as men and younger and older adults, as well as those with less advanced HIV disease. Future research will investigate the effect of UTT on long-term outcomes such as retention in care, HIV viral suppression, morbidity, and mortality.

Comparative Assessment of Serum Selenium Status in HIV-Infected and Non-infected Children: A Pilot Study in a Tertiary Hospital in Nigeria.

Background Selenium is an essential micronutrient that plays a crucial role in a wide range of physiological processes, including immune responses. Selenium deficiency has been recognized as an associated factor in the progression of HIV to advanced HIV disease and/or mortality. Although selenium supplementation has been shown to reduce hospitalizations andimprovecellular immunity, the evidence remains mixed. This study aimed to determine the prevalence of selenium deficiency and its relationshipwithHIV disease markers in HIV-infectedchildren at the Lagos University Teaching Hospital. Methodology This is a cross-sectional, comparative, pilot study of plasma concentrations of selenium in HIV-infected (n = 30) and non-infected (n = 20) children enrolled in the pediatric HIV clinic of the Lagos University Teaching Hospital, Lagos, Nigeria, from May 2019 to May 2021. HIV-infected children were on stable antiretroviral therapy (ART) with an undetectable viral load. The serum concentrationof selenium was measured using the automated atomic absorption spectrophotometer (hydride generation method).Logistic regression was used to study the effect of selenium status on the levels of HIV disease markers (CD4 count, viral load, weight, opportunistic infections) in the study participants. Results The median age of all participants was nine (4-12) years, with 74% being boys. The mean selenium concentrations were lower in HIV-infected children (91.1 ± 12.0 µg/L) compared to the comparison group without HIV(147.8 ± 4.9 µg/L) (p = 0.001). After controlling for age, ART duration, markers of HIV infection, and other potentially confounding variables, participants with selenium deficiency had approximately 11-fold odds of increased hospital admissions (adjusted odds ratio = 10.57, 95% confidence interval = 1.58 to 70.99; p = 0.015). Conclusions In this study, selenium concentrations were significantly lower in HIV-infected children than in the HIV-negative comparison group. Lower serum selenium concentrations were associated with increased hospitalizations. Although our findings suggest the potential need for selenium supplementation for children living with HIV in Nigeria, further studies are warranted to determine the safety and efficacy of selenium supplementation in this key population.

Streamlining Global and Local Data on HIV: Underscoring Role of Institutions and Ethics in Improving Quality of HIV Research

ObjectivesThere are inconsistencies in the South Africa HIV mortality data reported by Institute of Health Metrics and Evaluation (IHME), Joint United Nations Programme on HIV/AIDS (UNAIDS), and Statistics South Africa (StatsSA) platforms. Between 2006 and 2016, these global data sets (IHME and UNAIDS) show that HIV-related mortalities were improving in South Africa, whereas StatsSA argues the opposite. We explain the causes of this differing stands and highlight areas that may be improved to address such inconsistencies. MethodsThis observational analysis uses data from IHME, UNAIDS, and StatsSA platforms. ResultsWe demonstrate that IHME and UNAIDS data sets are based on a mathematical compartmental model, which is not dynamic to all HIV epidemiological aspects. Such limitation may cause inflated improvement in HIV mortality outcomes that are not in line with HIV mortality evidence recorded at the household level as demonstrated by StatsSA. ConclusionThere is a need to streamline the IHME, UNAIDS, and StatsSA data on HIV to improve the quality of HIV research and programming in South Africa.

Cryptococcal Meningitis and Spatial Distribution of Pigeons (Columba livia) in Colombia (P4-8.004)

<h3>Objective:</h3> To analyze the biogeographical distribution of <i>Columba livia</i> (Cl) in Colombia and its association with the density of meningeal cryptococcosis and HIV cases. <h3>Background:</h3> Cryptococcus spp. is widely distributed and the main cause of meningitis in HIV patients from low-income countries. Colombia exhibits a high prevalence of antigenemia and an above average incidence, while the most common (&gt;80%) clinical presentation of cryptococcosis in the country is meningitis. Exposure to pigeons feces has been stated as one of the risk factors and small studies from Colombia have found the fungus in 25% of these samples; nonetheless, it is still unknown if the geographical distribution of common pigeons (Cl) correlates with that of HIV and meningeal cryptococcosis. <h3>Design/Methods:</h3> Occurrences of Cl were extracted from the Global Biodiversity Information Facility and then mapped by municipalities. Information regarding HIV prevalence and mortality were provided by the Ministry of Health and cryptococcal meningitis prevalence was inferred from the passive laboratory-based surveillance system. Densities were calculated per 100 Km². Spearman correlation coefficients and robust linear regression were implemented. <h3>Results:</h3> In Colombia, 32226 occurrences of pigeons have been reported in 698 municipalities (55.25% of the country’s area). Median density of occurrence was 1.66 per 100 Km². Regarding the geographical distribution of HIV cases and fatalities, most were found in the highly populated departments. There was a moderate correlation of Cl occurrence distribution with HIV density by municipality (ρ=0.443, p=0.000) and cryptococcus cases at the departmental level (ρ=0.699, p=0.000). Significant association with occurrence persisted after adjusting by population density (β=0.603 CI 95% 0.258–0.949, p=0.001). <h3>Conclusions:</h3> There is evidence of geographical correlation between pigeons occurrence and density of cryptococcal meningitis. Further studies should address the impact of environmental variables on the fungus niche. <b>Disclosure:</b> Dr. Pinilla Monsalve has nothing to disclose. Miss Forero has nothing to disclose.

Providing telemedicine services to persons living with HIV in an urban community: a demonstration project

ABSTRACT Although HIV incidence and mortality rates have declined over the past 20 years, HIV health disparities continue to persist among patients living in urban communities. Barriers to proficient health outcomes for persons with HIV (PWH) in urban communities include lack of access to care, resulting from limited transportation or clinic availability. While healthcare systems in rural communities provide telemedicine (TM) services to PWH to eliminate transportation and accessibility barriers, few examples exist regarding TM use for PWH in urban communities. This project’s goal was to increase the provision of healthcare services in an urban setting to PWH, using TM. As guided by “Integration of Healthcare Delivery Service” theories and key principles, we created an integration framework comprised of several simultaneous, overlapping activities to include: (1) capacity building (2) clinical standardization (3) community and patient engagement and (4) evaluation performance and measurements. This paper describes major activities involved with developing, implementing and evaluating a TM program for PWH. We discuss results, challenges, and lessons learned from integrating this program into our existing healthcare system.

'If I am on ART, my new-born baby should be put on treatment immediately': Exploring the acceptability, and appropriateness of Cepheid Xpert HIV-1 Qual assay for early infant diagnosis of HIV in Malawi.

Early infant diagnosis of HIV (EID-HIV) is key to reducing paediatric HIV mortality. Traditional approaches for diagnosing HIV in exposed infants are usually unable to optimally contribute to EID. Point-of-care testing such as Cepheid Xpert HIV-1 Qual assay-1 (XPertHIV) are available and could improve EID-HIV in resource constrained and high HIV burden contexts. We investigated the acceptability and perceived appropriateness of XpertHIV for EID-HIV in Mulanje Hospital, Malawi. Qualitative cross-sectional study using semi-structured interviews (SSI) among caregivers and health care workers at Mulanje District Hospital. The qualitative study was nested within a larger diagnostic study that evaluated the performance of XpertHIV using whole-blood-sample in a resource limited and high burden setting. A total of 65 SSIs were conducted among caregivers (n = 60) and health care providers (n = 5). Data were coded using deductive and inductive approaches while thematic approach was used to analyse data. Point-of-care XPertHIV was perceived to be acceptable among caregivers and health care providers. Caregivers' motivations for accepting XPertHIV HIV-testing for their infants included perceived risk of HIV emanating from child's exposure and validation of caregiver's own HIV sero-status. Although concerns about pain of testing and blood sample volumes taken from an infant remained amplified, overall, both caregivers and health care providers felt XpertHIV was appropriate because of its quick result turn-around-time which decreased anxiety and stress, the prospect of early treatment initiation and reduction in hospital visits and related costs. Implementation of XpertHIV has a great potential to improve EID-HIV in Malawi because of its quick turn-around-time and associated benefits including overcoming access-related barriers. Scaled implementation of this diagnostic technology require a robust community engagement strategy for managing caregivers and community myths and misconceptions towards the amount of blood sample collected from infants.

HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study

Epidemiological monitoring of HIV among transgender women is minimal despite prioritisation of this group in the US National HIV/AIDS Strategy (2022-2025). We aimed to estimate HIV incidence in a multisite cohort of transgender women in the eastern and southern USA. Participant deaths were identified during follow-up; thus, we felt it was an ethical imperative to report mortality alongside HIV incidence. In this study, we established a multisite cohort across two modes: a site-based, technology-enhanced mode in six cities (Atlanta, Baltimore, Boston, Miami, New York City, and Washington, DC) and an exclusively digital mode that spanned 72 eastern and southern US cities that matched the six site-based cities based on population size and demographics. Trans feminine adults (≥18 years) who were not living with HIV were eligible and followed up for at least 24 months. Participants completed surveys and oral fluid HIV testing with clinical confirmation. We ascertained deaths through community and clinical sources. We estimated HIV incidence and mortality using the number of HIV seroconversions and deaths, respectively, divided by person-years accumulated from enrolment. Logistic regression models were used to identify predictors of HIV seroconversion (primary outcome) or death. Between March 22, 2018, and Aug 31, 2020, we enrolled 1312 participants with 734 (56%) in site-based and 578 (44%) in digital modes. At the 24-month assessment, 633 (59%) of 1076 eligible participants consented to extending participation. 1084 (83%) of 1312 participants were retained at this analysis based on the study definition of loss to follow-up. As of May 25, 2022, the cohort participants had contributed 2730 accumulated person-years to the analytical dataset. Overall HIV incidence was 5·5 (95% CI 2·7-8·3) per 1000 person-years and incidence was higher among Black participants and those living in the south. Nine participants died during the study. The overall mortality rate was 3·3 (95% CI 1·5-6·3) per 1000 person-years, and the rate was higher among Latinx participants. Identical predictors of HIV seroconversion and death included residence in southern cities, sexual partnerships with cisgender men, and use of stimulants. Participation in the digital cohort and seeking care for gender transition were inversely associated with both outcomes. As HIV research and interventions are increasingly delivered online, differences by mode highlight the need for continued community and location-based efforts to reach the most marginalised transgender women. Our findings underscore community calls for interventions that address social and structural contexts that affect survival and other health concerns alongside HIV prevention. National Institutes of Health. For the Spanish translation of the abstract see Supplementary Materials section.