Human Immunodeficiency Virus Interventions Research Articles

Barriers to viral load suppression among adolescents living with HIV on anti-retroviral therapy: a retrospective study in Tanga, Tanzania.

Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region. We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants' socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths). 2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41-15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44-7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30-0.99). The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities.

Ending the HIV Epidemic in Black America: Qualitative Insights Following COVID-19.

The disproportionate effects of the human immunodeficiency virus (HIV) and the Coronavirus 2019 (COVID-19) on Black American communities highlight structural systems rooted in racism and must be addressed with national strategies that improve both biomedicine and social determinants of health. The purpose of this study was to qualitatively examine the experiences and interpretations of experts in the HIV workforce (local, state, and national HIV-related organizations) regarding the state of HIV and COVID-19 among Black Americans. Within key informant interviews and a focus group recorded and transcribed verbatim, fifteen members of the HIV workforce and Black community described their experiences and provided insights to inform ending the negative outcomes resulting from HIV and COVID-19. Data were analyzed using NVivo software, and eight themes emerged to address disease disproportionality through a Black lens. Themes reflected (1) accessing information and care; (2) key potential partners/stakeholders; (3) investing in Black communities; (4) governmental support; (5) increasing engagement and advocacy; (6) HIV-related community conversations; (7) developments since COVID-19; and (8) the Ending the HIV Epidemic (EHE) trajectory. Themes directly speak to recommendations to adjust education and policy strategies for HIV and COVID-19 prevention and intervention. Such recommendations, (1) amplifying Black voices, (2) investing sustainable dollars into Black communities, and (3) leaning into advocacy, can bolster the foundation for the HIV workforce and Black community to break ineffective response patterns and lead the fight against these systemic issues of inequity.

Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review.

Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.

Community-Wide Universal Human Immunodeficiency Virus (HIV) Test and Treat Intervention Reduces Tuberculosis Transmission in Rural Uganda: A Cluster-Randomized Trial.

Human immunodeficiency virus (HIV) treatment reduces tuberculosis (TB) disease and mortality; however, the population-level impact of universal HIV-test-and-treat interventions on TB infection and transmission remain unclear. In a sub-study nested in the SEARCH trial, a community cluster-randomized trial (NCT01864603), we assessed whether a universal HIV-test-and-treat intervention reduced population-level incident TB infection in rural Uganda. Intervention communities received annual, population-level HIV testing and patient-centered linkage. Control communities received population-level HIV testing at baseline and endline. We compared estimated incident TB infection by arms, defined by tuberculin skin test conversion in a cohort of persons aged 5 and older, adjusting for participation and predictors of infection, and accounting for clustering. Of the 32 trial communities, 9 were included, comprising 90 801 participants (43 127 intervention and 47 674 control). One-year cumulative incidence of TB infection was 16% in the intervention and 22% in the control; SEARCH reduced the population-level risk of incident TB infection by 27% (adjusted risk ratio = 0.73; 95% confidence interval [CI]: .57-.92, P = .005). In pre-specified analyses, the effect was largest among children aged 5-11 years and males. A universal HIV-test-and-treat intervention reduced incident TB infection, a marker of population-level TB transmission. Investments in community-level HIV interventions have broader population-level benefits, including TB reductions.

Joint modeling HIV and HPV using a new hybrid agent-based network and compartmental simulation technique.

Persons living with human immunodeficiency virus (HIV) have a disproportionately higher burden of human papillomavirus infection (HPV)-related cancers. Causal factors include both behavioral and biological. While pharmaceutical and care support interventions help address biological risk of coinfection, as social conditions are common drivers of behaviors, structural interventions are key part of behavioral interventions. Our objective is to develop a joint HIV-HPV model to evaluate the contribution of each factor, to subsequently inform intervention analyses. While compartmental modeling is sufficient for faster spreading HPV, network modeling is suitable for slower spreading HIV. However, using network modeling for jointly modeling HIV and HPV can generate computational complexities given their vastly varying disease epidemiology and disease burden across sub-population groups. We applied a recently developed mixed agent-based compartmental (MAC) simulation technique, which simulates persons with at least one slower spreading disease and their immediate contacts as agents in a network, and all other persons including those with faster spreading diseases in a compartmental model, with an evolving contact network algorithm maintaining the dynamics between the two models. We simulated HIV and HPV in the U.S. among heterosexual female, heterosexual male, and men who have sex with men (men only and men and women) (MSM), sub-populations that mix but have varying HIV burden, and cervical cancer among women. We conducted numerical analyses to evaluate the contribution of behavioral and biological factors to risk of cervical cancer among women with HIV. The model outputs for HIV, HPV, and cervical cancer compared well with surveillance estimates. Model estimates for relative prevalence of HPV (1.67 times) and relative incidence of cervical cancer (3.6 times), among women with HIV compared to women without, were also similar to that reported in observational studies in the literature. The fraction attributed to biological factors ranged from 22-38% for increased HPV prevalence and 80% for increased cervical cancer incidence, the remaining attributed to behavioral. The attribution of both behavioral and biological factors to increased HPV prevalence and cervical cancer incidence suggest the need for behavioral, structural, and pharmaceutical interventions. Validity of model results related to both individual and joint disease metrics serves as proof-of-concept of the MAC simulation technique. Understanding the contribution of behavioral and biological factors of risk helps inform interventions. Future work can expand the model to simulate sexual and care behaviors as functions of social conditions to jointly evaluate behavioral, structural, and pharmaceutical interventions for HIV and cervical cancer prevention.

The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.

Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). This meta-analysis of 331 reports (clusters; number of effect sizes [k] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Methods for Assessing Spillover in Network-Based Studies of HIV/AIDS Prevention among People Who Use Drugs.

Human Immunodeficiency Virus (HIV) interventions among people who use drugs (PWUD) often have spillover, also known as interference or dissemination, which occurs when one participant's exposure affects another participant's outcome. PWUD are often members of networks defined by social, sexual, and drug-use partnerships and their receipt of interventions can affect other members in their network. For example, HIV interventions with possible spillover include educational training about HIV risk reduction, pre-exposure prophylaxis, or treatment as prevention. In turn, intervention effects frequently depend on the network structure, and intervention coverage levels and spillover can occur even if not measured in a study, possibly resulting in an underestimation of intervention effects. Recent methodological approaches were developed to assess spillover in the context of network-based studies. This tutorial provides an overview of different study designs for network-based studies and related methodological approaches for assessing spillover in each design. We also provide an overview of other important methodological issues in network studies, including causal influence in networks and missing data. Finally, we highlight applications of different designs and methods from studies of PWUD and conclude with an illustrative example from the Transmission Reduction Intervention Project (TRIP) in Athens, Greece.

Opioid Dependence Syndrome and Quality of Life: A Facility-based Exploratory Study among Drug Addicts at a Tertiary Care Hospital of Kolkata, India

Introduction: Opioid dependence syndrome is considered a chronic-relapsing medical illness that can affect the Quality of Life (QoL) of Injecting Drug Users (IDUs). They are at risk of contracting Human Immunodeficiency Virus (HIV) due to unsafe injection practices. Opioid Substitution Therapy (OST) is an effective treatment option for opioid dependence as well as HIV prevention and intervention among IDUs, subsequently improving their QoL. Aim: To identify the opioids injected by addicts and evaluate QoL across different life areas among IDUs attending an OST centre. The authors also aimed to determine the factors affecting QoL regarding relationships with family and friends. Materials and Methods: A facility-based, observational crosssectional study was conducted on 168 IDUs at an OST centre in Calcutta National Medical College from April 2016 to March 2018. A predesigned and pretested structured schedule was used, which included socio-demographic characteristics, pattern of substance abuse, and HIV status. To evaluate QoL, the authors used a Likert scale with five domains specific to chronic diseases. Logistic regression was employed to determine associated factors with two QoL domains regarding relationships with family and friends. The Statistical Package for Social Sciences (SPSS) version 16.0 was used for data analysis. Results: The mean age {Standard Deviation (±SD)} of the study participants was 36.53±9.514 years. The most common opioids injected by IDUs were buprenorphine (89.2%). Although QoL scores varied across different domains, it can be interpreted that the majority of participants had poor QoL. When assessing QoL in terms of relationships with family and friends, there was a significant association between better QoL and financial support {Adjusted Odds Ratios (AOR) Confidence Intervals (CI)} 2.550 (1.431-6.082), favourable living arrangements AOR(CI) 2.450 (1.010-4.443), and absence of seropositivity AOR(CI) 2.462 (1.141-7.476). Conclusion: Buprenorphine was the most common substance of abuse among IDUs. The study revealed a high proportion of IDUs with poor QoL. The findings of the study might be helpful in designing appropriate strategies to improve personal relationships and social situations among IDUs.

Spatial disparities of HIV prevalence in South Africa. Do sociodemographic, behavioral, and biological factors explain this spatial variability?

In 2021, an estimated 38 million people were living with human immunodeficiency virus (HIV) globally, with over two-thirds living in African regions. In South Africa, ~20% of South African adults are living with HIV. Accurate estimation of the risk factors and spatial patterns of HIV risk using individual-level data from a nationally representative sample is invaluable for designing geographically targeted intervention and control programs. Data were obtained from the 2016 South Africa Demographic and Health Survey (SDHS16). The study involved all men and women aged 15 years and older, who responded to questions and tested for HIV in the SDHS. Generalized additive models (GAMs) were fitted to our data with a nonparametric bivariate smooth term of spatial location parameters (X and Y coordinates). The GAMs were used to assess the spatial disparities and the potential contribution of sociodemographic, biological, and behavioral factors to the spatial patterns of HIV prevalence in South Africa. A significantly highest risk of HIV was observed in east coast, central and north-eastern regions. South African men and women who are widowed and divorced had higher odds of HIV as compared to their counterparts. Additionally, men and women who are unemployed had higher odds of HIV as compared to the employed. Surprisingly, the odds of HIV infection among men residing in rural areas were 1.60 times higher (AOR 1.60, 95% CI 1.12, 2.29) as compared to those in urban areas. But men who were circumcised had lower odds of HIV (AOR 0.73, 95% CI 0.52, 0.98), while those who had STI in the last 12 months prior to the survey had higher odds of HIV (AOR 1.76, 95% CI 1.44, 3.68). Spatial heterogeneity in HIV risk persisted even after covariate adjustment but differed by sex, suggesting that there are plausible unobserved influencing factors contributing to HIV uneven variation. This study's findings could guide geographically targeted public health policy and effective HIV intervention in South Africa.

HIV incidence among men who have sex with men (MSM) in Metro Manila, the Philippines: A prospective cohort study 2014-2018.

The human immunodeficiency virus (HIV) epidemic in the Philippines has been driven by sexual transmission among men who have sex with men (MSM) over the past 2 decades. As the incidence of HIV infection among MSM has not been extensively evaluated, this study aimed to determine the incidence of HIV infections and the associated risk factors among MSM in Metro Manila, Philippines.This prospective cohort study was conducted in 2 community centers in Metro Manila, the Philippines, between March 2014 and December 2018. MSM who had anal or oral sex in the past 12 months, aged ≥18 years, and confirmed HIV-negative status were enrolled. Participants were followed up every 3 months with repeat HIV testing and assessment of HIV-related practices.Of the 708 MSM included in this study, a total of 59 HIV seroconversions occurred during the follow-up, resulting in an incidence of 2.7 (95% confidence interval: 2.1–3.5) per 100 patient-years. Multivariate risk regression analysis indicated that age (P = .002) and anal sex with a consensual male partner in the past 3 months (P = .039) were significantly associated with HIV infection.Our study has shown high rates of incident HIV infection among Filipino MSM. This demonstrates the need for effective HIV prevention, surveillance, treatment, and intervention strategies targeting this population.

Assessing spatial patterns of HIV prevalence and interventions in semi-urban settings in South Africa. Implications for spatially targeted interventions.

Equitable allocation of resources targeting the human immunodeficiency virus (HIV) at the local level requires focusing interventions in areas of the greatest need. Understanding the geographical variation in the HIV epidemic and uptake of selected HIV prevention and treatment programmes are necessary to identify such areas. Individual-level HIV data were obtained from a 2012 national HIV survey in South Africa. Spatial regression models on each outcome measure (HIV infection, sub-optimal condom use or non-anti-retroviral treatment (ART) adjusted for spatial random effects at the ward level were fitted using WINBUGS software. In addition, ward-level data was utilized to estimate condom use coverage and ART initiation rates which were obtained from routinely collected data in 2012. Ordinary Kriging was used to produce smoothed maps of HIV infection, condom use coverage and ART initiation rates. HIV infection was associated with individuals undertaking tertiary education [posterior odds ratio (POR): 19.53; 95% credible intervals (CrI): 3.22- 84.93]. Sub-optimal condom use increased with age (POR: 1.09; 95%CrI: 1.06-1.11) and was associated with being married (POR: 4.14; 95%CrI: 1.23-4.28). Non-ART use was associated with being married (POR: 6.79; 95%CrI: 1.43-22.43). There were clusters with high HIV infection, sub-optimal condom use, and non- ART use in Ekurhuleni, an urban and semi-urban district in Gauteng province, South Africa. Findings show the need for expanding condom programmes and/or strengthening other HIV prevention programmes such as pre-exposure prophylaxis and encouraging sustained engagement in HIV care and treatment in the identified areas with the greatest need in Ekurhuleni Metropolitan Municipality.

Prospects for the Implementation of HIV Molecular Transmission Network–Informed AIDS Prevention and Control in China

Abstract The human immunodeficiency virus (HIV)–infected population with a transmission link has a strong genetic similarity in viral gene sequences that tend to cluster. In recent years, a strategy for guiding HIV/acquired immunodeficiency syndrome (AIDS) prevention using sequence-based transmission networks has been proposed. The execution of this strategy provides an opportunity to effectively control the spread of the AIDS epidemic in China. HIV molecular transmission network research has been actively pursued by a number of Chinese research groups. Medium- and long-term strategies were created with the goal of using HIV molecular transmission networks to guide targeted prevention and control in China. Technical guidelines for HIV transmission network monitoring and intervention have been written and released. Pilot studies are continuing in the meantime. Despite the fact that this strategy has a bright future, there are still many challenges to overcome to achieve the intended AIDS prevention and control goals.

Frequently Transmission and Close Relationship Among Immigrants in the China-Myanmar Border Region Indicated by Molecular Transmission Analysis From a Cross-Sectional Data.

BackgroundAccurate identification of molecular transmission clusters (MTCs) and understanding the dynamics of human immunodeficiency virus (HIV) transmission are necessary to develop targeted interventions to prevent HIV transmission. We evaluated the characteristics of antiretroviral therapy-naïve individuals who belonged to HIV-1 MTCs in the China–Myanmar border region to inform targeted effective HIV intervention.MethodsPhylogenetic analyses were undertaken on HIV-1 pol sequences to characterize subtypes or circulating recombinant forms and identify MTCs. MTCs were defined as those with 2 or more sequences having bootstrap support > 80% and a pairwise gene distance less than or equal to 0.03. Factors correlated with MTCs were evaluated using logistic regression analysis. The chi-square test was used to compare differences between Chinese and Burmese participants belonging to MTCs.ResultsA total of 900 people had their pol gene successfully sequenced. Twenty-one MTCs were identified and included 110 individuals (12.2%). Individuals in MTCs were more likely to be Burmese [aOR = 2.24 (95% CI: 1.33, 3.79), P = 0.003], be younger [aOR = 0.34 (95% CI: 0.20, 0.58), P < 0.001 for age 26–50 vs. 25 years or younger], have a lower CD4 T cell count [aOR = 2.86 (95% CI: 1.34, 6.11), P = 0.007 for < 200 vs. 350 or greater], and have subtypes CRF07_BC or C [CRF07_BC: aOR = 7.88 (95% CI: 3.55, 17.52), P < 0.001; C: aOR = 2.38 (95% CI: 1.23, 4.62), P = 0.010 compared to CRF01_AE]. In MTCs, Burmese were younger (89.7 vs. 57.7% for age 25 years or younger), had a lower education level (41.0 vs. 8.5% for illiterate), were more likely to be infected through injection drug use (35.9 vs. 12.7%), and had a higher proportion of subtype BC (33.3 vs. 15.5%) and CRF01_AE (20.5 vs. 8.5%) compared to Chinese (P < 0.05 for all).ConclusionBurmese participants were more likely to belong to MTCs, and most MTCs had both Burmese and Chinese participants. These data highlight the bidirectional transmission of HIV-1 frequently transmission and close relationship among immigrants in the China–Myanmar border region. Local health departments should pay more attention to HIV screening and intervention to immigrants Burmese with the characteristics of younger age, having lower CD4 T cell count and infected with HIV subtypes CRF07_ BC or C.

Difference in HIV testing behavior by injection status, among users of illicit drugs

ABSTRACT Human Immunodeficiency Virus (HIV) infection remains prevalent among the marginalized and drug using population in the United States. Testing for HIV is an important and cost-effective way to reduce HIV prevalence. Our objective was to determine if there is a difference in the number of HIV testing by injection status among users of illicit drugs and if a person’s social network characteristics is a contributing factor. Using a cross-sectional design and negative binomial regression models, we assessed HIV testing behavior of people who use non-injected drugs (PWND) compared to people who use injected drugs (PWID). In an analytic sample of 539 participants, PWND tested for HIV 19% less compared to PWID, PR (95% CI) = 0.81 (0.66, 0.98), p = 0.03. Other contributing factors of testing were education, condomless sex, STIs, heroin use, and participant’s sex network. The interaction term between PWND and emotional support in relation to HIV testing was significant, 1.33 (1.03, 1.69), p=0.03. These findings suggest HIV testing behavior differed by injection status, and this relationship may be dependent on emotional support. To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in PWND, an understudied at-risk sub-population, are warranted.

Scale up mHealth HIV interventions: site and public health perspectives and lessons learned from P3.

A number of mobile health (mHealth) interventions have been shown to be effective and highly acceptable tools for improving human immunodeficiency virus (HIV) prevention and care for youth. Scale-up of efficacious technology-based interventions is challenging and best practices for scale-up have not been clearly established. Developers of mHealth interventions should have plans in mind for wide scale implementation throughout all stages of development including planning, during trials and during analysis and dissemination. We discuss an approach of focus on researchers, funders and potential implementers including members of the community, public health practitioners and policymakers during initial planning, trials, analysis and dissemination, and planning for scale-up. Development of the P3 (Prepared, Protected, emPowered) mobile application (app), an intervention built to encourage and increase pre-exposure prophylaxis (PrEP) adherence among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM), is discussed in terms of designing for scale-up and lessons learned.

“We have to create our own community”: Addressing HIV/AIDS among Men who have Sex with Men (MSM) in the Neuropolis

The inclusion of Men who have Sex with Men (MSM) in global health policies has resulted in significant resource prioritisations in order to treat and prevent the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). MSM policy inclusions and health prioritisations, however, are primarily motivated by an epidemiological understanding of male same‐sex sexual behaviours, based on biological risks associated with HIV infection. Owing to South Africa's high HIV rates and MSM policy prioritisations, we aimed to examine experiences of engagement in urban MSM‐targeted HIV interventions. Qualitative interviews were conducted with participants (n = 20) who previously engaged in MSM‐HIV interventions, across a variety of historically marginalised “township” spaces in Cape Town, South Africa. Interviews were audio‐recorded with the consent of all participants, transcribed verbatim, and verified, and anonymised using alpha‐numeric codes. Data were analysed for core themes and in this paper we describe interactions between biological and social risks that shape city life for MSM in diverse township spaces. When positioned against the background of the Neuropolis, a recent sociological intervention by Des Fitzgerald, Nikolas Rose and Ilina Singh, our results portray urban life among MSM as a form of biological citizenship: (1) constructed by experiences that are constitutive of biosocial stressors, based on (2) health‐seeking attitudes and behaviours, and (3) reinforced through socio‐spatial engagements in peer‐led and community‐based HIV interventions. We conclude by offering critical insight into recent calls for the development of comprehensive and localised peer‐led health programmes as a current void in the geographies of health and sexualities in the global south.

Effectiveness of prevention of mother to child transmission of HIV in Bowen University Teaching Hospital, 0yo State, Nigeria

Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) is the most significant route of HIV infection in children. Over 90% of HIV infections in children are acquired through the mother-to-child transmission route. This study aimed to evaluate the effectiveness of prevention of mother to child transmission (PMTCT) of HIV interventions. It employed a retrospective approach. Records of HIV positive pregnant women who registered and received ANC between January 1st 2015 to December 31st 2018 and HIV exposed infants followed-up for 6 weeks until HIV status was determined by DNA polymerase chain reaction techniques were collected and analysed. 87 pregnant women were HIV positive during the 4 years period, among these group, only 80 had their babies followed up till 6 weeks to determine HIV status by DNA polymerase chain reaction. There were three set of twins making a total of 83 exposed infants. The overall MTCT rate was 4.8%, maternal and infant ART was found to have significant influence on mother to child transmission of HIV with χ2=41.41, P&lt;0.001 and χ2=34.554, P&lt;0.001 respectively. Mode of delivery and infant feeding practice were statistically not significantly related to mother to child transmission of HIV with χ2=3.92, P=0.41 and χ2=1.859, P=0.173 respectively. Though this facility achieved the goal of reducing the rate of HIV mother to child transmission down to less than 5%, there is still need to strengthen service provision and follow up to conform to global plan for the elimination of new HIV infections among children.

International perspectives on HIV/AIDS in schools: A call to action for school psychologists and educators

ABSTRACT Rates of pediatric human immunodeficiency virus (HIV) as well as mortality and morbidity related to HIV and Acquired Immune Deficiency Syndrome (AIDS) depend, in part, on the resources available in the child’s country. HIV prevention and intervention efforts also are influenced by cultural factors. The purpose of this article is to summarize key findings from this special issue on international perspectives of HIV/AIDS in schools with a focus on neuropsychological and psychoeducational implications. After providing a brief summary of each article, we outline a call to action for school psychologists and educators.

Impact of fluctuation in frequency of human immunodeficiency virus/simian immunodeficiency virus reactivation during antiretroviral therapy interruption.

Antiretroviral therapy (ART) provides effective control of human immunodeficiency virus (HIV) replication and maintains viral loads of HIV at undetectable levels. Interruption of ART causes rapid recrudescence of HIV plasma viremia due to reactivation of latently HIV-infected cells. Here, we characterize the timing of both the initial and subsequent successful viral reactivations following ART interruption in macaques infected with simian immunodeficiency virus (SIV). We compare these to previous results from HIV-infected patients. We find that on average the time until the first successful viral reactivation event is longer than the time between subsequent reactivations. Based on this result, we hypothesize that the reactivation frequency of both HIV and SIV may fluctuate over time, and that this may impact the treatment of HIV. We develop a stochastic model incorporating fluctuations in the frequency of viral reactivation following ART interruption that shows behaviours consistent with the observed data. Furthermore, we show that one of the impacts of a fluctuating reactivation frequency would be to significantly reduce the efficacy of 'anti-latency' interventions for HIV that aim to reduce the frequency of reactivation. It is therefore essential to consider the possibility of a fluctuating reactivation frequency when assessing the impact of such intervention strategies.

Improving the Delivery of Chronic Opioid Therapy Among People Living With Human Immunodeficiency Virus: A Cluster Randomized Clinical Trial.

Chronic pain is prevalent among people living with human immunodeficiency virus (PLWH); managing pain with chronic opioid therapy (COT) is common. Human immunodeficiency virus (HIV) providers often diverge from prescribing guidelines. This 2-arm, unblinded, cluster-randomized clinical trial assessed whether the Targeting Effective Analgesia in Clinics for HIV (TEACH) intervention improves guideline-concordant care compared to usual care for PLWH on COT. The trial was implemented from 2015 to 2018 with 12-month follow-up at safety-net hospital-based HIV clinics in Boston and Atlanta. We enrolled 41 providers and their 187 patients on COT. Prescribers were randomized 1:1 to either a 12-month intervention consisting of a nurse care manager with an interactive electronic registry, opioid education, academic detailing, and access to addiction specialists or a control condition consisting of usual care. Two primary outcomes were assessed through electronic medical records: ≥2 urine drug tests and any early COT refills by 12 months. Other outcomes included possible adverse consequences. At 12 months, the TEACH intervention arm had higher odds of ≥2 urine drug tests than the usual care arm (71% vs 20%; adjusted odds ratio [AOR], 13.38 [95% confidence interval {CI}, 5.85-30.60]; P < .0001). We did not detect a statistically significant difference in early refills (22% vs 30%; AOR, 0.55 [95% CI, .26-1.15]; P = .11), pain severity (6.30 vs 5.76; adjusted mean difference, 0.10 [95% CI, -1.56 to 1.75]; P = .91), or HIV viral load suppression (86.9% vs 82.1%; AOR, 1.21 [95% CI, .47-3.09]; P = .69). TEACH is a promising intervention to improve adherence to COT guidelines without evident adverse consequences.