Human Immunodeficiency Virus Programs Research Articles

Factors Impacting ART Adherence among HIV-Positive Older Adolescents and Younger Adults in Namibia: A Qualitative Analysis

Background Namibia, like many sub-Saharan African countries, faces the challenges of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) affecting diverse age groups. However, the demographic group of older adolescents and younger adults, specifically those aged 15-24, faces distinct challenges in terms of psychological, sociocultural, and healthcare-related factors that impact their adherence to Antiretroviral Treatment (ART). It is important to conduct further research to investigate these specific challenges and address them effectively. Aim This paper aimed to investigate factors impacting adherence to ART medication among Older Adolescents (OA) and Younger Adults Living with HIV (YALHIV) in the seven high-burden regions in Namibia. Objective The objective of this study was to explore and describe the factors that influence adherence to ART medication among older adolescents and younger adults living with HIV to provide valuable insights to inform the development of evidence-based HIV programs that can effectively address the adherence challenges in this particular population. Methods A qualitative descriptive phenomenology research design was followed, utilising an in-depth interview to capture the experiences of older adolescents and younger adults living with HIV. Participants were recruited from healthcare facilities across Namibia, ensuring a diverse sample in terms of gender, socio-economic status, and urban-rural representation. A purposive sampling technique was employed to select 29 participants who were willing to take part in the study and data saturation was achieved with this sample size. The interviews were telephonically recorded with the permission of the participants. The researcher used Colaizzi's six steps for phenomenological study to analyze the data. Results The study reveals four main themes that contribute to adherence issues in OALHIV and YALHIV and include patients-related factors, family-related factors, facility and healthcare providers-related factors, and community and socio-cultural characteristics-related factors. Conclusion The study sheds light on factors affecting adherence to ART among OALHIV and YALHIV. It emphasizes the necessity of comprehensive interventions addressing personal, sociocultural, economic, and healthcare challenges for their well-being. Future research and policies should focus on tailored interventions based on these diverse findings.

Reasons for implementation success despite health system constraints: qualitative insights on ‘what worked’ for cotrimoxazole preventive therapy

BackgroundAlthough Cotrimoxazole preventive therapy (CPT) has shown to be highly efficacious in reducing morbidity and mortality among people living with Human immunodeficiency virus (HIV) under ‘ideal world’ study conditions, operational challenges are limiting its effectiveness when implementing in countries most affected by the HIV epidemic. The fact that Mozambican authorities reported high coverage of CPT among patients with HIV, has led to this qualitative case study aimed at exploring possible factors responsible for the successful implementation of CPT in the Province of Maputo.MethodsBetween February and April 2019, we individually interviewed nine governmental stakeholders, including the person responsible for the HIV Program, the person responsible for the TB Program and the person responsible for Pharmaceutical management at three administrative levels (central, provincial and district level). Interviews were recorded, transcribed, and analysed thematically using MAXQDA Analytics Pro. Findings were translated from Portuguese into English.ResultsFive themes iteratively emerged: (a) Role of governance & leadership, (b) Pharmaceutical strategies, (c) Service delivery modifications, (d) Health care provider factors, and (e) Patients’ perspectives.Interviews revealed that continuous supply of cotrimoxazole (CTZ) had been facilitated through multiple-source procurement and a push-pull strategy. One part of CTZ arrived in kits that were imported from overseas and distributed to public health facilities based on their number of outpatient consultations (push strategy). Another part of CTZ was locally produced and distributed as per health facility demand (pull strategy). Strong district level accountability also contributed to the public availability of CTZ. Interviewees praised models of differentiated care, the integrated HIV service delivery and drug delivery strategies for reducing long queues at the health facility, better accommodating patients’ needs and reducing their financial and organisational burden.ConclusionsThis study presents aspects that governmental experts believed to be key for the implementation of CPT in the Province of Maputo, Mozambique. Enhancing the implementation outcomes – drug availability and feasibility of the health facility-based service delivery – seemed crucial for the implementation progress. Reasons for the remarkable patient acceptability of CPT in our study setting should be further investigated.

Investigating the Relationship between Medication Adherence Behaviors and the Achievement of Sustained Viral Load Suppression among People Living with HIV (PLHIV) on Antiretroviral Therapy (ART) in Akwa Ibom State, from 2018 - 2022

Background: Nigeria is still endemic for Human Immuno-Deficiency Virus (HIV), and currently among the top five countries with the highest burdens of HIV infection. For a successful HIV program, there should be good access to antiretroviral therapy (ART) and record of viral load suppression (VLS). This study aimed at investigating the relationship between medication adherence behavior (MAB) and sustained VLS among people living with HIV (PLHIV) receiving ART in Akwa Ibom State. Methods: This was a retrospective cohort study of the medical records of 1,763 PLHIV receiving ART services from January 2018 to December 2022, in selected ten health facilities in Akwa Ibom State. Relevant demographic, clinical, immunological, viral load (VL) information were obtained from the patients’ medical records and databases. The proportion of VLS and associated variables were then analyzed. Results: Out of the 2,550 PLHIV whose medical records were accessed, data for 1,763 PLHIV was accepted for analysis. A total of 795 (45.1%) male and 968 (54.9%) female participated in the study, with a mean age of 38.4 ± 5 years. While 23.8% (n = 420) have unsuppressed VL of >1,000 copies/mL; 76.2% (n = 1,343) of participants achieved VLS of <1,000 copies/mL. 90.4% (n = 1,213) of the virally suppressed participants recorded moderate to high medication adherence levels (X2 = 94.977, df = 2, p-value = 2.2 x 10-16). CD4 counts and HAART regimen have significant impact on VLS (p < 0.05), while pregnancy status, TB Infection, duration on HAART, and WHO disease stage do not have significant effects on VLS (p > 0.05). Conclusion: There was a strong evidence to reject the null hypothesis, which states that there is no positive association between MAB and sustained VLS among PLHIV on ART (p < 0.05). The VLS rate in this study indicates a good HIV epidemic control. Good medication adherence level, high baseline CD4 count, and being on first line HAART regimen were strongly associated with VLS.

Nurse-patient relationship and its implications for retention in the PMTCT of HIV programme in Ghana: an appreciative inquiry

BackgroundRelationships established between nurses and midwives, and their patients have far-reaching implications; the most significant being their impact on the health-related outcomes of patients. These relationships are especially relevant in the Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) programme as women, diagnosed with HIV navigate the emotional and psychological effects of their diagnosis while carrying pregnancies. This study aimed to explore the relationships between nurses, midwives and mothers diagnosed with HIV and its impact on retention in the PMTCT Programme.MethodsAn Appreciative Inquiry approach that employed qualitative research methods was conducted among twenty-four participants made up of 12 HIV positive mothers, and eight midwives and four community health nurses engaged in the PMTCT programme. Individual generative interviews were conducted among the mothers while paired interviews were conducted among the health professionals. Thematic analysis guided by Colaizzi’s approach was conducted.ResultsThree main themes emerged each with its subthemes. Under Establishing Rapport, two sub-themes emerged; making the connection and building trusting relationships. The second theme, Journeying Together, describes how the nurse-patient relationship evolved as the participant engaged in the programme; sub-themes include developing mutual goals, impactful communication, and showing commitment and building self-worth. The third theme; Ending the professional relationship details two sub-themes; continuity of care across the cascade, and termination of care which proved unsuccessful in some relationships due to blurring professional boundaries.ConclusionsThe nurse-patient relationship in the PMTCT programme evolved as the relationship progressed along the PMTCT cascade. Strengthening of the nurse-patient relationships was underscored by building trust through the maintenance of confidentiality, setting mutual goals, shared emotional experiences and personal stories, and building clients’ self-worth. Therefore, there is a need to ensure that professional boundaries are set and maintained to reduce the occurrence of over-dependence of the clients and burnout of the nurses.

A 2-arm randomized controlled study to improve the oral health of children living with HIV in Nigeria: Protocol and study design

BackgroundGood oral health is an integral part of overall child health. However, immunodeficiency states like those associated with the presence of Human Immunodeficiency Virus (HIV) compromise oral health and salivary bacterial composition, leading to adverse oral conditions. Nigeria has 1.9 million people living with HIV, and 0.2% of incident HIV infections occur among children below 15 years. AimThis study aims to determine through a randomized controlled study, the effect of an educational intervention on the oral health status and oral health-related quality of life (OHRQoL) of children living with HIV presenting to five pediatric HIV clinics in Kano, Nigeria. Methods/designThis 2-arm randomized controlled study will be conducted in five pediatric HIV outpatient clinics in Kano State, Nigeria over a period of 6 months. Eligible participants will include 172 HIV-positive children aged 8–16 years (able to self-implement the oral health intervention with minimal supervision from the caregivers). The evaluation and oral health assessment will be carried out by five examiners who will be trained and calibrated. DiscussionOur findings will help inform policies to improve the oral health and OHRQoL of HIV-positive Nigerian children and inform the need to integrate oral health care services into HIV programs in similar settings. Trial registrationClinicalTrails.gov ID: National Clinical Trial (NCT) NCT05540171. Registered on 12th September 2022.

Converging Epidemics: A Narrative Review of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) Coinfection.

Tuberculosis (TB), primarily caused by Mycobacterium tuberculosis (MTB), remains a leading cause of mortality in individuals living with human immunodeficiency virus (HIV) infection, posing a significant strain on healthcare systems. Coinfection of HIV and TB results in a mutually advantageous relationship that accelerates the progression of both diseases. TB is a major contributor to mortality in individuals with HIV. However, diagnosing coinfected individuals is challenging due to the prevalence of extrapulmonary TB and smear-negative disease. Overthe past decade, significant progress has been made in the fight against TB, thanks to advances in molecular techniques. Yet, these molecular diagnostic assays remain inaccessible to many individuals coinfected with HIV and TB due to their high cost. To expedite treatment and reduce transmission, it is crucial to integrate HIV and TB control programs more closely, thereby minimizing diagnostic delays and enhancing early case detection. This review aims to provide a comprehensive overview of the current state of knowledge regarding the interplay between HIV and TB. It highlights recent developments in sensitive and rapid TB diagnostic tests, cutting-edge preventive strategies, and the screening of individuals coinfected with both HIV and TB. The objectives of this review are to shed light on the complex relationship between these two diseases and to emphasize the importance of integrated efforts in combating their impact on public health.

DETERMINANTS OF STIGMA ON PEOPLE LIVING WITH HIV AND AIDS IN INDONESIA (EVIDENCE FROM 2017 IDHS DATA)

Introduction: People living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) face bio-psycho-socio-spiritual problems. The stigma against PLWHA exists in more than 65 countries. Indonesia occupied the highest position in the Pacific with a case rate of 62.8%. Stigma has contributed to the failure of HIV and AIDS epidemic-control programs. Aims: To determine the stigma against PLWHA in Indonesia. Method: This study used the 2017 IDHS dataset with a cross-sectional design. The study sample comprised 47.233 people. The variables studied included age, sex, marital status, educational level, economic status, employment status, mass media exposure, type of residence, knowledge about HIV and AIDS, and stigma against PLWHA. The data analysis technique was the chi-square test and logistic regression with α 0.05 (5%). Result: Factors that determined the stigma of PLWHA include age 15-19 (OR 1.611), age 20-24 (OR 1.438), age 25-29 (OR 1.131), age 30-34 (OR 0.993), male gender (OR 0.834), married status (OR 1.416), educational level less (1.247), very poor economic status (OR 1.503), poor (OR, 1.134), medium (OR 1.080), rich (OR 0.972), not working ( OR 1.065), and lack of knowledge (OR 2.588). Conclusion: person aged 15-24 years, female, single, have low education, poorest/poor, do ot have a job, and have a low level of knowledge about HIV and AIDS are very likely to be stigmatized towards PLWHA. Education related to HIV and AIDS, especially how HIV and AIDS are transmitted, still needs to be improved so that it can reach all levels in society

Young women who sell sex in Bangui, Central African Republic: a neglected group highly vulnerable to HIV.

The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15-24years) and adult sex workers, engaged in consensual sex for money (AFSW). A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model. The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR=1.43 [1.07-1.91]). Consistent condoms use last 3months were very low at 22.3% and 41.2%, respectively (PR=0.52 [0.37-0.74]), the low education level among YWSS versus AFSW (PR=0.55 [0.40-0.76]); YWSS having been a victim of sexual violence in the last 12months (PR=2.00 [1.52-2.63]), were also more likely to be HIV positive. The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk.

Peer facilitators’s role to support pregnant women in utilizing HIV services during the COVID-19 pandemic

<p>Human immunodeficiency virus (HIV) prevalence on pregnant women in Indonesia is estimated around 0.3%. The prevention of mother-to-child disease transmission (PMTCT) program has been implemented nationally since 2008, though, less than 50% of the total pregnant women each year get an HIV test and only 18% of those who are HIV positive get antiretroviral (ARV) treatment until now. COVID-19 pandemic, occurred since 2019, has brought significant changes to public health aspects including the utilization of HIV services. This study is aimed to determine factors influencing the PMTCT program services utilization during pandemic. This study used mix method approach with quantitative approach using a cross-sectional study design (174 HIV mothers from six provinces in Indonesia) and qualitative approach with in-depth interviews of 13 informants consisting of HIV mothers, health workers, program holders and peer facilitators. The results showed the HIV services utilization during pandemic was 52.3%. The most influenced factor was peer facilitators support (POR 2.96; 95% CI=1.45-6.03), HIV mothers who did not receive assistance from peer facilitators had 2.96 times chance of not utilizing the services compared to them who received. It requires to strengthen cooperation between health services and peer facilitators to support HIV mothers in accessing HIV services.</p>

National HIV programme testing recommendations.

In recognition of the morbidity and mortality associated with human immunodeficiency virus (HIV), the Joint United Nations Programme on HIV/acquired immunodeficiency syndrome (AIDS) (UNAIDS) aims to end the epidemic by setting and striving to achieve the ambitious 95-95-95 targets. However, Singapore is still not performing well in the first UNAIDS target. The National HIV Programme (NHIVP) developed this set of recommendations based on an adaptation of major international guidelines from the World Health Organization and the US Centers for Disease Control and Prevention. The goals of this recommendation are: (1) to increase the uptake of HIV testing; (2) to allow earlier detection and identification of individuals with unrecognised HIV infection; (3) to facilitate linkage to clinical services; and (4) reduce further transmission of HIV infection in Singapore.

HIV-TB Cross-referral and Collaborative Strategy: 8 Years of Our Experience from An Urban Health Centre in North India

Human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics continue to fuel each other and with dual infections with these two deadly diseases on the rise, it becomes imperative to devise effective HIV-TB collaborative strategies. The present study was designed to evaluate the existing HIV-TB cross-referral mechanism at an urban health centre; to determine HIV sero-prevalence among pulmonary TB patients referred from chest clinic to the integrated counselling and testing centre (ICTC); and to evaluate the TB suspects referred from ICTC to the chest clinic for a possible TB aetiology. The present study was a retrospective analysis of HIV-TB cross-referrals whereby a line list of all the patients referred under this strategy from January 2006 to December 2013 was retrieved and analysed. A total of 3726 TB cases were referred to the ICTC and 641 TB suspects were identified by ICTC counsellors and referred to the chest clinic during this period. HIV sero-prevalence among TB patients was 2.8% (106 of 3726) and TB prevalence among HIV sero-positive and sero-negative TB suspects was 9.3% (10/108) and 4.3% (9/211), respectively (p=0.07). HIV prevalence was found to be significantly higher among male (n=2024) than among female (n=1702) TB patients (4.4% versus 0.9%; p<0.0001). Only 319 of 641 (49.8%) ICTC patients referred to the chest clinic reached there. Our study highlights the strong need to scale up the integration and partnership between HIV and TB programmes for better and integrated diagnosis and care of HIV-TB co-infected patients.

An Integrated Reporting Tool for Management of Hiv And Non-communicable Diseases for Primary Health Care Facilities in Limpopo Province, South Africa

Introduction:Reporting of a health programme such as integrated management of the Human Immunodeficiency Virus (HIV) and Non-communicable Diseases (NCDs) is essential for programme evaluation to improve patient clinical outcomes. It is a criterion that all services that are provided in primary health care facilities and hospitals are monitored, evaluated and reported according to the approved reporting tools and approved health indicators.Aim:This study aimed to develop a reporting tool to report the implementation of integrated management of HIV and NCDs in Limpopo Province, South Africa.Methodology:The South African National Indicators Data Sets (NIDS) were adopted and used to develop the integrated management of HIV and NCDs reporting tool. A Delphi technique was used to validate the developed reporting tool. Eight (8) HIV and NCDs programme experts participated in the review process to establish the validity of the developed tool.Results:Eight integrated HIV and NCDs data elements reporting tool were developed and reviewed by eight (8) programme experts. The tool was found to be relevant and useful and likely to be adopted by Limpopo province for implementation.Conclusion:This was the first integrated HIV and NCDs reporting tool to be developed for Nurse Initiated Management of Antiretroviral Therapy (NIMART) Nurses in Limpopo Province to serve as a basic reporting tool to improve the integrated management of HIV and NCDs including patient outcomes.

Diagnosis and treatment of tuberculosis in adults with HIV.

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), continues to pose a major public health problem and is the leading cause of mortality in people infected with human immunodeficiency virus (HIV). HIV infection greatly increases the risk of developing TB even before CD4+ T-cell counts decrease. Co-infection provides reciprocal advantages to both pathogens and leads to acceleration of both diseases. In HIV-coinfected persons, the diagnosis and treatment of tuberculosis are particularly challenging. Intensifying integration of HIV and tuberculosis control programmes has an impact on reducing diagnostic delays, increasing early case detection, providing prompt treatment onset, and ultimately reducing transmission. In this Review, we describe our current understanding of how these two pathogens interact with each other, new sensitive rapid assays for TB, several new prevention methods, new drugs and regimens.

The Negative Impact of COVID-19 in HCV, HIV, and HPV Surveillance Programs During the Different Pandemic Waves.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been a worldwide stress test for health systems. 2 years have elapsed since the description of the first cases of pneumonia of unknown origin. This study quantifies the impact of COVID-19 in the screening program of chronic viral infections such as human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) along the six different pandemic waves in our population. Each wave had particular epidemiological, biological, or clinical patterns.MethodsWe analyzed the number of samples for screening of these viruses from March 2020 to February 2022, the new infections detected in the pandemic period compared to the previous year, the time elapsed between diagnosis and linking to treatment and follow-up of patients, and the percentage of late HIV diagnosis. Moreover, we used the origin of the samples as a marker for quantifying the restoration of activity in primary care.ResultsDuring the first pandemic year, the number of samples received was reduced by 26.7, 22.6, and 22.5% for molecular detection of HPV or serological HCV and HIV status respectively. The highest decrease was observed during the first wave with 70, 40, and 26.7% for HPV, HCV, and HIV. As expected, new diagnoses also decreased by 35.4, 58.2, and 40.5% for HPV, HCV, and HIV respectively during the first year of the pandemic. In the second year of the pandemic, the number of samples remained below pre-pandemic period levels for HCV (−3.6%) and HIV (−9.3%) but was slightly higher for HPV (8.0%). The new diagnoses in the second year of the pandemic were −16.1, −46.8, and −18.6% for HPV, HCV, and HIV respectively.ConclusionsUndoubtedly, an important number of new HPV, HCV, and HIV infections were lost during the COVID-19 pandemic, and surveillance programs were disrupted as a consequence of collapse of the health system. It is a priority to reinforce these surveillance programs as soon as possible in order to detect undiagnosed cases before the associated morbidity-mortality increases. New pandemic waves could increase the risk of reversing the achievements made over the last few decades.

Exploring drivers of food choice among PLHIV and their families in a peri-urban Dar es Salaam, Tanzania

BackgroundA nutritious diet is critical to minimizing disease progression of human immunodeficiency virus (HIV) and maximizing treatment efficacy. In low resource settings, meeting the food preference needs of people living with the HIV (PLHIV) can be achieved with a supportive food environment when HIV status is disclosed. However, less is known about family-level strategies related to building a supportive food environment. The Diet, Environment, and Choices of positive living (DECIDE), a mixed-methods observational study conducted in peri-urban Dar es Salaam, Tanzania, explored food preferences as influenced by the personal, family, and external food domains.MethodsWe completed a qualitative analysis of data generated from 40 interviews (n = 20 PLHIV and n = 20 family members) aimed at exploring the dynamics of food choice for using a family perspective. We expanded on Turner’s food environment framework and drew on Giddens’ structuration theory to guide our data collection and analysis. Interviews were audio recorded, transcribed, translated from Kiswahili to English, coded, and organized into themes.ResultsWe found PLHIV personal food preferences were influenced by organoleptic properties, medications, disease stage, and gender norms. Family members were knowledgeable about the importance of nutritious food for HIV treatment and prioritized these needs to avoid HIV-related stigma and fulfill family obligations. With high prices of nutritious foods (animal source foods, fruits), family members strategized to secure preferred foods for the PLHIV by, 1) forgoing their own food preferences; 2) reallocating food within the household; 3)making food substitutions; and 4) leveraging external networks. These strategies were increasingly employed as the disease progressed.ConclusionThe use of this expanded framework that included a family perspective on PLHIV food choice illuminated the various households decision-making dynamics that took place in this low resource community. Family members of PLHIV tried to buffer the limitations imposed by the external food environment, especially as the disease progressed. In the context of HIV status disclosure, integrating a family perspective into HIV nutrition interventions and programs has the potential to influence health outcomes and slow disease progression.

Recommendations for the use of antiretroviral therapy in adults living with human immunodeficiency virus in Singapore.

Since the advent of combination antiretroviral therapy (ART), the mortality attributable to human immunodeficiency virus (HIV) infection has decreased by 80%. Newer antiretroviral agents are highly efficacious, have minimal side effects as compared to older drugs, and can be formulated as combination tablets to reduce patients' pill burden. Despite these advances, 680,000 people worldwide died of acquired immunodeficiency syndrome-related illnesses in 2020. The National ART and Monitoring Recommendations by the National HIV Programme have been created to guide physicians on the prescribing of ART based on the patients' needs. These recommendations are based on international guidelines and tailored to the local context and unique domestic considerations. We hoped that with the publication of these recommendations, the care of people living with HIV can be enhanced, bringing us closer to ending HIV in our lifetime.

Socio-Demographic Correlates of HIV Sero-Discordance among Couples in West Bengal, India: a Cross Sectional Analysis.

Serodiscordant couples serve as potential sources of human immunodeficiency virus (HIV) transmission. Understanding the demographic dynamics of serodiscordant couples plays an important role in tailoring interventions to eliminate HIV infection. We conducted this cross-sectional analysis among 314 integrated counseling and testing centers in West Bengal, India, from April 2016 to March 2020. General individuals who were detected as HIV-reactive and whose spouses were also tested for HIV comprised the study population, in which a total of 8,740 couples were included. Sociodemographic variables were compared across concordant and discordant arms, as well as between male positive (M+ F-) and female positive (F+ M-) subgroups of serodiscordant couples. Among the couples studied, 35.2% (95% CI: 34.2-36.2%) were serodiscordant. Among serodiscordant couples, the proportion of M+ F- (86.1%) was significantly higher than that of F+ M- (13.9%). We observed that higher mean ages of couples, higher education, business and service occupations, and urban residence were significantly associated with the serodiscordance relationship (P < 0.05). A high mean age of couples and a low proportion of housewives were associated with the F+ M- subgroup. As approximately 35% of serodiscordant couples carry the risk of transmission to negative spouses, particularly in older age and urban residence, reorientation of HIV programs may be required to avert transmission in the future.

HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo.

Human immunodeficiency virus (HIV) infections and less-than-optimal care of people living with HIV (PLHIV) continue to challenge public health and clinical care organizations in the communities that are most impacted by HIV. In the era of evidence-based public health, it is imperative to monitor viral load (VL) in PLHIV according to global and national guidelines and assess the factors associated with variation in VL levels. Purpose: This study had two objectives—(a) to describe the levels of HIV VL in persons on antiretroviral therapy (ART), and (b) to analyze the significance of variation in VL by patients’ demographic and clinical characteristics, outcomes of HIV care, and geographic characteristics of HIV care facilities. Methods: The study population for this quantitative study was 49,460 PLHIV in the Democratic Republic of Congo (DRC) receiving ART from 241 CDC-funded HIV/AIDS clinics in the Haut-Katanga and Kinshasa provinces of the DRC. Analysis of variance (ANOVA) was performed, including Tamhane’s T2 test for pairwise comparisons using de-identified data on all patients enrolled in the system by the time the data were extracted for this study by the HIV programs in May 2019. Results: The VL was undetectable (<40 copies/mL) for 56.4% of the patients and 24.7% had VL between 40 copies/mL and less than 1000 copies per mL, indicating that overall, 81% had VL < 1000 and were virologically suppressed. The remaining 19% had a VL of 1000 copies/mL or higher. The mean VL was significantly (p < 0.001) higher for males than for females (32,446 copies/mL vs. 20,786, respectively), persons <15 years of age compared to persons of ages ≥ 15 years at the time of starting ART (45,753 vs. 21,457, respectively), patients who died (125,086 vs. 22,090), those who were lost to follow-up (LTFU) (69,882 vs. 20,018), those with tuberculosis (TB) co-infection (64,383 vs. 24,090), and those who received care from urban clinics (mean VL = 25,236) compared to rural (mean VL = 3291) or semi-rural (mean VL = 26,180) clinics compared to urban. WHO clinical stages and duration on ART were not statistically significant at p ≤ 0.05 in this cohort. Conclusions: The VL was >1000 copies/mL for 19% of PLHIV receiving ART, indicating that these CDC-funded clinics and programs in the Haut-Katanga and Kinshasa provinces of DRC have more work to do. Strategically designed innovations in services are desirable, with customized approaches targeting PLHIV who are younger, male, those LTFU, with HIV/TB co-infection, and those receiving care from urban clinics.

HIV and TB Workplace Program for Street Vendors: A Situational Analysis.

In South Africa, 15 percent of informal economy workers are street vendors. The organization of occupational health services in the country is fragmented and does not cover informal workers. Conditions of work make informal workers extremely vulnerable to human immunodeficiency virus (HIV) and tuberculosis (TB) exposure. In this study, a qualitative risk assessment was conducted among street vendors, followed by focus group discussions. Interpretation of data was according to major themes extracted from discussions. Workers are exposed to several occupational health hazards identified during the risk assessment. There is a lack of workplace HIV and TB services and overall poor access to healthcare. Street vendors, especially females, are at higher risk of HIV, due to gender inequalities. Comprehensive gender-sensitive training on occupational health and safety, HIV, and TB should be prioritized. To reach Universal Health Coverage and achieve the Sustainable Developmental Goals' targets, the health system should improve services for informal economy workers.

Treatment-adjusted prevalence to assess HIV testing programmes.

Scale-up of human immunodeficiency virus (HIV) testing and antiretroviral therapy (ART) for people living with HIV has been increasing in sub-Saharan Africa. As a result, areas with high HIV prevalence are finding a declining proportion of people testing positive in their national testing programmes. In eastern and southern Africa, where there are settings with adult HIV prevalence of 12% and above, the positivity from national HIV testing services has dropped to below 5%. Identifying those in need of ART is therefore becoming more costly for national HIV programmes. Annual target-setting assumes that national testing positivity rates approximate that of population prevalence. This assumption has generated an increased focus on testing approaches which achieve higher rates of HIV positivity. This trend is a departure from the provider-initiated testing and counselling strategy used early in the global HIV response. We discuss a new indicator, treatment-adjusted prevalence, that countries can use as a practical benchmark for estimating the expected adult positivity in a testing programme when accounting for both national HIV prevalence and ART coverage. The indicator is calculated by removing those people receiving ART from the numerator and denominator of HIV prevalence. Treatment-adjusted prevalence can be readily estimated from existing programme data and population estimates, and in 2019, was added to the World Health Organization guidelines for HIV testing and strategic information. Using country examples from Kenya, Malawi, South Sudan and Zimbabwe we illustrate how to apply this indicator and we discuss the potential public health implications of its use from the national to facility level.