Human Immunodeficiency Virus Services Research Articles

Human immunodeficiency virus and solid organ transplantation: a 15-year retrospective audit at a tertiary Australian transplant centre.

The incidence of end-stage organ disease in people living with human immunodeficiency virus (HIV) (PLWH) is increasing, as people live longer due to potent, tolerable antiretroviral therapy (ART). Consequently, the number of PLWH who would benefit from solid organ transplant (SOT) is rising. The SOT experience in PLWH in Australia remains limited. Aim To retrospectively review the outcomes for SOT in PLWH at our service, in Victoria, Australia. A retrospective cohort study of PLWH undergoing SOT over a 15-year period was performed. Adult PLWH age >18 years were eligible and identified from the Victorian HIV Service database. Descriptive statistics were used to summarise baseline demographics and clinical data, and outcomes following SOT. Nine virologically suppressed PLWH underwent SOT from HIV-negative donors (five kidneys, two livers and two bilateral sequential lung transplants). All patients were male, with a median age of 57.3 years (interquartile range (IQR)=54.3-60.1) and CD4 count of 485 (IQR=342-835) at transplantation, and comorbidities were common at baseline. After a median follow up of 3.9 years (IQR=2.7-7.6), 8 (89%) patents were alive, 7 (78%) had functioning grafts, although 5 (56%) experienced organ rejection. Infections were common. Two patients required modification to their ART due to significant drug-drug interactions prior to transplant, while 5 (56%) had modifications post-SOT. No patients experienced HIV virologic failure. PLWH with end-stage organ disease experience good clinical and functional outcomes and should be considered for SOT where indicated. However, multidisciplinary planning and care is essential to optimise care in this patient group.

Utilisation of HIV services by female sex workers in Zimbabwe during the COVID-19 pandemic: a descriptive phenomenological study

This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers’ experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba’s trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.

Recurrent Subclinical Tuberculosis Among Antiretroviral Therapy-Accessing Participants: Incidence, Clinical Course, and Outcomes.

Undiagnosed asymptomatic subclinical tuberculosis (TB) remains a significant threat to global TB control, accounting for a substantial proportion of cases among people living with human immunodeficiency virus (HIV)/AIDS (PLWHA). We determined incidence, progression, and outcomes of subclinical TB in antiretroviral therapy (ART)-accessing PLWHA with known previous TB in South Africa. A total of 402 adult PLWHA previously treated for TB were enrolled in the prospective Centre for the AIDS Programme of Research in South Africa TRuTH (TB Recurrence Upon TB and HIV treatment) Study. Participants were screened for TB with quarterly clinical and bacteriologic evaluation and biannual chest radiographs over 36 months. Those with suspected or confirmed TB were referred to the National TB Programme. Participants received HIV services, including ART. Incidence rate of TB was estimated using Poisson regression and descriptive statistical analyses summarized data. A total of 48 of 402 (11.9%) bacteriologically confirmed incident recurrent TB cases were identified, comprising 17 of 48 (35.4%) subclinical TB cases and 31 of 48 (64.5%) clinical TB cases. Age, sex, and body mass index were similar among subclinical, clinical, and no TB groups. Incidence rates (95% Confidence Interval [CI]) of recurrent TB overall, in clinical and subclinical TB groups were 2.3 (1.7-3.0), 1.5 (1.1-2.2), and 0.9 (0.5-1.4) per 100 person-years, respectively. In the subclinical TB group, 14 of 17 (82.4%) were diagnosed by TB culture only, 11 of 17 (64.7%) received TB treatment, and 6 of 17 (35.3%) resolved TB spontaneously. High incidence rates of recurrent subclinical TB in PLWHA highlight inadequacies of symptom-based TB screening in high TB-HIV burden settings.

Perspectives on linkage to care for patients diagnosed with HIV: A qualitative study at a rural health center in South Western Uganda.

Linkage to care for newly diagnosed human immunodeficiency virus (HIV) patients is important to ensure that patients have good access to care. However, there is little information about factors influencing linkage to care for HIV patients. We aimed to identify existing measures in place that promote linkage to care and to explore facilitators and barriers to linkage to care for clients diagnosed with HIV/acquired immune deficiency syndrome at a rural health center in Uganda. This descriptive qualitative study enrolled 33 purposively selected participants who included expert clients, linkage facilitators, heads of families with people living with HIV, and health workers. Data were collected using in-depth interviews that were audio-recorded, transcribed, and translated. The data were manually analyzed to generate themes. The following four themes were generated: 1) availability of services that include counseling, testing, treatment, follow-up, referral, outreach activities, and support systems. 2) Barriers to linkage to care were at the individual, health facility, and community levels. Individual-level barriers were socioeconomic status, high transport costs, fear of adverse drug effects, fear of broken relationships, and denial of positive results or treatment, while health facility barriers were reported to be long waiting time, negative staff attitude, and drug stock outs. Community barriers were mostly due to stigma experienced by HIV clients, resulting in discrimination by community members. 3) Facilitators to linkage to care were positive staff attitudes, access to information, fear of death, and support from others. 4) Suggestions for improving service delivery were shortening waiting time, integrating HIV services, increasing staff numbers, and intensifying outreaches. Our findings highlight the importance of stakeholder involvement in linkage to care. Access and linkage to care are positively and negatively influenced at the individual, community, and health facility levels. However, integration of HIV services and intensifying outreaches are key to improving linkage to care.

Acceptability of Home-Based HIV Care Offered by Community Health Workers in Tshwane District, South Africa: A Survey.

Human immunodeficiency virus (HIV) remains the biggest public health challenge faced by South Africa (SA). To alleviate overcrowding in health facilities, ward-based primary health care outreach teams, consisting of community health workers (CHWs) led by a nurse, were introduced. The aim of this study was to assess the acceptability of community-based HIV services offered by CHWs. A survey was conducted in 10 clinics across Tshwane district, Gauteng, SA, between November 2020 and May 10, 2021. CHWs conducted interviewer-administered standardized questionnaires with 674 adult participants. Overall, 95.5% of participants thought that home-based HIV care is a good initiative and rated screening for illnesses and referral to health facilities highly. Although the vast majority (>94%) were willing to disclose their status to health professionals in clinics, women were more willing to do so. Only 53.6% of participants were willing to disclose their HIV status to a CHW from the same neighborhood and 28.8% would find it problematic if CHWs visited them at home with branded cars. Participants had different preferences, mostly determined by region, how long they had been on antiretroviral treatment, whether they had been informed about CHWs, age, and gender. More work is needed to understand and accommodate regional differences and individual preferences.

Client Satisfaction: Understanding its Predictors to improve HIV treatment and care in a tertiary facility southwestern state, Nigeria

Objective: Human Immunodeficiency Virus (HIV) infection is a major public health concern. Frequent hospital visits are needed on the part of the patient to achieve decreased prevalence, the efficacy of antiretroviral therapy (ART), and viral suppression. Patient satisfaction is needed to achieve the aforementioned outcomes of care. This study, therefore, was conducted to assess clients’ satisfaction and perception of the quality of HIV/AIDs services and to elicit factors associated with dissatisfaction. Method: A cross-sectional survey was done using a systematic sampling method to select the study population. Data were analyzed by descriptive statistics, chi-square test, and logistic regression at a p-value set at < 0.05. Results: Most of the respondents (34.4%) were within the age range of 36- 44years. The mean age was 42.1± 11.5years. The overall satisfaction was 85.6%. The majority of respondents (95.2%) affirmed that the quality of care received was good. Unavailability of HIV educational materials was shown to predict clients’ satisfaction more than other factors with 3.545; 95% CI: 1.519 - 8.275; p = 0.003. Likewise, clients who perceived health workers to be non-accepting and judgmental are 3.6 times more likely to be unsatisfied with HIV services provided compared to those who do not (3. 580; 95% CI: 1.264- 10.141; p = 0.016). Conclusion: The study demonstrated impressive overall clients’ satisfaction with services provided at the health facility and the quality of care. Attention must be paid to the availability of HIV materials and training and retraining of staff to reduce stigmatization and discrimination against patients.

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.

Contraceptive Counseling Strategies for Women Living With Human Immunodeficiency Virus: The Role of Integrating Reproductive Health and Human Immunodeficiency Virus Services to Prevent Perinatal Transmission in Colombia

ObjectivesThis study aimed to evaluate the cost-effectiveness of 2 contraceptive counseling strategies in Colombia for women living with human immunodeficiency virus (HIV). The first integrates (1) reproductive health and HIV services (integrated model [IM]), and the second (2) offers these services separately (non-IM). MethodsCost-effectiveness analysis from the third-party payer perspective (Colombian healthcare system). A decision analysis tree was used over a 24-month time horizon at a 3% discount rate, considering only direct costs. The outcome was the number of averted HIV perinatal transmission infections. We performed a discrete sensibility analysis and a probabilistic second-order sensitivity analysis with 10 000 iterations (Monte Carlo simulation). ResultsCompared with the non-IM, the IM prevented 3% additional HIV perinatal transmission infections, with an incremental cost-effectiveness of US dollar 525 and the highest net monetary benefit at the proposed willingness to pay. In the probabilistic sensitivity analysis, we found a substantial amount of parameter uncertainty that challenges the evidence in favor of the cost-effectiveness of the IM strategy. ConclusionsThis study opens the possibility of integrating reproductive health and HIV services for women living with HIV in Colombia. In addition, it raises the necessity to produce additional good quality local empirical evidence to inform better and support the estimation of the economic efficiency of such a model in the country.

Factors associated with HIV testing and counselling services among women and men in Nepal: a cross-sectional study using data from a nationally representative survey

ObjectivesThis study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal.Study designNepal Demographic and Health Survey, 2016 adopts a...

Gaps and Opportunities in HIV Service Delivery in High Volume HIV Care Centers in Liberia: Lessons From the Field.

Background:Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression.Objective:To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery.Methods:A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors.Findings:Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic.Conclusion:Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.

Effects of the Coronavirus Disease 2019 Pandemic on Human Immunodeficiency Virus Services: Findings from 11 Sub-Saharan African Countries.

BackgroundDue to concerns about the effects of the coronavirus disease 2019 (COVID-19 pandemic on health services, we examined its effects on human immunodeficiency virus (HIV) services in sub-Saharan Africa.MethodsQuarterly data (Q1, 10/2019–12/2019; Q2, 1/2020–3/2020; Q3, 4/2020–6/2020; Q4, 7/2020–9/2020) from 1059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1–Q2 to Q3–Q4 by higher vs lower stringency.ResultsThere was a 3.3% decrease in the number HIV tested from Q2 to Q3 (572 845 to 553 780), with the number testing HIV-positive declining by 4.9% from Q2 to Q3. From Q3 to Q4, the number tested increased by 10.6% (612 646), with an increase of 8.8% (23 457) in the number testing HIV-positive with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2 to Q3 but increased in Q4 by 9.8%. Across all quarters, the number on ART increased (Q1, 419 028 to Q4, 476 010). The number receiving viral load (VL) testing in the prior 12 months increased (Q1, 255 290 to Q4, 312 869). No decrease was noted in VL suppression (Q1, 87.5% to Q4, 90.1%). HIV testing (P < .0001) and new ART initiations (P = .001) were inversely associated with stringency.ConclusionsAfter initial declines, rebound was brisk, with increases noted in the number HIV tested, newly initiated or currently on ART, VL testing, and VL suppression throughout the period, demonstrating HIV program resilience in the face of the COVID-19 crisis.

Knowledge and utilization of prevention of mother-to-child transmission of HIV services among pregnant women in Tanzania

Background: Human Immunodeficiency Virus (HIV) infection among children is mainly vectored through mother-to-child transmission. Prevention of mother-to-child-transmission strategy is highly effective; however, its accessibility and utilization is affected by the lack of knowledge among other factors.&#x0D; Methods: A cross-sectional study was conducted among antenatal care attendees in two districts in Tanzania to determine their knowledge and utilization of the prevention of MTCT services.&#x0D; Results: We interviewed 160 antenatal care attendees aged 18-45 years with a mean (SD) age of 30.4 (6.3) years; 74 (46.2 %) were HIV-infected. HIV-infected women demonstrated significantly correct knowledge of HIV (p=0.001) and AIDS (p=0.014) than uninfected individuals. HIV-infected women also significantly demonstrated correct knowledge of mother-to-child transmission during pregnancy than HIV-uninfected women (p=0.016) and during delivery (p=0.005). A significant proportion of HIV-positive women compared to HIV-negative women were aware that correct use of antiretroviral during pregnancy can reduce the risk of mother-to-child-transmission of HIV (p&lt;0.039), but only 6 (3.75%) of all women were aware that correct use of antiretroviral during delivery can significantly reduce the risk of mother-to-child-transmission. HIV-infected women had significant comprehensive knowledge of HIV/AIDS (p=0.001) and prevention of mother-to-child transmission of HIV (p=0.006) than HIV-negative women. Comprehensive knowledge prevention of mother-to-child transmission of HIV was low among the study participants. Male partners’ involvement in maternal antenatal care was significantly higher among HIV-infected women than males from the HIV-infected women group (p&lt;0.006).&#x0D; Conclusion: The study demonstrated inadequate knowledge of PMTCT among women who made ANC visits. HIV uninfected women had poorer knowledge compared to the HIV-infected ones. Routine HIV counseling and testing services were highly accepted among these women.

A realist evaluation of the continuum of HIV services for men who have sex with men

BackgroundMen who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways.MethodsGuided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement.ResultsThe results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance.ConclusionsThe study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.

Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance.

Among the 1.9 billion women of reproductive age worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. For women and adolescent girls living with human immunodeficiency virus (HIV), using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes. The World Health Organization (WHO) recommends that sexual and reproductive health services, including contraception, may be integrated within HIV services. Integration is associated with increased offers and uptake of sexual and reproductive health services, including contraception, which is likely to result in improved downstream clinical outcomes. Integrating HIV and sexual and reproductive health services has been found to improve access, the quality of antenatal care and nurse productivity while reducing stigma and without compromising uptake of care. Research is encouraged to identify approaches to integration that lead to better uptake of sexual and reproductive health services, including contraception. Implementation research is encouraged to evaluate different strategies of integration in different health systems and social contexts; such research should include providing contraception, including long-acting contraception, in the context of less frequent clinical and ART refill visits.

Perception and utilization of prevention of mother-to-child transmission of human immunodeficiency virus (HIV) services among women living with HIV.

INTRODUCTIONMother-to-child transmission is the major route of pediatric Human Immunodeficiency Virus (HIV) infection accounting for 90% of childhood HIV infection. Poor utilization of prevention of mother-to-child transmission (PMTCT) of HIV services has been shown in this situation. Hence, the study assessed the perception and utilization of PMTCT services among Women Living with HIV (WLHIV).METHODSA cross-sectional research design was used with a purposive sampling technique to select 182 WLHIV within reproductive age attending President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR)/AIDS Prevention Initiative in Nigeria (APIN) clinic in two secondary Health facilities in Ibadan, Oyo State. A validated structured questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis.RESULTSThe mean age of the women was 37.0±6.5 years. Majority (74.2%) of the respondents had good knowledge on PMTCT of HIV, positive perception (89%) towards PMTCT services while only 42.9% of the respondents have utilized PMTCT services during pregnancy. However, some of the challenges to use of PMTCT services identified by the respondents were stigma (16.5%), discrimination (15.4%), financial constraint (11.5%) and non-involvement of partner (8.2%). There was a significant association between level of knowledge and PMTCT services utilization (χ2=6.244, p=0.012).CONCLUSIONSThere is need for improvement of knowledge and perception of HIV, MTCT and PMTCT among women through counseling and antenatal education, thereby increasing PMTCT services uptake. Partner involvement, good quality PMTCT services and lack of discrimination of people living with HIV in our society should be encouraged, hence promoting the utilization of PMTCT services.

Patient outcomes in integrated HIV and non-communicable disease models of care: a scoping review

Background High rates of non-communicable diseases (NCD) among people living with human immunodeficiency virus (HIV) have been reported in high HIV burden, low-resource settings. The growing dual burden of HIV and NCD epidemics has necessitated introduction of integrated models of HIV and NCD care in order to leverage existing HIV care infrastructure for NCDs. There is a paucity of evidence on the effects of integrated care on long-term patient outcomes. We sought to review literature that described effects of integration on long-term patient outcomes. Methods We reviewed literature published between 01 Jan 2000 to 25 September 2019, that described long-term patient outcomes in HIV and NCD integrated models of care in order to understand the effects of integration on long-term patient outcomes. Relevant literature was searched in PubMed, Scopus, EBSCOhost and Web of Science. A manual search of abstracts in the International AIDS Society and the Journal of Acquired Immunodeficiency Syndrome was also conducted. Results One thousand six hundred and sixty articles were identified, 31 of which were read in full, with 11 meeting eligibility criteria. Patient outcomes in four models of integrated care were identified: (i) integration of NCD screening and treatment services into established HIV centres; (ii) integration of HIV screening and treatment services into established NCD centres; (iii) simultaneous integration of HIV and NCD services at health facilities; and (iv) integrated HIV and NCD care specifically for multi-morbid patients. Studies reported high rates of control of HIV and NCD across the various models of integrated care. However, majority of studies lacked comparator groups required to ascertain non-inferiority of integrated care over non-integrated care. Conclusions There is limited evidence on the effect of integrated HIV and NCD models of care on long-term patient outcomes especially in low-resource, high-burden settings. Randomized clinical trials with clearly defined comparator groups and standardized measures of HIV and NCD outcomes are needed to demonstrate non-inferiority of integrated against non-integrated care.

Frequency of visits to health facilities and HIV services offered to men, Malawi.

ObjectiveTo determine how often men in Malawi attend health facilities and if testing for human immunodeficiency virus (HIV) is offered during facility visits.MethodsWe conducted a cross-sectional, community-representative survey of men (15–64 years) from 36 villages in Malawi. We excluded men who ever tested HIV-positive. Primary outcomes were: health facility visits in the past 12 months (for their own health (client visit) or to support the health services of others (guardian visit)); being offered HIV testing during facility visits; and being tested that same day. We disaggregated all results by HIV testing history: tested ≤ 12 months ago, or in need of testing (never tested or tested > 12 months before).FindingsWe included 1116 men in the analysis. Mean age was 34 years (standard deviation: 13.2) and 55% (617/1116) of men needed HIV testing. Regarding facility visits, 82% (920/1116) of all men and 70% (429/617) of men in need of testing made at least one facility visit in the past 12 months. Men made a total of 1973 visits (mean two visits): 39% (765/1973) were as guardians and 84% (1657/1973) were to outpatient departments. Among men needing HIV testing, only 7% (30/429) were offered testing during any visit. The most common reason for not testing was not being offered services (37%; 179/487).ConclusionMen in Malawi attend health facilities regularly, but few of those in need of HIV testing are offered testing services. Health screening services should capitalize on men’s routine visits to outpatient departments as clients and guardians.

Sociodemographic, behavioral, and geriatric characteristics in older adults with and without HIV: A case-control study.

Older adults with human immunodeficiency virus (HIV) have higher risks for early manifestations of age-related disabilities. The objective of this study was to compare HIV-positive and HIV-negative adults aged ≥50 years in relation to sociodemographic, behavioral, and geriatric characteristics. A case-control study was conducted with a >90% estimated statistical power. A total of 52 individuals living with HIV were matched by age, sex, and neighborhood of residence with 104 community controls. Age-related disabilities were assessed throughout a comprehensive geriatric assessment. Review of medical records and interviews were used to obtain behavioral and clinical covariates. No statistical differences on clinically significant age-related disabilities were found. However, multivariate regression analyses, controlling for education and income, revealed that behavioral (use of condom [odds ratio {OR}: 7.03; 95% confidence intervals {CI}: 2.80–7.65] and number of medical visits [OR: 1.25; 95%CI: 1.09–1.43]), along with faster gait speed (OR: 17.68; 95%CI: 2.55–122.85) and lower body and muscle mass indexes were independently associated with HIV (OR: .88; 95%CI: .79–.98 and OR: .72; 95%CI: .54–.97, respectively). In summary, results on age-related disabilities between groups could mean that public policies on HIV might be contributing to patients’ positive outcomes regardless of the effects of aging, albeit gait speed, body and muscle mass indexes were independently associated with HIV. Screenings for age-related disabilities in specialized HIV services are recommended.

Clinical characteristics and impacts of HIV infection in people with bipolar disorders

People with bipolar disorders (BD) may be at increased risk of Human Immunodeficiency Virus (HIV) infection but our understanding of the impacts of HIV infection on psychiatric outcomes is poor. This study aimed to examine the prevalence, temporal relationship, and clinical impact of HIV infection in people with BD. In this retrospective case-control study, anonymised electronic case records of patients with BD who had been under the care of South London and Maudsley mental health services were used for data extraction. 54 HIV+ people with BD were identified and compared to a matched control group of 54 HIV- people with BD. The prevalence of HIV co-morbidity in the BD population was around 1%. 76% of HIV+ BD men identified as men who have sex with men (MSM). 65% of the HIV+ BD group were diagnosed with BD before becoming HIV+. The HIV+ BD group experienced significantly higher rates of stimulant, GBL/GHB and psychedelic use compared to the HIV- BD group. 85% of the HIV+ BD group were recorded as taking antiretroviral medications. Retrospective and cross-sectional study design, and a relatively small sample size CONCLUSIONS: The prevalence of HIV comorbidity in BD was comparable to the local general population. HIV infection in BD is associated with MSM status and stimulant, GHB/GBL and psychedelics use suggesting that HIV prevention strategies should particularly target these groups. Lower use of antiretroviral medications by people with BD underlines the importance of engaging HIV+ BD people in HIV services.

Management practices in community-based HIV prevention organizations in Nigeria

BackgroundNigeria has one of the largest Human Immunodeficiency Virus (HIV) epidemics in the world. Addressing the epidemic of HIV in such a high-burden country has necessitated responses of a multidimensional nature. Historically, community-based organizations (CBOs) have played an essential role in targeting key populations (eg. men who have sex with men, sex workers) that are particularly burdened by HIV. CBOs are an essential part of the provision of health services in sub-Saharan Africa, but very little is known about the management practices of CBOs that provide HIV prevention interventions.MethodsWe interviewed 31 CBO staff members and other key stakeholders in January 2017 about management practices in CBOs. Management was conceptualized under the classical management process perspective; these four management phases—planning, organizing, leading, and evaluating—guided the interview process and code development. Data analysis was conducted thematically using Atlas.ti software. The protocol was approved by the ethics committees of the National Institute of Public Health of Mexico (INSP), the National Agency for the Control of AIDS in Nigeria (NACA), and the Nigerian Institute for Medical Research (NIMR).ResultsWe found that CBOs implement variable management practices that can either hinder or facilitate the efficient provision of HIV prevention services. Long-standing CBOs had relatively strong organizational infrastructure and capacity that positively influenced service planning. In contrast, fledgling CBOs were deficient of organizational infrastructure and lacked program planning capacity. The delivery of HIV services can become more efficient if management practices are taken into account.ConclusionsThe delivery of HIV services by CBOs in Nigeria was largely influenced by inherent issues related to skills, organizational structure, talent retention, and sanction application. These, in turn, affected management practices such as planning, organizing, leading, and evaluating. This study shows that KP-led CBOs are evolving and have strong potentials and capacity for growth, and can become more efficient and effective if attention is paid to issues such as hierarchy, staff recruitment, and talent retention.