Number Of People Living With HIV Research Articles

Acceptance of assisted partner notification among HIV-positive adults with severe mental illness at a national referral hospital in Uganda: a cross-sectional study

BackgroundHIV mostly affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the acceptance of the APN strategy among PLHIV who had a diagnosis of SMI.MethodsThis study used a cross-sectional study design that was retrospective to determine acceptance of APN among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants’ demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined acceptance of APN as the number of PLHIV with SMI diagnoses who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the acceptance of APN.ResultsA total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age was 30 (interquartile range (IQR) (25–34)), and 41 (33%) of them accepted APN (95% CI: 25.05–41.61). Receipt of at least three counselling sessions before enrollment in APN (aPR = 1.8, 95% CI: 1.72–1.98) was the most significant factor associated with increased acceptance of APN. Poor adherence to ART (aPR = 0.62, 95% CI: 0.54–0.80), being escorted to hospital by a distant relative (aPR = 0.55, 95% CI: 0.39–0.80), being married/cohabiting (aPR = 0.65, 95% CI: 0.60–0.81), and being a Seventh Day Adventist (SDA) (aPR = 0.53, 95% CI: 0.45–0.71) or Pentecostal (aPR = 0.44, 95% CI: 0.22–0.98) by faith were associated with reduced acceptance of APN.Conclusion and recommendationThe acceptance of APN is low among PLHIV with a diagnosis of SMI. More structured counselling would facilitate earlier identification of undiagnosed HIV-positive partners. We recommend a follow-up study to compare acceptance of APN among PLHIV with SMI and those without SMI.

Increasing incidence and prevalence of metabolic syndrome in people living with HIV during the COVID-19 pandemic.

The aim of this study was to analyze the impact of COVID-19 pandemic restrictions on the prevalence and incidence of metabolic syndrome (MS), and to identify predictors of new MS cases in people living with HIV (PLWH). This cohort study included PLWH followed at the IRCCS San Raffaele, Milan, Italy, with at least one body mass index (BMI) determination during the pre-pandemic period (1 December 2018 to 29 February 2020) and the pandemic period (1 March 2020 to 31 May 2021). MS diagnosis was based on NCEP ATP III 2005 criteria. Univariable Poisson regression model was used to compare MS incidence rates. Univariable mixed linear models estimated the crude mean change in metabolic parameters during each time period. Multivariable Cox proportional hazards model was used to assess risk factors for MS. This study included 1,564 PLWH, of whom 460 and 1,104 were with and without a diagnosis of MS, respectively, at the beginning of the pre-pandemic period, with an overall prevalence of MS of 29.4%. During the pre-pandemic period, 528/1,564 PLWH had MS, with a prevalence of 33.8% (95%CI = 31.5%-36.1%), while during the pandemic period, the number of PLWH with a diagnosis of MS increased to 628/1,564, with a prevalence of 40.2% (95%CI 37.8%-42.6%; McNemar's test: p < 0.0001). Similarly, the MS incidence rate increased from 13.7/100 person-years of follow-up (PYFU; 95%CI = 11.7-16.0) in the pre-pandemic period to 18.5/100 PYFU (95%CI = 16.2-21.1) in the pandemic period (p = 0.004), with 201 subjects developing MS during the pandemic period. In addition, we observed a significant increase in the crude mean change during the pandemic period compared with the pre-pandemic period for: total cholesterol, LDL cholesterol, plasma glucose, blood pressure, and atherosclerotic cardiovascular disease (ASCVD) risk score. Finally, after adjustment for HIV risk factors, HBV, HCV, ART duration, duration of virologic suppression and use of INSTIs, age [adjusted hazard ratio (AHR) per 3 years older = 1.12 (95%CI = 1.08-1.17)], sex [AHR female vs. male = 0.62 (95%CI = 0.44-0.87)] and CD4+ cell count [AHR per 100 cells/μL higher = 1.05 (95%CI = 1.01-1.09)] were associated with the risk of MS. The COVID-19 pandemic affected the metabolic profile of PLWH and increased the prevalence and incidence of MS.

ВНЕДРЕНИЕ ВИЧ УСЛУГ В УЧРЕЖДЕНИЯ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ ТАДЖИКИСТАНА НА ПРИМЕРЕ Г. ДУШАНБЕ: ТЕКУЩИЕ РЕЗУЛЬТАТЫ И ПЕРСПЕКТИВЫ ДАЛЬНЕЙШЕГО РАЗВИТИЯ

Objective: To assess the current results of the integration of HIV services into primary health care (PHC) facilities in Tajikistan in the example of Dushanbe Methods: A comparative analysis of the official statistical data on human immunodeficiency virus infection (HIV) of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan (MHSP RT) was carried out in dynamics. The data of electronic records of people living with HIV (PLHIV) in the system of electronic tracking of HIV cases, including patients receiving integrated HIV services in PHC facilities, were analyzed. The materials of local and foreign scientific medical journals were studied. The method of descriptive statistics was used in the work. Results: In 2021, 922 new cases of HIV were detected in Tajikistan, including 1) people with sexual transmission – 83.7%; 2) labor migrants (LM) and those tested for clinical indications – 49.2%; 3) people over 50 years of age – 12.3%. The share of LM during HIV testing was 3% of the total population tested for HIV in 2021. The number of PLHIV in the country as of December 31, 2021, was 10,077; 8740 of them (86.7%) received antiretroviral therapy (ART), of which 14.2% were above 50 years of age. As of December 31, 2021, 1,155 (11.5% of all PLHIV in the country) received HIV service at the PHC facilities, 21.2% of them were children (&lt;18 years old), and 78.8% – were adults (18+). Among adult patients, 34.7% were from key population groups (KPs); 1146 (99.2%) PLHIV received ART, of which 97.6% showed viral load (VL) suppression. Coverage of PLHIV with ART in the regions of the country varied from 81.8% to 90.1%. Conclusion: According to the research data, the HIV epidemic continues in the country with increasing infection circulation in the general population and “aging” of HIV. So far, the integration of HIV services into PHC facilities of the country was carried out only in the City Health Centers (CHCs) of Dushanbe, where every third adult PLHIV was from KPs. Almost all PLHIV received ART at the CHCs, and VL suppression was observed in most of them. In the CHCs, it is necessary to expand HIV testing at the initiative of health workers. It is recommended to start implementing the integration of HIV services in the CHCs of other large cities of the country. Keywords: HIV infection, people living with HIV, antiretroviral therapy, viral load suppression, integration of HIV services, primary health care.

Intersecting HIV and mpox epidemics: more questions than answers.

Intersecting HIV and mpox epidemics: more questions than answers.

Youth HIV services in the context of COVID-19 pandemic in Sofala Province, Mozambique

Abstract Background After the first COVID-19 case in Mozambique, the government established a state of emergency in period April - September 2020. To reduce exposure for people living with HIV (PLWHIV), the Ministry of Health modified service delivery guidance, interrupting community activities, and revising patient flow within health facilities. The study aimed to measure the impact of the COVID-19 pandemic on HIV testing and treatment services in Sofala Province, Mozambique. Methods The study analysed the activities in 9 youth HIV services called SAAJs (Serviço amigo do adolescente e jovem) supported by Doctors with Africa CUAMM in 2020 and 2021. The following data were gathered and analysed: number of counselling sessions, number of HIV tests performed, number of people who tested positive and therefore started the antiretroviral treatment (ART), number of PLHIV on ART. Data were disaggregated by sex and age. Results In 2020 and 2021 85466 and 141844 counselling sessions were performed, respectively. A decrease of 41% was observed in the second trimester of 2020 compared with the previous one. The number of counselling sessions came back at pre-pandemic levels in the 2nd trimester of 2021. People aged 20-24 accessed more in 2020, while those aged 15-19 in 2021. In 2020 people tested for HIV were 22753, while the number was twice in 2021: the increase was higher among males(p&amp;lt;.05). In 2020 females were more likely to be tested, while in 2021 it was the opposite(p&amp;lt;.05). The positivity rate was 2.5% and 1.5%, respectively; in both years males were more likely to be tested positive(p&amp;lt;.05). In 2020 86.1% of people tested positive started the ART, in 2021 98%. Males were more at risk of not starting the ART(p&amp;lt;.05). The number of PLWHIV on ART did not decrease over time. Conclusions ART provision was generally maintained during the COVID-19 pandemic, while other services were heavily impacted. The difference observed among sex was significant and may inform future interventions. Key messages

Integrase inhibitor-based regimens are related to favorable systemic inflammatory index and platecrit scores in people living with HIV (PLWH) up to 2 years

ABSTRACT Objectives Despite the advances in antiretroviral treatment (ART), persistent inflammation remained a challenge. We analyzed the inflammatory-score changes through 2-years in people living with HIV (PLWH) treated with different antiretroviral regimes. Methods This study was conducted in Hacettepe University HIV/AIDS Treatment and Research Center. PLWH diagnosed between 2014-2020 were included. Inflammatory and metabolic markers (CD4/CD8 ratio, C-reactive protein (CRP), Systemic Inflammatory Index (SII), Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV), Platecrite (PCT), and Low-Density Lipoprotein/High-Density Lipoprotein (LDL/HDL), Platelet-to-Lymphocyte Ratio (PLR)) and ARTs were captured from database through 2-years from the diagnosis. The 2-year change (Δ) in markers was calculated and compared by ART type (backbone and 3rd agent). Mann-Whitney-U test and T-test were used for statistical analysis. Results This study included 205 PLWH; 175 (85.4%) were male, and the mean age was 38.98 (±10.88) years. The number of PLWH with suppressed viremia (<40 HIV-RNA copies/ml) was 164 (80%) at the end of the second year. MPV increased significantly higher among PLWH receiving ABC/3TC compared to PLWH receiving TDF/FTC (p<0.05). The CD4:CD8 ratio increased, and SII, NLR, LDL/HDL ratios decreased significantly among PLWH treated with integrase strand transfer inhibitors (INSTI) compared with protease inhibitors (PI) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (p<0.05). Conclusions : Integrase inhibitor treatment is related to favorable inflammatory marker profile among PLWH in the 2-year follow-up. A favorable inflammatory profile may, in turn, contribute to the prevention of non-communicable diseases (NCD) among PLWH. This study showed that simple, easy-to-calculate markers could be implemented to define ongoing inflammation among PLWH under suppressive ART.

HIV index partner testing services in urban Lusaka: a retrospective review of medical records

Background: As the proportions of people living with HIV (PLHIV) who do not know their HIV infection status decrease, reaching the remaining few who are asymptomatic and not in contact with the health care system becomes a critical challenge. Therefore, reaching the first 90 of the UNAIDS 90-90-90 targets will require effective and efficient HIV testing approaches. The number of PLHIV who know their HIV status and who receive antiretroviral therapy could increase by the expansion of index testing services. Methods: This project was a retrospective study looking at medical records of HIV positive clients who were elicited for index testing between October and December 2019. It was conducted in three high volume health facilities in Matero Urban sub-district 3 in Lusaka, Zambia. Results: The HIV test outcomes for index contacts were as follows: 452 index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested HIV positive, 108 index contacts (12.8%) were known HIV positive, and 172 index contacts (20.4%) were not yet tested for HIV. Of the 113 contacts who tested HIV positive, 90 index contacts started anti-retroviral therapy within 7 days (79.6%). The total number of 845 contacts were elicited from 604 index clients, giving a low elicitation ratio of 1:1.4. There was not much difference between gender for elicited contacts (423 men and 422 women). A total number of 565 index contacts were eligible for HIV test. 113 of them tested HIV positive, representing a positivity yield of 20%. Pearson Chi-Square test value was 6.376 and the p value was 0.012. This result is statistically significant since p value (0.481) is smaller than the designated alpha level (0.05). Conclusions: HIV programs need to explore and address barriers to HIV partner testing services to avoid over-testing and maximize HIV case identification (thus, improving HIV testing positivity yield).

A national HIV clinical mentorship program: Enabling Zambia to accelerate control of the HIV epidemic.

Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018-September 2018 and the post-mentorship period was July 2019-September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P <0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p <0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.

HIV index testing services in urban Lusaka: a retrospective review of medical records

Background: As the proportions of people living with HIV (PLHIV) who do not know their HIV infection status decrease, reaching the remaining few who are asymptomatic and not in contact with the health care system becomes a critical challenge. Therefore, reaching the first 90 of the UNAIDS 90-90-90 targets will require effective and efficient HIV testing approaches. The number of PLHIV who know their HIV status and who receive antiretroviral therapy could increase by the expansion of index testing services. Methods: This project was a retrospective study looking at medical records of HIV positive clients who were elicited for index testing between October and December 2019. It was conducted in three high volume health facilities in Matero Urban sub-district 3 in Lusaka, Zambia. Results: The HIV test outcomes for index contacts were as follows: 452 index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested HIV positive, 108 index contacts (12.8%) were known HIV positive, and 172 index contacts (20.4%) were not yet tested for HIV. Of the 113 contacts who tested HIV positive, 90 index contacts started anti-retroviral therapy within 7 days (79.6%). The total number of 845 contacts were elicited from 604 index clients, giving a low elicitation ratio of 1:1.4. There was not much difference between gender for elicited contacts (423 men and 422 women). A total number of 565 index contacts were eligible for HIV test. 113 of them tested HIV positive, representing a positivity yield of 20%. Pearson Chi-Square test value was 0.498 and the p value was 0.481. This result is not significant since p value (0.481) is greater than the designated alpha level (0.05). Conclusions: HIV programs need to explore and address barriers to HIV partner testing services toavoid over-testing and maximize HIV case identification(thus, improving HIV testing positivity yield).

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030.

UNAIDS has established new program targets for 2025 to achieve the goal of eliminating AIDS as a public health threat by 2030. This study reports on efforts to use mathematical models to estimate the impact of achieving those targets. We simulated the impact of achieving the targets at country level using the Goals model, a mathematical simulation model of HIV epidemic dynamics that includes the impact of prevention and treatment interventions. For 77 high-burden countries, we fit the model to surveillance and survey data for 1970 to 2020 and then projected the impact of achieving the targets for the period 2019 to 2030. Results from these 77 countries were extrapolated to produce estimates for 96 others. Goals model results were checked by comparing against projections done with the Optima HIV model and the AIDS Epidemic Model (AEM) for selected countries. We included estimates of the impact of societal enablers (access to justice and law reform, stigma and discrimination elimination, and gender equality) and the impact of Coronavirus Disease 2019 (COVID-19). Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010. Lack of progress on societal enablers could endanger these achievements and result in as many as 2.6 million (44%) cumulative additional new HIV infections and 440,000 (54%) more AIDS-related deaths between 2020 and 2030 compared to full achievement of all targets. COVID-19-related disruptions could increase new HIV infections and AIDS-related deaths by 10% in the next 2 years, but targets could still be achieved by 2025. Study limitations include the reliance on self-reports for most data on behaviors, the use of intervention effect sizes from published studies that may overstate intervention impacts outside of controlled study settings, and the use of proxy countries to estimate the impact in countries with fewer than 4,000 annual HIV infections. The new targets for 2025 build on the progress made since 2010 and represent ambitious short-term goals. Achieving these targets would bring us close to the goals of reducing new HIV infections and AIDS-related deaths by 90% between 2010 and 2030. By 2025, global new infections and AIDS deaths would drop to 4.4 and 3.9 per 100,000 population, and the number of people living with HIV (PLHIV) would be declining. There would be 32 million people on treatment, and they would need continuing support for their lifetime. Incidence for the total global population would be below 0.15% everywhere. The number of PLHIV would start declining by 2023.

Covid-19 Escaled Ongoing Injustices: Voices of Women Living With HIV in Nepal

The first HIV case in Nepal was reported in 1988. As of July 2020, the total number of PLHIV was 29,503 PLHIV whereas the numbers for male and females were respectively 17, 587 and 11, 916 (UNAIDS, 2021.). More than 72% of People Living with HIV (PLHIV) are of age group 25 to 49 years (Ministry of Health National Centre for AIDS and STD Control, 2020). There are 80 ART (Anti-Retroviral therapy) centres providing services to PLHIV in seven Provinces and a number of community-based organizations to provide services to PLHI (Ministry of Health National Centre of AIDS and STD Control, 2020). The current knowledge on this area are maninly the reports from HIV Service Agencies that do not capture the silenced voices of PLHIV on intersectional oppression. By acknowledging the need of a evidence-based study, a Participatory Action Research (PAR) project was developed in 2019 to understand the challenges of the Women Living with HIV in Kathmandu, Nepal (Dhungel, 2020; Dhungel &amp; Lama, 2020). This understanding was reached through a variety of means, including photovoice, individual interviews and street dramas. Four major intersectional challenges were identified including discriminations against WLHIV at workplace, violations of privacy in health sectors, excluding from parental's property and discriminations against their children at school. The same study suggested the need for a further study, focusing on intersectional oppressions and public health services and programs available for WLHIV with a focus on Mental Health Services. Therefore, this study was initiated to bridge the gaps in current knowledge with a foucs on COVID-19 policies/programs. Keywords: COVID-19, HIV community, injustice, intersectional oppression

HIV index partner testing services in urban Lusaka: a retrospective review of medical records

Background: As the proportions of people living with HIV (PLHIV) who do not know their HIV infection status decrease, reaching the remaining few who are asymptomatic and not in contact with the health care system becomes a critical challenge. Therefore, reaching the first 90 of the UNAIDS 90-90-90 targets will require effective and efficient HIV testing approaches. The number of PLHIV who know their HIV status and who receive antiretroviral therapy could increase by the expansion of index testing services. Methods: This project was a retrospective study looking at medical records of HIV positive clients who were elicited for index testing between October and December 2019. It was conducted in three high volume health facilities in Matero Urban sub-district 3 in Lusaka, Zambia. Results: The HIV test outcomes for index contacts were as follows: 452 index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested HIV positive, 108 index contacts (12.8%) were known HIV positive, and 172 index contacts (20.4%) were not yet tested for HIV. Of the 113 contacts who tested HIV positive, 90 index contacts started anti-retroviral therapy within 7 days (79.6%). The total number of 845 contacts were elicited from 604 index clients, giving a low elicitation ratio of 1:1.4. There was not much difference between gender for elicited contacts (423 men and 422 women). A total number of 565 index contacts were eligible for HIV test. 113 of them tested HIV positive, representing a positivity yield of 20%. Pearson Chi-Square test value was 6.376 and the p value was 0.012. This result is statistically significant since p value (0.481) is smaller than the designated alpha level (0.05). Conclusions: HIV programs need to explore and address barriers to HIV partner testing services to avoid over-testing and maximize HIV case identification (thus, improving HIV testing positivity yield).

Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study

ObjectivesIn Senegal, a national health coverage system named Couverture Medicale Universelle (CMU) has been under development since 2013; its impact on out-of-pocket (OOP) expenses for people living with HIV (PLHIV)...

The effect of implementing HIV testing on healthcare services: a literature review

People Living with HIV (PLWH) in Indonesia continue to increase in number. Government is needed to know objectively about the number of PLWH. One way is by HIV testing. HIV testing is an important strategy for preventing the spread of HIV. This paper reviews the effectiveness of HIV testing in other countries in order to reduce HIV transmission, so hopefully the result can be adapted to be done in Indonesia for making health policy, especially on urban healthcare services. The publications reviewed comes from Science Direct, PubMed, as well as Google Scholar database covering the period 2016 - 2020 using the keywords “HIV” or “AIDS” and “HIV Testing” and “Healthcare Services” and ‘Urban Healthcare”. Five articles were reviewed in this study. Based on this review, the implementation of HIV testing can be done on several strategies, such as community-based, home-based as well as provider-based testing. Respondents who were given HIV test also varied, from neonates to adults. All of the strategy can succeed for implemented. HIV testing is a promising intervention strategy on healthcare services to reduce HIV transmission that can be adapted in Indonesia.

A comparison of different community models of antiretroviral therapy delivery with the standard of care among stable HIV+ patients: rationale and design of a non-inferiority cluster randomized trial, nested in the HPTN 071 (PopART) study

BackgroundFollowing the World Health Organization’s (WHO) 2015 guidelines recommending initiation of antiretroviral therapy (ART) irrespective of CD4 count for all people living with HIV (PLHIV), many countries in sub-Saharan Africa have adopted this strategy to reach epidemic control. As the number of PLHIV on ART rises, maintenance of viral suppression on ART for over 90% of PLHIV remains a challenge to government health systems in resource-limited high HIV burden settings. Non facility-based antiretroviral therapy (ART) delivery for stable HIV+ patients may increase sustainable ART coverage in resource-limited settings. Within the HPTN 071 (PopART) trial, two models, home-based delivery (HBD) or adherence clubs (AC), were offered to assess whether they achieved similar viral load suppression (VLS) to standard of care (SoC). In this paper, we describe the trial design and discuss the methodological issues and challenges.MethodsA three-arm cluster randomized non-inferiority trial, nested in two urban HPTN 071 trial communities in Zambia, randomly allocated 104 zones to SoC (35), HBD (35), or AC (34). ART and adherence support were delivered 3-monthly at home (HBD), adherence clubs (AC), or clinic (SoC). Adult HIV+ patients defined as “stable” on ART were eligible for inclusion. The primary endpoint was the proportion of PLHIV with virological suppression (≤ 1000 copies HIV RNA/ml) at 12 months (± 3months) after study entry across all three arms. Viral load measurement was done at the routine government laboratories in accordance with national guidelines, annually. The study was powered to determine if either of the community-based interventions would yield a viral suppression rate drop compared to SoC of no more than 5% in its absolute value. Both community-based interventions were delivered by community HIV providers (CHiPs). An additional qualitative study using observations, interviews with PLHIV, and FGDs with community HIV providers was nested in this study to complement the quantitative data.DiscussionThis trial was designed to provide rigorous randomized evidence of safety and efficacy of non-facility-based delivery of ART for stable PLHIV in high-burden resource-limited settings. This trial will inform policy regarding best practices and what is needed to strengthen scale-up of differentiated models of ART delivery in resource-limited settings.Trial registrationClinicalTrials.gov NCT03025165. Registered on 19 January 2017

Brief Report: Programmatic Scale-up of Tuberculosis Preventive Treatment Among People Living With HIV Through Targeted Technical Assistance to High-Volume Antiretroviral Treatment Sites-Nigeria, 2018-2019.

Tuberculosis preventive treatment (TPT) is a critical intervention to reduce tuberculosis mortality among people living with HIV (PLHIV). To facilitate scale-up of TPT among PLHIV, the Nigeria Ministry of Health and the US Centers for Disease Control and Prevention (CDC) Nigeria, supported by US President's Emergency Plan for AIDS Relief implementing partners, launched a TPT-focused technical assistance strategy in high-volume antiretroviral treatment (ART) sites during 2018. Nigeria has an estimated 1.9 million PLHIV, representing the second largest national burden of PLHIV in the world, and an estimated 53% of PLHIV are on ART. In 50 high-volume ART sites, we assessed readiness for TPT scale-up through use of a standardized tool across the following 5 areas: clinical training, community education, patient management, commodities and logistics management, and recording and reporting. We deployed a site-level continuous quality improvement strategy to facilitate TPT scale-up. Implementing partners rapidly disseminated best practices from these sites to across all CDC-supported sites and reported aggregate data on monthly TPT initiations. Through this targeted assistance and rapid dissemination of best practices to all other sites, the number of PLHIV who initiated TPT across all CDC-supported sites increased from 6622 in May 2018, when the approach was implemented, to 48,661 in September 2018. Gains in monthly TPT initiations were sustained through March 2019. Use of a standardized tool for assessing readiness for TPT scale-up provided a "checklist" of potential barriers to TPT scale-up to address at each site. The quality improvement approach allowed each site to design a specific plan to achieve desired TPT scale-up, and best practices were implemented concurrently at other, smaller sites. The approach could assist scale-up of TPT among PLHIV in other countries.

HIV index testing services in urban Lusaka: a review of medical records

Background: As the proportions of people living with HIV (PLHIV) who do not know their HIV infection status decrease, reaching the remaining few who are asymptomatic and not in contact with the health care system becomes a critical challenge. Therefore, reaching the first 90 of the UNAIDS 90-90-90 targets will require effective and efficient HIV testing approaches. The number of PLHIV who know their HIV status and who receive antiretroviral therapy could increase by the expansion of index testing services. Methods: This project was a retrospective study looking at medical records of HIV positive clients who were elicited for index testing between October and December 2019. It was conducted in three high volume health facilities in Matero Urban sub-district 3 in Lusaka, Zambia. Results: The HIV test outcomes for index contacts were as follows: 452 index contacts (53.5%) tested HIV negative, 113 index contacts (13.4%) tested HIV positive, 108 index contacts (12.8%) were known HIV positive, and 172 index contacts (20.4%) were not yet tested for HIV. Of the 113 contacts who tested HIV positive, 90 index contacts started anti-retroviral therapy within 7 days (79.6%). The total number of 845 contacts were elicited from 604 index clients, giving a low elicitation ratio of 1:1.4. There was not much difference between gender for elicited contacts (423 men and 422 women). A total number of 565 index contacts were eligible for HIV test. 113 of them tested HIV positive, representing a positivity yield of 20%. Pearson Chi-Square test value was 0.498 and the p value was 0.481. This result is not significant since p value (0.481) is greater than the designated alpha level (0.05). Conclusions: HIV programs need to explore and address barriers to HIV partner testing services to maximize HIV case identification.

The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017

BackgroundThere were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC.SettingThis cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH’s viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.MethodsDescriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions.ResultsThe results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV.ConclusionsThese results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.

Assessment of Knowledge related to HIV/AIDS among Medical Students

Background: WHO estimates that approximately 36.7 million people living with HIV at the end of 2015, out of which 46% were receiving antiretroviral treatment. About 77% of all pregnant women living with HIV globally received medicines that prevent transmission to their babies in 2015. National adult (15–49 years) HIV prevalence in India is estimated at 0.26% in 2015. The total number of People Living with HIV (PLHIV) in India is estimated at 21.17 lakhs in 2015 compared with 22.26 lakhs in 2007 out of which Undivided Andhra Pradesh and Telangana have the highest estimated number of PLHIV (3.95 lakhs). This study was conducted to assess the extent of Knowledge related to HIV/AIDS among medical students in a private medical college in South India. Methodology: This was a cross sectional study conducted among 126 second year medical students of a private medical college of south India for a period of 3 months. After taking informed consent, information regarding Knowledge related to HIV, modes of its transmission, prevention and socio-demographic variables were collected from them using a predesigned, pretested semi structured questionnaire. Data was entered and analyzed using Microsoft Office Excel 2010 and the results were expressed in percentages. Results: out of 126 students participated; 38.1% were males and 61.9% were females. Correct knowledge regarding HIV transmission from mother to child through pregnancy and breast feeding were 81.7% and 45.2% respectively. About 14.3% of the students opinioned that they will consider suicide if they were discovered HIV positive. Conclusion: Most of the students were having basic knowledge of HIV/AIDS although there were some misconceptions which should be corrected. There is a need of Information, Education activities related to HIV/AIDS to increase the knowledge and awareness among medical students.

The Role of Depression, Anxiety and Illness Characteristics on Risky Sexual Behaviour among People Living with HIV in A Malaysian Tertiary Reference Hospital

Background: People living with HIV (PLHIV) have a longer lifespan with treatment and continue to be sexually active. To date, the extent of risky sexual behaviour among local PLHIV and its associated factors were undetermined. Objective: To examine the role of depression, anxiety and illness characteristics on risky sexual behaviour among PLHIV attending care in a Malaysian tertiary reference hospital (N= 406). Method: It was a cross-sectional study. Subjects were recruited by systematic random sampling. Risky sexual behaviour was determined by using the modified National Youth Risk Behaviour Survey. PHQ-9 and GAD-7 were used to measure the depressive and anxiety symptoms, respectively. Chi-square test was used to examine the association between the variables. Multiple logistic regression was used to examine the predictors of the study. A p value of less than 0.05 was considered significant and odds ratio was used as the measure of risk association. Results: Our study showed that 29.3% had risky sexual behaviour. Meanwhile, 21.9% and 26.4% had depressive and anxiety symptoms, respectively. Risky sexual behaviour was significantly associated with age, religion, education level, duration of HIV diagnosis, depressive and anxiety symptoms. From multivariate logistic regression, duration of HIV diagnosis and anxiety symptoms significantly predicted risky sexual behaviour. Conclusion: This study highlights that a substantial number of PLHIV had risky sexual behaviour and psychological symptoms. It is important for psychological interventions that reduce risky sexual behaviour among PLHIV who attend treatment, especially during the early phase.