People Living With HIV Group Research Articles

What Might Surviving Coronavirus Disease 2019 Look Like for People Living with HIV?

What Might Surviving Coronavirus Disease 2019 Look Like for People Living with HIV?

Descriptive account of 18 adults with known HIV infection hospitalised with SARS-CoV-2 infection

ObjectiveTo report on the clinical characteristics and outcome of 18 people living with HIV (PLWH) hospitalised with SARS-CoV-2 infection in a London teaching hospital.MethodsThe hospital notes of 18 PLWH hospitalised...

The University of California San Diego performance-based skills assessment: a useful tool to detect mild everyday functioning difficulties in HIV-infected patients with very good immunological condition

Everyday functioning (EF) impairment is frequent in people living with HIV (PLWH). Our aim was to better explore EF and its association with PLWH cognition, by administering both the IADL scale, the most common functional scale, and a new and ecologic multi-domain (communication and financial skills) tool to measure EF as the University of California San Diego (UCSD) Performance-Based Skills Assessment-Brief Version (UPSA-B). Eighty-five PLWH on cART with very good immunological condition and 23 age- and education-matched healthy controls (HC) were enrolled. PLWH underwent a standardized neuropsychological battery plus IADL, and cognitive impairment was defined according to Frascati criteria. Both groups underwent the UPSA-B. Only 6 subjects (7%) were affected by cognitive impairment (asymptomatic profile). While IADL score was at ceiling for all patients, the UPSA-B total score was significantly worse in PLWH when compared with HC [mean 82.1 (SD 9.3) vs 89.2 (SD 6.2); p < 0.001]. At communication subtest, PLWH group and HC were significantly different (p = 0.002), while no difference emerged at financial skills (p = 0.096). Higher score at UPSA-B was independently associated with better global cognitive performance (composite Z-score) (β 7.79; p < 0.001). Also considering each single cognitive domain, UPSA-B performance (both total and at subtests) confirmed the association with neurocognitive performance. In conclusion, UPSA-B seems to better discriminate EF impairment than IADL in PLWH, and it was associated with cognitive functions, also in the absence of symptomatic cognitive impairment. Thus, it appears a promising tool in the context of HIV infection to avoid misdiagnosis and to better detect also mild EF.

Expansion and scale-up of HIV care and treatment services in four countries over ten years.

BackgroundScale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years.MethodsWe describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005–2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre- and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start.ResultsFrom 2005–2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0–42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.9% and 15.3% in 2005–2006 to 43.5% and 41.7% in 2013–2014 (p<0.0001). Median CD4+ cell count at enrollment increased from 171 cell/mm3 in 2005–2006 (IQR 71–339) to 289 cell/mm3 in 2013–2014 (IQR 133–485) (p<0.0001). A total of 460,758 (57.4%) PLHIV initiated treatment. Cumulative risk of LTF for PLHIV prior to ART initiation 12 months after enrollment was 33.5% (95%CI 33.36–33.58) and 21.98% (95%CI 21.9–22.1) after ART initiation. Pregnant women and the youngest PLHIV group had the highest attrition after ART initiation, at 24 months 40.8% (95%CI 40.1–41.6) of pregnant women and 47.4% (95%CI 46.4–48.4) of PLHIV 15–19 years were not retained. Attrition at 12 months after enrollment among PLHIV regardless of ART status was 38.5% (95%CI 38.4–38.6).ConclusionOver 10 years of HIV scale-up in four sub-Saharan African countries, close to a million PLHIV were enrolled in care increasingly at rural and primary facilities with increasing CD4 count. Loss to follow-up from HIV care remains alarmingly high, particularly among pregnant women and younger PLHIV.

Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study.

BackgroundThe development of electronic health (eHealth) has offered the opportunity for remote care provision. eHealth addresses issues for patients and professionals favoring autonomy and compliance, respectively, while fostering closer links both between patients and health care professionals and among health care professionals themselves.ObjectiveThe aim of this study was to analyze the patterns of use, benefits, and perceived obstacles in eHealth among people living with HIV (PLHIV) and their caring physicians at hospitals.MethodsAn online multicenter observational survey was conducted October 15-19, 2018 in 51 medical units across France by means of self-administered questionnaires to collect sociodemographic and medical data, and perceptions of eHealth. Multiple correspondence analysis followed by mixed unsupervised classification were performed to analyze data of the respondents.ResultsA total of 279 PLHIV and 219 physicians responded to all parts of the questionnaire. Three groups of PLHIV were identified based on multivariate analysis. Group 1 comprised “eHealth believers” (121/279, 43.4%), who were more frequently above 60 years old and more likely to be receiving treatments other than antiretrovirals. Group 2, the “technology skeptics” (86/279, 30.8%), comprised more women with at least one child. Group 3, the “internet adopters” (72/279, 25.8%), were more frequently under 49 years of age, men who have sex with men, and more likely to use mobile apps for obtaining wellness/health information and related subjects. Three groups of physicians also emerged. Group 1 comprised those “strongly confident in eHealth” (95/219, 43.4%), who more frequently used mobile apps for wellness/health information and were more likely to accept prescription assistance software. Group 2 comprised physicians “strongly opposed to eHealth” (80/219, 36.5%), frequently asserting that eHealth challenges confidentiality. Group 3 were “open to eHealth” (44/219, 20.1%), comprising a higher proportion of infectious disease specialists, and were more likely to believe that medical apps are useful for patient education and information. No link was found between the groups of PLHIV and physicians.ConclusionsThe literature on eHealth mainly classifies people as enthusiasts and skeptics; however, we identified a third profile among both PLHIV and physicians, albeit without a direct link between them. For PLHIV, this third group is attentive to eHealth for improving their health condition, and for physicians, this group considers eHealth to offer benefits to patients and their own practice.

Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline.

Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross-sectional study involving PLWH on combination antiretroviral therapy (cART) (n=250) compared with sex-matched cART-naïve PLWH (n=201) in Ghana. Hypertension was defined as blood pressure≥140/90mmHg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP≥130/80mmHg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7±8.6years, and 42.9±8.8years among PLWH cART-naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART-naïve was 36.9% and 23.4%, P=0.002 at BP≥140/90mmHg and 57.2% and 42.3%, respectively, P=0.0009, at BP≥130/80mmHg. Factors associated with hypertension at BP≥140/90mmHg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60-2.71) per 10years, and body mass index, 1.53 (1.24-1.88) per 5kg/m2 rise. At BP≥130/80mmHg, cART exposure, aOR of 1.77 (95% CI: 1.20-2.63), family history of hypertension, aOR of 1.43 (1.12-1.83), and hypertriglyceridemia, aOR of 0.54 (0.31-0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.

Contribution and Constraints for the Involvement of People Living with HIV in HIV Prevention and Control Activities: A Qualitative Study at Mandalay Region, 2016

There were nearly 170 positive self-help groups of people living with HIV (PLHIV) in 2013 in Myanmar. This study was conducted at Mandalay City and two townships from Mandalay Region during 2016 to assess the contribution of PLHIV in HIV prevention and control related activities, and identify the challenges for the sustainability of their contribution. Seven focus group discussions with six to seven PLHIV in each group, eight indepth interviews with leaders of HIV positive groups, and two key informant interviews with team leaders of HIV/AIDS were conducted. The average age of respondents was 40 years, male and female ratio was 1:5. The average years of involvement in HIV/AIDS-related activities was 4 years. Generally, PLHIV were very supportive especially to the AIDS/ STD teams which have limited human resources. The achievement of PLHIV involvement could be mainly seen in condom promotion and distribution to vulnerable groups, HIV-test counseling, supporting PLHIV from hard-to-reach areas and with poor socio-economic conditions, assisting in antiretroviral therapy (ART) provision at AIDS/STD teams, home-based care for the HIV positive adult and children, and referring people to get HIV tested and ART treatment. Areas and activities which need to be focused were also reported. The key challenges for the sustainability of their contribution were poor resource of basic equipments and facilities especially the place and funding for office, the lower interest of PLHIV and poor technical knowledge to develop income generation activities, the changing attitudes of PLHIV on their involvement, and uncertain future plans of PLHIV groups. To conclude, the challenges among PLHIV groups should be addressed by National AIDS Programme.

Equity of antiretroviral treatment use in high HIV burden countries: Analyses of data from nationally-representative surveys in Kenya and South Africa.

ObjectiveTo assess changes and equity in antiretroviral therapy (ART) use in Kenya and South Africa.MethodsWe analysed national population-based household surveys conducted in Kenya and South Africa between 2007 and 2012 for factors associated with lack of ART use among people living with HIV (PLHIV) aged 15–64 years. We considered ART use to be inequitable if significant differences in use were found between groups of PLHIV (e.g. by sex).FindingsART use among PLHIV increased from 29.3% (95% confidence interval [CI]: 22.8–35.8) to 42.5% (95%CI: 37.4–47.7) from 2007 to 2012 in Kenya and 17.4% (95%CI: 14.2–20.9) to 30.3% (95%CI: 27.2–33.6) from 2008 to 2012 in South Africa. In 2012, factors independently associated with lack of ART use among adult Kenyan PLHIV were rural residency (adjusted odds ratio [aOR] 1.98, 95%CI: 1.23–3.18), younger age (15–24 years: aOR 4.25, 95%CI: 1.7–10.63, and 25–34 years: aOR 5.16, 95%CI: 2.73–9.74 versus 50–64 years), nondisclosure of HIV status to most recent sex partner (aOR 2.41, 95%CI: 1.27–4.57) and recent recreational drug use (aOR 2.50, 95%CI: 1.09–5.77). Among South African PLHIV in 2012, lack of ART use was significantly associated with younger age (15–24 years: aOR 4.23, 95%CI: 2.56–6.70, and 25–34 years: aOR 2.84, 95%CI: 1.73–4.67, versus 50–64 years), employment status (aOR 1.61, 95%CI: 1.16–2.23 in students versus unemployed), and recent recreational drug use (aOR 4.56, 95%CI: 1.79–11.57).ConclusionAlthough we found substantial increases in ART use in both countries over time, we identified areas needing improvement including among rural Kenyans, students in South Africa, and among young people and drug users in both countries.

Intergenerational Interventions for People Living with HIV and Their Families: A Systematic Review.

A variety of interventions have been tested targeting people living with HIV (PLH) and their relationships with their children. The purpose of this study was to synthesize evidence on the goals, types, scope, and outcomes of such intergenerational interventions for PLH. Randomized trials targeting PLH alone or together with their children, published in English, with an intergenerational intervention component were included in this review. Thirteen studies met eligibility criteria. The types and goals of interventions varied greatly but often involved educational sessions with groups of PLH, skill-building sessions, or parental disclosure of HIV status among mothers living with HIV; six studies targeted problem behaviors, resilience, and self-esteem among their children. Two studies addressed general family coping with HIV. Seven studies reported positive outcomes as a result of an intergenerational intervention, with the greatest improvements being observed in those participants with the most stress. Most studies failed to report specific intervention methodology. Due to gaps in the literature noted, future intergenerational interventions targeting PLH should include more diverse groups of PLH. Studies should also explore the impact of intergenerational-based interventions on the mental health of PLH and their families.

HIV-infected patients’ expectations about emotional and sexual health

Summary Objectives People living with HIV (PLWH) are particularly affected in their sexual life. Medical support of PLWH's sexuality is increasingly proposed however no data are available. We assessed the interest of PLWH for sexual and emotional health support within a French HIV outpatient care facility. Population and methods Anonymous questionnaire proposed to PVWH attending our facility. Five types of consultations were investigated: overall sexual and emotional health; HIV transmission and prevention; sexually transmitted diseases; sexual practices; recreational drugs. Cluster analysis in order to identify groups of PLWH with similar expectations. Results One hundred and thirty-eight questionnaires completed: 64.5% were interested by at least one type of consultation. No significant differences between clusters by gender, age, or sexual orientation. Conclusion These results confirm patients’ demand for sexual and emotional health support in the frame of PLWH's health care. Patients declaring no interest for this type of consultation were no different from those interested.

Suicidality among nonadherent patients living with HIV in Buenos Aires, Argentina: prevalence and correlates

ABSTRACTOf those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.

Virologic Failure Among People Living With HIV Initiating Dolutegravir-Based Versus Other Recommended Regimens in Real-World Clinical Care Settings.

Guidelines for initial antiretroviral treatment (ART) regimens have evolved, with integrase strand transfer inhibitors (INSTIs) increasingly prominent. Research on virologic failure (VF) with INSTI therapy is predominantly from clinical trials not care settings, especially for recently approved medications including dolutegravir. We compared outcomes among people living with HIV (PLWH) who initiated recommended regimens in clinical care across the United States. We examined 2 groups of PLWH at 8 clinics who initiated ART regimens (August 1, 2013-March 31, 2017): those ART treatment-naive at initiation, and those treatment-experienced. The outcome in this longitudinal cohort study was VF, defined as a viral load of ≥400 copies/mL ≥6 months after ART initiation. We examined the proportion of individuals who remained on, switched, or discontinued the regimen. Associations between regimens and outcomes were examined with adjusted Cox proportional hazards models. Among 5177 PLWH, a lower proportion experienced VF on dolutegravir- versus other INSTI- or darunavir-based regimens for previously treatment-naive (7% vs. 12% vs. 28%) and treatment-experienced PLWH (6% vs. 10% vs. 21%). In adjusted analyses, hazard ratios were similar across regimens for the combined outcome of regimen discontinuation or treatment switch. The hazard ratios for VF comparing dolutegravir- to darunavir-based regimens was 0.30 (95% CI: 0.2 to 0.6) among previously treatment-naive PLWH and was 0.60 (95% CI: 0.4 to 0.8) among treatment-experienced PLWH. The proportion of previously treatment-naive PLWH remaining on recommended ART regimens did not differ by regimen. The likelihood of VF was lower with dolutegravir- than darunavir-based regimens for previously treatment-naive and treatment-experienced PLWH.

Engaging therapeutic citizenship and clientship: Untangling the reasons for therapeutic pacifism among people living with HIV in urban Zambia

ABSTRACTThis article explores the reasons for therapeutic pacifism among people living with HIV (PLHIVs) in urban Zambia. It contributes to a growing ethnography on global health, biosociality, and patient-provider dynamics. Therapeutic citizenship is a biopolitical citizenship that includes claims and ethical projects that emerge from techniques to control and manage bodies. In some contexts, therapeutic citizenship has included activism and claims-making against local, national, and international power brokers. This article investigates therapeutic citizenship in the specific context of impoverished urban Zambian compounds, sites of food insecurity, unemployment, and political exclusion, as well as targets for donor, NGO, and faith-based organisation projects and PLHIV support group proliferation. The article utilises data from participant observations at two Lusaka AIDS clinics, interviews, and focused discussions with support groups of PLHIVs. It argues that PLHIVs continuously negotiate subjectivities related to kinship, clientship, religious belief, and political citizenship in processes that complicate therapeutic citizenship. Rather than fostering participation in PLHIV support groups or challenging ‘politics as usual’ through activist claims-making to institutions of biopower, these processes lead to therapeutic pacifism.

Tobacco smoking in HIV-infected versus general population in france: heterogeneity across the various groups of people living with HIV.

BackgroundAlthough the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV.MethodsWe used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin.ResultsAmong the 3,019 participants aged 18–85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07–1.32), French-native women (aPRR: 1.32, 95% CI: 1.10–1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98–1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64–0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78–1.02) and women (aPRR: 0.84, 95% CI: 0.70–1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population.ConclusionsSmoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.

A Comprehensive HIV Stigma-reduction and Wellness-enhancement Community Intervention: A Case Study

We describe the implementation of a comprehensive HIV stigma-reduction and wellness-enhancement community intervention that focused on people living with HIV (PLWH), as well as people living close to them (PLC) from six designated groups. A holistic multiple case study design was used in urban and rural settings in the North West Province, South Africa. Purposive voluntary sampling was used to recruit the PLWH group; snowball sampling was used for the PLCs. Data were analyzed by means of open coding and text document analysis. The comprehensive nature of the intervention ensured enhancement in relationships in all groups. The increase in knowledge about stigma, coping with it, and improved relationships led to PLWH feeling less stigmatized and more willing to disclose. PLCs became aware of their stigmatizing behaviors and were empowered to lead stigma reduction in their communities. Many community members were reached through these initiatives.

The Relevance of Blue Moods and Depression in the Context of Smoking and Natural Quitting Rates in People Living with HIV

Objective: Research suggests that smoking-cessation interventions are less successful among people living with HIV (PLWH). The factors influencing the limited success of evidence-based smoking-cessation interventions in this population are not well understood. Design: Longitudinal analyses (of the first 12-months of an ongoing cohort (“FILTERS”) sociodemographically matched sample of 160 PLWH and 180 without HIVcomprised of both smokers and non-smokers . Methods: Semi-annual visits include a detailed survey of smoking behaviors (e.g., type of cigarette, amounts) and cessation efforts (i.e., prior attempts to quit, interest in quitting). Additionally, a fasting blood sample was obtained to assess serum cotinine, biochemical, and viroimmune parameters. Results: Compared to seronegatives, PLWH were more likely to be smokers (OR=1.4; 95% CI: 1-2.2;p=0.05).The readiness-to-quit-stages assessment showed that only 45% of the participants in the PLWH group were in the preparation or ready-to-action stages.PLWH were less likely to express interest in quitting than HIV negatives (OR=0.6; 95% CI: 0.4-1;p=0.05). Analyses indicated that PLWH were twice more likely to report stress, depression and anxiety as causes of relapse in prior quitting attempts (OR=1.6; 95% CI: 1.5- 2.4;p=0.004). After a natural course of 12 months,subjects receiving antidepressants exhibited larger reductions in number of cigarettes smoked per day (-2.6 CPD, p=0.06), than those without treatment (-0.8 CPD, p=0.2). Conclusions: Our analyses indicated that negative moodsimpact quitting success rates, particularly among PLWH. Our findings suggest that evaluation and treatment of depression may be a critical component of a smoking cessation program.

P4.141 Predictors of Incident and Persistent Common Mental Disorder (CMD) in People Living with HIV (PLHIV)- A Longitudinal Follow Up Study in Goa, India

Common mental disorders (CMD) are common in people with HIV. Depression adds to the burden of disease experienced, contributes to difficulties with medication adherence as well as self care skills;...

On the way towards zero discrimination; What do people living with HIV think?

<strong>Background: </strong>Sri Lanka is a country with a low prevalence of HIV infection. Nevertheless, number of people infected with HIV continues to rise with a considerable gap between the number identified and estimated. It is well known that stigma and discrimination to people living with HIV play a major role preventing people accessing services for HIV testing, care and support, worldwide.Sri Lanka is no exception. <strong>Methods: </strong>We interviewed 102 HIV patients using an interviewer administered questionnaire. In depth interviews were conducted with some of them. <strong>Results</strong>: Major discrimination was within the health sector with 43% being discriminated at health care settings. 28.4% of them had to undergo testing for HIV, before foreign employment. The rates of voluntary testing were very low. 80% of people living with HIV (PLHIV) have disclosed the positive status, someone else. <strong>Conclusions: </strong>A multi sectoral approach is necessary to provide care, support and treatment without stigma and discrimination. There should be self help groups of PLHIV to help each other and to liaise with healthcare personnel when required. DOI: <a href="http://dx.doi.org/10.4038/sljv.v3i1.5410">http://dx.doi.org/10.4038/sljv.v3i1.5410</a> Sri Lanka Journal of Venereology Vol.3(1) 2012 pp.33-37

Only connect – the role of PLHIV group networks in increasing the effectiveness of Ugandan HIV services

In recent years, Uganda has experienced rapid growth in networked groups of people living with HIV (PLHIV) who provide support, engage in advocacy, treatment and care and raise the profile of HIV in the public domain. This qualitative study focused the benefits of joining a networked group, relationships between groups, impact of networked groups on the community and shaping private and public experience living with HIV. Data were collected from two Ugandan districts, using semi-structured interviews, focus group discussions (FGDs), observation and reviews of group records and archives. Respondents (n=46) were adults living with HIV, and members of rural and urban PLHIV groups. Narratives from PLHIV (n=27) were gathered, and records from PLHIV group service-registers (n=20) reviewed. Key Informants (n=15) were purposively selected for interview, based on participation in PLHIV groups, utilisation of network services and their positions as key stakeholders. FGDs were held with network support agents (NSAs), members of PLHIV groups, and their leaders. Following qualitative analysis, findings suggest that for respondents, PLHIV networks enhance the impact and effectiveness of individual groups: the whole is greater than the sum of the parts. For groups, being part of a wider network allows for diversity of service delivery, and well-defined roles for individuals to participate in community support and sensitisation, with a reduction in the experience of stigma. We conclude that networking PLHIV groups is an effective strategy for improving the quality and reach of community-based HIV services. Governments should be encouraged to support networks and include them in policy-making at the national level. Local and regional groups should explore further ways to collaborate and expand support to PLHIV in Uganda.

Tuberculosis preventative therapy as part of a care package for people living with HIV in a district of Thailand.

We studied the risk factors for default in isoniazid preventative therapy (IPT) against tuberculosis in 412 people living with HIV (PLWH) in Mae Chan Hospital, Thailand. Default rates decreased from 57% in 1995 to 17% in 1999. Female sex, residence inside Mae Chan District, and registered in the PLWH group at enrollment of IPT were associated with lower default rates. The integration of IPT into the PLWH day care centre activities over the years might contribute to improvements.