Unknown Human Immunodeficiency Virus Status Research Articles

Lung transplantation in HIV seropositive recipients: An analysis of the UNOS registry.

Experience with lung transplantation (LT) in patients with human immunodeficiency virus (HIV) is limited. Many studies have demonstrated the success of kidney and liver transplantation in HIV-seropositive (HIV+) patients. Our objective was to conduct a national registry analysis comparing LT outcomes in HIV+ to HIV-seronegative (HIV-) recipients. The United Network for Organ Sharing database was queried to identify LTs performed in adult HIV+ patients between 2016 and 2023. Patients with unknown HIV status, multiorgan transplants, and redo transplants were excluded. The primary endpoints were mortality and graft rejection. Survival time was analyzed using Kaplan-Meier analysis. The study included 17487 patients, 67 of whom were HIV+. HIV+ recipients were younger (59 vs. 62years, p=.02), had higher pulmonary arterial pressure (28 vs. 25mm Hg, p=.04), and higher lung allocation scores (47 vs. 41, p=.01) relative to HIV- recipients. There were no differences in graft/recipient survival time between groups.HIV+ recipients had higher rates of post-transplant dialysis (18% vs. 8.4%, p=.01), but otherwise had similar post-transplant outcomes to HIV-recipients. This national registry analysis suggests LT outcomes in HIV+ patients are not inferior to outcomes in HIV- patients and that well-selected HIV+ recipients can achieve comparable patient and graft survival rates relative to HIV- recipients.

Inequities Along the Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis Services Continuum for Black Women in the United States, 2015-2020.

To estimate the number of women who received human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing and HIV pre-exposure prophylaxis (PrEP) services by race and ethnicity in seven THRIVE (Targeted Highly Effective Interventions to Reverse the HIV Epidemic)-funded jurisdictions and to estimate associations of age and syphilis and gonorrhea diagnoses with receipt of HIV PrEP services. We analyzed data collected from 2015 to 2020 in Birmingham, Alabama; Baltimore City, Maryland; Washington, DC, New Orleans, Louisiana; Brooklyn, New York; Philadelphia, Pennsylvania; and Hampton Roads, Virginia. We compared Black women and women of additional racial and ethnic groups by age, HIV status at enrollment, receipt of STI testing and test positivity, and steps in the PrEP continuum (screened, eligible, referred, linked, and prescribed). We also examined the association of age, syphilis, or gonorrhea with the following steps in the PrEP continuum: screened, referred, linked, and prescribed. Black women made up 69.2% (8,758/12,647) of women served in THRIVE. Compared with non-Black women, Black women were more likely to have a positive test result for syphilis (3.3% vs 2.1%), gonorrhea (4.9% vs 3.5%), chlamydia (5.1% vs 1.9%), or more than one STI (1.4% vs 0.3%). Among women with negative HIV test results or unknown HIV status, Black women were more likely to be screened for PrEP eligibility (88.4% vs 64.9%). Among Black women, the proportion screened for PrEP was higher among those diagnosed with syphilis (97.3%) or gonorrhea (100%) than among those without an STI (88.1% and 87.8%, respectively). Among 219 Black women who presented with syphilis, only 10 (4.6%) were prescribed PrEP; among 407 with gonorrhea, only 11 (2.7%) were prescribed PrEP. Although most Black women seeking services received STI testing, the proportion of Black women who were eligible for PrEP and prescribed PrEP was low. To achieve national HIV-prevention goals, it is imperative that Black women have access to PrEP information and services.

The Influence of HIV Status on Acute Appendicitis: A Retrospective Study from South Africa.

Despite the human immunodeficiency virus (HIV) being the most common comorbidity in South African surgical patients, its impact on appendicitis has not been well-described. We aimed to determineHIV status' influence on patients' presentation, assessment, management and outcomes with acute appendicitis. The retrospective chart review included all patients aged 12years and older who were HIV-positive or HIV-negative and presented with acute appendicitis between 1 January 2013 and 31 December 2019. The primary outcome measure was survival to discharge. Secondary outcomes included analysis of the presentation (vital signs), assessment (biochemical, inflammatory markers) and management (intraoperative anatomical severity grading, length of hospital stay). Of the 1096 patients with appendicitis, 196 (17.9%) were HIV-positive, and CD4 counts were available for 159. The median age was 23years, with the HIV-positive patients being older and HIV-negative group having more males (58.7%). While the HIV-positive patients had a longer median length of hospital stay, there was no statistically significant difference in the two groups' incidence of high-grade appendicitis (p=0.670). The HIV-positive patients had a higher median shock index (OR 7.65; 95% [CI 2.042-28.64]) than their HIV-negative counterparts. HIV-positivity had a significant association with mortality (OR 9.56; 95% CI [1.68-179.39]), and of the seven HIV-positive patients who died, 66.7% (n=4) had a CD4 < 200 cells/mm3 (OR 8.6; 95% CI [1.6-63.9]). HIV-positive patients, those with CD4 < 200 cells/mm3 or not on ART, have increased mortality risk and may benefit from increased perioperative surveillance. Patients with an unknown HIV status in a high-prevalence population should be offered HIV testing to risk stratify more accurately.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study.

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study. A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021. The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart. The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

Prevalence and Predictors of HIV Infection among Under FiveYear Children Born to HIV Positive Mothers in Muheza District, North-Eastern Tanzania

Background: Human Immunodeficiency Virus (HIV) pandemic has become a serious public health concern worldwide. The prevalence of paediatric HIV infection is largely unknown in many countries in Sub-Saharan Africa (SSA). We aimed to determine the prevalence and predictors of HIV infection among under-5 years children in Muheza District, Tanzania. Methods: A facility-based study among mothers/guardians with their under-5 years children exposed to HIV infection was conducted from June 2015 to June 2016. Information on HIV status, socio-demographic and other family characteristics was collected using a structured questionnaire. Data analysis was performed using STATA version 13.0. Results: A total of 576 HIV-exposed under-5 years children were recruited together with their respective mothers/guardians. The HIV prevalence among under-5 years children was 10.6% (95% CI: 8.1-13.1%). The burden of HIV infection was observed among older children aged 25 to 59 months (AOR= 8.0, 95% CI 2.5-26.0) than in the younger children. There was a four-fold (AOR=3.9, 95% CI 1.7-9.1) risk of HIV infection among children born to mothers of unknown HIV status at conception than among children born to mothers with known HIV status. The odds of HIV infection were higher among children who were delivered from home (AOR=2.6, 95% CI 1.0-6.5), received mixed feeding (AOR=2.4, 95% CI 1.2-4.9), and those living far from a health facility (AOR=3.0, 95% CI 1.4-6.5). Conclusion: The prevalence of HIV among under-5 years children in Muheza is higher among older children. The high prevalence is associated with being born to mothers with unknown HIV status at conception, received mixed feeding, home delivery, and living far from the health facility. Campaigns that provide health educational massages addressing risk factors of HIV need to be emphasised in order to promote the control and prevention of HIV among children.

Women diagnosed with HIV and unknown HIV status perceived susceptibility to cervical cancer and perceived benefits of cervical cancer screening in Ghana: a cross-sectional study

BackgroundCervical cancer is an issue of global health concern, and it seems to be the next epidemic in Sub-Saharan Africa after Human Immunodeficiency Virus (HIV). This study compared the perceptions of susceptibility to cervical cancer and benefits of cervical cancer screening among women diagnosed and those with unknown HIV status and determined the association between socio-demographic factors and HIV status.MethodsA cross-sectional study was conducted with 600 women diagnosed with HIV and 600 women with unknown HIV status in the Central Region of Ghana. Convenience sampling was used and a structured interview schedule was the main data collection instrument. Data were analysed using frequencies, percentages, chi-square test and independent samples t-test.ResultsA high proportion of women diagnosed with HIV 94.8% (n = 569) and those with unknown HIV status 93.5% (n = 561) agreed that “screening can find cervical changes”. Also, 58.0% (n = 348) of women diagnosed with HIV agreed that they have been in polygamous relationships so they may get cervical cancer. There was a statistically significant association between marital status (X2 = 167.071, p = 0.001), religion (X2 = 57.720, p = 0.001), level of education (X2 = 118.997, p = 0.001), employment status (X2 = 782.646, p = 0.001) and HIV status. A comparison of the mean difference for women diagnosed and those with unknown HIV status in relation to perceived benefits of cervical cancer screening showed a statistically significant difference (t = 7.418, df = 1198, p = 0.001). Nonetheless, there was no statistically significant difference in the means for women diagnosed and those with unknown HIV status regarding perceived susceptibility to cervical cancer (t = 0.935, df = 1198, p = 0.351).ConclusionsWomen with HIV perceived higher benefits of cervical cancer screening. Perception of susceptibility to cervical cancer by women with and those without HIV need to be addressed in efforts to improve their health. Furthermore, interventions for women with HIV should consider some important sociodemographic factors.

Vikela Ekhaya: A Novel, Community-based, Tuberculosis Contact Management Program in a High Burden Setting.

BackgroundThe prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT.MethodsVikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants’ homes.ResultsIn total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts.ConclusionVikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control.

Treatment outcomes of Gene Xpert positive tuberculosis patients in KwaMashu Community Health Centre, KwaZulu-Natal, South Africa: A retrospective review

BackgroundWe sought to investigate the relationship between tuberculosis (TB) treatment outcomes and its predictors in the KwaMashu region in KwaZulu-Natal (KZN). This area is currently a hotbed for TB and human immunodeficiency virus (HIV) co-infection.MethodA retrospective study design was adopted to characterise adult patients diagnosed with Gene Expert (GXP) positive pulmonary TB from 01 January 2016 to 31 December 2017. Tuberculosis treatment outcomes were assessed after two months and five months according to the standard World Health Organization (WHO) criteria. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of the possible determinants associated with unsuccessful treatment outcomes.ResultsAmongst the 596 patients diagnosed, 57.4% (95% confidence interval [CI]: 53.3–61.4; 342 of 596) had successful treatment outcomes. Of these reported cases, 88.89% (85.1–92.0; 304 of 342) were cured. For the unsuccessful treatment outcomes, 52.4% (46.0–58.6; 133 of 254) patients were lost to follow-up, 20.9% (16.0–26.4; 53 of 254) failed treatment, 1.2% (0.2–3.4; 3 of 254) died and 25.6% (20.3–31.4; 65 of 254) of the patients could not be accounted for. Patients with unknown HIV status were more likely to have unsuccessful treatment outcomes (adjusted OR [aOR] = 4.94 [1.83–13.36]). Patients who had sputum conversion at 2 months (aOR = 1.94 [1.27–2.96]) were significantly more likely to exhibit unsuccessful treatment outcomes.ConclusionTreatment success rate was 57.4% which was below the target set by the WHO. This underscores the urgent need to strengthen treatment adherence strategies to improve outcomes, especially in high HIV burden settings.

Comparison of HIV-Positive Incidence Among Transgender Women and Men Who Have Sex with Men at Stand-Alone and Mobile Voluntary Counseling and Testing Facilities in Chiang Mai Province, Thailand

Human immunodeficiency virus (HIV) infection is still a major cause of death in Thais and new cases of infection are still emerging among the key population comprising men who have sex with men (MSM), sex workers and their clients, and transgender women (TGW) and people who inject drugs. The objective of this study was to compare the incidence of HIV infection between MSM and TGW who were tested at stand-alone and mobile HIV voluntary counseling and testing (VCT) centers and to identify factors associated with HIV-positive individuals from the two services. We conducted an observational study using MSM and TGW individuals with unknown HIV status from the databases at a stand-alone center and a mobile VCT belonging to the MPlus in Chiang Mai province, Thailand. Factors associated with HIV-positive status were identified using logistic regression model. HIV VCT data were obtained for 6971 individuals at both MPlus center and mobile care unit. Among 3033 and 3938 clients tested at each facility, respectively, 168 (5.6%) and 101 (2.6%) clients were HIV positive. Individuals tested at the stand-alone centers were at a 1.91-fold higher risk of being HIV positive compared with those tested at the mobile VCT unit. Individuals who were 20-24 or >24 years old, sex workers, or sexually transmitted infection positive were more likely to be HIV positive. Our results show the beneficial effect of mobile HIV VCT facilities that enable testing of more of the at-risk population. Developing mobile VCT activities that attract a particular target population is needed to be able to reach the 90-90-90 goals. This study was approved by the Ethics Committee of the Faculty of Medicine, Chiang Mai University (0BG-2562-06418).

Exploring perceptions of low risk behaviour and drivers to test for HIV among South African youth.

Human Immunodeficiency Virus (HIV) prevalence among South African youth is high, yet HIV testing remains suboptimal. We explored how perceptions of HIV risk and behaviours informed decisions to test for HIV. This study was conducted from April 2018 to March 2019 in Ekurhuleni district, Gauteng Province with males and females aged between 15–24 years. Twenty-five youth with unknown HIV status participated in in-depth interviews (IDIs); while four focus group discussions (FGDs) were conducted with those that previously tested for HIV. Probes used in the guides included types of incentives that youth would value when testing for HIV or receiving treatment; barriers and motivators to HIV testing; enablers and challenges to using cellphone technology and preferences on type of social media that could be used to create awareness about HIV testing services. IDIs and FGDs were audio-recorded, transcribed, and translated. QSR NVIVO 10 was used for the analysis. The majority of the youth perceived that their risk of HIV infection was low due to factors such as being young, lacking physical signs of HIV, being sexually inactive and parents not being HIV positive. However, youth identified high risk behaviours such as unprotected sex, multiple sexual partners, excessive drinking of alcohol, being victims of sexual abuse, road accidents and violent behaviour as increasing their vulnerability to HIV. Most youth highlighted cues to action that would motivate them to test for HIV such as support of parents, receiving incentives, improved confidentiality during HIV testing and receiving information about HIV via social media (Facebook, Twitter and Whatsapp). Despite perceptions of low risk to HIV, youth remain vulnerable to HIV. Disseminating HIV information via digital platforms; giving youth options to choose between testing locations that they consider to be private; providing incentives and equipping parents/guardians to encourage youth to test could optimise HIV testing.

Common Methods of Contraception Used at Monkey Bay Community Hospital in Mangochi District, Malawi

To determine commonly used methods of contraception at Monkey Bay Community hospital, to compare different methods of contraception used by people of various age groups, parity, Human Immunodeficiency Virus (HIV) and Marital status, a clinical audit of family planning methods used by clients at Monkey Community hospital from January 2018 to June 2019 was done. Data was collected from the registers. A total number of 1734 clients reported at family planning clinic of Monkey-Bay Community Hospital between January 2018 and June 2019. All the clients were females. Most of these clients were in the age range of 15 - 34 years (83.33%). There were 1,486 (87%) HIV negative clients, 208 (12%) HIV positive clients and 24 (1%) had unknown HIV status. Most clients had a parity of 1 - 2 (905, 52.71%) followed by 3 - 4 (540, 31.45%) and 5 or plus (272, 15.84%). There were more married people (1641, 97.23%) than unmarried ones (46, 2.73%). There was only one person who was divorced (1, 0.05%). Education status was not recorded. The five commonly used contraceptive methods were: Intramuscular (IM) injectable Depo-IM (1366, 79.51%), Jadelle (122, 7.10%), Subcutaneous (SC) injectable Depo-SC (65, 3.78%), Combined Oral Contraceptives (COC) (60, 3.49%) and Implanon (40, 2.33%). None of the clients was used female condoms as a method of contraception. The contraceptive use was common between the age group of 15 - 24 (707, 44.92%) and 25 - 34 (709, 45%). Depo-IM was most used in age group 25 - 34 (44.5%) while Jadelle was mostly used by 15 - 24 years old (48%). 1181 clients (79.5%) of HIV negative clients used Depo-IM as the contraceptive method while 164 clients (78.8%) of HIV positive clients used Depo IM as a method of contraception. More HIV negative clients used Jadelle and COC as compared to HIV positive clients. The choice of a particular method of contraception was influenced by many factors. Parity, marital status, age as well as HIV status did have some association with the preferred method of contraception. Our study shows that there could be varied reason for women chose types of contraception in this part of Malawi. Interventions that aim to increase access to family planning methods, should consider exploring the reasons why clients use some methods more than the other for better planning of these services. Absence of male clients accessing vasectomy at the hospital raises concern and more studies will be needed to determine the reason why men do not come forward for family planning services at Monkey Community Hospital.

Mortality, Human Immunodeficiency Virus (HIV) Transmission, and Growth in Children Exposed to HIV in Rural Zimbabwe.

BackgroundClinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain.MethodsThe Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or improved water, sanitation, and hygiene in 2 rural Zimbabwean districts with 15% antenatal HIV prevalence and > 80% prevention of mother-to-child transmission (PMTCT) coverage. Children born between February 2013 and December 2015 had longitudinal HIV testing and anthropometry. We compared mortality and growth between children who were HIV-exposed and HIV-unexposed through 18 months. Children receiving IYCF were excluded from growth analyses.ResultsFifty-one of 738 (7%) children who were HIV-exposed and 198 of 3989 (5%) children who were HIV-unexposed (CHU) died (hazard ratio, 1.41 [95% confidence interval {CI}, 1.02–1.93]). Twenty-five (3%) children who were HIV-exposed tested HIV positive, 596 (81%) were HIV-exposed uninfected (CHEU), and 117 (16%) had unknown HIV status by 18 months; overall transmission estimates were 4.3%–7.7%. Mean length-for-age z score at 18 months was 0.38 (95% CI, .24–.51) standard deviations lower among CHEU compared to CHU. Among 367 children exposed to HIV in non-IYCF arms, 147 (40%) were alive, HIV-free, and nonstunted at 18 months, compared to 1169 of 1956 (60%) CHU (absolute difference, 20% [95% CI, 15%–26%]).ConclusionsIn rural Zimbabwe, mortality remains 40% higher among children exposed to HIV, vertical transmission exceeds elimination targets, and half of CHEU are stunted. We propose the composite outcome of “alive, HIV free, and thriving” as the long-term goal of PMTCT programs.Clinical Trials RegistrationNCT01824940.

Feasibility of Identifying Household Contacts of Rifampin-and Multidrug-resistant Tuberculosis Cases at High Risk of Progression to Tuberculosis Disease.

We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing. From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged ≥5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy. The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.

HIV in pregnancy: Identification of intrapartum and perinatal HIV exposures.

The benefits of human immunodeficiency virus (HIV) testing in pregnancy, when combined with appropriate maternal antiretroviral therapy and intrapartum and postnatal prophylaxis, are well established. The vertical rate of transmission of HIV in North America is now well below 2%. Efforts must continue to ensure that these benefits are sustained. Women who have received little or no prenatal care and those who present for delivery with unknown HIV status need immediate testing. As more infants are exposed to antiretroviral agents, strategies need to be implemented to ensure adequate follow-up of these infants. Issues relating to the identification of HIV-exposed infants are highlighted.

HIV infection and unknown HIV status among tuberculosis patients in Ethiopia: a systematic review and meta-analysis

Each case of human immunodeficiency virus (HIV) infection worsens the global HIV situation, leads to the failure to achieve tuberculosis (TB) control targets worldwide, and impacts on the use of health service resources. We determined the prevalence of HIV infection among TB patients and the proportion of TB patients with unknown HIV status in Ethiopia. We searched PubMed, EMBASE, Google Scholar and Web of Science electronic databases. Heterogeneity of the included studies was checked using the I² statistic and publication bias was assessed using funnel plots and Egger's regression statistical test. We employed a random-effects model to determine the pooled prevalence of HIV infection and unknown HIV status. A sensitivity analysis was also conducted to examine the effect of possible outliers on the overall estimate. The prevalence of HIV infection among TB patients and the proportion of TB patients with unknown HIV status was respectively 23.4% (95%CI 19.6-27.2) and 6.4% (95%CI 1.7-11.0). Based on geographical location, the prevalence of HIV infection was 31.4% (95%CI 19.2-43.6) in Amhara Region, 23.2% (95%CI 9.9-36.5) in Oromia, 20.9% (95%CI 17.8-24.0) in Addis Ababa and 16.5% (95%CI 12.0-21.0) in Southern Nations, Nationalities and Peoples' Region (SNNPR). In Ethiopia, almost one in four TB patients is infected with HIV. Given the epidemiological variation of Ethiopia, responsive, integrated sustainable programmes for HIV and TB are essential to minimise the epidemics of HIV infection and TB.

Mortality among tuberculosis patients in New York City.

To quantify tuberculosis (TB) related mortality among TB patients in New York City (NYC), NY, USA, and identify risk factors associated with TB-related mortality. We performed a retrospective analysis of verified TB patients in NYC, 2004-2013. NYC Office of Vital Statistics death certificate data and TB surveillance data were matched. Death certificate data were used to identify TB-related deaths. Risk factors for TB-related death for US-born and non-US-born populations were evaluated using multivariable logistic regression. Of 8209 TB patients in NYC, 168 (2%) suffered TB-related deaths before or during anti-tuberculosis treatment. Of these, 62% occurred among non-US-born patients, and 38% occurred among US-born patients. Among the latter, TB-related death was associated with increased age (65 vs. 18-44 years, adjusted OR [aOR] 8.27, 95%CI 3.47-19.71), being culture-positive (aOR 6.79, 95%CI 2.10-21.97), and having both pulmonary and extra-pulmonary disease (aOR 5.06, 95%CI 1.91-13.40). The same factors were also significant among non-US-born patients; TB-related death was also associated with male sex (aOR 1.80, 95%CI 1.11-2.91), history of TB disease (aOR 3.16, 95%CI 1.28-7.77), alcohol use (aOR 1.85, 95%CI 1.00-3.43), homelessness (aOR 2.66 95%CI 1.15-6.19), and unknown human immunodeficiency virus status (aOR 3.91, 95%CI 2.43-6.29). Different risk factors between the US- and non-US-born populations were identified. Interventions specific to each population may be needed for reducing TB-related mortality.

Treatment outcomes and associated factors in tuberculosis patients at Jimma University Medical Center: A 5-year retrospective study.

Monitoring the outcome of tuberculosis (TB) treatment and investigating factors associated with unsuccessful outcome are essential, as unsuccessful treatment fuels resistance to antibiotics. This study aimed to investigate the treatment outcome and associated factors with an unsuccessful outcome at Jimma University Medical Center (JUMC), Southwest Ethiopia. A 5-year retrospective analytical study, including all types of TB cases who sought care at JUMC between September 1, 2012, and August 31, 2017, was conducted. Treatment outcomes and TB types were categorized according to the National TB Control guideline. Bivariate analysis was used to analyze the association between treatment outcome and potential variables. Overall data from 1249 patients' records were included in the study. The proportion of male patients was higher (815, 65.3%) than that of females. The mean age (± standard deviation, range) of the cases was 26 (±11. 6, 1-71) years. Of the total, 292 (23.3%) were smear-positive pulmonary TB (PTB), 489 (39.2%) smear-negative PTB, and 468 (37.5%) extra-PTB (EPTB) cases. Available treatment outcomes indicate that 253 (20.2%) were cured, 850 (68.0%) completed therapy, 58 (4.8%) died, 83 (6.6%) defaulted, and 5 (0.4%) failed the therapy. About 76 (5.6%) cases were transferred out and 44 (3.2%) cases were lost to follow-up. In total, 146 (11.7%) patients had an unsuccessful outcome. Unsuccessful treatment outcome was associated with smear-negative PTB (odds ratio [OR] =2.0, 95% confidence intervals [CI] =1.1, 3.7), EPTB (OR = 2.1, 95% CI = 1.2, 3.4), and unknown human immunodeficiency virus (HIV) status (OR = 7.9, 95% CI = 2.5, 25.0). The treatment success rate of overall TB patients is lower than end TB Strategy target of ≥90% success rate. Smear-negative PTB, EPTB cases, and those with unknown HIV status tend to have unsuccessful outcome.

INVASIVE CERVICAL CANCER IN IBADAN: SOCIO-SEXUAL CHARACTERISTICS, CLINICAL STAGE AT PRESENTATION, HISTOPATHOLOGY DISTRIBUTIONS AND HIV STATUS.

Background:Human Papillomavirus (HPV) infection persistence is the necessary but not sufficient cause of invasive cervical cancer (ICC). The effects of Human Immunodeficiency Virus (HIV) co-infection have been well documented. The purpose of this study was to describe our experience on the clinico-pathological characteristics of patients with cervical cancer and HIV status at a tertiary Hospital in Nigeria.Materials and Methods:This was a descriptive study among ICC patients presenting for clinical staging and biopsy for histological diagnosis at the Obstetrics and Gynaecology outpatient theatre of our hospital between January 2009 and February 2011.Results:Sixteen (6.8%) of the 248 patients with histologically confirmed ICC in this study were HIV positive. The mean age of all the participants was 55.4 (SD±10.2) years with the HIV positive patients’ younger than the HIV-negative and those that declined HIV testing. Coitarche was at lower age (18 [SD±4.4] vs 22[SD±3.4] years vs 24.5[SD±4.4], respectively). The modal lifetime sexual partners were four, one and two, respectively. Clinically, more HIV positive patients, presented at advanced stage of ≥ 2B. Also, the adenocarcinoma histological variant was slightly more among the HIV positive patients.Conclusion:HIV seemed relatively common among ICC patients and they presented at lower ages, at more advanced stages, earlier coitarche and more lifetime sexual partners. The proportion of adenocarcinoma histological types was slightly higher among the HIV positive patients compared with seronegative patients and those with unknown HIV status. Larger studies to substantiate these findings and ICC-HIV causal relationship are required.

HIV screening of tuberculosis patients in Portugal: what are we missing?

Knowledge of human immunodeficiency virus (HIV) status is essential to effectively manage both tuberculosis (TB) and HIV infection. This is why the World Health Organization (WHO) recommends routine HIV testing in all TB patients. To determine the number of TB patients with unknown HIV status in Portugal and to identify the factors associated with unknown HIV status. A retrospective study of all TB notifications from 2008 to 2014 in Portugal was conducted. A multiple logistic regression model was used to evaluate the association of sociodemographic and clinical factors with unknown HIV status. We examined the records of 18 445 patients with TB notification, 2402 of whom (13%) had unknown HIV status. Unknown HIV status was positively associated with age 65 years (adjusted odds ratio [aOR] 1.208, 95%CI 1.037-1.408) and extra-pulmonary TB (aOR 1.381, 95%CI 1.252-1.523), but negatively associated with unemployment (aOR 0.755, 95%CI 0.637-0.895), alcohol dependence (aOR 0.809, 95%CI 0.682-0.959) and drug dependence (aOR 0.566, 95%CI 0.449-0.713). Risk perception is the most important barrier to complete knowledge of HIV status in TB patients in Portugal. Given the importance of HIV screening in TB patients, every effort should be made to ensure that all TB patients undergo HIV screening.

Women's utilisation of prevention of mother-to-child transmission of human immunodeficiency virus services in Addis Ababa, Ethiopia.

BackgroundHuman immunodeficiency virus (HIV) mother-to-child transmission (MTCT) can be prevented when HIV-positive pregnant women use effective prevention of mother-to-child transmission (PMTCT) of HIV services. Approximately 50% of HIV-positive pregnant women used free PMTCT services in Ethiopia.AimThis study attempted to identify factors influencing women’s utilisation of PMTCT services. Addressing such factors could enable more Ethiopian women to use PMTCT services. The study investigated whether women’s utilisation of services was affected by socio-demographic issues, their partners’ known HIV status, disclosure of their HIV-positive status, stigma and discrimination, and satisfaction with services.SettingPrenatal clinics in Addis Ababa, Ethiopia.MethodsA quantitative, cross-sectional study design was used and 384 questionnaires were completed by women who used PMTCT services in Addis Ababa.ResultsNo socio-demographic characteristic prevented women’s utilisation of PMTCT services, nor did stigma, discrimination or disclosure of their HIV-positive status. Most respondents’ partners with unknown HIV status did not know that the respondents used PMTCT services. Most women were satisfied with the PMTCT services.ConclusionsPrevention of mother-to-child transmission services should remain accessible to all HIV-positive women in Ethiopia. Concurrent HIV partner testing should be encouraged with appropriate counselling. HIV-positive pregnant women should be encouraged to disclose their status to their partners so that they need not use PMTCT services secretly. Patients’ high levels of satisfaction with PMTCT services are a good indicator for rolling out PMTCT initiatives at other facilities. Future research should focus on HIV-positive pregnant women who do not use PMTCT services.