AIDS Research and Treatment最新文献

Background: The burden of Human Immune Deficiency Virus or Acquired Immune Deficiency Syndrome is high in sub-Saharan countries including Ethiopia which have over two-thirds of the global HIV burden. Many would argue that consistent condom use is not most effective method for HIV prevention. Condoms offer protection against unwanted pregnancy and some sexually transmitted infections including Human Immune Deficiency Virus, when used correctly and consistently. Inconsistent use of condom by People Living with Human Immune Deficiency Virus or Acquired Immune Deficiency Syndrome on Antiretroviral Therapy will lead to further worsening the Human Immune Deficiency Virus infection epidemic and reinfection with new drug resistant viral strains.

Objective: To assess magnitude of consistent condom use and associated factors among HIV-positive clients on Antiretroviral Therapy in North West Ethiopian health center, 2016 GC.

Method: An institutional based cross-sectional study was conducted, from April 15 to June 10, 2016. A total of 358 patients on ART in Koladiba Health Center had participated in this research. Koladiba Health Center is the first health center in Ethiopia that is found in Debbie district, which is located in north Gondar Zone. Study participants were selected by simple random sampling technique. Data were collected by using pretested structured questionnaires and analyzed using SPSS version 22. Descriptive statistics was computed and binary and multiple logistic regressions were also conducted to examine the effect of selected independent variables on consistent condom use.

Result: A total of 358 ART clients participated in the study with response rate of 90%. Among study participants, 138 (38.5%) were in the age category of 35-44 years. About 216 (60.3%) of the participants were female and 325 (90.8%) were Orthodox followers. Consistent condom use was reported by 130 (55.8%) sexually active study subjects. Respondents in rural residence (AOR=0.326, 95% CI: 0.109, 0.973) and sexual partner initiated condom use (AOR=0.031, 95% CI: 0.005, 0.186) were found to be the independent predictors of consistent condom use.

Conclusion and recommendations: Consistent condom utilization among HIV clients on ART was low (55.8%). Place of residence and condom use initiation during sexual contact were significantly associated with consistent condom use. It is better to give more emphasis on health education and counseling service about consistent condom use for PLWHA who are on ART during follow-up especially for those who came from rural areas.

[This corrects the article DOI: 10.1155/2017/8239428.].

Background: In order to accelerate the HIV response to meet the UNAIDS 90-90-90 indicators for children, healthcare workers need to lead a scale-up of HIV services in primary healthcare settings. Such a scale-up will require investigation into existing barriers that prevent healthcare workers from effectively providing those services to children. Furthermore, if the identified barriers are not well understood, designing context-specific and effective public health response programmes may prove difficult.

Objective: This study reviews the current literature pertaining to healthcare workers' perspectives on the barriers to providing HIV services to children in the primary care setting in Sub-Saharan Africa.

Methods: English articles published between 2010 and April 2018 were searched in electronic databases including Sabinet, MEDLINE, PubMed, and Google Scholar. Key search words used during the search were "healthcare workers' perspectives" and "barriers to providing HIV testing to children" OR "barriers to ART adherence AND children" and "barriers to HIV disclosure AND children." Results. There are various barriers to provider-initiated counselling and testing (PICT) of children and disclosure of HIV status to children, including the following: lack of child-friendly infrastructure at clinics; lack of consensus on legal age of consent for both HIV testing and disclosure; healthcare worker unfamiliarity with HIV testing and disclosure guidelines; lack of training in child psychology; and confusion around the healthcare worker's role, which most believed was only to provide health education and clinical services and to correct false information, but not to participate in disclosure. Additionally, primary caregivers were reported to be a barrier to care and treatment of children as they continue to refuse HIV testing for their children and delay disclosure.

Conclusion: Training, mentoring, and providing healthcare workers with guidelines on how to provide child-focused HIV care have the potential to address the majority of the barriers to the provision of child-friendly HIV services to children. However, the need to educate primary caregivers on the importance of testing children and disclosing to them is equally important.

Background: Antiretroviral treatment may lead to the emergence of HIV drug resistance, which can be transmitted. HIV primary drug resistance (PDR) is of great public health concern because it has the potential to compromise the efficacy of antiretroviral therapy (ART) at the population level.

Objective: To estimate the level of primary drug resistance among recently infected cases of HIV in 6 ART centres of North-Western India from September 2014 to June 2016.

Methods: The level of primary drug resistance was studied among 37 recently infected HIV cases identified by Limiting antigen (Lag) avidity assay based on modified Recent Infection Testing Algorithm (RITA). The reverse transcriptase region of HIV-1 pol gene (1-268 codons) was genotyped. The sequences were analyzed using the Calibrated Population Resistance (CPR) tool of Stanford University HIV drug resistance (DR) database to identify drug resistance.

Results: Among 37 isolates studied, 6 (16.2%) samples showed primary drug resistance (PDR) against reverse transcriptase (RT) inhibitor. The proportion of primary drug resistance was 22.2% (2/9) among female sex workers, 14.3% (1/7) among men having sex with men, and 14.3% (3/21) among injecting drug users. Observed mutations were K219R, L74V, K219N, and Y181C. Injecting drug user (IDU) has showed resistance to either nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) or nonnucleotide reverse transcriptase inhibitors (NNRTI).

Conclusion: Resistance to either NRTI or NNRTI among the recently is a new challenge that needs to be addressed. The fact that both Y181C isolates are IDUs is important and represents 2/21 (~10%) NNRTI drug resistance. Surveillance for primary drug resistance (PDR) needs to be integrated into next generation of HIV surveillance as access to ART is increasing due to introduction of test and treat policy.

Background: Postexposure chemoprophylaxis can prevent human immunodeficiency virus (HIV) infection in risk health care workers; however routine adoption of these practices by the workers has been limited.

Methods: A cross-sectional study was conducted on 311 health care workers of Hiwot Fana Specialized University Hospital between February and March 2016. Data was collected using a structured self-administered questionnaire and analysed using STATA 12.

Results: In all, 83% of the participants had adequate knowledge of postexposure prophylaxis for HIV. All the respondents had heard about postexposure prophylaxis for HIV; however, only 37 (22.4%) workers know the definition of the postexposure prophylaxis. Among study participants, the majority of them, 272 (87.5%), knew the preferable time to initiate postexposure chemoprophylaxis. A significant number of the workers (43.4%) had an unfavorable attitude towards postexposure prophylaxis. Among 53 workers with a potential exposure to HIV, 38 (71.7%) took postexposure chemoprophylaxis and only 26 (44.8%) completed taking postexposure prophylaxis correctly.

Conclusion: In all, most of the health care workers had adequate knowledge about postexposure prophylaxis against HIV/AIDS. The result shows that a significant number of individuals had a negative attitude and poor practice with regard to postexposure prophylaxis. Therefore, formal training that aims to improve attitudes and support to improve postexposure prophylaxis implementation and completion are needed. We would recommend the establishment of appropriate guidelines and the supply chain to ensure the availability of postexposure prophylaxis drugs for the protection of healthcare workers with potential high risk exposure to HIV.

Depression is most frequently and highly occurring common mental disorder in HIV/AIDS patients especially youth living with HIV/AIDS. This study aimed to assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals in Addis Ababa, Ethiopia. Objective. To assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals Addis Ababa, Ethiopia, 2016. Method. In a cross sectional study, 507 HIV-positive young people from public health hospitals were recruited by systematic random sampling technique. Beck Depression Inventory-II was used to assess depressive symptoms. Morisky medication adherence rating scale, social support rating scale, and HIV stigma scale were the instruments used to assess the associated factors. Results. Prevalence of depressive symptoms among HIV-positive youth was 35.5% (95% CI:31.3, 39.6). In multivariate analysis, age range between 20 and 24 years with (AOR=2.22, 95% CI: 1.33,3.62), history of opportunistic infection (AOR=1.94, 95% CI:1.15,3.27), poor medication adherence (AOR=1.73, 95%CI:1.13,2.64, low social support (AOR=2.74, 95%CI:1.13,2.64), moderate social support (AOR=1.75 95% CI: 1.03,2.98), and stigma (AOR=2.06, 95% CI: 1.35,3.14) were associated with depressive symptoms. The results suggest that prevalence of depressive symptoms among HIV-positive youth was high. Prevention of opportunistic infection, stigma, and counseling for good medication adherence are necessary among HIV-positive youth.

Background: Adverse effects from antiretroviral therapy (ART) have an impact on quality of life and medication adherence. There is no clear understanding of how people manage the adverse effects of ART. The individual taking medications which cause serious adverse effects may choose to stop or reduce the medications to relieve the adverse effects. Hence, this study was aimed at assessing coping strategies for adverse effects of ART among adult human immunodeficiency virus (HIV) patients.

Methods: A cross-sectional study was conducted at HIV clinic of University of Gondar Referral Hospital (UoGRH). A total of 394 study participants were recruited by systematic random sampling. Data were collected through interviewing patients. Data were entered to Epi-Info 3.5.4 and analyzed using SPSS-20.0. Descriptive statistics were used to summarize patient's sociodemographic data and the adverse effects of their ART regimen. Binary and multivariate logistic regressions were used to investigate the potential predictors of nonadherence coping strategies.

Results: The majorities of study participants were females (66%) and aged between 35 and 44 years (38.1%). The major adverse effects reported by the participants were headache (48.2%) followed by fatigability (18%) and loss of appetite (17.5%). Coping strategies used by HIV patients for adverse effect of ART were positive emotion coping strategy (91.1%), social support seeking (76.6%), taking other medications (76.6%), information seeking (48.7%), and nonadherence (35.5%). Younger age (AOR = 29.54, 95% CI = 2.49-35.25, p = 0.007), low level of education (AOR = 5.70, 95% CI = 2.16-15.05, p < 0.001), and living far from the health institution (AOR = 2.68, 95% CI = 1.29-5.57, p = 0.008) were associated with nonadherence coping strategy to relieve the adverse effects of ART.

Conclusion: The present study revealed that positive emotion coping was the most commonly used strategy. Age, level of education, and distance from health institution were the predictors of nonadherence coping strategy.

Background: The major mode of HIV transmission in many resource-limited settings is via heterosexual intercourse, but the primary risk factor for youth is primarily through perinatal infection. With the maturing of the HIV epidemic, youth who acquired the virus perinatally are now reaching adolescence and becoming young adults. There is a paucity of data on the sexual practices of perinatally infected youth in Ethiopia.

Methods: This a cross-sectional study among 343 HIV positive youths receiving HIV care and treatment in the two hospitals in northwest Ethiopia. A self-administered questionnaire was administered among those who were able to read and write, and the questionnaire was administered by a trained study team member for those who were illiterate. Data were entered using Epi data version 3.5 and analyzed using SPSS. Sexual behaviors of the two groups were compared using bivariate logistic regression and the significant ones were further analyzed using multivariate logistic regression. Statistical significance was declared at 95% confidence interval and P-value less than 0.05.

Result: About (63.3%) were females, and 177 (51.6%) were between 20 and 24 years of age. The modes of HIV acquisition were 133 (35%) through perinatal HIV infection, 120 (35%) through sexual contact, 27 (7.9%) through exposure to HIV infected sharp materials, and 63 (18.4%) unsure how they acquired HIV. More than half 155 (59.3%) had multiple sexual partners, and 50 (63.3%) of their sexual partners were HIV negative. Among those who were sexually active, only 77 (56.2%) use a condom consistently.

Conclusions: More children who acquired HIV from their mothers are joining the youth population. Their sexual behavior is similar to those youth with behaviorally acquired HIV. There is significant risky sexual behavior among both groups. There is great urgency to effectively address the HIV the prevention strategy to break the cycle of "transgenerational" infection.

Background: With improving standards of care of children living with HIV (CLHIV), pediatric HIV related mortality rates are declining. New challenges like HIV status disclosure are emerging which need to be addressed to ensure their smooth transition into adulthood. Poor disease disclosure rates are observed in CLHIV globally.

Aims: This study was done to assess the prevalence of HIV disclosure in North Indian CLHIV, know the perceptions of caregivers regarding disclosure, and evaluate the impact of disclosure on CLHIV.

Methods: It was a questionnaire based cross-sectional study carried out amongst 144 caregivers of CLHIV aged 6-16 years attending the pediatric HIV clinic of a tertiary care teaching hospital.

Results: Though the majority (93.8%) caregivers felt that it is important to disclose but only 33% of the children were actually disclosed. Eighty five percent felt that disclosure must be done by one of the family members and correspondingly 73% of the disclosed children were actually disclosed by their parents. Forty seven percent believed that the most appropriate age for disclosure is 10-12 years. The mean age at which disclosure was actually done was 11.06 ± 1.62 years. Comparison of the disclosed and undisclosed CLHIV revealed that the disclosed group had significantly higher age, longer duration of taking ART, and higher proportion of paternal orphans. Age of the CLHIV was the only significant factor for disclosure. Several reasons were cited by the caregivers for nondisclosure. The caregivers observed improved drug adherence in 47.9% of the children following disclosure.

Conclusions: There is a need to develop region specific pediatric HIV disclosure guidelines keeping in mind the caregivers' perceptions. The guidelines must be age appropriate, systematic, and socioculturally acceptable. The most suitable age for disclosure appears to be 10-12 years. Involvement of caregivers and health care providers in the process is a must.

Background: In 2016, Mashonaland West Province had 7.4% (520) dried blood spot (DBS) samples for early infant diagnosis (EID) rejected by the Zimbabwe National Microbiology Reference Laboratory (NMRL). The samples were suboptimal, delaying treatment initiation for HIV-infected children. EID is the entry point to HIV treatment services in exposed infants. We determined reasons for DBS sample rejections and suggested solutions.

Methods: A cause-effect analysis, modelled on Ishikawa, was used to identify factors impacting DBS sample quality. Interviewer-administered questionnaires and evaluation of sample collection process, using Standard Operating Procedure (SOP) was conducted. Rejected samples were reviewed. Epi Info™ was used to analyze findings.

Results: Eleven (73.3%) facilities did not adhere to SOP and (86.7%) did not evaluate DBS sample quality before sending for testing. Delayed feedback (up to 4 weeks) from NMRL extended EID delay for 14 (93.3%) of the facilities. Of the 53 participants, 62% knew valid sample identification. Insufficient samples resulted in most rejections (77.9%). Lack of training (94.3%) and ineffective supervision (69.8%) were also cited.

Conclusion: Sample rejections could have been averted through SOP adherence. Ineffective supervision, exacerbated by delayed communication of rejections, extended EID delay, disadvantaging potential ART beneficiaries. Following this study, enhanced quality control through perstage evaluations was recommended to enhance DBS sample quality.