HIV AIDS-Research and Palliative Care最新文献

Sexual abuse is any non-consensual sexual act or behavior using force, with significant concern in "men who have sex with men" (MSM), and younger individuals. The incidence of sexually transmitted infections (STI) is also prevalent in the cases of sexual abuse in this population, showing the need for comprehensive medical and psychological intervention. This study presents a case of a 15-year-old Indonesian MSM adolescent who experienced three forced sexual intercourse with a mid-thirties male friend 6 months before the consultation. Psychological evaluation showed signs of moderate depression, then the patient reported erythematous macules and collarettes on the palms and soles. These symptoms appeared 1 month before consultation, without associated pain or pruritus. Additionally, moist, skin-colored verrucous papules and plaques were observed in the perianal area, along with a history of unintentional weight loss. The Kinsey score was calculated as three, showing bisexuality. Testing confirmed positive results for both HIV and syphilis, leading to the secondary diagnosis. The patient tested negative for additional STI and was treated with benzathine benzylpenicillin G 2.4 million international unit (IU) and antiretroviral therapy. After one month, the skin lesions improved and the patient was referred to the psychiatric department for psychological treatment. Syphilis and HIV are the predominant infections, showing the critical necessity of administering appropriate medical treatment, such as antiretroviral therapy and comprehensive STI management, with psychological assessment and management to enhance the psychological well-being of sexually abused individuals.

Background: The Human Immunodeficiency Virus (HIV) is a major public health issue, particularly in underdeveloped nations, where limited knowledge contributes to high prevalence among women facing socio-economic and educational barriers. To the best of our knowledge, no study has comprehensively examined HIV knowledge among Somali married women using nationally representative data. This study aims to assess the level of comprehensive HIV knowledge and its determinants among currently married women in Somalia, identifying regions and groups with limited awareness to prioritize targeted education and healthcare interventions, support NSP goals, and provide baseline data for future efforts.

Methods: A multivariable ordinal logistic regression analysis was performed to examine the relationship between comprehensive HIV knowledge and various sociodemographic factors using data from the 2018-2019 SDHS. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to determine significant associations.

Results: The analysis revealed that 55.1% of respondents had high comprehensive knowledge of HIV. Moreover, the study found the following significant factors associated with comprehensive HIV knowledge: Women aged 30-34 had an AOR of 1.25 (95% CI: 1.02-1.53) compared to those aged 15-19. Regionally, compared to women in the Awdal region, women in Gedo had an AOR of 0.39 (95% CI: 0.29-0.52), while women in Lower Juba had an AOR of 0.52 (95% CI: 0.38-0.69). Women in nomadic settings had an AOR of 0.61 (95% CI: 0.51-0.74) compared to urban dwellers. Women with higher education had an AOR of 3.04 (95% CI: 1.85-5.00) compared to uneducated women. Women in the highest wealth quintile had an AOR of 1.28 (95% CI: 1.03-1.59) compared to the poorest women.

Conclusion: The findings stress the need for public campaigns in rural, nomadic, and urban areas with limited HIV knowledge. Interventions should prioritize improving education access and enhancing media outreach to boost awareness and prevention efforts among Somali women.

Purpose: Numerous studies focus on stigma, HIV disclosure's impact on treatment compliance, especially in younger groups. Limited research exists about older individuals. We therefore explored issues related to disclosure of HIV status and HIV-related stigma in the elderly.

Patients and methods: This was an exploratory qualitative study, employing Straussian Grounded Theory. We enrolled individuals aged 60 and above, living with HIV and receiving care from the Infectious Disease Institute, Uganda. We conducted 4 focus group discussions to explore HIV related stigma and self-disclosure in participants using questionnaires that we had developed and pilot-tested. The discussions were audio recorded, transcribed and translated. Using NVivo software package for qualitative analysis, we developed primary and secondary nodes and subsequent emergent themes.

Results: We recruited 38 participants for the focus group discussions. Emergent themes were: types of disclosure, reasons for disclosure or non-disclosure, who was disclosed to and the reasons for disclosure, experienced stigma and resolving dissonance in non-disclosure.

Conclusion: Our findings reveal HIV-related challenges for the elderly due to stigma and disclosure. There is need to combat this situation by normalizing societal expectations, roles and sexuality in the elderly as a way of fighting HIV/AIDS related stigma.

Background: HIV self-testing (HIVST) offers a novel solution for increasing HIV testing among pregnant and postpartum women and their male partners, especially in low-resource settings. These groups often face barriers such as stigma, fear, and limited access to traditional HIV-testing services.

Methods: We reviewed qualitative and quantitative studies focusing on HIVST implementation in both public and private healthcare settings among pregnant and postpartum women and male partners in sub-Saharan Africa (SSA), analyzed uptake, male involvement, and barriers. Articles from Scopus, PubMed, and Google Scholar were included to examine public and private settings, distribution models, and psychosocial support.

Results: HIVST showed substantial success in increasing the testing rates. For example, maternal retesting during pregnancy has increased by 35% in Kenya due to the adoption of HIVST. The secondary distribution also drove male partner testing, with 90.8% of male partners accepting HIVST kits from their pregnant partners in South Africa and 75.4% participating in couple testing. Combining HIVST with clinical invitations increased both female and male testing 12-fold in other studies. Despite these successes, challenges persisted, with approximately 30% of women testing HIV-positive not returning to follow-up care. In addition, a few women reported adverse partner reactions, including intimate partner violence (IPV), after delivering HIVST kits.

Conclusion: HIVST presents a critical opportunity to close gaps in HIV prevention between pregnant women and their male partners. Addressing barriers, such as stigma and enhancing male partner involvement, provides a pathway for more equitable testing practices. Scaling up successful community-based and secondary distribution models, alongside addressing challenges such as follow-up care and IPV concerns, is essential for reducing HIV transmission in SSA.

Background: Older people living with HIV (PLHIV) are at high risk of developing geriatric syndromes. Data on geriatric syndromes among older PLHIV in sub-Saharan Africa are scarce. We examined sex differences in the prevalence and correlates of geriatric syndromes among PLHIV aged ≥60 years on antiretroviral therapy in Kampala, Uganda.

Methods: This cross-sectional study analyzed data obtained during the enrollment of older PLHIV into a prospective observational cohort in Kampala. We used the Poisson regression model to explore the association between the number of geriatric syndromes and non-communicable diseases (NCDs), sociodemographic factors, and HIV-related factors.

Results: We included 500 participants (48.8% women) with a median age of 64 years (interquartile range, IQR: 62.68). Almost all (94.4%) participants had at least one geriatric syndrome. More women were frail (13.1% vs 5.1%, P-value = 0.01) and had lower physical performance measured using the Short Physical Performance Battery (43.3% vs 26.6%, P-value < 0.01). Similarly, more women had cognitive impairment (83.2% vs 62.9%, P-value < 0.01) and reported falling (48.8% vs 34.0%, P-value < 0.01). Women (adjusted mean ratio, AMR 1.17, 95% CI 1.05-1.30, P-value < 0.01), older age (AMR 1.11, 95% CI 1.07-1.16, P-value < 0.01), no formal education (AMR 1.39, 95% CI 1.06-1.82, P-value = 0.01), underweight (AMR 1.49, 95% CI 1.26-1.76, P-value < 0.01), World Health Organization (WHO) stage 3 or 4 (AMR 1.11, 95% CI 0.01-1.22, P-value = 0.04) and having two or more NCDs (AMR 1.11, 95% CI 1.00-1.23, P-value = 0.04) were associated with a higher number of geriatric syndromes.

Conclusion: The prevalence of geriatric syndromes was high among older PLHIV and was more common in women. There is a need to incorporate the screening and management of geriatric syndromes into the care of older PLHIV in sub-Saharan Africa, with a particular focus on women.

Background: In the landscape of HIV treatment, combined antiretroviral therapy (cART) is a cornerstone in managing viral loads and boosting CD4+ T-cell counts. Nevertheless, disparities in treatment outcomes remain persistent, and a subset of children fail to achieve adequate immunologic reconstitution (IR). This study aims to investigate the demographic and clinical factors associated with inadequate IR in HIV-infected children in Eritrea.

Methodology: A retrospective observational study was conducted on 822 children followed at Orotta National Pediatric Referral Hospital between 2005 and 2020. Two distinct analyses were performed, with univariate and multivariate logistic regression models employed to investigate risk factors contributing to inadequate immunologic reconstitution (IR) at the study endpoints of 6- and 12-months post-cART initiation.

Results: From the initial cohort of 822 patients [53.4% were males, cohort median age at cART initiation was 78 (IQR: 48-101) months and median absolute CD4 count 270 (151-441) cells/µL]. Two separate analyses were conducted on two cohort subsets with complete data, including 456 children at the 6-month mark and 495 children at 12 months of follow-up. Following 6 months on cART, Immunologic reconstitution was achieved in 87.8% (95% CI: 84.3-91.2) and increased to 90.4% (95% CI: 87.3-93.5) after 12 months of treatment. Independent predictors of inadequate IR after 6 months of cART were higher baseline absolute CD4 counts (aOR = 1.003, (95% CI: 1.002-1.005); p-value <0.001) and NNRTI (EFV: aOR = 3.9, (95% CI: 1.3-11.9); p-value = 0.01). Meanwhile, gender (females: aOR = 0.3, (95% CI: 0.1-0.9, p-value = 0.03) and higher baseline absolute CD4 counts (aOR = 1.003, (95% CI: 1.002-1.005); p-value < 0.001) were independent risk factors of inadequate IR after 12 months of treatment.

Conclusion: The study underscores the interplay of baseline CD4 count, gender, and regimen choice in shaping the effectiveness of cART in children. Lower baseline absolute CD4 count was associated with IR after starting cART. Notably, children on EFV had a higher likelihood of inadequate IR after 6 months, and male children were more prone to insufficient IR at 12 months. Targeting these population-specific factors may be pivotal in advancing gender-responsive therapeutic strategies and improving health outcomes for HIV-infected children in sub-optimal clinical settings and resource-constrained environments.

Background: Majority of deliveries occurring in the Cameroon part of the Lake Chad basin is assisted by traditional birth attendants (TBA). The aim of the present study was to assess if training and involving TBA in community-based Prevention of Mother to Child Transmission (PMTCT) interventions can contribute in improving targeted population access to these interventions.

Methods: This was a retrospective cohort study that assessed among mothers of children aged 0-24 months the effect of training and involving TBA in PMTCT activities. The exposed mother-child pairs were those inhabiting communities were TBA were trained and involved during the 24 previous months in PMTCT activities (exposed communities) while the non-exposed groups where those living in communities with no study intervention. Data were collected in households selected by stratified cluster random sampling from children's mothers or guardians using a face-to-face administered questionnaire (undocumented) and from antenatal booklets (documented) used in health facilities to record antenatal care.

Results: A total of 637 mothers-children couples were included, 416 (65.3%) in the exposed group and 221 (34.7%) in the control group. Exposed mother-child pairs had significantly higher documented access to mother antenatal HIV testing compared to the couples living in non-exposed communities with adjusted relative risk (ARR) of 4.20 (2.52-6.99). The mean number of antenatal consultations was significantly higher in the exposed group (Student T-test =6.00, p= 0.000). However, this exposure to community with trained TBA increased but not significantly the proportion of pregnant women who benefit from antenatal consultations (ARR=0.94 (0.70-1.25), p=0.678) and those who withdraw their HIV test results (X2 = 0.271, p=0.786).

Conclusion: The training and involvement of TBA in delivering PMTCT interventions at the community level can improve population access to these interventions. The consistency of these findings should be tested in other communities in needs and with other health care interventions.

Background: Uganda faces a significant dual challenge with tuberculosis (TB), ranking among these countries most affected by the disease worldwide. The World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for managing latent TB. However, the adherence to IPT in military settings remains under-explored in Uganda. This study aims to assess IPT adherence and identify its predictors among soldiers undergoing HIV antiretroviral therapy at a General Military Hospital in Uganda.

Methodology: We conducted a cross-sectional study involving 300 HIV-positive soldiers receiving antiretroviral therapy (ART) at the General Military Hospital in Uganda. Due to the small sample size, we employed a consecutive sampling method. We utilized descriptive statistics and modified Poisson regression model for prevalence of IPT adherence and associated factors respectively.

Results: Among the 300 clients, the prevalence of isoniazid preventive therapy (IPT) was 94.7%, 95% CI: 92.1-97.2; adherence to IPT was associated with being aged ≥ 50 years, with a prevalence ratio (PR) of 1.061 and 95% CI: 1.01-1.12; being married, with a PR of 1.438, 95% CI:1.12-1.84; having social support, with a PR of 1.498, 95% CI:1.17-1.92; and having social support played a significant role in IPT adherence among married participants, with a PR of 0.817,95% CI:0.72-0.93.

Conclusion: To enhance adherence to isoniazid preventive therapy among young soldiers with HIV, targeted interventions are crucial, as older individuals tend to adhere better. Implementing marital support programs and strengthening community engagement can bolster adherence through social support networks. Educational campaigns should focus on the importance of IPT, while regular follow-ups will ensure effective monitoring and support. Further research is needed to explore how social support can mitigate stigma associated with HIV. The findings highlight the importance of improving IPT adherence among married soldiers and suggest that this approach could be effective in other low-resource settings.

Purpose: AIDS presents serious harms to public health worldwide. In this paper, we used five single models: ARIMA, SARIMA, Prophet, BP neural network, and LSTM method to model and predict the number of monthly AIDS incidence cases and mortality cases in China. We have also proposed the LSTM-SARIMA combination model to enhance the accuracy of the prediction. This study provides strong data support for the prevention and treatment of AIDS.

Methods: We collected data on monthly AIDS incidence cases and mortality cases in China from January 2010 to February 2024. Among them, for modeling, we used data from January 2010 to February 2021 and the rest for validation. Treatments were applied to the dataset based on its characteristics during modeling. All models in our study were performed using Python 3.11.6. Meanwhile, we used the constructed model to predict monthly incidence and mortality cases from March 2024 to July 2024. We then evaluated our prediction results using RMSE, MAE, MAPE, and SMAPE.

Results: The deep learning methods of LSTM and BPNN outperform ARIMA, SARIMA, and Prophet in predicting the number of mortality cases. When predicting the number of AIDS incidence cases, there is little difference between the two types of methods, and the LSTM method performs slightly better than the rest of the methods. Meanwhile, the average error in predicting AIDS mortality cases is significantly lower than in predicting AIDS incidence cases. The LSTM-SARIMA method outperforms other methods in predicting AIDS incidence and mortality.

Conclusion: Due to the different characteristics of the AIDS incidence and mortality cases series, the performance of distinct methods is slightly different. The AIDS mortality series is smoother than the incidence series. The combined LSTM-SARIMA model outperforms the traditional method in prediction and the LSTM method alone, which is of practical significance for optimizing the prediction results of AIDS.

Background: The benefits of antiretroviral therapy (ART) for people living with HIV/AIDS (PLHIV) include immune system strengthening, viral load suppression, and improved health-related quality of life (HRQOL). This present study compares the HRQOL of PLHIV visiting ART clinics versus that of PLHIV attending traditional healers (THs)' offices, assesses the adherence of PLHIV to ART, identifies possible predictors of nonadherence of PLHIV to ART and HRQOL, and estimates the proportion of patients with HIV referred by THs to health centers in Bukavu.

Patients and methods: Between February and June 2023, a cross-sectional comparative study was conducted on 150 adult PLHIV attending ART clinics and 150 adult PLHIV visiting THs' offices in the 3 urban health zones of Bukavu. The World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and a self-report questionnaire measuring ART adherence were used to collect the data. Regression models were used to identify the predictors of no adherence to ART and the HRQOL of PLHIV.

Results: Compared with those attending THs, PLHIV attending ART clinics had higher mean scores in all HRQOL domains. Approximately 84% of the participants were compliant with ART. The predictors associated with nonadherence to ART included illiterate participants [OR=23.3 (95% CI=1.23-439.5), p=0.004] and divorced or separated participants [OR=10.3 (95% CI=1.12-94.4), p=0.034]. The proportion of PLHIV referred to ART clinics by THs was only 10.7%.

Conclusion: PLHIV visiting ART clinics had a better HRQOL than did PLHIV attending THs' offices. The rate of adherence to ART among PLHIV who attended ART clinics was high. It is recommended that PLHIV visiting THs be referred to ART clinics for improved HRQOL.