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Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia. 纳米比亚温得和克公共初级卫生保健机构为解决未接受艾滋病毒治疗的青少年的治疗缺口而采取的卫生系统应对措施》(Health System Responses to Address Treatment Gaps of Unsuppressed Adolescents on HIV Treatment in Public Primary Health Care Facilities in Windhoek, Namibia)。
IF 1.5 Q4 INFECTIOUS DISEASES Pub Date : 2024-07-10 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S459124
Farai Kevin Munyayi, Brian van Wyk

Background: Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia.

Methods: We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis.

Results: The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success.

Conclusion: The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.

背景:青少年艾滋病病毒感染者(ALHIV)面临着独特的挑战,导致在实现和维持抑制病毒载量方面持续存在差距。虽然解决青少年治疗差距的有效循证干预措施现成可用,但在资源有限、HIV 感染率高的环境中,卫生系统在实施这些干预措施以实现疫情控制方面面临挑战。在此,我们介绍了纳米比亚温得和克卫生系统为解决接受抗逆转录病毒治疗的未抑制 ALHIV 的治疗缺口而采取的应对措施:我们于 2023 年 6 月至 10 月在温得和克开展了一项定性描述和探索性研究。我们有目的地选择了 19 位关键信息提供者进行了访谈,其中既有儿科艾滋病项目经理,也有医疗服务提供者。对深入访谈进行了录音和逐字记录。笔录上传到 ATLAS.ti,并进行了主题分析:四个主要专题阐明了与坚持治疗和保留治疗相关的挑战,以及卫生系统以干预和支持计划的形式采取的应对措施。ALHIV 在坚持服药和继续服药方面面临的主要挑战是心理健康问题、行为和药物相关挑战以及护理和社会支持不足。卫生系统应对这些挑战的措施包括提供社会心理支持、同伴支持、优化治疗和护理,以及采用有效的服务提供模式。已确定的关键卫生系统支持要素包括能力充足的人力资源、高效的药品供应链系统、创造和维护有利于优化护理的环境,以及对计划成功至关重要的强有力的监测系统:为解决温得和克未受抑制的 ALHIV 剩余的治疗缺口问题,卫生系统采取了多种应对措施,尽管这些措施以证据为基础,但似乎各自为政。我们建议提供统一的、多方面的指导,整合社会心理、治疗、护理和同伴引导支持,并加强以客户为中心的差异化服务模式,为未接受治疗的青少年提供服务。
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引用次数: 0
Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania. 坦桑尼亚乞力马扎罗山地区艾滋病病毒感染者忘记服药、坚持治疗及其与病毒载量抑制的关系。
IF 1.5 Q2 Medicine Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S452875
Lyidia V Masika, Innocent B Mboya, Rehema Anenmose Maro, Benson Mtesha, Mtoro J Mtoro, Kennedy Ngowi, Michael Johnson Mahande, I Marion Sumari-de Boer

Background: Antiretroviral therapy (ART) adherence is crucial for virological suppression and positive treatment outcomes among people living with HIV (PLHIV), but remains a challenge in ensuring patients achieve and sustain viral load suppression. Despite the recommended use of digital tools medications uptake reminders, the contribution of forgetting to take medication is unknown. This study investigated the contribution of forgetting to take medication on the total missed medication and its effects on detectable viral load (VL).

Methods: This mixed-method research was conducted among children, adolescents, pregnant, and breastfeeding women living with HIV on ART in northern Tanzania. Forgetting to take medication constituted reporting to have missed medication due to forgetfulness. A multivariable logistic regression model was used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to determine the contribution of forgetting medication intakes on total missed medication and other factors associated with having a detectable VL.

Results: Of 427 respondents, 33.3% were children, 33.4% adolescents, and 33.3% pregnant and breastfeeding women, whose median age (interquartile range) was 9 (7-12), 18 (16-18), and 31 (27-36) years, respectively. Ninety-two (22.3%) reported missing medication over the past month, of which 72 (17.9%) was due to forgetting. Forgetting to take medication (AOR: 1.75 95% CI: 1.01-3.06) and being on second-line regimen (AOR: 2.89 95% CI: 1.50-5.55) increased the chances of a detectable VL, while females had lower chances of detectable VL (AOR: 0.62 95% CI: 0.41-0.98). The themes on the reasons for forgetting to take medication from qualitative results included being busy with work and the importance of reminders.

Conclusion: Forgetting to take medication is common among PLHIV and an important predictor of a detectable VL. This calls for the use of automated short message services (SMS) reminders or Digital Adherence Tools with reminders to improve and promote good ART adherence among PLHIV.

背景:坚持抗逆转录病毒疗法(ART)对于艾滋病病毒感染者(PLHIV)的病毒学抑制和积极治疗效果至关重要,但在确保患者实现并维持病毒载量抑制方面仍存在挑战。尽管建议使用数字工具提醒服药,但忘记服药的影响尚不清楚。本研究调查了忘记服药对漏服药物总量的影响及其对可检测到的病毒载量(VL)的影响:这项混合方法研究的对象是坦桑尼亚北部接受抗逆转录病毒疗法的儿童、青少年、孕妇和哺乳期女性艾滋病感染者。遗忘服药是指因遗忘而漏服药物。采用多变量逻辑回归模型估算调整后的几率比(AOR)和 95% 的置信区间(CI),以确定忘记服药对总漏服药物量的影响以及与检测到 VL 相关的其他因素:在 427 名受访者中,33.3% 是儿童,33.4% 是青少年,33.3% 是孕妇和哺乳期妇女,她们的中位年龄(四分位数间距)分别为 9(7-12)岁、18(16-18)岁和 31(27-36)岁。有 92 人(22.3%)报告在过去一个月中遗漏服药,其中 72 人(17.9%)是因为忘记服药。忘记服药(AOR:1.75 95% CI:1.01-3.06)和服用二线药物(AOR:2.89 95% CI:1.50-5.55)会增加检测到 VL 的几率,而女性检测到 VL 的几率较低(AOR:0.62 95% CI:0.41-0.98)。定性结果中关于忘记服药原因的主题包括工作繁忙和提醒的重要性:结论:忘记服药在 PLHIV 中很常见,也是检测到 VL 的一个重要预测因素。这就需要使用自动短信服务(SMS)提醒或带有提醒功能的数字坚持治疗工具来改善和促进艾滋病毒携带者坚持抗逆转录病毒疗法。
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引用次数: 0
Healthcare Workers' Perspectives on the Utilization of the International HIV Dementia Scale for the Screening HIV-Associated Neurocognitive Disorders: A Qualitative Study at TASO Centres in Central and Southwestern Uganda. 医护人员对使用国际艾滋病痴呆量表筛查艾滋病相关神经认知障碍的看法:乌干达中部和西南部 TASO 中心的定性研究。
IF 1.5 Q2 Medicine Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S444668
Jane Kasozi Namagga, Godfrey Zari Rukundo, Vincent Batwala, Vallence Niyonzima, Hanifah Nantongo, Grace Nambozi

Introduction: HIV-associated neurocognitive disorders (HAND) are becoming a significant public health concern in the continuum of human immune virus (HIV) treatment. These disorders range from subtle cognitive impairments to severe dementia. Despite many early-stage HAND cases being asymptomatic, healthcare workers (HCWs) rarely perform routine neurocognitive assessments. This leads to a high number of unrecognized cases and increases the risk of HAND among people living with HIV (PLWH).

Material and methods: We aimed to explore HCWs' perspectives on integrating the International HIV Dementia Scale (IHDS) into routine care for screening HAND at The AIDS Support Organization (TASO) centres in central and southwestern Uganda.

Results: We conducted five focus group discussions with 37 HCWs from five TASO centres. Thematic analysis revealed eight key theme: 1) Impaired brain function, 2) Changes in activities of daily living, 3) Promotion of quality care perspectives, 4) Tool applicable and user-friendly, 5) Client increased self-awareness and self-confidence, 6) Integration of IHDS into routine HIV care, 7) Uncertainty about IHDS use, and 8) Continuous training for HCWs.

Conclusion: As PLWH enjoy longer and healthier lives, their risk for HAND increases, potentially affecting their quality of life. The use of the IHDS has raised awareness among HCWs and improved decision-making through cognitive assessments, emphasizing it value in PLWH. We recommend a prospective study to assess the long-term outcomes and efficacy of increased HAND screening. Furthermore, integrating a HAND screening module into the consolidated HIV guidelines is recommended to enhance its relevance.

导言:艾滋病毒相关神经认知障碍(HAND)正成为人类免疫病毒(HIV)治疗过程中的一个重要公共卫生问题。这些疾病包括从细微的认知障碍到严重的痴呆。尽管许多早期 HAND 病例并无症状,但医护人员(HCWs)却很少进行常规神经认知评估。这导致大量病例未被发现,并增加了艾滋病病毒感染者(PLWH)罹患 HAND 的风险:我们的目的是在乌干达中部和西南部的艾滋病支持组织(TASO)中心,探讨医护人员对将国际艾滋病痴呆量表(IHDS)纳入常规护理以筛查 HAND 的看法:我们与来自五个 TASO 中心的 37 名医护人员进行了五次焦点小组讨论。主题分析揭示了八个关键主题:1)大脑功能受损;2)日常生活活动的改变;3)促进优质护理的观点;4)工具的适用性和用户友好性;5)客户自我意识和自信心的增强;6)将 IHDS 纳入常规 HIV 护理;7)IHDS 使用的不确定性;8)对医护人员的持续培训:随着 PLWH 寿命的延长和健康状况的改善,他们患手足口病的风险也在增加,这可能会影响他们的生活质量。IHDS 的使用提高了医护人员的认识,并通过认知评估改善了决策,强调了其在 PLWH 中的价值。我们建议开展一项前瞻性研究,以评估增加手足口病筛查的长期效果和有效性。此外,我们还建议将手足口病筛查模块纳入艾滋病综合指南,以提高其相关性。
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引用次数: 0
Trends of HIV Infection and Progress Towards the 95-95-95 Targets in Gambella Regional State from 2019 to 2023, Southwest ETHIOPIA. 2019 至 2023 年甘贝拉地区州艾滋病毒感染趋势和实现 95-95-95 目标的进展情况,西南埃塞俄比亚。
IF 1.5 Q2 Medicine Pub Date : 2024-05-06 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S457550
Asmelash Abera Mitiku, Abraham Lomboro Dimore, Wiw Gach

Background: In 2022, there were 1.3 million new HIV infections, 630,000 AIDS-related deaths, and 39.0 million HIV-positive individuals worldwide. To put the world on track to eradicate AIDS by 2030, there are ambitious goals and commitments for 2025. However, the likelihood of these goals being met or even close to being met is highly dependent on the trend of new HIV infection, the prevalence of the disease, the commitment and capability of leaders, and the application of the planned strategies to achieve the goal.

Objective: To look trend of HIV infection is changing and how far we have come toward the three 95-95-95 goals in Gambella Regional State, Southwest Ethiopia, 2023.

Methods: From August 1 to August 20, 2023, a descriptive cross-sectional study was carried out. This study included all HIV testing service clients who were enrolled in HIV care and treatment and had viral load records or tests. The data were gathered from the electronic form of the territorial reports of District Health Information Software 2 (DHIS-2). Reviewing regional DHIS-2, a standardized checklist was used. Epi-Data version 3.1 software was used to enter the data. SPSS version 25 was used for the analysis. The proposed objectives' trend was described using a descriptive statistic.

Results: The number of people living with HIV decreased by 4.5%, new HIV infections decreased by 42.28% and adult HIV prevalence decreased from 4.37% to 3.69% between 2019 and 2023. The finding showed that the region progress toward the 95-95-95 goals was 73%, 75% and 95% in 2023.

Conclusion: In the Gambella region, HIV testing services and linking HIV-positive cases to HIV treatment have increased. Despite the good progress toward achieving the three 95 targets; first 95 targets for HIV diagnosis are impractical. As a result, adequate attention is required.

背景:2022 年,全球新增 130 万艾滋病病毒感染者,63 万艾滋病相关死亡病例,3,900 万艾滋病病毒抗体阳性者。为了使世界在 2030 年之前根除艾滋病,2025 年有了雄心勃勃的目标和承诺。然而,这些目标能否实现,甚至接近实现,在很大程度上取决于艾滋病毒新感染的趋势、艾滋病的流行程度、领导人的承诺和能力,以及实现目标的计划战略的实施情况:研究埃塞俄比亚西南部甘贝拉地区州 2023 年艾滋病毒感染趋势的变化以及我们在实现 95-95-95 三个目标方面取得的进展:从 2023 年 8 月 1 日至 8 月 20 日,我们开展了一项描述性横断面研究。这项研究包括所有接受艾滋病护理和治疗并有病毒载量记录或检测的艾滋病检测服务对象。数据收集自地区卫生信息软件 2(DHIS-2)的地区报告电子版。在审查地区 DHIS-2 时,使用了标准化核对表。使用 Epi-Data 3.1 版软件输入数据。使用 SPSS 第 25 版进行分析。使用描述性统计描述了拟议目标的趋势:从 2019 年到 2023 年,艾滋病毒感染者人数减少了 4.5%,新感染艾滋病毒人数减少了 42.28%,成人艾滋病毒感染率从 4.37%降至 3.69%。调查结果显示,该地区在实现 95-95-95 目标方面取得的进展分别为 73%、75% 和 2023 年的 95%:在甘贝拉地区,艾滋病毒检测服务和将艾滋病毒阳性病例与艾滋病毒治疗联系起来的工作有所增加。尽管在实现三个 95 目标方面取得了良好进展,但艾滋病毒诊断的第一个 95 目标并不切实际。因此,需要给予足够的重视。
{"title":"Trends of HIV Infection and Progress Towards the 95-95-95 Targets in Gambella Regional State from 2019 to 2023, Southwest ETHIOPIA.","authors":"Asmelash Abera Mitiku, Abraham Lomboro Dimore, Wiw Gach","doi":"10.2147/HIV.S457550","DOIUrl":"10.2147/HIV.S457550","url":null,"abstract":"<p><strong>Background: </strong>In 2022, there were 1.3 million new HIV infections, 630,000 AIDS-related deaths, and 39.0 million HIV-positive individuals worldwide. To put the world on track to eradicate AIDS by 2030, there are ambitious goals and commitments for 2025. However, the likelihood of these goals being met or even close to being met is highly dependent on the trend of new HIV infection, the prevalence of the disease, the commitment and capability of leaders, and the application of the planned strategies to achieve the goal.</p><p><strong>Objective: </strong>To look trend of HIV infection is changing and how far we have come toward the three 95-95-95 goals in Gambella Regional State, Southwest Ethiopia, 2023.</p><p><strong>Methods: </strong>From August 1 to August 20, 2023, a descriptive cross-sectional study was carried out. This study included all HIV testing service clients who were enrolled in HIV care and treatment and had viral load records or tests. The data were gathered from the electronic form of the territorial reports of District Health Information Software 2 (DHIS-2). Reviewing regional DHIS-2, a standardized checklist was used. Epi-Data version 3.1 software was used to enter the data. SPSS version 25 was used for the analysis. The proposed objectives' trend was described using a descriptive statistic.</p><p><strong>Results: </strong>The number of people living with HIV decreased by 4.5%, new HIV infections decreased by 42.28% and adult HIV prevalence decreased from 4.37% to 3.69% between 2019 and 2023. The finding showed that the region progress toward the 95-95-95 goals was 73%, 75% and 95% in 2023.</p><p><strong>Conclusion: </strong>In the Gambella region, HIV testing services and linking HIV-positive cases to HIV treatment have increased. Despite the good progress toward achieving the three 95 targets; first 95 targets for HIV diagnosis are impractical. As a result, adequate attention is required.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Time to Treatment Failure and Its Predictors Among Second-Line ART Clients in Amhara Region, Ethiopia: A Retrospective Follow-Up Study. 埃塞俄比亚阿姆哈拉地区二线抗逆转录病毒疗法患者治疗失败的时间及其预测因素:回顾性随访研究。
IF 1.5 Q2 Medicine Pub Date : 2024-05-02 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S455885
Habtamu Wagnew Abuhay, Tizazu Endalew, Tilahun Yemanu Birhan, Achenef Asmamaw Muche

Background: Second-line antiretroviral treatment failure has become a major public health issue, and the time to treatment failure among second-line ART clients varies globally, and the Sub-Saharan African region having a high rate of second-line ART treatment failures. In addition, after the ART treatment guideline changed there is limited information on Ethiopia. Therefore, this study aimed to assess time to treatment failure and its determinants among second-line ART clients in Amhara Region, Ethiopia.

Methods: A multi-centered retrospective follow-up study was conducted. A random sample of 860 people on second-line ART was selected by using a computer-generated simple random sampling technique from January 30, 2016, to January 30, 2021, at the University of Gondar Compressive Specialized Hospital, Felege Hiwot Compressive Specialized Referral Hospital, and Debre Tabor Compressive Specialized Referral Hospital, in Amhara region, Ethiopia. Data was captured using a checklist.

Results: A total of 81 (9.4%) ART clients developed second-line treatment failure, with a median follow-up time of 29 months with an interquartile range (IQR: 18, 41]. The risk of second-line treatment failure is higher among patients aged 15 to 30 years (adjusted hazard ratio (AHR) = 2.01, 95% confidence interval (CI): [1.16, 3.48]). Being unable to read and write (AHR = 1.312, 95% CI: [1.068, 1.613]), and poor ART drug adherence (AHR = 3.067, 95% CI: [1.845, 5.099]) were significant predictors of second-line ART treatment failures.

Conclusion: In the current study, the time to second-line ART treatment failure was high compared with a previous similar study in Ethiopia. Factors like being younger age, ART clients who are not being able to read and write, and having poor ART drug adherence was significant predictors of second-line ART treatment failure.

背景:二线抗逆转录病毒疗法治疗失败已成为一个重大的公共卫生问题,全球二线抗逆转录病毒疗法患者治疗失败的时间各不相同,撒哈拉以南非洲地区的二线抗逆转录病毒疗法治疗失败率较高。此外,在抗逆转录病毒疗法治疗指南变更后,有关埃塞俄比亚的信息非常有限。因此,本研究旨在评估埃塞俄比亚阿姆哈拉地区二线抗逆转录病毒疗法患者治疗失败的时间及其决定因素:方法:开展了一项多中心回顾性随访研究。从 2016 年 1 月 30 日至 2021 年 1 月 30 日,在埃塞俄比亚阿姆哈拉地区的贡达尔大学压缩专科医院、Felege Hiwot 压缩专科转诊医院和 Debre Tabor 压缩专科转诊医院,使用计算机生成的简单随机抽样技术随机抽取了 860 名二线抗逆转录病毒疗法患者。数据采用核对表采集:共有 81 名(9.4%)抗逆转录病毒疗法患者出现二线治疗失败,随访时间中位数为 29 个月,四分位数间距(IQR:18-41])。15-30 岁的患者二线治疗失败的风险更高(调整后危险比 (AHR) = 2.01,95% 置信区间 (CI):[1.16, 3.48])。不识字(AHR = 1.312,95% CI:[1.068, 1.613])和抗逆转录病毒疗法药物依从性差(AHR = 3.067,95% CI:[1.845, 5.099])是二线抗逆转录病毒疗法治疗失败的重要预测因素:结论:与之前在埃塞俄比亚进行的类似研究相比,本次研究中抗逆转录病毒疗法二线治疗失败的时间较长。年龄较小、抗逆转录病毒疗法患者不识字、抗逆转录病毒疗法药物依从性差等因素是二线抗逆转录病毒疗法治疗失败的重要预测因素。
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引用次数: 0
A Review and Case Study of Genital and Extragenital Human Papillomavirus Type 6 and 11 Infections in Men Who Have Sex with Men Accompanied by Human Immunodeficiency Virus Infection. 对伴有人类免疫缺陷病毒感染的男男性行为者生殖器和生殖器外人类乳头瘤病毒 6 型和 11 型感染的综述和病例研究。
IF 1.5 Q2 Medicine Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S451989
Pati Aji Achdiat, Rita Septharina, Rasmia Rowawi, Hartati Purbo Dharmadji, Diah Puspitosari, Hermin Aminah Usman, Retno Hesty Maharani

Extragenital warts caused by HPV types 6 and 11 are rarely reported. However, major risk factors for anogenital warts (AGW) include men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) infection. The incidence of extragenital warts among these populations has not been reported. This study presented a case report of a 33-year-old male with high-risk sexual behavior who showed symptoms of flesh-colored and hyperpigmentation papules. Furthermore, verrucous surfaces were observed at genital and extragenital. The patient had a history of using the same razor for pubic and armpit hair, bathing with a mesh scrub, and scratching the anal area. The histopathological result showed koilocytes, while polymerase chain reaction (PCR) examination for both genital and extragenital lesions confirmed HPV type 6 and 11. This represented the first reported case describing the incidence of extragenital and AGW caused by HPV types 6 and 11. The transmission of extragenital warts was facilitated through fomites autoinoculation, particularly in the immunocompromised condition induced by HIV, which was common among MSM. Extragenital warty-like lesions were considered as warts caused by HPV type 6/11, in HIV-infected persons, specifically MSM.

由 HPV 6 型和 11 型引起的生殖器外疣很少见报道。然而,生殖器疣(AGW)的主要风险因素包括男男性行为者(MSM)和人类免疫缺陷病毒(HIV)感染。这些人群中生殖器外疣的发病率尚未见报道。本研究报告了一例 33 岁男性高危性行为患者的病例,该患者出现肉色和色素沉着丘疹症状。此外,还在生殖器和生殖器外观察到疣状表面。患者曾用同一把剃须刀剃阴毛和腋毛,用网状磨砂膏洗澡,并搔抓肛门部位。组织病理结果显示为柯伊氏细胞,而生殖器和生殖器外病变的聚合酶链反应(PCR)检查证实了 6 型和 11 型人乳头瘤病毒。这是首次报道由 6 型和 11 型 HPV 引起的生殖器外疣和成人疣。生殖器外尖锐湿疣的传播是通过寄生虫自体接种的方式进行的,尤其是在艾滋病病毒引起的免疫功能低下的情况下,这在男男性行为者中很常见。在艾滋病毒感染者,特别是男男性行为者中,生殖器外疣状病变被认为是由 6/11 型 HPV 引起的疣。
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引用次数: 0
Exploring Effective Approaches: Integrating Mental Health Services into HIV Clinics in Northern Uganda. 探索有效方法:将心理健康服务纳入乌干达北部的艾滋病诊所。
IF 1.5 Q2 Medicine Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S459461
Amir Kabunga, Halimah Namata, Eustes Kigongo, Marvin Musinguzi, Raymond Tumwesigye, Anna Grace Auma, Jannat Nabaziwa, Enos Mwirotsi Shikanga, Ponsiano Okalo, Viola Nalwoga, Samson Udho

Background: Integrating mental health services into HIV clinics is recognized as a promising strategy. However, the literature reveals gaps, particularly in the unique context of Northern Uganda, where factors such as historical conflict, stigma, and limited resources pose potential barriers.

Material and methods: This qualitative study, conducted between October and November 2023, employed a phenomenological design. The study involved primary healthcare facilities across diverse urban and rural settings, focusing on healthcare providers, village health teams, and service users. A purposive sampling approach ensured diverse demographics and perspectives. In-depth interviews and focus group discussions were conducted, with healthcare providers and service users participating individually, and village health teams engaged in group discussions. Thematic analysis was employed during data analysis.

Results: Findings revealed a predominance of females among healthcare providers (18 of 30) and service users (16 of 25), as well as in VHTs. Average ages were 33.4 (healthcare providers), 38.5 (service users), and 35.1 (VHTs). Most healthcare providers (15) held diplomas, while 12 service users and 4 VHTs had certificates. The majority of healthcare providers (n=20) and 4 VHTs had 6-10 years of experience. Thematic analysis highlighted three key themes: benefits of integrated mental health services, implementation challenges, and the role of community engagement and cultural sensitivity.

Conclusion: This study contributes valuable insights into the integration of mental health services into HIV clinics in Northern Uganda. The perceived benefits, challenges, and importance of cultural sensitivity and community engagement should guide future interventions, fostering a holistic approach that enhances the overall well-being of individuals living with HIV/AIDS in the region. Policymakers can use this information to advocate for resource allocation, training programs, and policy changes that support the integration of mental health services into HIV clinics in a way that addresses the identified challenges.

背景:将心理健康服务纳入艾滋病诊所被认为是一项很有前景的策略。然而,文献显示存在差距,尤其是在乌干达北部的独特背景下,历史冲突、污名化和资源有限等因素构成了潜在的障碍:这项定性研究于 2023 年 10 月至 11 月间进行,采用了现象学设计。研究涉及城市和农村不同环境下的初级医疗保健设施,重点关注医疗保健提供者、村卫生小组和服务使用者。有目的的抽样方法确保了人口统计学和观点的多样性。研究人员进行了深入访谈和焦点小组讨论,医疗服务提供者和服务使用者单独参与,村卫生小组参与小组讨论。数据分析采用了主题分析法:调查结果显示,在医疗服务提供者(30 人中有 18 名女性)、服务使用者(25 人中有 16 名女性)以及村卫生队中,女性占绝大多数。平均年龄为 33.4 岁(医疗服务提供者)、38.5 岁(服务使用者)和 35.1 岁(志愿服务队)。大多数医疗服务提供者(15 人)持有文凭,12 名服务使用者和 4 名志愿服务队成员持有证书。大多数医疗服务提供者(20 人)和 4 名志愿服务队成员拥有 6-10 年的工作经验。专题分析强调了三个关键主题:综合心理健康服务的益处、实施挑战以及社区参与和文化敏感性的作用:本研究为乌干达北部艾滋病诊所整合心理健康服务提供了宝贵的见解。我们所认识到的益处、挑战以及文化敏感性和社区参与的重要性应能指导未来的干预措施,促进采取综合方法,提高该地区艾滋病毒/艾滋病感染者的整体健康水平。政策制定者可以利用这些信息来倡导资源分配、培训计划和政策变革,以支持将心理健康服务纳入艾滋病诊所,从而应对已发现的挑战。
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引用次数: 0
Determinants of Loss to Follow Up Among Adult People Living with HIV Enrolled in Antiretroviral Therapy in West Wollega Public Hospitals, Oromia, Ethiopia. 埃塞俄比亚奥罗米亚州西沃勒加公立医院接受抗逆转录病毒疗法的成年艾滋病病毒感染者失去随访的决定因素。
IF 1.5 Q2 Medicine Pub Date : 2024-02-26 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S426196
Siraj Benti Biratu, Abreha Addis Gesese

Background: Antiretroviral Treatment (ART) reduces morbidity and mortality in patients with human immunodeficiency virus (HIV). However, clients loss to follow-up (LTFU) from the treatment poses a paramount problem to the public, healthcare, and patient outcome. Thus, this study identified determinants of loss to follow-up to ART among adult clients in West Wollega hospitals, Oromia, Ethiopia, in 2021.

Methods: An unmatched case-control study was conducted and a systematic random sampling technique was used. Data were collected from patient charts by three BSC nurses and three card reporters using a structured checklist. Then, it was entered into Epi-data version 3.1 and analyzed using SPSS version 21. Descriptive statistics (frequency and percentage) were used to present the results. Bivariate and multivariable logistic regression analyses were performed using the backward stepwise method. Adjusted odds ratio (AOR) and p-values <0.05 were used to declare significant association with loss to follow-up. Model fitness was checked using Hosmer-Lemeshow goodness-of-fit.

Results: A total of 399 (133 patients and 266 controls) participated in this study. Rural residents (AOR:3.46, 95% CI:1.65, 7.25), male patient (AOR: 2.65 95% CI 1.54,4.55), lack of formal education (AOR: 4.35, 95% CI 1.53, 12.41), base line CD4 ≤350 (AOR: 5.25, 95% CI 1.93,14.24), poor functional status (AOR: 4.298, 95% CI 5.33,34.62) and WHO stages III & IV (AOR: 2.65, 95% CI 1.68,4.19), and tuberculosis co-infection (AOR: 2.82, 95% CI 1.11,7.45) were determinant factors of loss to follow up.

Conclusion: Rural residence, male sex, daily laborer, no formal education, baseline CD4 count <350 cells/mm3, baseline advanced WHO clinical stage, and TB co-infection were determinants of LTFU. Therefore, emphasis should be given to the identified factors along with awareness creation and health education sessions. Regular TB screening, optimal adherence regardless of their stay on ART, and follow-up study are recommended.

背景:抗逆转录病毒治疗(ART)可降低人类免疫缺陷病毒(HIV)患者的发病率和死亡率。然而,患者失去治疗随访(LTFU)对公众、医疗保健和患者的治疗效果都构成了严重的问题。因此,本研究确定了 2021 年埃塞俄比亚奥罗莫州西沃勒加医院成年患者失去抗逆转录病毒疗法随访的决定因素:方法:采用系统随机抽样技术进行了一项非匹配病例对照研究。数据由三名 BSC 护士和三名记卡员使用结构化核对表从患者病历中收集。然后将数据输入 Epi-data 3.1 版,并使用 SPSS 21 版进行分析。结果采用描述性统计(频率和百分比)。采用后向逐步法进行二元和多元逻辑回归分析。调整后的几率比(AOR)和 p 值 结果:共有 399 人(133 名患者和 266 名对照者)参与了这项研究。农村居民(AOR:3.46,95% CI:1.65,7.25)、男性患者(AOR:2.65,95% CI 1.54,4.55)、缺乏正规教育(AOR:4.35,95% CI 1.53,12.41)、基线 CD4 ≤350(AOR:5.25,95% CI 1.93,14.24)、功能状况不佳(AOR:4.298,95% CI 5.33,34.62)、WHO III 期和 IV 期(AOR:2.65,95% CI 1.68,4.19)以及结核合并感染(AOR:2.82,95% CI 1.11,7.45)是随访丧失的决定性因素:农村居民、男性、日工、未受过正规教育、基线 CD4 细胞数
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引用次数: 0
Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria. 尼日利亚阿夸伊博姆州艾滋病病毒感染者(PLHIV)在获得医疗服务时遭受的侮辱和歧视。
IF 1.5 Q2 Medicine Pub Date : 2024-02-19 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S447551
Peters Adekoya, Faith D Lannap, Fatima Anne Ajonye, Stanley Amadiegwu, Ifeyinwa Okereke, Charity Elochukwu, Christopher Ayaba Aruku, Adeyemi Oluwaseyi, Grace Kumolu, Michael Ejeh, Ayodotun O Olutola, Doreen Magaji

Background: Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State.

Methods: The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14.

Results: The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization.

Conclusion: Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.

背景:最近在护理和治疗方面取得的进展已使艾滋病毒成为一种 "慢性但可控制的疾病"。尽管如此,一些艾滋病病毒感染者(PLHIV)在获得医疗保健服务方面仍然遭受着羞辱和歧视。本研究调查了阿夸伊博姆州艾滋病毒感染者遭受羞辱和歧视的经历以及获得医疗服务的情况:临床护理和临床研究中心(CCCRN)在尼日利亚阿夸伊博姆州的 12 个随机选取的地方政府辖区开展了一项基于社区的横断面调查。数据收集采用了结构化定量问卷。在获得知情同意后,共随机抽取了 425 名艾滋病毒感染者进行了访谈。使用数据分析应用程序 Stata 14 进行了描述性统计和双变量分析:研究显示,在阿夸伊博姆州,有 215 名艾滋病毒感染者(50.4%)因其艾滋病毒感染状况而无法获得医疗服务,包括牙科护理。受访者报告称,他们害怕:因为自己的阳性身份而遭受流言蜚语(78%)、辱骂(17%)、身体骚扰或攻击(13%)。自我污名化现象也很明显;受访者报告说,他们因为艾滋病毒呈阳性而感到羞耻(29%),表现出自责(16%),自卑(38%),以及自我孤立(36%)。女性、农村居民、未受过教育的艾滋病毒感染者、失业者、单身者、19 至 29 岁的年轻人和老年人更容易受到与艾滋病毒相关的侮辱:研究数据显示,在阿夸伊博姆州,因感染艾滋病毒而在健康方面遭受侮辱的艾滋病毒感染者比例很高。这一发现要求优先采取干预措施,以减少污名化、增强自尊、促进对艾滋病毒感染者的同情和怜悯。它还凸显了对家庭和社区成员以及医疗保健提供者进行艾滋病毒教育的必要性,以增强对艾滋病毒的了解,提高家庭、社区和医疗保健机构对艾滋病毒感染者的接受程度。
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引用次数: 0
The Association Between Oral Mucosal Lesions and Oral Health-Related Quality of Life Using the Validated Indonesian Version of OHIP-14 Among People Living with HIV/AIDS. 使用经过验证的印尼版 OHIP-14 研究艾滋病毒/艾滋病感染者口腔黏膜病变与口腔健康相关生活质量之间的关系。
IF 1.5 Q2 Medicine Pub Date : 2024-02-08 eCollection Date: 2024-01-01 DOI: 10.2147/HIV.S452154
Irna Sufiawati, Tuty Amalia, Tenny Setiani Dewi, Rudi Wisaksana

Background: Oral mucosal lesions in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients, posing a concern for healthcare professionals, impact their oral health-related quality of life (OHRQoL). This study aimed to evaluate the association between oral mucosal lesions and OHRQoL as measured by the validated Indonesian version of the oral health impact profile-14 questionnaire (OHIP-14) among people living with HIV/AIDS (PLWHA).

Methods: A cross-sectional study was conducted at the Central Referral Hospital in West Java, Indonesia. The validity of OHIP-14 was evaluated in 30 PLWHA using inter-item corrected correlation, while reliability was assessed through Cronbach's alpha and kappa coefficient agreement. Subsequently, a consecutive sample of 110 PLWHA self-completed the validated Indonesian version of OHIP-14 and underwent an oral examination. The association between oral mucosal lesions and OHRQoL was analyzed using the chi-squared test.

Results: The validity test of the OHIP-14 questionnaire produced a rcount > 0.189, meaning that all question items were valid and could be used to describe OHRQoL. The reliability test of the OHIP-14 questionnaire produced a Cronbach's alpha value of 0.960 (> 0.7), which means that overall, the OHIP-14 questionnaire is reliable and feasible to be used to assess OHRQoL. Among the 110 enrolled participants, 61.8% were female and 38.2% were male, with the mean age 23.5 years old, the majority of them (59.1%) had been taking antiretrovirals (ARV), and (81.5%) had good QoL. There was a statistically significant relationship between oral lesions and quality of life (p<0.05), particularly acute pseudomembranous candidiasis, angular cheilitis, recurrent intraoral herpes, and Stevens-Johnson syndrome.

Conclusion: This study indicated a significant association between oral mucosal lesions and OHRQoL in PLWHA. The successfully validated Indonesian version of the OHIP-14 questionnaire serves as a reliable and effective tool for assessing OHRQoL among PLWHA.

背景:人类免疫缺陷病毒(HIV)和获得性免疫缺陷综合征(AIDS)患者的口腔黏膜病变会影响他们与口腔健康相关的生活质量(OHRQoL),引起医护人员的关注。本研究旨在评估口腔黏膜病变与口腔健康影响档案-14 问卷(OHIP-14)印尼验证版在艾滋病病毒感染者/艾滋病患者(PLWHA)中测量的口腔健康相关生活质量(OHRQoL)之间的关系:方法:在印度尼西亚西爪哇的中央转诊医院进行了一项横断面研究。方法:在印度尼西亚西爪哇的中央转诊医院进行了一项横断面研究,使用项目间校正相关性对 30 名艾滋病感染者进行了 OHIP-14 的有效性评估,并通过 Cronbach's alpha 和 kappa 系数一致性对其可靠性进行了评估。随后,110 名连续抽样的 PLWHA 自行填写了经过验证的印尼版 OHIP-14,并接受了口腔检查。采用卡方检验分析了口腔黏膜病变与 OHRQoL 之间的关联:结果:OHIP-14问卷的有效性测试结果为rcount>0.189,这意味着所有问题项目均有效,可用于描述OHRQoL。OHIP-14问卷的信度测试结果显示,Cronbach's alpha值为0.960(大于0.7),这意味着总体而言,OHIP-14问卷是可靠的,可以用来评估OHRQoL。在 110 名登记的参与者中,61.8% 为女性,38.2% 为男性,平均年龄为 23.5 岁,其中大多数人(59.1%)一直在服用抗逆转录病毒药物(ARV),81.5% 的人具有良好的 QoL。口腔病变与生活质量之间存在统计学意义上的显著关系(p 结论:这项研究表明,在 PLWHA 患者中,口腔黏膜病变与 OHRQoL 之间存在明显关联。成功验证的印尼版 OHIP-14 问卷是评估 PLWHA 口腔健康和生活质量的可靠而有效的工具。
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引用次数: 0
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HIV AIDS-Research and Palliative Care
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