HIV AIDS-Research and Palliative Care最新文献

Background: People living with HIV (PLHIV) with good adherence to antiretroviral therapy (ART) achieve good health outcomes. However, treatment interruptions remain a major challenge, particularly in rural Africa. This study explored factors related to dropout, return, retention in care, and treatment adherence among PLHIV returning to care after missing clinical visits.

Methods: We conducted an exploratory study using a phenomenological approach in rural South-eastern Tanzania, from July to October 2023. In-depth interviews (IDIs) were conducted with 21 PLHIV who resumed care after missing visits for three months or more from the last scheduled appointment and who were taking ART less than 60 days within the last three months, and their 13 treatment supporters. Interviews were conducted at St. Francis Regional Referral Hospital and Kibaoni Health Center.Five focus group discussions (FGDs) were conducted with 6-8 healthcare workers from Kibaoni, Mang'ula, Mkamba, Mgeta Health Center, and St. Francis Hospital. Data were analyzed by thematic analysis, with NVivo 12 software.

Results: The median age of the 21 PLHIV was 40 years (range 21 to 63); 10 (47.6%) were females. Reasons for dropping out of care reported included fear of disclosure, complacency with improved health, denial of HIV status, work-related absence, and religious beliefs. Reasons for returning included health deterioration, completion of work obligations causing care interruption, family support, and clinic follow up. Factors promoting retention and adherence were improved health through ART, trust in healthcare services, counseling, health education, clinic follow-up, longer drug refill periods, and family support.

Conclusion: Our study highlights persisting stigmatization contributing to dropping from care, with strong family and social support improving adherence and clinic attendance. Future interventions should focus on these factors to enhance retention of lifelong treatment adherence. Working obligations remain a challenge, that could be addressed by facilitated access to remote drug pickup.

Background: Female sex workers have a 13-fold higher risk of acquiring HIV than women who do not engage in sex work. The willingness and acceptability of a product is crucial for the development of microbicides. This research aimed to evaluate the sexual practices, existing HIV prevention methods, and willingness to use a microbicide for HIV prevention among female sex workers in Nigeria. We also explored factors that might influence their willingness to use a new microbicide product.

Methods: A cross-sectional study was conducted among female sex workers recruited from brothels within Lagos-Nigeria, in which participants were selected via purposive sampling over a period of five-months. An interviewer-administered, semi-structured questionnaire was used to obtain information. Descriptive statistics were used to present the results, and a multiple logistic regression model was used to determine the factors associated with willingness to use a microbicide.

Results: A total of 461 female participants with a mean-age of 29.63 ± 8.8 years were included in the analysis of which 34.3% had >4 sexual partners, 91.8% used condoms, 53.6% engaged in anal sex, 69.6% had experienced condom rupture, and 31% would "accept unprotected sex" if the male partner refuses to use a condom. Approximately 43% had received PEP, of which only 15% completed the one-month PEP-regimen. On the other hand, 64.6% had taken PrEP medications, of which 28% admitted skipping doses. Although 41% were concerned about male partner acceptance, a total of 95% will be willing to use a microbicide. The number of sexual partners ([aOR] 1.555; 95% Cl 1.035-2.335), use of condoms ([aOR] 4.701; 95% Cl 1.418-15.584), and condom rupture experience ([aOR] 2.550; 95% Cl 1.817-7.959) were associated with greater odds of willingness to use an HIV microbicide.

Conclusion: There is a high level of willingness to use a future microbicide among the female commercial sex workers in this study. In addition, majority of the participants will prefer a microbicide product that is female controlled, affordable, and provided as an over-the-counter medication. This cohort of women engage in high-risk sexual practices and play a significant role in HIV prevention efforts. Therefore, their product preferences and concerns should be considered in microbicide development to enhance the acceptability, adherence, and efficacy of future microbicides.

Purpose: This study aims to investigate the prevalence of sexually transmitted infections (STIs) and associated factors among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWHA) registered in a community health center (CHC) with HIV/AIDS support and treatment services in Indonesia.

Methods: A cross-sectional study that included all PLWHA data from medical records registered in a CHC with HIV/AIDS support and treatment services was conducted in Bandung City, Indonesia, between March 2019 and March 2024. This CHC provides comprehensive and continuous HIV/AIDS services, including HIV testing, antiretroviral therapy (ART), and opportunistic infection management. The factors associated with the prevalence of STIs in PLWHA, including sociodemographic factors such as gender, age, education level, marital status, occupation, population group, referral origin, and clinical factors such as length of illness, duration of ART, clinical stage, and comorbidities, were analyzed by using chi-square analysis.

Results: Total 156 PLWHA data with STIs from medical records were collected (male, n = 152, 97.4%; female, n = 4, 2.6%). The prevalence of STIs among PLWHA was 32.1%, consisting of syphilis (n = 36; 72%), gonorrhea (n = 11; 22%), genital herpes (n = 2; 4%), and condyloma (n = 1; 2%). The following significant factors associated with the prevalence of STIs were population group men who have sex with men (MSM) (p = 0.046), referral origin from non-government organizations (NGOs) (p = 0.030), duration of disease (p = 0.023) and duration of ART ranging from 12 to 36 months (p = 0.023), and early clinical stage (p = 0.010).

Conclusion: STIs affected over one-third of CHC-registered PLWHA, with syphilis being the most common. MSMs and patients referred by NGOs, with illness and treatment durations ranging from 12 to 36 months, as well as the early clinical stage of HIV, are associated with STIs among PLWHA. Intervention strategies to improve STI prevention and control in these populations are urgently needed.

Background: HIV represents a significant public health challenge, contributing to increased mortality and morbidity within the population. Despite the implementation of various HIV testing strategies, the uptake rate of HIV testing remains low.

Objective: This study aims to assess the factors associated with HIV testing uptake among women and men in Cameroon.

Methods: A secondary analysis of the 2018 Cameroon demographic and health survey (DHS) was conducted using data of sexually active men and women aged 15-64. Multivariate logistic regression was employed to identify the key factors associated with HIV testing in Cameroon.

Results: We included a total of 18,112 participants (12563 women and 5549 men). The study found that 47.8% (95% CI 46.9-48.7) of women and 45% (95% CI 43.7-46.3) of men were tested for HIV in the past 12 months. Among women and men, age above 20-24 years (AOR= 1.3, p<0.01 vs AOR= 2.3, p<0.001), a high level of education (AOR= 2.1, p<0.001 vs AOR= 2.3, p<0.001) and high wealth (AOR= 1.9, p<0.001 AOR= 2.0, p<0.001) were positively associated with HIV testing uptake. Conversely, residing in the northern regions (AOR= 0.5, p<0.001 vs AOR= 0.4, p<0.001), was negatively associated. Among men, no independent significant association was found between HIV testing uptake and never being married.

Conclusion: This study, utilizing data from the Cameroon DHS, provides valuable insights into HIV testing in Cameroon. To achieve UNAIDS targets of "zero new infections and zero deaths" by 2030, interventions must prioritize less educated individuals, younger age groups and low income earners. The findings from this research can inform recommendations for decision-makers and contribute to the development of effective public health interventions to combat HIV in Cameroon.

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.