HIV AIDS-Research and Palliative Care最新文献

Purpose: In recent years, People Living with HIV (PLHIV) in sub-Saharan Africa have experienced a growing burden of non-communicable diseases (NCDs), straining already limited health systems. Identifying behavioural risk factors for NCDs in both PLHIV and HIV-negative individuals is essential for designing targeted interventions. This study aimed to identify common risk factors for NCDs in these groups and determine their predictors.

Patients and methods: A comparative cross-sectional study was conducted among 250 PLHIV and 250 age- and sex-matched HIV-negative individuals attending the Antiretroviral Therapy (ART) and General Out-Patient clinics of Jos University Teaching Hospital from March 1-12, 2021. Participants aged 18-65 years were enrolled. Data were collected using a semi-structured questionnaire and blood pressure measurements. Multivariable logistic regression was used to identify predictors of behavioural risk factors while adjusting for potential confounders.

Results: While both groups had similar age and gender distributions, significant differences were observed in education level, marital status, employment, residence, income, ethnicity, and household size (p<0.05). Among PLHIV, long-term ART use reduced smoking by 93%. In HIV-negative individuals, urban residence and non-harmful alcohol use reduced smoking by 94% and 99%, respectively. Problematic alcohol use was significantly lower in women and non-smokers among PLHIV and HIV-negative individuals, respectively. Low physical activity was associated with poor self-rated health status in both groups, with gender and age playing additional roles among PLHIV and HIV-negative participants, respectively. Among the HIV-negative, unhealthy diets were linked to lower income.

Conclusion: Predictors of behavioural risk factors among PLHIV included ART duration, gender, and self-rated health. In the HIV-negative group, age, gender, residence, income, and self-rated health were key predictors. The notable overlap between smoking and alcohol use underscores the need for integrated interventions targeting these behaviours in both populations.

Background: HIV-positive pregnant women in refugee settings face significant barriers to accessing quality maternal healthcare. In Uganda, Kiryandongo Settlement Camp, one of the largest refugee settlements, exemplifies these challenges with limited healthcare infrastructure, stigma, and socio-economic constraints affecting healthcare delivery. This study explores the healthcare experiences and service delivery gaps for HIV-positive pregnant women in the camp.

Materials and methods: An exploratory qualitative research design was employed in Kiryandongo Settlement Camp, involving purposive sampling of 30 pregnant women living with HIV, 10 healthcare providers, and 5 key informants. Data were collected through in-depth interviews and key informant interviews.

Results: The findings revealed multiple barriers to healthcare access, categorized into three sub-themes: inadequate healthcare infrastructure, long waiting times and staff shortages, and stigma and discrimination. Participants reported frustration with the lack of medical supplies, inadequate facilities, and the impact of stigma on their willingness to seek care. Healthcare providers also acknowledged these challenges, noting limited resources and strained personnel as contributing factors. The most significant finding was the pervasive impact of stigma, which not only hindered service access but also contributed to a reluctance to engage with healthcare services, further affecting ART adherence.

Conclusion: This study highlights the critical need for improvements in healthcare infrastructure, policy interventions to reduce stigma, and increased support for healthcare providers in Kiryandongo Settlement Camp. Addressing these gaps is essential for enhancing ART adherence, maternal health outcomes, and the effectiveness of PMTCT programs in refugee settings. Despite the focus on a single site, the findings have broader implications for refugee health policy and service delivery in similar contexts.

Background: Low physical activity and unhealthy diets are among the key modifiable risk factors for non-communicable diseases (NCDs), often initiated in adolescence. Little is known about the underlying factors influencing these two behaviors, particularly in adolescents living with HIV (ALHIV). This study aimed at qualitatively exploring the factors perceived to influence physical activity and diet consumption in this vulnerable population.

Methods: Semi-structured in-depth interviews were conducted with ALHIV aged 15 to 19 years (N=22) and their parents and caregivers (N=10) to explore the lived experiences and perceptions regarding physical activity and diet consumption. The interviews were carried out from May to July 2024 at the Chronic Diseases Clinic in Ifakara (CDCI) in Tanzania. Thematic content analysis was performed aided by NVivo software version 14. Three levels of the socio-ecological model (intrapersonal, interpersonal, and community levels) guided the theoretical categorization of findings.

Results: Factors reported to influence physical activity in ALHIV were intrapersonal factors (time constraints, insufficient knowledge); interpersonal (encouragement from family members and peers); and community level aspects (gender and social norms, negative beliefs, inadequate facilities). On the other hand, intrapersonal factors (lack of autonomy, weight gain concerns, food preferences); interpersonal factors (low family income, large family size); and community level factors (increased availability of fast foods) were reported to influence diet consumption among ALHIV. The adolescents' parents and caregivers similarly shared some of these views.

Conclusion: The findings suggest that both physical activity and diet consumption in ALHIV are influenced by multiple factors in the socio-ecological system. The community, parents and caregivers need to be engaged to provide support systems to address barriers to physical activity and diet consumption in ALHIV. Physical activity and nutrition education need to be integrated into HIV care programs and guidelines to emphasize these health behaviors in this population.

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.