Southern African Journal of Hiv Medicine最新文献_第4页

Utilisation of cervical cancer screening among women living with HIV at Kenya's national referral hospital. 在肯尼亚国家转诊医院对感染艾滋病毒的妇女进行宫颈癌筛查

IF 1.6 4区医学 Q4 INFECTIOUS DISEASES

Southern African Journal of Hiv Medicine

Pub Date : 2022-04-25 eCollection Date: 2022-01-01 DOI: 10.4102/sajhivmed.v23i1.1353

James M Kangethe, Aliza Monroe-Wise, Peter N Muiruri, James G Komu, Kenneth K Mutai, Mirriam M Nzivo, Jillian Pintye

Background: In 2009, Kenyatta National Hospital (KNH) integrated cervical cancer screening within HIV care using visual inspection with acetic acid (VIA) and Pap smear cytology.

Objectives: We evaluated utilisation of cervical cancer screening and human papillomavirus (HPV) vaccination among women living with HIV (WLHIV) receiving HIV care at KNH.

Method: From November 2019 to February 2020, WLHIV aged ≥ 14 years were invited to participate in a survey following receipt of routine HIV services. We assessed awareness of cervical cancer, uptake of cervical cancer screening, uptake of the HPV vaccine, and barriers to utilisation of these services. In a subset of survey participants, focus group discussions (FGDs) were also conducted to identify screening barriers.

Results: Overall, 305 WLHIV participated in the survey. Median age was 36 years (interquartile range [IQR]: 28-43), 41% were married, and 38% completed secondary education. Most (90%) had HIV RNA < 1000 copies/mL. Awareness of cervical cancer was high (84%), although only 45% of WLHIV had screened for cervical cancer at the referral hospital and only 13% knew how to prevent high-risk HPV. No participants had received an HPV vaccination. Older age, higher education, and knowledge of the HPV vaccine were associated with higher likelihood of cervical cancer screening (P < 0.05). In FGDs, barriers to utilising the services included user fees, fear of the procedure impacting fertility, age and gender of the provider, and long waiting times.

Conclusion: Despite integration with HIV services, the utilisation of cervical cancer screening was low among WLHIV and implementation barriers contributed to low utilisation.

背景2009年，肯雅塔国家医院（KNH）将宫颈癌症筛查纳入HIV治疗，使用醋酸目视检查（VIA）和巴氏涂片细胞学检查。目的我们评估了在KNH接受HIV治疗的HIV感染者中，宫颈癌症筛查和人乳头瘤病毒（HPV）疫苗接种的使用情况。方法从2019年11月至2020年2月，邀请年龄≥14岁的WLHIV患者在接受常规HIV服务后参加调查。我们评估了对宫颈癌症的认识、对宫颈癌症筛查的接受、对HPV疫苗的接受以及使用这些服务的障碍。在一部分调查参与者中，还进行了焦点小组讨论，以确定筛查障碍。结果共有305名WLHIV患者参与了调查。中位年龄为36岁（四分位间距[IQR]：28-43），41%已婚，38%完成中等教育。大多数（90%）的HIV RNA<1000拷贝/mL。对宫颈癌症的认识很高（84%），尽管只有45%的WLHIV患者在转诊医院筛查过宫颈癌症，只有13%的人知道如何预防高危HPV。没有参与者接种过HPV疫苗。年龄较大、教育程度较高和对HPV疫苗的了解与更高的宫颈癌症筛查可能性相关（P<0.05）。在女性生殖器切割中，使用该服务的障碍包括用户费用、对该程序影响生育能力的恐惧、提供者的年龄和性别以及漫长的等待时间。结论尽管纳入了HIV服务，但宫颈癌症筛查在WLHIV中的利用率较低，实施障碍导致了低利用率。

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引用次数: 0

Where are the children? Case finding in 5–14-year-olds living with HIV in Johannesburg 孩子们在哪里？约翰内斯堡5-14岁艾滋病毒感染者的病例发现

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-04-14 DOI: 10.4102/sajhivmed.v23i1.1378

J. Dunlop, C. Tait, M. Mabitsi, K. Rees

No abstract available.

没有可用的摘要。

引用次数: 0

Understanding patients reinitiating antiretroviral therapy in two South African districts 了解南非两个地区的患者重新开始抗逆转录病毒疗法

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-04-14 DOI: 10.4102/sajhivmed.v23i1.1380

K. Rees., Melanie A Bisnauth, Cara O'Connor, Tshifhiwa Ramvhulela, Nomzamo Vali

No abstract available.

没有可用的摘要。

引用次数: 2

Psychosocial support for adolescents and youth living with HIV during COVID-19: A differentiated approach is needed 2019冠状病毒病期间为感染艾滋病毒的青少年和青年提供社会心理支持:需要采取区别对待的办法

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-04-14 DOI: 10.4102/sajhivmed.v23i1.1379

C. Tait, Njabulo Mbanda, Rudairo Tumba, M. Vujovic, Kate Rees

No abstract available.

没有摘要。

引用次数: 0

Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series 弥散性非结核分枝杆菌的Alere测定-结核脂阿拉伯糖甘露聚糖阳性:一个说明性病例系列

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-04-04 DOI: 10.4102/sajhivmed.v23i1.1369

R. Greyling, G. Meintjes, B. Sossen

Introduction In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM) should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/µL or with signs of being ‘seriously ill’. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either Mycobacterium tuberculosis or NTM) from dual infection. Patient presentation We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV (all CD4 < 20 cells/µL) and strongly positive (grade 4+) AlereLAM results in whom Mycobacterium avium or kansasii were later cultured from blood or urine and sputum. Management and outcome Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM infection was detected. Two were managed for dual infection (TB and NTM) but died within two years. Conclusion Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis of NTM infection should be considered, particularly in patients with a very low CD4 count.

在门诊患者中，世界卫生组织建议在CD4计数≤100细胞/µL或有“严重疾病”迹象的HIV感染者(PLHIV)中，应使用尿Alere测定-结核脂阿拉伯糖甘露聚糖(AlereLAM)来支持结核病(TB)的诊断。弥散性非结核分枝杆菌(NTM)感染存在AlereLAM假阳性的风险，并且可能难以区分单一感染(结核分枝杆菌或NTM)和双重感染。我们报告了三名患者，他们参加了一项评估AlereLAM在门诊使用情况的操作性研究，他们患有晚期HIV(所有CD4 < 20细胞/µL)，并且AlereLAM结果强烈阳性(4+级)，随后从血液或尿液和痰中培养出了禽分枝杆菌或kansasii。管理和结果基于AlereLAM阳性结果，所有三人都开始了结核病治疗。1人在发现NTM感染前死亡。其中两人因双重感染(结核病和NTM)而接受治疗，但在两年内死亡。结论结核病仍然是导致死亡的主要原因，其中不成比例的死亡发生在艾滋病毒感染者中。应根据AlereLAM阳性结果开始结核病治疗，随后应进行额外检测，以确认结核病诊断并获得药物敏感性结果。对于那些对结核病治疗无反应且唯一阳性结果是AlereLAM的患者，应考虑对NTM感染进行替代或额外诊断，特别是CD4计数非常低的患者。

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引用次数: 0

Association between socio-economic factors and HIV self-testing knowledge amongst South African women 南非妇女的社会经济因素与艾滋病毒自我检测知识之间的关系

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-03-24 DOI: 10.4102/sajhivmed.v23i1.1347

Michael Ekholuenetale, CHIMEZIE IGWEGBE NZOPUTAM, Osaretin Christabel Okonji

Background Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes. Objectives This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women. Method We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05. Results The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9–26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37–11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51–0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection. Conclusion Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women.

背景:艾滋病毒自我检测是提高艾滋病毒检测率的一种有效的替代方法，也是向艾滋病毒检测服务不足的人群提供服务的一种战略。尽管如此，许多资源有限的国家尚未将艾滋病毒自我检测纳入其国家艾滋病毒规划。本研究旨在研究社会经济因素与南非妇女艾滋病知识之间的关系。方法采用2016年南非人口与健康调查中具有全国代表性的数据。对8182名育龄妇女进行了分析。结果变量是hiv知识。这是二分法测量的;知道与不知道艾滋病毒感染。采用多变量logistic模型检验相关指标，显著性水平为P < 0.05。结果南非妇女艾滋病知识的患病率约为24.5%(95%可信区间[CI]: 22.9-26.1)。与没有受过正规教育的妇女相比，受过高等教育的妇女掌握艾滋病毒知识的可能性高出3.93倍(优势比[OR]: 3.93;95% ci: 1.37-11.26)。与居住在城市地区的人相比，农村居民对艾滋病毒的知识减少了33% (OR: 0.67;95% ci: 0.51-0.89)。了解艾滋病毒感染的较富有和最富有的妇女与了解艾滋病毒感染的最贫穷富裕家庭的妇女相比，了解艾滋病毒感染的可能性分别是前者的1.88倍和2.24倍。结论基于艾滋病知识水平较低，研究结果强调了开展有效的艾滋病教育活动的重要性。此外，方案的设计应考虑到社会经济上处于不利地位的妇女的独特需要。

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引用次数: 5

Evaluation of the modified Wells score in predicting venous thromboembolic disease in patients with tuberculosis or HIV in a South African setting 改良Wells评分预测南非结核病或HIV患者静脉血栓栓塞疾病的评估

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-03-23 DOI: 10.4102/sajhivmed.v23i1.1349

Tweedy Keokgale, S. V. van Blydenstein, Ishmail S. Kalla

Background There is paucity of data on the modified Wells score (MWS) utility on patients with venous thromboembolism (VTE) in a South African setting where there is a high burden of HIV and tuberculosis (TB). This study analyses the performance of this score in HIV/TB-infected patients compared with non-infected patients. Objectives To assess the performance of the MWS as an additional risk factor for VTE in hospitalised patients with a high burden of HIV/TB infections. Method This study was a retrospective cross-sectional cohort analysis of the utility of the MWS in 156 HIV/TB-infected and non-infected adult patients diagnosed with VTE on compression ultrasonography (CUS) or computed tomography pulmonary angiography (CTPA) in a medical inpatient setting over six months. Patients with HIV and/or TB were assessed as having an additional risk factor (1 point for each), and this was compared with the MWS. A McNeymar’s paired sample chi-squared test was used to compare the sensitivity of this score against the MWS. Results Of the 156 patients with VTE who were enrolled, HIV was the commonest risk factor (42.31%) with TB accounting for 10.90% of cases. When the MWS adjusted for HIV/TB was used, the sensitivity increased from 25% to 100% for the HIV–/TB+ category, it increased from 77.36% to 98.11% in the HIV+/TB– category and it increased from 84.62% to 92.95% in the HIV+/TB+ category. These differences were statistically significant at P < 0.05 in all categories. Conclusion The MWS performs better when the infectivity of HIV/TB is included as an additional risk factor in the score.

背景在艾滋病毒和结核病负担较高的南非，关于静脉血栓栓塞症（VTE）患者的改良威尔斯评分（MWS）实用性的数据很少。这项研究分析了该评分在HIV/TB感染患者和未感染患者中的表现。目的评估MWS作为VTE的额外危险因素在高HIV/TB感染负担住院患者中的表现。方法本研究是一项回顾性横断面队列分析，对156名经压缩超声（CUS）或计算机断层扫描肺动脉造影（CTPA）诊断为VTE的HIV/TB感染和未感染成年患者进行MWS的效用分析。HIV和/或TB患者被评估为具有额外的风险因素（各1分），并与MWS进行比较。使用McNeymar配对样本卡方检验将该分数的敏感性与MWS进行比较。结果在入选的156例VTE患者中，HIV是最常见的危险因素（42.31%），结核病占10.90%。当使用针对HIV/TB调整的MWS时，HIV//TB+类别的敏感性从25%增加到100%，HIV/+TB-类别的敏感性由77.36%增加到98.11%，HIV/+TB+类别的灵敏度由84.62%增加到92.95%。这些差异在所有类别中均具有统计学意义（P<0.05）。结论当将HIV/TB的传染性作为一个额外的危险因素纳入评分时，MWS表现更好。

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引用次数: 1

Cytomegalovirus retinitis and antiretroviral treatment: A fifteen year experience 巨细胞病毒性视网膜炎与抗逆转录病毒治疗：15年经验

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-03-08 DOI: 10.4102/sajhivmed.v23i1.1322

Serisha Jay Narain, L. Visser, W. Sibanda

Background South Africa’s public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated. Objectives To determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time. Methods This is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province. Results A total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year (R2 of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9–51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART > 6 months (36.7%), and the difference was statistically significant, P < 0.01. Conclusion ART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL.

南非的公共抗逆转录病毒治疗(ART)规划自2004年推出以来经历了渐进式的变化。在SA中，这对艾滋病定义的机会性感染巨细胞病毒视网膜炎(CMVR)负担的影响尚未得到充分的认识。目的确定南澳大利亚州公共部门抗逆转录病毒治疗可及性对新诊断CMVR病例数随时间变化趋势的影响。方法:回顾性研究于2002年11月1日至2017年8月31日在夸祖鲁-纳塔尔省一家三级医院进行。结果共纳入383名参与者，其中60.1%为女性，94%为非洲黑人。患者平均年龄34.08岁(SD±7.24)。线性趋势模型显示，每年CMVR新病例数总体呈线性下降(R2为0.67)。CD4+≤350 cells/μL的HIV感染者(PLWH)在ART治疗前和ART治疗后每年平均新增CMVR病例数分别为34例和13例，差异有统计学意义(61.76%)，P = 0.001。诊断CMVR时CD4+计数中位数为22(四分位数范围:9 ~ 51.25)个细胞/μL。在这项研究中，51%的患者在诊断CMVR时接受了ART治疗。ART≤6个月的患者比例(63.3%)高于ART≤6个月的患者比例(36.7%)，差异有统计学意义，P < 0.01。结论抗逆转录病毒治疗减轻了KZN地区许多CMVR患者的眼科服务负担，特别是在所有CD4≤350细胞/μL的PLWH引入抗逆转录病毒治疗后。

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引用次数: 0

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-02-24 DOI: 10.4102/sajhivmed.v23i1.1335

Anisca Louwrens,Carla M.T. Fourie,Shani Botha-Le Roux,Yolandi Breet

Background: As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.Objective: We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.Method: This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined.Results: Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups.Conclusion: Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.

背景:由于抗逆转录病毒治疗(ART)，艾滋病毒感染者的预期寿命增加，他们患血管合并症和早期血管老化(EVA)的风险也增加。目的:我们旨在研究HIV感染是否与南非黑人成人的血管结构和功能有关，以及这种关系是否与年龄有关。方法:这项横断面研究在南非西北省的城市和农村地区进行，包括572名年龄和性别匹配的艾滋病毒感染者(PLWH)和非艾滋病毒感染者。来自EndoAfrica研究和PURE研究的参与者根据年龄分位数进行分层。测量血管结构(颈动脉内膜-中膜厚度)和功能(颈-股脉波速度、中心收缩压、中心脉压和脉压放大)。结果:PLWH组血压指标低于对照组(P均≤0.001)，尤其是中青年组(P均≤0.031)，而血管指标无差异(P均≥0.611)。在多变量线性回归分析中，血管测量与艾滋病毒阳性状态无关，无论是在总年龄组还是任何年龄组。结论:南非黑人艾滋病毒感染者有较低的不良血压档案比他们的同行没有艾滋病毒。在任何年龄组中，hiv阳性状态与血管结构或功能测量无关。结果表明HIV对该人群的EVA没有贡献;然而，进一步的纵向调查是必要的。

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引用次数: 0

IF 1.7 4区医学 Q3 Medicine

Southern African Journal of Hiv Medicine

Pub Date : 2022-02-24 DOI: 10.4102/sajhivmed.23i1.1335

Anisca Louwrens, C. Fourie, Shani Botha-le Roux, Y. Breet

Background As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases. Objective We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent. Method This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined. Results Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups. Conclusion Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.

由于抗逆转录病毒治疗(ART)，艾滋病毒感染者的预期寿命增加，他们患血管合并症和早期血管老化(EVA)的风险也增加。目的研究HIV感染是否与南非黑人成年人的血管结构和功能有关，以及这种关系是否与年龄有关。方法在南非西北省的城市和农村地区进行横断面研究，包括572名年龄和性别匹配的艾滋病毒感染者(PLWH)和未感染艾滋病毒的人。来自EndoAfrica研究和PURE研究的参与者根据年龄分位数进行分层。测量血管结构(颈动脉内膜-中膜厚度)和功能(颈-股脉波速度、中心收缩压、中心脉压和脉压放大)。结果PLWH组血压指标低于对照组(P均≤0.001)，尤其是中青年组(P均≤0.031)，血管指标无显著差异(P均≥0.611)。在多变量线性回归分析中，血管测量与艾滋病毒阳性状态无关，无论是在总年龄组还是任何年龄组。结论南非黑人艾滋病毒感染者的不良血压状况低于非艾滋病毒感染者。在任何年龄组中，hiv阳性状态与血管结构或功能测量无关。结果表明HIV对该人群的EVA没有贡献;然而，进一步的纵向调查是必要的。

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引用次数: 1