Southern African journal of HIV medicine最新文献

Background: The success of HIV treatment hinges on consistent adherence to antiretroviral therapy (ART).

Objectives: To conduct a longitudinal pilot study to assess the feasibility, acceptability and effectiveness of a mobile app to improve ART adherence.

Method: This study included adults living with HIV and using ART, who were allocated into two groups according to their willingness to use the app: users of the mobile application for ART management (Mobile) and non-users (Control). The application was developed by the researchers, and uses an alarm system to record ART use. Adherence was also assessed using the 'Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral' (CEAT-VIH) and the Multi-Method Tool questionnaire. Another questionnaire was administered to application users to assess acceptability. After 90 days, all the questionnaires were reapplied.

Results: A significant difference in adherence was observed between the Mobile and Control groups (P = 0.04), but there was no significant difference in time (P = 0.2) or interaction (P = 0.5).

Conclusion: The application was not effective in improving ART adherence and showed low viability, but was considered acceptable among the participants.

Background: Kidney disease is a growing non-AIDS-related comorbidity among people living with HIV (PLWH). Tenofovir disoproxil fumarate (TDF) can result in proximal tubulopathy and acute tubular injury, whereas atazanavir/ritonavir (ATV/r) can cause interstitial nephritis and renal stones, both of which can lead to chronic kidney disease.

Objectives: To examine the relationship between second-line combination antiretroviral therapy (ART) and the risk of kidney disease and morphological changes among PLWH in Dar es Salaam, Tanzania.

Method: A cross-sectional study of adult PLWH receiving TDF-based second-line ART. Socio-demographic and clinical data were gathered, and laboratory tests were conducted to determine the estimated glomerular filtration rate (eGFR). Ultrasonography was performed to visualise the kidneys.

Results: A total of 323 patients were enrolled (67.8% women), with a median age of 44 (interquartile range [IQR]: 39-51) years. Patients were on second-line ART for a median of 49 [IQR: 25-73] months, and 60% received ATV/r. Low eGFR (< 90 mL/min per 1.73 m²) was found in 22% of patients, proportionately higher among patients on ATV/r compared to those on a lopinavir/ritonavir (LPV/r) (P < 0.05). Nearly one-third (32.2%) of patients had a triad of renal calcinosis, renal calculi, and nephritis on ultrasonography. Patients using ATV/r had significantly smaller kidney volumes and greater proportions of renal calculi and nephritis compared to those on LPV/r (P < 0.05).

Conclusion: Adults on second-line ART containing TDF were found to have a high prevalence of renal kidney disease in the Tanzanian context. Predictors of kidney disease were older age, proteinuria, and ATV/r-based regimen as compared to LPV/r.

Background: Rare cases of HIV cure exist. Clinical trials of HIV cure are also underway. However, little is documented about how potential cures are perceived by African people living with HIV, although they are key stakeholders.

Objectives: We explored knowledge, beliefs, and experiences about HIV cure in Soweto, South Africa.

Method: We conducted qualitative research with five stratified focus groups (N = 49). Consenting adults living with HIV were eligible. Facilitators asked participants about their knowledge of HIV cure, experience of purported cures, and beliefs about cure possibilities. Transcripts from audio recordings were thematically analysed.

Results: Participants had knowledge of the concept of cure as eradication, not remission. Three main themes emerged about possible HIV cures. Firstly, hope and scepticism: people feared unequal access to technologies. Secondly, cultural and conventional approaches: there were beliefs in traditional healers, scepticism towards culturally purported cures (e.g. imbiza herbal tonic), and a desire for medical cures to obviate pill burdens. Thirdly, anticipated socio-behavioural effects: beliefs existed that cures might improve happiness, reduce emotional burdens of disclosure, facilitate HIV-free generations, increase risk behaviours, and reduce health checks, but not change societal attitudes to HIV.

Conclusion: In Soweto, South Africa, people living with HIV hope for medical technologies - such as cure and long-acting treatments - to relieve the biopsychosocial burdens of chronic treatment. Despite treatment knowledge, some people try culturally purported cures for HIV. In HIV cure trials, consent language should avoid 'cure' when remission is meant. Care should address pill burden, and counselling should address sex, substances, exercise, and nutrition.

Background: In South Africa, men are less likely than women to use HIV-testing services (HTS). They are also unlikely to start and adhere to antiretroviral therapy until the virus has progressed to advanced AIDS stages.

Objectives: To explore young men's barriers to and facilitators of accessing and utilising HTS at the rural Driefontein and peri-urban Steadville Township in Ladysmith, KwaZulu-Natal (KZN) province, and to develop a comprehensive framework of care for young men to encourage and support them to utilise HTS at primary healthcare facilities.

Method: This exploratory-descriptive qualitative study entailed using semi-structured interviews conducted via WhatsApp and landline audio calls with 17 young men between 18 years and 30 years of age in Steadville and Driefontein communities in KZN in September 2021. Participants were purposively and conveniently sampled, and the data were analysed thematically.

Results: All participants were unmarried isiZulu African men experienced with HTS in the last 4 years. Fear of an HIV-positive test result, limited HTS knowledge, and stigma around HIV and AIDS were challenges linked to HTS utilisation. Unsafe sexual encounters, voluntary medical male circumcision, early virus-detection, having a significant other living with HIV, and HIV-status curiosity encouraged young men to utilise HTS.

Conclusion: Various barriers and facilitators to HTS utilisation, are key for consideration when deriving contextual interventions acceptable to young men as efforts to raise awareness and attract and retain men in care.

Background: Prevention of mother-to-child transmission (PMTCT) programmes are designed to prevent HIV transmission to infants and children. Despite efforts to achieve this goal, several factors continue to pose challenges.

Objectives: To investigate the level of adherence, perceptions, knowledge, and factors associated with adherence to the PMTCT programme in primary healthcare facilities.

Method: A descriptive cross-sectional study design and quantitative research approach was used, and clinical records were reviewed to determine the prevalence of seroconverted babies of mothers enrolled in a PMTCT programme for the past 2 years in the community healthcare centres. Bivariate and multivariate logistic regression analyses were performed.

Results: A total of 341 mother-baby pairs were recruited and took part in the study. Most women (263; 77%), perceived that a pregnant woman living with HIV can transmit the virus to her unborn baby. The following factors were independently associated with non-adherence: being unmarried, the period of maternal HIV diagnosis and initiation on antiretroviral therapy, unsuppressed viral load results, missed clinic appointments, side effects, and getting tired of taking HIV medication.

Conclusion: This study investigated adherence to and perceptions of all components of the PMTCT programme by pregnant and breastfeeding women in primary healthcare facilities. Despite the significant progress made, maternal and paediatric HIV pandemic pose a challenge to the PMTCT services. There is a need for follow-up research to monitor the ongoing adherence to the PMTCT programme and its long-term impact in reducing the rate of transmission of HIV in mothers.

Background: HIV is a major public health issue in South Africa, with around 7.7 million people living with the virus by 2023, including 4.9 million women. In 2022, 257 171 pregnant women received antiretroviral therapy to prevent mother-to-child transmission.

Objectives: To explore and describe the interpersonal relationships of pregnant women following HIV diagnosis in the Thembisile Hani Municipality, South Africa.

Method: An exploratory descriptive qualitative design was used. Twenty (20) women aged 18-35 years, who were diagnosed with HIV during pregnancy, were purposively selected from a local clinic in Thembisile Hani Municipality. Data were collected through unstructured face-to-face interviews and analysed using thematic analysis.

Results: Two themes emerged from the analysis; namely: (1) altered relationships with loved ones and (2) the role of psychosocial support to improve interpersonal relationships. These results indicate that being diagnosed with HIV during pregnancy has a negative impact on the interpersonal relationships of women.

Conclusion: HIV diagnosis during pregnancy affects relationships, necessitating psychosocial support services such as counselling and support groups to improve well-being and relationship quality in pregnant women.

Access to adolescent-friendly, culturally relevant and stigma-free mental health support is essential for reducing the long-term psychological, social and economic challenges of mental illness of youth living with HIV (YLWH). Now more than ever, innovative task-shifting interventions, through which non-mental health professionals provide mental health support to YLWH, need to be explored and supported. While many of these have considered shifting tasks to nurses, tapping into the wisdom and inspiration from artists in the community where YLWH are living could represent a novel and potentially powerful task-shifting strategy. In this opinion piece, we propose that the arts could be explored in future studies as a promising avenue for mental health interventions for YLWH in South Africa. Better Together is a peer-support intervention for youth living with chronic illness, which has been published previously by our team. As part of the discussion, we share feedback about the creative arts component of the Better Together groups provided by Better Together participants themselves. Overall, this feedback yielded several key insights which further underscore the idea that providing youth with opportunities to engage in creative arts in a group setting may represent a promising platform for addressing mental health in YLWH in South Africa. Specifically, we learned that (1) youth enjoyed the opportunity to engage creatively, (2) these experiences helped them connect with others, (3) they gained new insights and perspectives about themselves and their lives, and (4) they experienced a positive impact on their mood and well-being.

Background: Liver disease is the leading cause of non-AIDS-related mortality in people living with HIV (PLWH). Steatotic liver disease (SLD) is increasingly recognised as an important aetiological factor in liver dysfunction in PLWH.

Objectives: This study aimed to determine the post-mortem prevalence and severity of SLD and determine HIV- and non-HIV-related risk factors associated with it.

Method: We conducted a retrospective cross-sectional study in which liver histology from 59 deceased people who were infected with HIV was assessed for steatosis, and findings correlated with clinical, epidemiological, and biochemical data.

Results: Decedents were predominantly men (33/59); 63% (37/59) were virologically supressed. Median CD4+ T-cell count was 139 cells/µL (interquartile range [IQR]: 47-344). Steatosis was present in 39% (23/59) of decedents: 74% mild, 9% moderate, and 17% severe steatosis. There were no cases of steatohepatitis, and one case with mild fibrosis. Factors associated with SLD were: CD4 T-lymphocyte count > 200 cells/µL (odds ratio [OR]: 3.69; 95% confidence interval [CI]: 1.19-11.44), female sex (OR: 8.5; 95% CI: 2.57-28.17), hypertension (OR: 6.5; 95% CI: 2.05-21.00), and being normal or overweight (OR: 6.75; 95% CI: 1.12-40.56). Virological suppression and duration of antiretroviral drug use were not associated with steatosis.

Conclusion: We found a high proportion of SLD with heterogeneous causes in deceased people who were infected with HIV, exceeding previously reported prevalences from elsewhere in Africa. A preserved CD4 count and being female conferred the highest risk for steatosis, underscoring the need for screening in this subgroup and further research to delineate risks in a Southern African population.

Background: South Africa has the largest HIV epidemic globally. Despite the scale-up of antiretroviral therapy, people living with HIV are still presenting with low CD4 counts.

Objectives: This study assessed CD4 trends.

Method: A retrospective analysis of laboratory data from 2013 to 2023 was conducted. Annual test volumes, the median CD4, and the percentage of specimens with a count ≤ 200 cells/µL and > 500 cells/µL were reported at the national and provincial levels, and by age and gender. The percentage change in both CD4 categories between 2013 and 2023 was assessed, and the CD4 counts per 100 000 population reported.

Results: Data are reported for 32 154 644 specimens. The overall median CD4 increased from 396 cells/µL to 473 cells/µL. The percentage of specimens with CD4 counts > 500 cells/µL increased over time but the percentage with CD4 counts ≤ 200 cells/µL remained stable. Men had lower CD4 median and higher percentage of specimens with counts ≤ 200 cells/µL than women. However, the rate of, CD4 ≤ 200 cells/µL decreased from 1411 to 700 per 100 000 population; this decrease occurred in all provinces except the Western Cape.

Conclusion: This study found high percentage of specimens with CD4 counts ≤ 200 cells/µL despite an increase in median CD4 count. Men had lower CD4 counts than women.

Background: Definition of chest X-ray (CXR) features associated with laboratory-confirmed pneumocystis pneumonia (PCP) among HIV-positive adults is needed to improve diagnosis in high-burden settings.

Objectives: Our primary objective was to identify CXR features associated with confirmed PCP diagnosis and severe PCP (defined by hypoxia, intensive care unit referral/admission, and/or in-hospital death). We also explored the performance of logistic regression models, incorporating selected clinical and CXR predictors, for PCP diagnosis and severe PCP.

Method: We conducted a case-control study involving HIV-positive adults with laboratory-confirmed PCP and a matched cohort with non-PCP respiratory presentations at regional hospitals in Cape Town, South Africa (2012-2020).

Results: Records from 104 adults (52 PCP cases and 52 non-PCP controls) were included. Diffuse versus patchy ground-glass opacification was associated with increased odds of PCP diagnosis (adjusted odds ratio [aOR]: 6.2, 95% confidence interval [CI]: 1.6-28.9, P = 0.01) and severe PCP (aOR: 4.5, 95% CI: 1.6-14.4, P = 0.008). Consolidation was associated with severe PCP (aOR: 3.3, 95% CI: 1.2-11.0, P = 0.03) as was increasing ground-glass zone involvement (aOR: 2.1 for each one-unit increase in involved zone; 95% CI: 1.4-3.2, P = 0.0004). Models incorporating hypoxia (hypoxia model) or tachypnoea (respiratory rate model) with diffuse ground-glass opacities, absence of pleural effusion or reticular/reticulonodular changes on CXR performed well in predicting PCP (area under the receiver operating characteristic curve 0.828 [hypoxia model] and 0.857 [respiratory rate model]).

Conclusion: CXR evaluation alongside bedside clinical information offers good accuracy for discriminating definite PCP from other HIV-associated respiratory diseases.