Southern African journal of HIV medicine最新文献

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.

Background: Eswatini has a high HIV prevalence in adults and, despite being one of the first countries to achieve the UNAIDS 95-95-95 targets, AIDS-related deaths are still high.

Objectives: This study describes the causes of death among people living with HIV (PLHIV) receiving care at five clinics in Eswatini.

Method: A cross-sectional review of sociodemographic, clinical and mortality data of deceased clients who received care from 01 January 2021 to 30 June 2022, was conducted. Data were extracted from the deceased clients' clinical records, and descriptive and comparative analysis was performed.

Results: Of 257 clients, 52.5% (n = 135) were male, and the median age was 47 years (interquartile range [IQR]: 38, 59). The leading causes of death were non-communicable diseases (NCDs) (n = 59, 23.0%), malignancies (n = 37, 14.4%), COVID-19 (n = 36, 14.0%), and advanced HIV disease (AHD) (n = 24, 9.3%). Clients who had been on antiretroviral therapy (ART) for 12-60 months (OR: 0.01; 95% confidence interval [CI]: 0.0006, 0.06) and > 60 months (OR: 0.006; 95% CI: 0.0003, 0.029) had lower odds of death from AHD compared to those on ART for < 12 months. Clients aged ≥ 40 years had higher odds of dying from COVID-19, while female clients (OR: 2.64; 95% CI: 1.29, 5.70) had higher odds of death from malignancy.

Conclusion: Most clients who died were aged 40 years and above and died from NCD-related causes, indicating a need to integrate prevention, screening, and treatment of NCDs into HIV services. Specific interventions targeting younger PLHIV will limit their risk for AHD.

Background: Reflexed cryptococcal antigenaemia (CrAg) testing has been offered since 2016 in South Africa, on remnant CD4 specimens, for people with a count < 100 cells/μL. Local guidelines recommended extending testing to 200 cells/μL.

Objectives: This study assessed the cost per result and annual equivalent costs (AEC) for CD4 counts < 100 cells/μL and 100 to 200 cells/μL, as well as determining the cost to find one CrAg-positive case.

Method: An ingredients-based costing was used to determine the cost per result. The CrAg detection rate for < 100 cells/μL was obtained from operational reports of 2019. For 100 cells/μL to 200 cells/μL, a CrAg detection rate of 2% was assumed. One-way sensitivity analysis determined the impact of varying CrAg detection rates on the cost to find one case. Local data from the Western Cape province, which offers testing for counts of 100 cells/μL to 200 cells/μL, from September 2022 to January 2023, were interrogated to establish detection rates.

Results: There were 283 240 (AEC: $1 670 370) specimens with counts of < 100 cells/μL and 300 624 (AEC: $1 772 890) with counts of 100 cells/μL to 200 cells/μL. A cost per result of $5.897 was reported. The cost to find one CrAg case ranged from $589.74 to $73.72 for a detection rate of 1% to 8%. Local data for a count of 100 cells/μL to 200 cells/μL revealed a CrAg detection rate of 1.6%.

Conclusion: The study findings reveal that extending reflexed CrAg testing to 200 cells/μL would double test volumes with fewer positive cases reported for those with a count of 100 cells/μL to 200 cells/μL.

Background: Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation.

Objectives: To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM.

Method: Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI.

Results: A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003).

Conclusion: Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe.

Background: Achieving optimal adherence to antiretroviral therapy (ART) is challenging. Consistency in HIV care and treatment is crucial for achieving viral load suppression and preventing HIV-related illnesses, disease progression to AIDS, mortality, drug resistance, and onward transmission.

Objectives: The purpose of this research was to gain a comprehensive understanding of the beliefs that play a role in determining the level of ART adherence among individuals newly diagnosed with HIV. By examining these beliefs, the researchers aimed to identify potential barriers and facilitators to adherence, ultimately contributing to the development of effective interventions and strategies to improve ART adherence.

Method: An exploratory qualitative approach was employed in this study, utilising the Theory of Planned Behaviour (TPB) as its theoretical framework. To gather insights, in-depth interviews were conducted with 19 participants recruited post diagnosis, who shared their beliefs regarding ART adherence. Thematic analysis identified beliefs, categorised under TPB precursors, namely behavioural outcomes, subjective norms, and perceived behavioural control.

Results: Participants emphasised health improvement, treatment effectiveness, and disease prevention as advantages to ART adherence, while disadvantages included fear of lifelong commitment, side effects, and stigma. ART adherence was enhanced by family support but impeded by a number of social factors. Participants expressed confidence in creating personal reminders or seeking external help, but anticipated various challenges.

Conclusion: The research has shown that the beliefs affecting ART adherence in individuals recently diagnosed with HIV but not yet on treatment are like those that have been reported to influence adherence in HIV-positive participants currently receiving treatment.