Southern African journal of HIV medicine最新文献

Background: The provision of HIV treatment services was severely impacted by the COVID-19 pandemic and the subsequent lockdown measures, particularly among men who have sex with men (MSM), a population disproportionately affected by HIV.

Objectives: To explore the service providers' perspectives on the barriers and facilitators of the HIV treatment services during the COVID-19 lockdown in Capricorn District, Limpopo province.

Method: The study followed an exploratory design and was conducted in Capricorn District in Limpopo province. A purposive sample of 10 HIV treatment service providers were included in the study. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) domains and associated constructs. The transcribed qualitative data were captured and analysed on Atlas.ti version 24.

Results: The barriers included fear of COVID-19 transmission, movement restrictions during the initial phase of the lockdown period, target-driven performance pressure, lack of mobile clinics, and understaffing. The facilitators included teamwork among the various stakeholders in the programme, tailoring strategies to reach more MSM, partnerships and connections with the Department of Health and other relevant organisations.

Conclusion: The study revealed that the tailoring of the MSM programme facilitated access to HIV treatment services during COVID-19.

Background: In 2023, an estimated 39.9 million people globally were living with HIV, of which 1.55 million were adolescents aged 10-19 years. The 2021 Zambia HIV Impact Assessment revealed lower viral suppression rates in adolescents (15-24 years old) compared to adults on antiretroviral therapy (ART). Lusaka District, Zambia, has the highest number of adolescents on ART, with a 15.1% HIV prevalence in 2018.

Objectives: To determine the prevalence and factors associated with viral suppression among adolescents living with HIV (10-19 years) on ART in Lusaka District, Zambia.

Method: A retrospective cohort analysis was done of 3409 adolescents on ART at public health facilities in Lusaka from January 2023 to December 2023, and who had viral loads recorded. Socio-demographic, clinical, treatment and behavioural data were extracted from electronic health records and analysed using SPSS version 29.

Results: The adolescent cohort in Lusaka achieved 91.8% viral suppression rate (< 1000 copies/mL), with 79% fully suppressed (< 50 copies/mL). In multivariate analysis, older adolescents (15-19 years) had lower odds of suppression compared to younger adolescents (10-14 years) (adjusted odds ratio [AOR] = 1.79; confidence interval [CI] : 1.32-2.43). Higher odds of viral suppression were linked to first-line dolutegravir regimen (AOR = 5.12; CI: 3.23-8.11) and optimal adherence (AOR = 1.89; CI: 1.03-3.47), while regimen switches reduced the odds of viral suppression (AOR = 0.60; CI: 0.45-0.80).

Conclusion: Zambia reached the previous UNAIDS 90-90-90 targets with a viral suppression rate of 91.8%. However, to reach the revised 95% target by 2030, tailored interventions should be implemented to improve adherence and retention in care, particularly for older adolescents.

Background: Reflexed cryptococcal antigenaemia (CrAg) testing has been offered on remnant CD4 specimens with a count < 100 cells/µL from 2017 in South Africa. The Western Cape is the only province to introduce CrAg testing for counts of 100 cells/µL to 200 cells/µL.

Objectives: The objective of this study was to assess the reflexed CrAg detection rate in the Western Cape.

Method: The retrospective analysis of laboratory data for reflexed CrAg testing was conducted between September 2022 and May 2024. The CrAg detection rate was reported for the following CD4 categories at the provincial, district, and sub-district levels: (1) < 100 cells/µL, (2) ≥ 100 cells/µL - ≤ 200 cells/µL, and (3) ≤ 200 cells/µL.

Results: Data are reported for 80 809 specimens, with a CrAg detection rate of 4.0% for a CD4 ≤ 200 cells/µL compared to 6.2% for a count < 100 cells/µL. For a count of ≥ 100 cells/µL - ≤ 200 cells/µL, a CrAg detection rate of 2.1% was reported. The district CrAg detection rate for counts ≤ 200 cells/µL ranged from 1.4% (Central Karoo) to 5.9% (Cape Winelands). Excluding subdistricts without CrAg-positive specimens, the detection rate ranged from 1.3% (Beaufort West) to 8.3% (Swartland).

Conclusion: The study findings of a CrAg detection rate of 4.0% in the Western Cape province justifies their decision to extend reflexed screening to a threshold of 200 cells/µL. However, most CrAg-positive specimens were identified for a count < 100 cells/µL. Intensified approaches to find CrAg-positive patients with a count ≤ 200 cells/µL are required.

The integrase strand transfer inhibitor, dolutegravir (DTG), is widely used in first- and second-line antiretroviral therapy (ART) regimens in South Africa. We describe an adult with virological failure on second-line tenofovir/lamivudine/dolutegravir (TLD2) and rapid emergence of DTG resistance within 3 months, while receiving rifapentine-based tuberculosis preventive therapy.

Background: Maximising the use of HIV pre-exposure prophylaxis (PrEP) is crucial to eliminate new HIV transmissions, especially in high-prevalence areas such as South Africa. Strengthening access and acceptability of PrEP is essential for effective HIV prevention and to ensure sufficient uptake among those at risk.

Objectives: This review aims to explore the existing PrEP delivery models in the South African public health settings and their influence on its uptake.

Method: An integrative review approach was followed and electronic databases, namely PubMed, Medline, EBSCOhost, and Google Scholar, were searched. We selected qualitative and quantitative studies that focused on South Africa, written in English, and were published in peer-reviewed journals between 2016 and 2024.

Results: Two distinct models were identified, namely the health facility-based model and the community-based model which is inclusive of the use of pharmacies. Both models have constraints and facilitators that impact on access and acceptability, thus influencing uptake.

Conclusion: Decentralisation as a means to ensure access, and awareness to facilitate acceptability, are critical drivers of the PrEP service's success. Therefore, it is critical to develop intervention strategies that focus on access and acceptability among the target population, driven by the need to overcome barriers and ensure sustainability.

Background: Treatment response biomarkers are needed in the care of patients hospitalised with HIV-associated tuberculosis (TB).

Objectives: We describe the changes in bacillary load during early treatment using quantitative and semi-quantitative measures of Mycobacterium tuberculosis in blood and urine.

Method: We collected serial blood and urine samples at multiple timepoints in consenting adult patients with HIV and positive urine lipoarabinomannan (LAM), admitted to Mitchells Plain Hospital, Cape Town. Blood and urine Xpert Ultra, mycobacterial blood culture and urine LAM were performed. Survival analysis and mixed-effects modelling were used to determine time to a negative test, and to give the predicted probability of a positive test at the different timepoints.

Results: Sixteen participants, predominantly male (63%), with median age 39 years (interquartile range [IQR] 36-43), and CD4 count 27 cells/mm³ (IQR 8-83) were included. At day 14, urine LAM, urine Xpert Ultra and blood Xpert Ultra remained positive in between 75% and 86% of the participants. A mixed-effects model predicted a decline in ordinal values of urine Xpert Ultra (cycle threshold), blood Xpert Ultra (cycle threshold) and blood culture (time-to-positivity) in response to anti-TB treatment. Conversely, urine LAM grade intensity increased over the 14 days.

Conclusion: M. tuberculosis DNA was detectable in urine and blood in decreasing quantity up to 14 days of standard treatment in patients with HIV-associated TB. Urine Alere LAM showed an increasing grade intensity during this period. Further research in larger groups and extended periods are needed to assess relation to clinical outcomes.

The successful roll-out and improved delivery of antiretroviral therapy (ART) services has led to paediatric HIV patients surviving to reach adolescence. Adolescents living with HIV (ALHIV) are challenged when transitioning to adult HIV care programmes where they must negotiate new care pathways, changes in healthcare providers and self-manage their chronic condition, in addition to dealing with the psychological and physiological developmental changes of adolescence. The transition process needs to be well guided, to ensure that ALHIV on ART maintain optimal adherence and remain engaged in care. Viral suppression and retention in care are significantly lower for older adolescents (15-19 years) compared to children and younger adolescents under 15 years - coinciding with the post-transition period. Comprehensive and structured transition protocols may have a significant impact on positive health outcomes. In sub-Saharan Africa, there is a dearth of policies and implementation guidelines for ALHIV who are transitioning to adult HIV care. The current review reports on policies and guidelines for transitioning ALHIV to adult HIV care in South Africa. Eight policies were identified, which were developed at global (n = 2), national (n = 2) and provincial levels (n = 1), and guided implementation (n = 3). Current national and provincial policies provide guidance on when to transition a patient clinically to facilitate the switch to adult ART regimens. Although global policies and implementation guidelines emphasise specific and comprehensive care for ALHIV on ART, these are not carried over to national and provincial policies in South Africa. Further development of policies is required to guide comprehensive, adolescent-friendly transition processes for ALHIV on ART in South Africa.