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Malnutrition and associated factors among adults starting on antiretroviral therapy at PASADA Hospital in Temeke District, Tanzania.
Tanzania Journal of Health Research. 2018 Apr; 20(2): p.Background: Malnutrition is known to play a significant role in HIV/AIDS progression. Severe malnutrition has been previously found to be associated with early mortality among people living with HIV/AIDS (PLHIV) undergoing anti-retroviral therapy (ART) in Sub-Saharan Africa. The objective of this study was to determine the prevalence and factors associated with malnutrition among adult PLHIV attending care and treatment centre (CTC) in Temeke District, Tanzania. Methods: The cross-sectional descriptive study involved consecutive eligible patients attending the CTC for initiating in ART, between January and April, 2014. All participants who agreed to sign a consent form were enrolled. The participants had undergone baseline workup for ART initiation (by CTC), which included blood tests for liver and renal function tests, and CD4+ cell count, using calibrated instruments and standard techniques. In all patients the weight and height were measured to calculate the body mass index (BMI), denoting the nutritional status. This parameter was recorded in the study instrument together with the CD4+ count for each patient. A structured questionnaire was used to obtain more information, namely demographic and lifestyle data. Results: A total of 125 patients were included in this study. The prevalence of malnutrition among participants was 19.4%. Those with severe malnutrition comprised of 9%. Significant association was noted between malnutrition and irregular income (OR= 3.8, CI: 1.2-11.5) and also inability to get at least two meals a day (OR= 3.4, CI: 1.2-9.2). Severe malnutrition was significantly associated with the CD4+ counts of <200 cells/mm (OR =7.6; CI: 1.7-34.6). Conclusion: About 19% of participants were malnourished at the time of initiation of ART and among them 9% were severely malnourished. The most important risks for malnutrition were found to be irregular income and inability to get adequate feeding. This calls for routine nutritional assessment at CTCs prior to initiation of ART so as to identify those who need immediate intervention, including those with severe malnutrition.
Antiretroviral therapy clinic attendance among children aged 0-14 years in Kahama district, Tanzania: a cross-sectional study.
Tanzania Journal of Health Research. 2018 Jan; 20(1): p.Background: Efforts made to scale up care and treatment for HIV in Tanzania have started to pay off. The number of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) has massively increased owing to an increase in investment made. However, this is not reflected in all populations, especially children living with HIV. This study, therefore, aims to determine the magnitude and factors associated with ART uptake among children living with HIV in Kahama district, Tanzania. Methods: This cross-sectional study was conducted among pairs of children aged 0-14 years and their caregivers. A total of 423 randomly selected caregivers of HIV-positive children were interviewed using a structured questionnaire. The outcome variable was ART uptake while independent variables constituted of socio-demographic, health facility, and systemic factors. Results: A total of 132 (31%) of all caregivers reported to have missed at least one clinic visit for their children during a period of three months before the survey. Of them, one in four missed at least two clinics. Caregivers cited factors such as lack of transport fare and distance to the health facility as barriers to attend the planned clinics. After adjusting for the important confounders and other covariates, factors associated with ART uptake were being divorced/widowed (AOR= 0.57, 95% CI; 0.33-0.97) and having primary education or more (AOR 0.30, 95% CI 0.11-0, 82). Conclusion: One in every three HIV-positive children miss their scheduled routine ART clinics in Kahama, Shinyanga. Tailored interventions should target caregivers of such children who are divorced or widowed and those with low or no education while addressing distance and transportation challenges in this and other areas with similar contexts.
Antiretroviral treatment adherence among patients in selected health facilities in East London, South Africa: a cross-sectional study.
Online Journal of Health and Allied Sciences. 2018 Apr-Jun; 17(2): p.Studies on antiretroviral therapy (ART) adherence reported variations about the predictors and risk factors, which warrant regional and context-specific research on non-adherence profiles. The purpose of this study was to examine the underlying contributing factors to antiretroviral treatment non-adherence among HIV positive patients in selected health facilities. Methods: This was a descriptive cross-sectional study involving 371 HIV positive patients on antiretroviral treatment in six primary health care facilities in East London, South Africa. A self- designed structured questionnaire was the tool for data collection. Result: The majority (70%) of the participants were non-adherents. About 64% of the participants had been counselled before starting ARV treatment (92.2%) so had a good knowledge of HIV. The majority of the participants experienced no side effects. About 55.0% of the participants had a history of non-adherence, with 26.0% non-adherence rate in the previous month and 19.0% recorded in the previous week. Marital status (married) (p=0.005), having no formal education (p=0.035), being Christian (p=0.007), alcohol consumption (p= 0.021) and viral load suppression had significant associations with non-adherence to ARV treatment. After adjusting for confounders, only non-Christians and unsuppressed viral loads were the independent predictors of non-adherence. Participants who were non-Christians had 3.2 times the likelihood of failing to adhere to ARVs compared to those who were Christians. Furthermore, participants with unsuppressed viral loads were 3 times more likely to be non-adherent to their ARVs compared to participants with suppressed viral loads. The majority of the participants were satisfied with the quality of care they received while accessing the health facility. Concerning viral load distribution, 52% were undetectable, 26% unsuppressed and 22% suppressed. Conclusion: The main contributing factors to ART non-adherence among the participants on ARVs were marital status, level of education, religion and alcohol consumption. Non-Christians and unsuppressed viral loads independently predicted non-adherence among patients in this setting. The majority of the participants, though satisfied with other indicators of quality of care they received, had to wait for more than two hours before receiving service.
Archives De Pediatrie. 2018 Feb; 25(2):73-74.Add to my documents.
Patients' perspectives of acceptability of ART, TB and maternal health services in a subdistrict of Johannesburg, South Africa.
BMC Health Services Research. 2018 Nov 7; 18(1):839.BACKGROUND: The field of acceptability of health services is emerging and growing in coherence. But there are gaps, including relatively little integration of elements of acceptability. This study attempted to analyse collectively three elements of acceptability namely: patient-provider, patient-service organisation and patient-community interactions. METHODS: Mixed methods were used to analyse secondary data collected as part of the Researching Equity in Access to Health Care (REACH) study of access to tuberculosis (TB) treatment, antiretroviral therapy (ART) and maternal health (MH) services in South Africa's public health sector. RESULTS: Provider acceptability was consistently high across all the three tracer services at 97.6% (ART), 96.6% (TB) and 96.4% (MH). Service acceptability was high only for TB tracer (70.1%). Community acceptability was high for both TB (83.6%) and MH (96.8%) tracers. CONCLUSION: Through mixed methods, this paper provides a nuanced view of acceptability of health services.
Infection Control and Hospital Epidemiology. 2018 Feb; 39(2):247-248.Add to my documents.
Stigma management intervention to improve antiretroviral therapy adherence: Phase-I test of concept trial, Cape Town South Africa.
Global Public Health. 2018 Nov 30; 16 p.Combination antiretroviral therapy (cART) has transformed HIV infection from a universally fatal disease to a medically manageable chronic illness. We conducted a Phase-I test of concept intervention trial to examine feasibility and potential efficacy of behavioural self-regulation counselling designed to improve care retention and cART adherence. The intervention was culturally adapted from client-centered evidence-based interventions that are grounded in behavioural self-regulation theory and available in the US. The intervention adaptation included enhancements to directly address HIV stigma and alcohol-related sources of nonadherence. Fifty patients receiving cART in Cape Town, South Africa were randomised to receive either: (a) five weekly cellphone-delivered sessions of stigma and alcohol-enhanced behavioural self-regulation counselling or (b) a contact matched control condition. Participants were baseline assessed and followed for two weeks post-intervention, with 94% of participants retained throughout the study. Participants receiving the intervention significantly improved cART adherence from baseline-to-follow up and improvement was significantly greater than the control condition. Behaviours related to stigma and alcohol use that impede cART adherence were significantly reduced, and there was uptake of adherence improvement strategies. The current study supports the potential efficacy of relatively brief behavioural self-regulation counselling delivered by cellphone in a context of differentiated care in South Africa.
Variation in HIV prevalence and the population-level effects of antiretroviral therapy in reducing tuberculosis incidence in South Africa.
South African Medical Journal. 2018 Jul 25; 108(8):12370.Add to my documents.
Impact of maternal ART on mother-to-child transmission (MTCT) of HIV at six weeks postpartum in Rwanda.
BMC Public Health. 2018 Nov 12; 18(1):1248.BACKGROUND: In 2010, Rwanda adopted ART for prevention of mother to child transmission of HIV from pregnant women living with HIV during pregnancy and breasfeeding period. This study examines rates of mother-to-child-transmission of HIV at 6-10 weeks postpartum and risk factors for mother-to-child transmission of HIV (MTCT) among HIV infected women on ART during pregnancy and breastfeeding. METHODS: A cross-sectional survey study was conducted between July 2011-June 2012 among HIV-exposed infants aged 6-10 weeks and their mothers/caregivers. Stratified multi-stage, probability proportional to size and systematic sampling to select a national representative sample of clients. Consenting mothers/caregivers were interviewed on demographic and program interventions. Dry blood spots from HIV-exposed infants were collected for HIV testing using DNA PCR technique. Results are weighted for sample realization. Univariable analysis of socio-demographic and programmatic determinants of early mother-to-child transmission of HIV was conducted. Variables were retained for final multivariable models if they were either at least of marginal significance (p-value < 0.10) or played a confounding role (the variable had a noticeable impact > 10% change on the effect estimate). RESULTS: The study sample was 1639 infants with HIV test results. Twenty-six infants were diagnosed HIV-positive translating to a weighted MTCT estimate of 1.58% (95% CI 1.05-2.37%). Coverage of most elimination of MTCT (EMTCT) program interventions, was above 80, and 90.4% of mother-infant pairs received antiretroviral treatment or prophylaxis. Maternal ART and infant antiretroviral prophylaxis (OR 0.01; 95%CI 0.001-0.17) and maternal age older than 25 years were significantly protective (OR 0.33; 95%CI 0.14-0.78). No disclosure of HIV status, not testing for syphilis during pregnancy and preterm birth were significant risk factors for MTCT. Factors suggesting higher socio-demographic status (flush toilet, mother self-employed) were borderline risk factors for MTCT. CONCLUSION: ART for all women during pregnancy and breastfeeding was associated with the estimated low MTCT rate of 1.58%. Mothers who did not receive a full package of anti-retroviral therapy according to the Rwanda EMTCT protocol, and young and single mothers were at higher risk of MTCT and should be targeted for support in preventing HIV infection.
International Journal of Community Medicine and Public Health. 2018 Dec; 5(12):5096-5100.Background: India is among the list of countries with highest HIV prevalence. Retention in care is vital to maintain good health and obtain antiretroviral therapy (ART) medicines on time. The objectives of the study were to study the clinico-demographic profile of study population and to study the outcome of ART after one year of treatment initiation. Methods: This is an observational follow up (longitudinal) study done on 142 patients which included all newly diagnosed (diagnosed on or after 1st January 2012), sero positive, adult patients, enrolled at an ART centre and started on treatment during the months of December 2012, January 2013, February 2013, using a pre-designed, pre-tested questionnaire. They were visited again a year after ART initiation and outcome was assessed along with determinants of poor outcome. Results: Mortality at the end of one year was 9.15%, rate of loss to follow up (LFU) was 7.6%.Therefore a total of 73.2% cases were retained in care and 26.8% were disengaged from care (LFU and dead) after one year of ART initiation. Risk factors found to have significant association with being disengaged from care were male sex, unmarried/widowed/divorced/separated individuals, lower socio economic status, illiteracy, unskilled occupation, spouse status negative for HIV, presence of addictions like alcoholism, smoking, experience of drug side effects, early WHO clinical stage, presence of opportunistic infections and low CD4 counts. Conclusions: Many of the risk factors are amenable for intervention and may be incorporated to strengthen the programme.
International Journal of Community Medicine and Public Health. 2018 Oct; 5(10):4566-4572.Background: Antiretroviral drugs delay progression of HIV disease and improve the quality of life in the HIV infected people. A very high levels of adherence is required for ART to be effective long term and to prevent the emergence of resistant viral strains. The objectives were to assess the adherence of anti-retro viral treatment and its determinants and to estimate the status of CD4 count before and after ART in HIV patients. Methods: The study was a cross sectional study conducted in ART center Hamidia hospital at Bhopal, Madhya Pradesh. 256 participants with HIV who had registered in the center and receiving ART for the past 6 months were included in the study. A predesigned questionnaire was used for the study. Data was analysed using Epi Info. The significance of proportion were calculated using chi square test (p<0.05). Results: All the respondents knew that unprotected sexual contact, contaminated Blood transfusion and infected syringes were the major modes of transmission of HIV. About 60 (41.96%) in 143 patient with CD4 count <200 improved to >350. Majority of respondents 195 (76.17%) missed the dose often and 61 (23.83%) did not miss the dose at all. The major reasons for missing dose of ART regimen were forgot to take medicines (57.95%), alcoholic state (26.15%) and long duration of treatment (47.17%). Conclusions: The majority of patient missed the doses due to socio demographic and treatment related factors. A good treatment adherence is linked with the good quality drug and better environment in the clinics throughout the treatment period.
Effectiveness of interventions for unstable patients on antiretroviral therapy in South Africa: results of a cluster-randomised evaluation.
Tropical Medicine and International Health. 2018 Dec; 23(12):1314-1325.Background: As loss from HIV care is an ongoing challenge globally, interventions are needed for patients who don't achieve or maintain ART stability. The 2015 South African National Adherence Guidelines (AGL) for Chronic Diseases include two interventions targeted at unstable patients: early tracing of patients who miss visits (TRIC) and enhanced adherence counselling (EAC). Methods: As part of a cluster-randomised evaluation at 12 intervention and 12 control clinics in four provinces, intervention sites implemented the AGL interventions, while control sites retained standard care. We report on outcomes of EAC for patients with an elevated viral load (>400 copies/ml) and for TRIC patients who missed a visit by >5 days. We estimated risk differences (RD) of 3 and 12-month viral resuppression (<400 copies/ml) and 12-month retention with cluster adjustment using generalised estimating equations and controlled for imbalances using difference-in-differences compared to all eligible in 2015, prior to intervention roll-out. Results: For EAC, we had 358 intervention and 505 control site patients (61% female, median ART initiation CD4 count 154 cells/µl). We found no difference between arms in 3-month resuppression (RD: -1.7%; 95%CI:-4.3% to 0.9%), but <20% of patients had a repeat viral load within 3 months (19.8% intervention, 13.5% control). Including the entire clinic population eligible for EAC with a repeat viral load at all evaluation sites (n = 934), intervention sites showed a small increase in 3-month resuppression (28% vs. 25%, RD 3.0%; 95%CI: -2.7% to 8.8%). Adjusting for baseline differences increased the RD to 8.1% (95% CI: -0.1% to 17.2%). However, we found no differences in 12-month suppression (RD: 1.5%; 95% CI:-14.1% to 17.1% but suppression was low overall at 40%) or retention (RD: 2.8%; 95% CI: -7.5% to 13.2%). For TRIC, we enrolled 155 at intervention sites and 248 at control sites (44% >40 years, 67% female, median CD4 count 212 cells/µl). We found no difference between groups in return to care by 12 months (RD: -6.8%; 95% CI: -17.7% to 4.8%). During the study period, control sites continued to use tracing within standard care, however, potentially masking intervention effects. Conclusions: Enhanced adherence counselling showed no benefit over 12 months. Implementation of the tracing intervention under the new guidelines was similar to the standard of care. Interventions that aim to return unstable patients to care should incorporate active monitoring to determine if the interventions are effective.
Dyslipidaemias in women using hormonal contraceptives: a cross sectional study in Mulago Hospital Family Planning Clinic, Kampala, Uganda.
BMJ Open. 2018 Oct 18; 8(10):e022338.OBJECTIVE: To determine the prevalence and factors associated with dyslipidaemias in women using hormonal contraceptives. DESIGN: Cross-sectional study SETTING: Mulago Hospital, Kampala, Uganda PARTICIPANTS: Three hundred and eighty-four consenting women, aged 18-49 years, who had used hormonal contraceptives for at least 3 months prior to the study. STUDY OUTCOME: Dyslipidaemias (defined as derangements in lipid profile levels which included total cholesterol >/=200 mg/dL, high-density lipoprotein <40 mg/dL, triglyceride >150 mg/dL or low-density lipoprotein >/=160 mg/dL) for which the prevalence and associated factors were obtained. RESULTS: The prevalence of dyslipidaemias was 63.3% (95% CI: 58.4 to 68.1). Body mass index (BMI) (PR=1.33, 95% CI: 1.15 to 1.54, p<0.001) and use of antiretroviral therapy (ART) (PR=1.21, 95% CI: 1.03 to 1.42, p=0.020) were the factors significantly associated with dyslipidaemias. CONCLUSION: Dyslipidaemias were present in more than half the participants, and this puts them at risk for cardiovascular diseases. The high-risk groups were women with a BMI greater than 25 Kg/m(2) and those who were on ART. Therefore, lipid profiles should be assessed in women using hormonal contraceptives in order to manage them better. (c) Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study.
Reproductive Health. 2018 May 10; 15(1):76.BACKGROUND: Antiretroviral therapy (ART) in pregnancy was associated with a drastic reduction in HIV mother-to-child transmission (MTCT), although it was associated with neonatal adverse effects. The aim of this study was to evaluate the neonatal effects to maternal ART. METHODS: This study was a cohort of newborns from HIV pregnant women followed at the CAISM/UNICAMP Obstetric Clinic from 2000 to 2015. The following adverse effects were evaluated: anemia, thrombocytopenia, liver function tests abnormalities, preterm birth, low birth weight and congenital malformation. Data collected from patients' files was added to a specific database. Descriptive analysis was shown in terms of absolute (n) and relative (%) frequencies and mean, median and standard deviation calculations. The association between variables was tested through Chi-square or Fisher exact test (n < 5) and relative risk (RR) with its respective p values for the categorical ones and t-Student (parametric data) or Mann-Whitney (non-parametric data) for the quantitative ones. The significant level used was 0.05. A multivariate Cox Logistic Regression was done. Statistical analysis was performed using SAS version 9.4. RESULTS: Data from 787 newborns was analyzed. MTCT rate was 2.3%, with 0.8% in the last 5 years. Observed neonatal adverse effects were: liver function tests abnormalities (36%), anemia (25.7%), low birth weight (22.5%), preterm birth (21.7%), children small for gestational age (SGA) (18%), birth defects (10%) and thrombocytopenia (3.6%). In the multivariate analysis, peripartum CD4 higher than 200 cells/mm(3) was protective for low birth weight and preterm birth, and C-section was associated with low birth weight, but not with preterm birth. Neonatal anemia was associated with preterm birth and exposure to maternal AZT. Liver function tests abnormalities were associated with detectable peripartum maternal viral load and exposure to nevirapine. No association was found between different ART regimens or timing of exposure with preterm birth, low birth weight or congenital malformation. CONCLUSION: Highly active antiretroviral treatment in pregnant women and viral load control were the main factors associated with MTCT reduction. Antiretroviral use is associated with a high frequency but mainly low severity adverse effects in newborns.
Lancet. HIV. 2018 Apr; 5(4):e155.Add to my documents.
Lancet. HIV. 2017 Apr; 4(4):e147-e149.Add to my documents.
Lancet. 2017 Sep 30; 390(10102):1618-1619.Add to my documents.
African Journal of AIDS Research. 2017 Dec; 16(4):v-ix.Add to my documents.
Lancet. HIV. 2018 Feb; 5(2):e65-e67.Add to my documents.
Lancet. HIV. 2018 Mar; 5(3):e107.Add to my documents.
AIDS. 2016 Oct 23; 30(16):2569-2570.Add to my documents.
Namibia has a strong foundation for implementing the Treat All guidelines and reaching the UNAIDS 90-90-90 targets.
Washington, D.C., Population Council, Project SOAR, 2018 Mar. 4 p. (Results Brief; USAID Agreement No. AID-OAA-A-14-00060)This brief highlights baseline data collected as part of a larger study assessing the impact of implementing the treat-all guidelines on key treatment and health system outcomes. The baseline data provide a snapshot of ART services delivered by health facilities in northern Namibia during the year prior to the rollout of the treat all guidelines. We also examine ART service outcomes, including 12-month ART patient retention, viral load (VL) testing, and viral suppression, to determine the effects of service decentralization during the year preceding the national roll-out of Namibia’s treat all recommendations.
Early results demonstrate the feasibility and acceptability of community-based antiretroviral treatment delivery to female sex workers in Tanzania.
Washington, D.C., Population Council, Project SOAR, 2018 Apr. 4 p. (Results Brief; USAID Agreement No. AID-OAA-A-14-00060)Project SOAR in collaboration with the National AIDS Control Program of the government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, are conducting implementation science research to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. This brief summarizes key findings from a baseline survey administered to a cohort of FSWs enrolled in the study, qualitative interviews with FSWs conducted three months after the start of the community-based ART services, and routine monitoring data.
Journal of Nepal Paediatric Society. 2017 May-Aug; 37(2):164-167.Introduction: HIV in children is a public health problem in a developing country like Nepal. The aim of the study was to determine the clinical, nutritional and immunological profile of HIV +ve children enrolled in the ART clinic of Pokhara Academy of Health Sciences (PAHS). Materials and Method: This was a retrospective study of children enrolled in the ART clinic over a period of 10 years from July 2007 to June 2017. Clinical characters, Nutritional status and immunological status of children enrolled in the ART clinic were noted in the predesigned pro forma from the record of the clinic and review of the chart of the patients. Results: One hundred twelve children were enrolled in the Clinic during the study duration. Out of them 57 were males and 55 were females. All the children acquired infection through mother to child transmission. Majority of them from age group 1 to 5 years at the time of presentation. Fortysix percent were in the clinical stage III. The median CD4 count was 283.Fifty percent of the children were undernourished. Most of the children were started on AZT/3TC/NVP as first line ART. Conclusion: Although perinatal route was the most common route of transmission of HIV in children, diagnosis was late in the age group of 1-5 years and most of them were diagnosed in the advanced stage of HIV with Low CD4 count.
International Journal of STD and AIDS. 2018 Feb; 29(2):185-194.Malawi launched Option B+, a program for all pregnant or breastfeeding HIV-positive women to begin lifelong combination antiretroviral therapy (cART), in July 2011. This study characterises a portion of the continuum of care within an antenatal setting in Lilongwe. Women testing HIV-positive and having a cART initiation record at Bwaila Antenatal Clinic from July 2013 to January 2014 were included. Using logistic regression models, we analysed relationships between maternal characteristics and return for infant testing. Among 490 HIV-positive women with a cART initiation record, 360 (73%) were retained at three months. Of these, 203 (56%) were adherent. Records of infant testing were located for 204 women (42%). Women who were not retained were less likely to have an early infant diagnosis record (aOR = 0.20; 95% CI: 0.10, 0.41). Among the women retained, there was a non-significant association between maternal adherence and infant testing (OR = 1.35; 95% CI: 0.89, 2.06). Women lost at earlier continuum stages, who are at higher risk for mother-to-child-transmission, were less likely to bring infants for testing. Even with a test-and-treat program, many women did not remain in care or bring their infant for testing. Facilitating strategies to improve these measures remains an important unmet need.