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Chinogurei C, Manne-Goehler J, Kahn K, Kabudula CW, Cornell M, Rohr JK. Socio-Behavioural Barriers to Viral Suppression in the Older Adult Population in Rural South Africa. AIDS Behav 2024:10.1007/s10461-024-04328-9. [PMID: 38619653 DOI: 10.1007/s10461-024-04328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
South Africa has the largest share of people living with HIV in the world and this population is ageing. The social context in which people seek HIV care is often ignored. Apart from clinical interventions, socio-behavioural factors impact successful HIV care outcomes for older adults living with HIV. We use cross-sectional data linked with demographic household surveillance data, consisting of HIV positive adults aged above 40, to identify socio-behavioural predictors of a detectable viral load. Older adults were more likely to have a detectable viral load if they did not disclose their HIV positive status to close family members (aOR 2.56, 95% CI 1.89-3.46), resided in the poorest households (aOR 1.98, 95% CI 1.23-3.18), or were not taking medications other than ART (aOR 1.83, 95% CI 1.02-1.99) likely to have a detectable. Clinical interventions in HIV care must be supported by understanding the socio-behavioural barriers that occur outside the health facility. The importance of community health care workers in bridging this gap may offer more optimum outcomes for older adults ageing with HIV.
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Affiliation(s)
- Chido Chinogurei
- Centre of Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa.
| | - J Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - K Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - C W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - M Cornell
- Centre of Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - J K Rohr
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
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Alves AMCV, de Brito ÉHS, de Araújo MFM, de Hollanda Celestino JJ, Leite ACRDM, Cruz GS, Azevedo NF, Rodrigues CF. Antifungal Susceptibility and Candida sp. Biofilm Production in Clinical Isolates of HIV-Positive Brazilian Patients under HAART Therapy. Biomedicines 2024; 12:310. [PMID: 38397912 PMCID: PMC10886575 DOI: 10.3390/biomedicines12020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The aim of the present study was to characterize biofilms formed by Candida spp. clinical isolates (n = 19), isolated from the oral mucosa of HIV-positive patients. For characterizing the biofilms formed by several Candida sp. strains, isolated from HIV-positive patients, in terms of formed biomass, matrix composition and antifungal susceptibility profile, clinical isolates (n = 19) were collected from oral mucosa and identified. The biofilm of the samples was cultured with fluconazole (1250 mg/L), voriconazole (800 mg/L), anidulafungin (2 mg/L) or amphotericin B (2 mg/L). Afterwards, the quantification of the total biomass was performed using crystal violet assay, while the proteins and carbohydrates levels were quantified in the matrix. The results showed a predominance of C. albicans, followed by C. krusei. Around 58% of the Candida spp. biofilm had susceptibility to fluconazole and voriconazole (800 mg/L), 53% to anidulafungin and 74% to amphotericin B. C. krusei presented both the lowest and the highest biofilm matrix contents in polysaccharides and proteins. The low resistance to antifungal agents reported here was probably due to the fact that none of the participants had a prolonged exposure to these antifungals. A predominance of less virulent Candida spp. strains with low or no resistance to antifungals was observed. This can be attributed to a low fungal selective pressure. This most probably happened due to a low fungal selective pressure but also due to a good adherence to HAART therapy, which guarantees a stable and stronger immune patient response.
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Affiliation(s)
- Anelise Maria Costa Vasconcelos Alves
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-170, Ceará, Brazil;
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Érika Helena Salles de Brito
- Institute of Health Sciences, University of International Integration of Afro-Brazilian Luso-Phony, Redenção 62790-000, Ceará, Brazil; (É.H.S.d.B.); (J.J.d.H.C.); (A.C.R.d.M.L.)
| | | | - Juliana Jales de Hollanda Celestino
- Institute of Health Sciences, University of International Integration of Afro-Brazilian Luso-Phony, Redenção 62790-000, Ceará, Brazil; (É.H.S.d.B.); (J.J.d.H.C.); (A.C.R.d.M.L.)
| | - Ana Caroline Rocha de Melo Leite
- Institute of Health Sciences, University of International Integration of Afro-Brazilian Luso-Phony, Redenção 62790-000, Ceará, Brazil; (É.H.S.d.B.); (J.J.d.H.C.); (A.C.R.d.M.L.)
| | - Gabriela Silva Cruz
- Institute of Health Sciences, University of International Integration of Afro-Brazilian Luso-Phony, Redenção 62790-000, Ceará, Brazil; (É.H.S.d.B.); (J.J.d.H.C.); (A.C.R.d.M.L.)
| | - Nuno Filipe Azevedo
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Célia Fortuna Rodrigues
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- 1H-TOXRUN—One Health Toxicology Research Unit, Cooperativa de Ensino Superior Politécnico e Universitário—CESPU, 4585-116 Gandra PRD, Portugal
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Concepcion T, Velloza J, Kemp CG, Bhat A, Bennett IM, Rao D, Polyak CS, Ake JA, Esber A, Dear N, Maswai J, Owuoth J, Sing'oei V, Bahemana E, Iroezindu M, Kibuuka H, Collins PY. Perinatal Depressive Symptoms and Viral Non-suppression Among a Prospective Cohort of Pregnant Women Living with HIV in Nigeria, Kenya, Uganda, and Tanzania. AIDS Behav 2023; 27:783-795. [PMID: 36210392 PMCID: PMC9944362 DOI: 10.1007/s10461-022-03810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
Depression is common during pregnancy and is associated with reduced adherence to HIV-related care, though little is known about perinatal trajectories of depression and viral suppression among women living with HIV (WLHV) in sub-Saharan Africa. We sought to assess any association between perinatal depressive symptoms and viral non-suppression among WLWH. Depressive symptomatology and viral load data were collected every 6 months from WLWH enrolled in the African Cohort Study (AFRICOS; January 2013-February 2020). Generalized estimating equations modeled associations between depressive symptoms [Center for Epidemiological Studies Depression (CES-D) ≥ 16] and viral non-suppression. Of 1722 WLWH, 248 (14.4%) had at least one pregnancy (291 total) and for 61 pregnancies (21.0%), women reported depressive symptoms (13.4% pre-conception, 7.6% pregnancy, 5.5% one-year postpartum). Depressive symptomatology was associated with increased odds of viral non-suppression (aOR 2.2; 95% CI 1.2-4.0, p = 0.011). Identification and treatment of depression among women with HIV may improve HIV outcomes for mothers.
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Affiliation(s)
- Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ian M Bennett
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- US Army Medical Research Directorate-Africa, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate-Africa, Kisumu, Kenya
- HJF Medical Research International, Kisumu, Kenya
| | - Valentine Sing'oei
- U.S. Army Medical Research Directorate-Africa, Kisumu, Kenya
- HJF Medical Research International, Kisumu, Kenya
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Mbeya, Tanzania
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Abuja, Nigeria
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Pamela Y Collins
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Athanasakis K, Naoum V, Naoum P, Nomikos N, Theodoratou D, Kyriopoulos J. A 10-year economic analysis of HIV management in Greece: evidence of efficient resource allocation. Curr Med Res Opin 2022; 38:265-271. [PMID: 34873979 DOI: 10.1080/03007995.2021.2015158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Human Immunodeficiency Virus (HIV) prevalence has substantially increased over the years, leading to increased direct medical costs. The aim of the present study was to assess the long-term cost of HIV care in Greece incurred over the last decade. METHODS In order to assess the long-term cost of HIV care, a cost analysis was undertaken for three discrete time points (which reflect major changes in the HIV treatment paradigm), incorporating the evolution of the cost of pharmaceuticals, hospitalization, primary care visits and diagnostic tests. The cost per life year gained (LYG) was also estimated. RESULTS Total cost of HIV care increased by 57% over the last decade (€53.7 million in 2010 vs €84.5 million in 2019), which can be mainly attributed to a 107% (5084 in 2010 vs. 10,523 in 2019) increase observed in the number of people living with HIV (PLWH) under care. As a result, the cost per person on treatment has decreased by 24.0% (€10,567 in 2010 vs €8032 in 2019). Lifetime cost was lower and life expectancy higher in 2019 compared to 2010, leading to a - €711 cost per LYG, suggesting that the current treatment paradigm produces better health outcomes at a lower cost compared to a decade ago, implying that resources are used in a more efficient way. CONCLUSION The paper presents some evidence towards the direction that HIV management in Greece can be considered efficient in both clinical and financial terms, as it offers measurable clinical outcomes at well-controlled, almost inelastic spending.
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Affiliation(s)
- Kostas Athanasakis
- Laboratory for Health Technology Assessment (LabHTA), Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Lazarus JV, Safreed-Harmon K, Kamarulzaman A, Anderson J, Leite RB, Behrens G, Bekker LG, Bhagani S, Brown D, Brown G, Buchbinder S, Caceres C, Cahn PE, Carrieri P, Caswell G, Cooke GS, Monforte AD, Dedes N, Del Amo J, Elliott R, El-Sadr WM, Fuster-Ruiz de Apodaca MJ, Guaraldi G, Hallett T, Harding R, Hellard M, Jaffar S, Kall M, Klein M, Lewin SR, Mayer K, Pérez-Molina JA, Moraa D, Naniche D, Nash D, Noori T, Pozniak A, Rajasuriar R, Reiss P, Rizk N, Rockstroh J, Romero D, Sabin C, Serwadda D, Waters L. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun 2021; 12:4450. [PMID: 34272399 PMCID: PMC8285468 DOI: 10.1038/s41467-021-24673-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Adeeba Kamarulzaman
- University of Malaya, Kuala Lumpur, Malaysia
- International AIDS Society (IAS), Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Georg Behrens
- Medizinische Hochschule Hannover (MHH), Hannover, Germany
| | | | - Sanjay Bhagani
- Royal Free London NHS Trust and University College London, London, United Kingdom
| | - Darren Brown
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, United States
| | - Carlos Caceres
- Center for Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseilles, France
| | - Georgina Caswell
- Global Network of People Living with HIV (GNP+), Cape Town, South Africa
| | | | | | | | - Julia Del Amo
- National Plan on AIDS, Ministry of Health, Madrid, Spain
| | | | | | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Università degli studi di Modena e Reggio Emilia, Modena, Italy
| | - Tim Hallett
- Imperial College London, London, United Kingdom
| | | | | | - Shabbar Jaffar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Marina Klein
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Ken Mayer
- Fenway Health and Harvard Medical School, Boston, United States
| | - Jose A Pérez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Denis Nash
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | - Teymur Noori
- European Centre for Disease Control and Prevention, Solna, Sweden
| | - Anton Pozniak
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Laura Waters
- Central and North West London NHS Trust, London, United Kingdom
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