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Tumuhairwe F, Izudi J, Munina A, Bashaija A, Bajunirwe F. Quality of life and retention in care among people living with HIV initiated on ART in the era of "Universal Test and Treat" policy at a large HIV Clinic in South Western Uganda. PLoS One 2025; 20:e0324024. [PMID: 40373165 PMCID: PMC12080831 DOI: 10.1371/journal.pone.0324024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 04/19/2025] [Indexed: 05/17/2025] Open
Abstract
BACKGROUND Anti-retroviral therapy (ART) improves the quality of life (QoL) among people living with human immunodeficiency virus (PLWH). Most studies documenting the gains in QoL have been conducted among persons starting treatment at advanced HIV disease. In the era of Universal Test and Treat (UTT) policy, most PLWH start ART early with high CD4 counts. Therefore, we investigated the association between baseline CD4 count with QoL and retention among PLWH during UTT in southwestern Uganda. METHODS Between June 11, 2019, and June 10, 2020, we reviewed medical records for PLWH initiated on ART between April 2017 and September 2018 and interviewed them to collect QoL data. The primary exposure was CD4 count at ART initiation categorized as <500 cells/µl (low) versus ≥500 cells/µl (high). Physical and mental health-related QoL were the primary outcomes. Retention was the secondary outcome. Binary logistic regression was used to assess the association between the exposure and the primary outcome, while the Cox Proportional Hazard regression model was used for the secondary outcome. RESULTS Of 300 participants, 59.7% initiated ART at a low baseline CD4 count. ART initiation at a higher baseline CD4 count, compared to a lower baseline CD4 count, was associated with a lower mental health-related QoL (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.32-0.97) but similar physical health-related QoL (aOR 0.54, 95% CI 0.10-2.78) and retention (adjusted hazard ratio [aHR] 0.30, 95% CI 0.08-1.14). CONCLUSION In this cohort of PLWH on ART, those who initiated the treatment at a higher baseline CD4 were less likely to have good mental health-related QoL functioning compared to those initiating at lower CD4 counts. However, the two groups were comparable in physical health-related QoL and retention in care. PLWH initiating ART at a higher baseline CD4 may require mental health-related support as part of treatment.
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Affiliation(s)
| | - Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Abel Munina
- The AIDS Support Organization (TASO), Mbarara, Uganda
| | - Anthanasio Bashaija
- Department of Foundations of Education and Psychology, Kabale University, Kabale, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Izudi J, Cattamanchi A, Bajunirwe F. Causal inference methodologies to assess the effect of missed clinic visits on treatment success rate among people with tuberculosis in rural Uganda. BMC Med Res Methodol 2025; 25:104. [PMID: 40247175 PMCID: PMC12004605 DOI: 10.1186/s12874-025-02553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 04/07/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND Although randomized controlled trials are the gold standard design for cause-effect analysis, high costs and challenges around practicability, feasibility, and ethics may limit their use. In such situations, causal inference methods can improve the rigor of cause-effect analysis using observational data but such methods have infrequently been applied in tuberculosis (TB) research. We conducted a parallel comparison across three causal inference methods in order to assess the causal association between missed clinic visit/s and treatment success among people with drug-susceptible bacteriologically confirmed pulmonary TB. METHODS We used causal inference methods to analyze cross-sectional data of adults with drug-susceptible bacteriologically confirmed pulmonary TB at clinics in rural eastern Uganda. We compared effect estimates from three causal inference methods, namely instrumental variable analysis, propensity-score analysis (adjustment, matching, weighting, and stratification), and double-robust estimation for cause-effect analysis. The exposure was missing a TB clinic visit/s and the outcome was treatment success defined as cure or treatment completion, both measured on a binary scale. Covariates were selected based on the literature, and their social and biological relevance to the outcome. We report the odds ratio and 95% confidence interval from each causal analysis. RESULTS Of 762 participants (mean age of 39.3 ± 15.8 years) included, 186 (24.4%) had missed a clinic visit/s while 687 (90.2%) were successfully treated for TB. Missed clinic visit/s lowered treatment success across all analyses with instrumental variable analysis (OR 0.41, 95% CI 0.20-0.82), propensity-score analysis (adjustment [OR 0.49, 95% CI 0.30-0.82], matching [OR 0.43, 95% CI 0.21-0.91)], weighting [OR 0.52, 95% CI 0.30-0.91], and stratification [OR 0.34, 95% CI 0.19-0.62]), and double-robust estimation (OR 0.49, 95% CI 0.28-0.85). CONCLUSIONS Missed clinic visit/s reduced the likelihood of TB treatment success rate across all causal inference methods, supporting a causal relationship. Studies are needed to examine interventions that enhance retention in TB treatment.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Adithya Cattamanchi
- Center for Tuberculosis, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Bekele AA, Tegegne AS, Muhie NS. Determinants Associated With CD4 Cell Count and Disclosure Status Among First-Line Antiretroviral Therapy Patients Treated at Felege Hiwot Comprehensive Specialized Hospital, Ethiopia. J Trop Med 2025; 2025:5989447. [PMID: 40260411 PMCID: PMC12009679 DOI: 10.1155/jotm/5989447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 03/08/2025] [Indexed: 04/23/2025] Open
Abstract
Background: In the last two decades, Human immune deficiency virus has been a major health concern in sub-Saharan Africa particularly in Ethiopia. The objective of this study was to identify determinants associated with CD4 cell count and disclosure status among first-line antiretroviral therapy patients treated at Felege Hiwot Comprehensive Specialized Hospital, Ethiopia. Methods: This retrospective study was conducted at Felege Hiwot Comprehensive Specialized Hospital. Data analysis was conducted using Statistical System Analysis (SAS) software Version 9.4. In this study, quasi-Poisson mixed-effects model for CD4 cell count, a binary logistic regression model for disclosure status, and joint modeling were used. Result: Out of 300 adult participants, around 76% of the patients were discloses their disease status to their family members. The correlation between CD4 cell count and disclosure was positive (0.4607). The current study indicates that among the predictor variables, noneducators (β = -0.6185, p-value < 0.01), primary educators (β = -0.3687, p-value < 0.01), employed patients (β = 0.3888, p-value < 0.01), adherent patients (β = 0.2274, p-value < 0.01), and patients who did not had social support (β = -0.1148, p-value = 0.030) have a significant effect for CD4 cell count. Similarly, noneducators (AOR = 0.000145, p-value < 0.01), primary educators (AOR = 0.004413, p-value < 0.01), employed patients (AOR = 3.4562, p-value = 0.021), adherent patients (AOR = 1.564, p-value < 0.01), and patients who did not had social support (AOR = 0.075, p-value = 0.0078) had a significant effect for disclosure status. Conclusion: This study concluded that patients who had disclosed their disease status to near relatives or families have a positive correlation with CD4 cell count through time. This study also concluded that significant determinants affected both the variables of interest were educational level, occupation, adherence, and social support. Health professionals should give more attention to these important determinants to create good status of patients. In addition, health staff should conduct health-related studies for individuals to understand better ART follow-up. Patients should be adhere to their prescribed HIV medication properly on time and disclose their disease status without fearing stigma and discrimination to the community; this may help to increase their CD4 cell count. The family members should give social support to the infected patients, and the government should work on education; this may help to improve their CD4 cell count and increase the prevalence of disclosure of the disease status. The authors also recommended that further studies of this nature include other important variables that are not included in this study such as income of the patients and many other covariates.
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Affiliation(s)
| | | | - Nurye Seid Muhie
- Department of Statistics, Mekdela Amba University, Tulu Awulia, Ethiopia
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Balogun M, Kuhns LM, Akanmu AS, Garofalo R, Badru T, Adekanmbi AF, Akinbami A, Agbaji O, David AN, Omigbodun O, Cevantes M, Janulis P, Akintan P, Awolude O, Kuti KM, Sodipo O, Yiltok E, Mautin GJ, Ezemelue P, Berzins B, Taiwo B. Risk Factors for Viral Non-suppression Among Youth Living with HIV in Nigeria: Findings from the iCARE Nigeria Study. AIDS Behav 2025; 29:848-857. [PMID: 39652275 DOI: 10.1007/s10461-024-04565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 02/18/2025]
Abstract
Viral suppression with antiretroviral therapy (ART) is a critical component of UNAIDS objectives to end the HIV epidemic. Youth living with HIV (YLH) have worse viral suppression rates than adults. The aim of this study was to identify risk factors for viral non-suppression among YLH in Nigeria. A secondary analysis of enrollment data from the iCARE Nigeria study, collected April-October 2021 for 541 YLH comprised demographic, psychosocial, behavioral, clinical variables, and viral load quantification. Viral non-suppression was defined as viral load ≥ 200 copies/mL. Generalized linear models using Akaike information criterion for selection of indicator variables in a stepwise approach were used to determine the risk factors for viral non-suppression. The final analytic sample was 491 and the proportion of non-suppressed participants at baseline was 40%. In the final model, substance use (other than alcohol, tobacco and/or cannabis) (aOR = 3.20 [95% CI: 1.05, 10.34]), missed medication doses (aOR = 1.09 [95% CI: 1.04, 1.15]), and a higher number of self-reported medication barriers (e.g., forgot, busy, change in routine) (aOR = 1.08 [95% CI: 1.00, 1.16]) were associated with a higher likelihood of viral non-suppression. Being prescribed a first-line regimen (aOR = 0.28 [95% CI: 0.17, 0.44]), disclosure to at least one brother (aOR = 0.64 [95% CI: 0.42, 0.97]), and higher treatment outcome expectancies (e.g., taking medication will improve health) (aOR = 0.81 [95% CI: 0.66, 0.98]), were all associated with a lower likelihood of viral non-suppression. Viral non-suppression among YLH in Nigeria is associated with psychosocial and behavioral factors, including missed doses, medication barriers, treatment outcome expectancies, and disclosure, that are potential targets for intervention to achieve ART goals.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.
| | - Lisa M Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Titilope Badru
- iCARE, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abiodun F Adekanmbi
- Department of Paediatrics, Olabisi Onabanjo University and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Akinsegun Akinbami
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Lagos, Nigeria
| | - Oche Agbaji
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Agatha N David
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Marbella Cevantes
- Division of Adolescent Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Patricia Akintan
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olutosin Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kehinde M Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Oluwajimi Sodipo
- Department of Family Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Esther Yiltok
- Department of Paediatrics, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Gbenayon J Mautin
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Priscilla Ezemelue
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, USA
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Muhie NS. Incidence Rate, Survival Rate, and Predictors for Virological Failure Among Adult TB/HIV Coinfected Clients. J Trop Med 2025; 2025:2011556. [PMID: 39990258 PMCID: PMC11846676 DOI: 10.1155/jotm/2011556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/20/2025] [Indexed: 02/25/2025] Open
Abstract
Background: Tuberculosis increases human immunodeficiency virus replication and accelerates human immunodeficiency virus progression in both tuberculosis and human immunodeficiency virus coinfected patients. The objective of this study was to determine the incidence rate, survival rate, and predictors for virological failure among adult tuberculosis/human immunodeficiency virus coinfected clients. Methods: A retrospective cohort study was conducted at the University of Gondar Compressive Specialized Hospital from March 2017 to 2022. Secondary data sources were extracted based on inclusion criteria for adult tuberculosis/human immunodeficiency virus coinfected patients. The Cox proportional hazards model was used for adult tuberculosis/human immunodeficiency virus coinfected patients data. Result: The overall incidence rate of virological failure was 9.23 per 1000 person-months observations. Out of 148 coinfected patients, about 24.3% had virological failure. More than half of the patients, 52.7% and 54.1% in this study had a CD4 cell count ≥ 200/mm3 and a weight < 50 kg, respectively. Gender (hazard ratio = 1.3291, 95% CI: 1.1878-1.4873), bedridden functional status (hazard ratio = 4.7174; 95% CI: 1.2263-14.1470), WHO clinical Stage IV (hazard ratio = 1.1122, 95% CI: 1.2072-5.9693), patients with opportunistic infections (hazard ratio = 1.2849, 95% CI: 1.4289-3.8504), cotrimoxazole preventive therapy users (hazard ratio = 0.2039, 95% CI: 0.0496-0.8386), patients disclosure status (hazard ratio = 0.1609, 95% CI: 0.0279-0.9286), baseline viral load count < 1000 (hazard ratio = 0.0819, 95% CI: 0.3619-0.8447), and CD4 cell count ≥ 200 (hazard ratio = 0.2728, 95% CI: 0.0749-0.9924) were significant predictors at 5% level of confidence for time to virological failure. Conclusion: The incidence and survival rate of virological failure were high. The current study revealed that male coinfected patients, bedridden functional status, WHO clinical Stage IV, and opportunistic infections other than tuberculosis were associated with a higher time to virological failure while patients disclosed the disease to a family member, cotrimoxazole preventive therapy users, baseline viral load < 1000 copies/mL, and CD4 cell count ≥ 200/mm3 had significantly lower time to virological failure. Therefore, public health organizations should be given special attention based on these important predictors to improve their health and prolong the lives of coinfected patients.
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Affiliation(s)
- Nurye Seid Muhie
- Department of Statistics, Mekdela Amba University, Tulu Awulia, Ethiopia
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Mashele V, Marincowitz GJO, Marincowitz C. Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province. S Afr Fam Pract (2004) 2024; 66:e1-e6. [PMID: 39099260 PMCID: PMC11369518 DOI: 10.4102/safp.v66i1.5973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND South Africa is among the countries with the greatest burden of human immunodeficiency virus (HIV) in the world. The introduction of antiretroviral therapy (ART) has made HIV a manageable chronic health condition with a return to normal life expectancy. Adherence to ART is a prerequisite to realising these benefits. METHODS A qualitative study was conducted using individual semi-structured interviews to understand factors influencing adherence to ART among young adults. The study was conducted at three busy primary care clinics around Mankweng Hospital. Participants aged 18-35 years who had been on ART for more than a year were purposefully selected. Open-ended questions were used to explore factors that influence ART. Recorded interviews were transcribed verbatim and translated. The coded transcripts were thematically analysed. RESULTS Eight major themes were identified to influence ART adherence among young adults: medication-related factors, healthcare system factors, attitudes of healthcare workers, economic factors, disclosure, acceptance, mobile phone reminders and family support. CONCLUSION Adherence to ART is a major problem in our communities, and people living with HIV are still finding it challenging to optimally adhere to their ART medication because of the identified factors that influence ART adherence. Family support is a significant factor that was identified to positively influence ART as it leads to disclosure and acceptance of HIV-positive status, better emotional well-being and subsequently improved ART adherence.Contribution: This study underscores the importance of a family-oriented, patient-centred care approach in managing HIV and ART adherence.
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Affiliation(s)
- Victoria Mashele
- Department of Family Medicine, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa; and Health Limpopo, Mankweng Hospital, Polokwane.
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Ayenew G, Agumas Y, Shibabaw T, Getaneh G, Getie M. Determinants of virological failure among HIV clients on second-line antiretroviral treatment at Felege-hiwot and University of Gondar comprehensive specialized hospitals in the Amhara Region, Northwest Ethiopia: A case-control study. PLoS One 2024; 19:e0289450. [PMID: 38980874 PMCID: PMC11232969 DOI: 10.1371/journal.pone.0289450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Second-line HIV treatment failure has become increasing worldwide, mainly in sub-Sahara Africa including Ethiopia. Even though the problem becomes increasing, inadequate information was available about its magnitude and associated factors in the current study area. OBJECTIVE To assess the factors of second-line Anti-Retroviral Treatment virological failure among second-line ART users. METHOD AND MATERIALS Institutional-based unmatched case-control study design was conducted from September to December 2021 at Felege Hiowt and University of Gondar Comprehensive Specialized Hospitals; Amhara region, Northwest Ethiopia. A total of 216 patients (60 cases and 156 controls) were recruited by a simple random sampling technique with a 1:3 cases-to-controls ratio. Patients who had two viral load results >1000 copies/ml within a 3-month interval after taking ART drugs for at least 6 months were cases and those who had ≤1,000 copies/ mL were controls. The sample size was calculated by using Epi-Info version 7.2.4. Structured questionnaires were used to gather the required information. SPSS version 26 was used to summarize the findings. In bivariate logistic regression model, Variables with two-tailed P-value ≤ 0.25 at 95% confidence interval were transferred into multivariate binary logistic regression model and P value at ≤ 0.05 was set as statistically significant. RESULTS Out of 216 patients recruited, 212 have participated with a response rate of 98.2%. From these participants, 117(55.2%) were males and 187(88.2%) were urban dwellers. Among the total respondents, 208(98.1%) had age > 24 years, 200(94.3) were at HIV clinical stage I, 72(34%) had poor ART adherence and 112(52.8) did not disclose their HIV status. Likewise, most of the patients 147(69.37) didn't use condoms. The associated factors were not disclosing HIV status (AOR = 3.4, 95% CI: 1.52-7.79), medium adherence (AOR = 3.7, 95% CI = 1.3-10.7), poor adherence level (AOR = 5.27, 95% CI: 2.2-12.5), not using condoms (AOR = 4.47, 95% CI: 1.63-12.2) and Viral load (>150 copies/ml) when switched to second-line ART (AOR = 3.56, 95% CI: 1.5-8). CONCLUSION AND RECOMMENDATIONS Non-disclosure, poor or medium adherence, not using condoms and high Viral load (>150 copes/ml) when switched to second-line ART were the main factors for second-line Anti-Retroviral Treatment virological failure. Disclosure about HIV status, using condoms and improving treatment adherence level are crucial to reduce second-line virological failure.
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Affiliation(s)
- Getahun Ayenew
- Department of Molecular Laboratory, Trachoma Elimination Program, The Carter Center Ethiopia, Bahir Dar, Ethiopia
| | - Yeshambel Agumas
- Department of Health System Management, Leadership Development Program, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tebkew Shibabaw
- Department of Environmental Health, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gebremariam Getaneh
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Michael Getie
- Department of Medical Microbiology, Amhara National Regional State Public Health Institute, Bahir Dar, Ethiopia
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Malaka RM, Cele L, Mogale M, Simbeni T. Completion rate of tuberculosis preventive therapy and incidence of tuberculosis among people living with the Human Immunodeficiency Virus on antiretroviral therapy in Ekurhuleni East subdistrict, Gauteng province. Pan Afr Med J 2024; 48:86. [PMID: 39465201 PMCID: PMC11512151 DOI: 10.11604/pamj.2024.48.86.43117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/07/2024] [Indexed: 10/29/2024] Open
Abstract
Introduction the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT. Methods this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses. Results the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001. Conclusion the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.
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Affiliation(s)
- Refiloe Mashego Malaka
- Department of Public Health, Epidemiology and Biostatistics Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Lindiwe Cele
- Department of Public Health, Epidemiology and Biostatistics Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mabina Mogale
- Department of Public Health, Epidemiology and Biostatistics Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Thembi Simbeni
- Health System Management and Policy Unit, Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
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Evangeli M, Gnan G, Musiime V, Fidler S, Seeley J, Frize G, Uwizera A, Lisi M, Foster C. The HIV Empowering Adults' Decisions to Share: UK/Uganda (HEADS-UP) Study-A Randomised Feasibility Trial of an HIV Disclosure Intervention for Young Adults with Perinatally Acquired HIV. AIDS Behav 2024; 28:1947-1964. [PMID: 38491226 PMCID: PMC11161430 DOI: 10.1007/s10461-024-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/18/2024]
Abstract
Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019.
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Affiliation(s)
- Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK.
| | - Georgina Gnan
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
| | - Victor Musiime
- Makerere University, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, Imperial College NIHR BRC, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Graham Frize
- Central and North West London NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Matteo Lisi
- Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK
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Ndongo FA, Kana R, Nono MT, Noah JPYA, Ndzie P, Tejiokem MC, Biheng EH, Ndie J, Nkoa TA, Ketchaji A, Ngako JN, Penda CI, Bissek ACZK, Ndombo POK, Hawa HM, Msellati P, Lallemant M, Faye A. Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202193. [PMID: 38523399 DOI: 10.1016/j.jeph.2024.202193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon. METHODS A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem. RESULTS In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070). CONCLUSION This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.
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Affiliation(s)
- Francis Ateba Ndongo
- University of Garoua, Cameroon; Centre Mère-enfant, Fondation Chantal Biya, Yaounde, Cameroon; Ministry of Public Health, Yaounde, Cameroun.
| | - Rogacien Kana
- Media Convergence Consulting Office, Yaounde, Cameroon
| | - Marius Tchassep Nono
- Action for Youths and Family, Douala, Cameroon; University of Douala, Douala, Cameroon
| | | | | | | | | | - Justin Ndie
- Ministry of Public Health, Yaounde, Cameroun
| | | | | | | | | | | | | | | | - Philippe Msellati
- Research Institute for Sustainable Development (IRD), Abidjan, Côte d'Ivoire
| | - Marc Lallemant
- Programs for HIV Prevention and Treatment (PHPT) Foundation - Research Institute for Sustainable Development (IRD), Paris, France
| | - Albert Faye
- Hôpital Universitaire Robert Debré, Paris, France
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Fisk-Hoffman RJ, Parisi CE, Siuluta N, Ding DD, Widmeyer M, Somboonwit C, Cook RL. Antiretroviral Therapy Concealment Behaviors and their Association with Antiretroviral Therapy Adherence among People with HIV: Findings from the Florida Cohort Study. AIDS Behav 2024; 28:1047-1057. [PMID: 37861924 PMCID: PMC10922241 DOI: 10.1007/s10461-023-04214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Little is known about HIV medication concealment behaviors and the effect of medication concealment on antiretroviral therapy (ART) adherence among people with HIV (PWH). This study aims to (1) to describe medication concealment behaviors and factors associated with these behaviors, and (2) assess the association between medication concealment and suboptimal ART adherence. The Florida Cohort Study enrolled adult PWH from community-based clinics around the state from October 2020 to September 2022 (n = 416, 62% aged 50+, 56% male, 44% non-Hispanic Black, 18% Hispanic). Participants responded to questions about sociodemographics, stigma, ART adherence (≥ 85%), symptoms of depression, social networks and disclosure to their networks, and actions to conceal ART to avoid inadvertent disclosure of their HIV status. Analyses were conducted using multivariable logistic regressions models. The most common concealment behavior was hiding ART while having guests over (32%), followed by removing ART labels (26%), and putting ART into a different bottle (16%). Overall, 43% reported ≥ 1 behavior. In multivariable models, depressive symptoms, incomplete disclosure of HIV to close social networks, and not having a close social network were associated with ART concealment. After adjusting for risk factors for suboptimal ART adherence, endorsing hiding medication while having guests was associated with suboptimal ART adherence (aOR 2.87, 95% CI 1.15-7.55). Taking any action and other individual behaviors were not associated. ART concealment behaviors were common but did not consistently negatively influence adherence when accounting for other factors. PWH may want to receive ART medications in ways that ensure privacy and reduce the risk of inadvertent disclosure.
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Affiliation(s)
- Rebecca J Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christina E Parisi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Nanyangwe Siuluta
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Delaney D Ding
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Charurut Somboonwit
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA.
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12
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Izudi J, Cattamanchi A, Castelnuovo B, King R. Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study. Soc Sci Med 2024; 343:116595. [PMID: 38242033 DOI: 10.1016/j.socscimed.2024.116595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; University of California Global Health Institute (UCGHI), University of California San Francisco, San Francisco, CA, USA.
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Rachel King
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Fauk NK, Gesesew HA, Mwanri L, Hawke K, Ward PR. Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia. PLoS One 2023; 18:e0280087. [PMID: 37440559 PMCID: PMC10343063 DOI: 10.1371/journal.pone.0280087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) is a major global public health issue that affects the quality of life (QoL) of people living with HIV (PLHIV) globally and in Indonesia. As a part of a large-scale qualitative study investigating HIV risk factors and impacts on PLHIV and facilitators of and barriers to their access to HIV care services in Yogyakarta and Belu, Indonesia, this paper describes their in-depth views and experiences of the influence of HIV on their QoL. Ninety-two participants were recruited using the snowball sampling technique. Data were collected using in-depth interviews. In addition, the World Health Organisation Quality of Life questionnaire (WHOQOL-HIV BREF) was also distributed to each of them to fill out prior to the interviews. Chi-Square analysis was used to analyse data from the survey and a framework analysis was applied to guide qualitative data analysis. The findings reported several factors affecting the QoL of the participants. These included (i) environmental factors, such as living in rural areas, the unavailability of HIV care services and public transport, and long-distance travel to healthcare facilities; (ii) personal beliefs associated with HIV; (iii) sexual and social relationships and their influence of the QoL of participants; and (iv) level of independence and physical health condition following HIV diagnosis. The findings indicate the need for intervention programs that address the availability and accessibility of HIV care services to PLHIV within rural communities and support various physical, psychological, and financial needs of PLHIV. These can be implemented by providing supplements and nutritious food, HIV counselling and door-to-door/community-based ART service delivery to PLHIV, which may increase their engagement in and adherence to the treatment and improve their physical and psychological condition and QoL.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, Kupang, Nusa Tenggara Timur, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
| | - Karen Hawke
- Infectious Disease—Aboriginal Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, South Australia, Australia
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Nangendo J, Katahoire AR, Karamagi CA, Obeng-Amoako GO, Muwema M, Okiring J, Kabami J, Semitala FC, Kalyango JN, Wanyenze RK, Kamya MR. Uptake and perceptions of oral HIV self-testing delivered by village health teams among men in Central Uganda: A concurrent parallel mixed methods analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002019. [PMID: 37315008 PMCID: PMC10266653 DOI: 10.1371/journal.pgph.0002019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
The World Health Organization (WHO) recommends HIV self-testing (HIVST) to increase access to and utilization of HIV services among underserved populations. We assessed the uptake and perceptions of oral HIVST delivered by Village Health Teams (VHTs) among men in a peri-urban district in Central Uganda. We used a concurrent parallel mixed methods study design and analyzed data from 1628 men enrolled in a prospective cohort in Mpigi district, Central Uganda between October 2018 and June 2019. VHTs distributed HIVST kits and linkage-to-care information leaflets to participants in 30 study villages allowing up-to 10 days each to self-test. At baseline, we collected data on participant socio-demographics, testing history and risk behavior for HIV. During follow-up, we measured HIVST uptake (using self-reports and proof of a used kit) and conducted in-depth interviews to explore participants' perceptions of using HIVST. We used descriptive statistics to analyze the quantitative data and a hybrid inductive, and deductive thematic analysis for the qualitative data and integrated the results at interpretation. The median age of men was 28 years, HIVST uptake was 96% (1564/1628), HIV positivity yield was 4% (63/1564) and reported disclosure of HIVST results to sexual partners and significant others was 75.6% (1183/1564). Men perceived HIVST as a quick, flexible, convenient, and more private form of testing; allowing disclosure of HIV test results to sexual partners, friends and family, and receiving social support. Others perceived it as an opportunity for knowing or re-confirming their sero-status and subsequent linkage or re-linkage to care and prevention. Utilizing VHT networks for community-based delivery of HIVST is effective in reaching men with HIV testing services. Men perceived HIVST as highly beneficial but needed more training on performing the test and the integrating post-test counseling support to optimize use of the test for diagnosing HIV.
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Affiliation(s)
- Joanita Nangendo
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Anne R. Katahoire
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles A. Karamagi
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gloria O. Obeng-Amoako
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- International Centre for Evaluation and Development, Tema, Ghana
| | - Mercy Muwema
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaffer Okiring
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jane Kabami
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred C. Semitala
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Joan N. Kalyango
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K. Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
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15
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Ndyanabo R, Nalugya A, Ssekamatte T, Nakafeero M, Kisakye A, Mukose AD. Early infant diagnosis testing for HIV in a hard-to-reach fishing community in Uganda. PLoS One 2023; 18:e0268416. [PMID: 37285359 DOI: 10.1371/journal.pone.0268416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Infants born to HIV-infected mothers are at a high risk of acquiring the infection. The World Health Organization recommends early diagnosis of HIV-exposed infants (HEIs) through deoxyribonucleic acid polymerase chain reaction (DNA PCR) and rapid HIV testing. Early detection of paediatric HIV is critical for access to antiretroviral therapy (ART) and child survival. However, there is limited evidence of the factors associated with receiving early infant diagnosis (EID) tests of the HIV testing protocol among HEIs in fishing communities in Uganda. This study established the factors associated with receiving EID tests of the HIV testing protocol among HEIs in a hard-to-reach fishing community in Uganda. METHODS A cross-sectional study was conducted among HEIs in selected healthcare facilities in Buvuma islands, Buvuma district. We obtained secondary data from mother-infant pair files enrolled in the EID program using a data extraction tool. Data were analysed using STATA Version 14. A modified Poisson regression analysis was used to determine the factors associated with not receiving the 1st DNA PCR test among HEIs enrolled in care. RESULTS None of the HEIs had received all the EID tests prescribed by the HIV testing protocol within the recommended time frame for the period of January 2014-December 2016. The proportion of infants that had received the 1st and 2nd DNA PCR, and rapid HIV tests was 39.5%, 6.1%, and 81.0% respectively. Being under the care of a single mother (PR = 1.11, 95% CI: 1.01-1.23, p = 0.023) and cessation of breastfeeding (PR = 0.90, 95% CI: 0.83-0.98, p = 0.025) were significantly associated with not receiving the 1st DNA PCR. CONCLUSION Our study revealed that none of the HEIs had received all the EID tests of the HIV diagnosis testing protocol. Receiving the 1st DNA PCR was positively associated with being an infant born to a single mother, and exclusive breastfeeding. Our findings highlight the need for the creation of an enabling environment for mothers and caregivers in order to increase the uptake of early diagnosis services for HEIs. Awareness-raising on the importance of EID should be scaled up in fishing communities. Demographic characteristics such as marital and breastfeeding status should be used as an entry point to increase the proportion of HEIs who receive EID tests.
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Affiliation(s)
- Remegio Ndyanabo
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Buvuma District Local Government, Lugazi, Uganda
- SWEEM Health Consults Limited, Kampala, Uganda
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- SWEEM Health Consults Limited, Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- SWEEM Health Consults Limited, Kampala, Uganda
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Angela Kisakye
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Aggrey David Mukose
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Meng X, Yin H, Ma W, Gu J, Lu Z, Fitzpatrick T, Zou H. Peer-Led Community-Based Support Services and HIV Treatment Outcomes Among People Living With HIV in Wuxi, China: Propensity Score-Matched Analysis of Surveillance Data From 2006 to 2021. JMIR Public Health Surveill 2023; 9:e43635. [PMID: 36961492 PMCID: PMC10131765 DOI: 10.2196/43635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Community-based organizations deliver peer-led support services to people living with HIV. Systematic reviews have found that peer-led community-based support services can improve HIV treatment outcomes; however, few studies have been implemented to evaluate its impact on mortality using long-term follow-up data. OBJECTIVE We aimed to evaluate the associations between the receipt of peer-led community-based support services and HIV treatment outcomes and survival among people living with HIV in Wuxi, China. METHODS We performed a propensity score-matched retrospective cohort study using data collected from the Chinese National HIV/AIDS Comprehensive Information Management System for people living with HIV in Wuxi, China, between 2006 and 2021. People living with HIV who received adjunctive peer-led community-based support for at least 6 months from a local community-based organization (exposure group) were matched to people living with HIV who only received routine clinic-based HIV care (control group). We compared the differences in HIV treatment outcomes and survival between these 2 groups using Kaplan-Meier curves. We used competing risk and Cox proportional hazards models to assess correlates of AIDS-related mortality (ARM) and all-cause mortality. We reported adjusted subdistribution hazard ratio and adjusted hazard ratio with 95% CIs. RESULTS A total of 860 people living with HIV were included (430 in the exposure group and 430 in the control group). The exposure group was more likely to adhere to antiretroviral therapy (ART; 396/430, 92.1% vs 360/430, 83.7%; P<.001), remain retained in care 12 months after ART initiation (402/430, 93.5% vs 327/430, 76.1%; P<.001), and achieve viral suppression 9 to 24 months after ART initiation (357/381, 93.7% vs 217/243, 89.3%; P=.048) than the control group. The exposure group had significantly lower ARM (1.8 vs 7.0 per 1000 person-years; P=.01) and all-cause mortality (2.3 vs 9.3 per 1000 person-years; P=.002) and significantly higher cumulative survival rates (P=.003). The exposure group had a 72% reduction in ARM (adjusted subdistribution hazard ratio 0.28, 95% CI 0.09-0.95) and a 70% reduction in all-cause mortality (adjusted hazard ratio 0.30, 95% CI 0.11-0.82). The nonrandomized retrospective nature of our analysis prevents us from determining whether peer-led community-based support caused the observed differences in HIV treatment outcomes and survival between the exposure and control groups. CONCLUSIONS The receipt of peer-led community-based support services correlated with significantly improved HIV treatment outcomes and survival among people living with HIV in a middle-income country in Asia. The 15-year follow-up period in this study allowed us to identify associations with survival not previously reported in the literature. Future interventional trials are needed to confirm these findings.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Hanlu Yin
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Wenjuan Ma
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Jing Gu
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Thomas Fitzpatrick
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Thapinta D, Srithanaviboonchai K, Uthis P, Suktrakul S, Wiwatwongnawa R, Tangmunkongvorakul A, Wannachaiyakul S, Sripan P. Association between Internalized Stigma and Depression among People Living with HIV in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084471. [PMID: 35457339 PMCID: PMC9031422 DOI: 10.3390/ijerph19084471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022]
Abstract
Internalized stigma and depression are among the most common mental health problems in people living with HIV (PLHIV). This study aimed to examine the association between depression and overall internalized stigma, as well as different aspects of internalized stigma in PLHIV. The study included 400 PLHIV receiving care in Bangkok and Chiang Mai, Thailand. Data were analyzed using descriptive statistics, Mann-Whitney U test, and Spearman correlation coefficients. The results indicated the PLHIV with mild depression had lower median scores for the social relationship internalized stigma subscale than PLHIV with major depressive disorder (p = 0.009). Total HIV internalized stigma scores were significantly correlated with PHQ-9 scores in the mild depression group (r = 0.327, p = 0.004). Depression and internalized stigma were prevalent and associated, especially in the area of social relationships. Health personnel should be aware of possible depression in PLHIV who have internalized stigma. Intervention to promote understanding and social support for PLHIV is warranted.
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Affiliation(s)
- Darawan Thapinta
- Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand; (D.T.); (S.W.)
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence:
| | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand; (P.U.); (S.S.)
| | - Sunisa Suktrakul
- Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand; (P.U.); (S.S.)
| | | | - Arunrat Tangmunkongvorakul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
| | | | - Patumrat Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (A.T.); (P.S.)
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