HIV remains a disease of public health importance, with an estimated 39.0 million people living with the virus globally as of 2022. The Association for Reproductive and Family Health (ARFH) is implementing the Integrated Child Health and Social Services Award (ICHSSA-2) project in Lagos with support from USAID. Triggers of unsuppressed viral load were examined among HIV-infected children and adolescents enrolled in the project. A descriptive cross-sectional analysis of routine data was conducted among 207 children and adolescents living with HIV (C/ALHIV) aged 1 to 17 years, enrolled in USAID-supported healthcare facilities across eleven (11) Local Government Areas (LGAs) in Lagos State. The data were analyzed using descriptive statistics, and the significance of the association was determined using the Chi-square test. Slightly above one-third (36.7%) of the C/ALHIV enrolled were between the ages of 14 and 17 years, while only 8.7% were within the age group of 1 to 4 years. The highest proportion of C/ALHIV (24.2%) was from Ajeromi LGA. Missed pills accounted for more than half (51.7%) of the reasons identified for unsuppressed viral load among clients, followed by a busy schedule (15.4%), forgetfulness, and missed appointments (8.2%), respectively. More than half (51.4%) of the clients who reported missed pills were males. The identified triggers of sub-optimal HIV viral load and corresponding LGAs were found to be statistically significant (p < 0.05). Incorporating these identified triggers as part of routine adherence counseling for clients during clinic and home visits will undoubtedly contribute to and accelerate progress towards achieving the UNAIDS 3rd 95 goal. Key words: Children, adolescents, HIV, viral load, suppression, Lagos, Nigeria.
People living with Human Immunodeficiency Virus (PLHIV) and Acquired Immunodeficiency Syndrome (AIDS) patients have increased risk for kidney diseases, including HIV-Associated Nephropathy (HIVAN), non-collapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, kidney injury following long term use of Highly Active-antiretroviral Therapy (HAART) or opportunistic infections medications. In this population, kidney dysfunction is now an increasingly recognized non-AIDS defining condition, and contributes to the increased morbidity and mortality of PLHIV. The role of HIV-related factors in kidney dysfunction still remains unclear. This hospital-based retrospective cross-sectional study investigates the prevalence and factors associated with kidney dysfunction in HIV people attending Care and Treatment Clinics (CTC) at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Clinical records of PLHIV were examined from October 2022 to April 2023. Participants included PLHIV on HAART for above 6 months. Serum creatinine was used to estimate eGFR using the 2021 CKD-EPI equation excluding race. Data were analyzed using STATA 14. Multivariate analysis was conducted and P < 0.05 indicated statistical significance. Among the 331 PLHIV on HAART who met the inclusion criteria, 40(12.1%) had impaired kidney function, based on an estimated glomerular filtration rate of ≤60 mL/min/1.73m2, 32 had an eGFR of 30 to 59 mL/min/1.73 m2, 2 had an eGFR of 15 to 29 mL/min/1.73 m2, and 6 had an eGFR of < 15 mL/min/1.73 m2. Anaemia (adjusted odds ratio [AOR] = 3.37, 95% confidence interval [CI]: 1.35-8.42) and femininity (AOR = 4.18, 95% CI: 1.42-8.19) were independent predictors of renal function impairment. Approximately one tenth of the patients had renal function impairment, with half being anaemic. Anaemia and being a woman correlated with impaired kidney function. For this population, routine screenings are recommended for early detection and treatment of anemia and renal function impairment. Key words: Kidney dysfunction, renal impairment, HIV positive, people living with HIV, HAART, Kilimanjaro Christian Medical Centre.
Noncommunicable diseases (NCDs) have become the leading causes of morbidity and mortality worldwide, accounting for 71% of deaths worldwide in 2019. This trend extends to sub-Saharan Africa, where NCDs are expected to overtake infectious diseases by 2030 amid rapid urbanization, population growth, and changing lifestyles. People living with HIV may be at even greater risk of NCDs due to chronic inflammation caused by HIV, co-infections, side effects of antiretroviral therapy (ART), and shared risk factors. However, research on NCD/HIV comorbidities is scarce in West Africa, which bears more than 30% of the global HIV burden. This study provides insights into the burden of NCD in HIV care in Guinea and reflects a growing regional trend. The study aimed to determine the prevalence and risk factors of hypertension, diabetes, and cancer among HIV-infected adults receiving care at a national hospital in Guinea. A retrospective analysis of the anonymized medical records of 901 HIV-infected adults was conducted using data from June to December 2021. Participants were receiving care at Donka National Hospital in Guinea. NCD diagnoses and sociodemographic and clinical variables were extracted from records. Logistic regression identified factors associated with each NCD. The prevalence was 36.7% for hypertension, 34.0% for diabetes and 21.4% for cancer. Older age, alcohol use, higher BMI, and viral load predicted hypertension risk. Diabetes is associated with no alcohol use, higher viral load, older age and normal BMI. Cancer is associated with smoking, alcohol use and older age. Integrating NCD and HIV services is warranted in Guinea, given the substantial burden observed. Longitudinal research is needed to confirm these patterns and inform prevention and management strategies. Key words: HIV, hypertension, diabetes, cancer, non-communicable diseases, comorbidities, Guinea.
Intimate partner violence (IPV), includes a wide range of abusive behaviors perpetrated by someone involved or who was involved in an intimate relationship with the victim.It is a serious and preventable public health problem globally.This article reports on the validation of an adaptation of the Women Abuse Screening Tool (WAST-S) in Mozambique and recommends its application for more effective prevention and ART treatment.The study utilized a quantitative approach in a prospective quasiexperimental crossover design, in which clusters, 4 health care units, were allocated to two intervention approaches in reverse order.IPV was measured using a translated, culturally-adapted version of WAST-S.This was compared to a standard clinical interview that included questions on IPV.There was a good agreement between the scales of WAST-Short and the standard clinical interview: 0.235 (95% CI: 0.219 -0.250).The WAST-Short was found to be more effective than the standard clinical interview as an IPV screening tool.It provides information about intimate relationships and can measure the presence of violence.The standard clinical interview is less effective at obtaining this information.WAST-S proved to be a more reliable instrument than a clinically adapted interview, and can be applied in the screening of IPV in high patient volume settings and efficiently implemented in primary health care units which can then refer patients for specialized care.The two questions of the WAST-S provide insight into the intimate relationship measuring the presence of violence, information not easily accessible by the standard clinical interview.This information when provided to clinicians has the potential for assuring more effective prevention and treatment adherence.
Human immunodeficiency syndrome ranks among the global worrisome health indices. This study was aimed at determining the effect of social support on medication adherence among people living with HIV/AIDS attending the general out-patient clinic of Kogi State Specialist Hospital (KSSH), Kogi State. A 20-item perceived social support-family scale (PSS-Fa) was used to assess patient’s levels of perceived social support. The number of pills missed were counted and used to calculate their adherence percentage after 4 weeks of medication use. A Morisky medication adherence scale (MMAS-4) was used to strengthen measurement of adherence by pill counting. An association was sought between the mean scores and they were tested for statistical significance. A total of 153 patients were analysed. The largest number of participants was aged between 28 and 37 years. There was a statistically significant association between respondents perceived support and medication adherence (p<0.001). A statistically significant association was recorded between respondents’ social class and perceived social support (p<0.05). However, there was no statistically significant association between other socio-demographic characteristics (age, gender, level of education, religion, place of domicile and ethnic groups) and perceived social support of respondents (p<0.05). There was no statistically significant difference association between family dynamics (marital status, type of marriage, family size and family income) and medication adherence of respondents (p<0.05). There was also no statistically significant association between respondents, family dynamics and perceived social support (p<0.05). A statistically significant association was found between respondents perceived social support and medication adherence. Social class was the predictor of perceived social support among respondents.
Recent studies reveal that Youths living with HIV (YLHIV) enrolled in HIV treatment experience a higher rate of interruption in treatment, sub-optimal medication adherence, and greater HIV-related mortality compared with other age groups. Therefore, this study investigated the effect of text messaging on medication adherence and antiretroviral-therapy (ART) retention practices among YLHIV in Niger state, Nigeria. The study was a quasi-experimental design in two selected hospitals. One hospital was assigned to a once-weekly text message intervention (TMI) for six weeks, and the 2nd served as the control group (CG). Data were collected at baseline, immediate post-intervention, and at the sixth-week follow-up. Data were analyzed using descriptive and inferential statistics at a 0.05 level of significance. Findings showed that between baseline and immediate post-intervention, there was a significant increase (p < 0.05) in the mean score of knowledge, perception, medication-adherence, and ART retention practices (from 9.62±12.28 to 22.98±4.57; 32.21±30.01 to 79.04±4.13; 13.50±8.41 to 26.65±13.15; 6.62±3.53 to 15.15±2.42) but there was no significant (p > 0.05) difference in the CG (from 10.29±11.08 to 10.58±10.74, 34.81±25.15 to 35.81±24.80, 17.13±9.23 to 17.23±9.16, 9.00±5.59 to 9.00±5.59) respectively. Between baseline and 6th week follow-up, there was a significant difference (p < 0.05) with a large effect size for knowledge (1.6), perception (2.2), medication-adherence (2.2) and ART retention practices (3.1) but no significant difference (p > 0.05) in the CG for all measures with an effect size of 0. The text messages intervention effectively influenced knowledge and perception of YLHIV, thereby improving treatment adherence practices. In addition, findings from this study can be used to design projects or interventions for scaling up the use of mobile phone text messaging to promote the adoption of health innovations and influence mHealth policy dialogue and review .
Health communication campaigns along with the targeted social health indicator such as the at-risk group can make an impactful difference in preventive care and chronic disease health maintenance.The logistic regression technique is employed to examine if Rwanda's health media campaign impacted household health behavior and whether this impact was influenced by literacy aptitude and current sexual health practices.Interactive effects of health campaigns were found on household sexual behavior among at-risk households in Rwanda.Tests on model validity and reliability favor the models and give statistically greater confidence in the results.
The Human Immunodeficiency Virus (HIV) is a neurotropic virus that is associated with cognitive, behavioral and motor deficits known as HIV Associated Neurocognitive Disorder (HAND). This was a prospective study aimed at determining the prevalence of cognitive impairment as well as comparing the performance of the HIV positive patients on a screening test, the International HIV Dementia Scale (IHDS), and subtests drawn from a neuropsychological test battery - WHO/UCLA. The screening test and neuropsychological test battery were administered to HIV positive patients while the HIV negative patients had only the test battery administered to determine the mean score of each test domain. Neurocognitive impairment was defined using the cut-off score of 10 for the International HIV Dementia scale and Z scores greater than 1 SD in at least two domains of the neuropsychological test battery. The mean performance on each domain of the test battery was determined after administration to the HIV negative individuals. Ninety-two HIV positive patients (57 females and 35 males) and ninety-two age, sex and education matched HIV negative subjects (46 females and 46 males) were enrolled into the study. The median age and interquartile range were 33(26-39) and 35(27-46) for the HIV positive and negative participants respectively. The prevalence estimates of cognitive impairment determined by the IHDS and the test battery were 42.4 and 76.1%, respectively. The IHDS in this study was found to have a sensitivity of 50% and a specificity of 81% for HAND. Neurocognitive impairment still persists in the combination anti-retroviral therapy (CART) era and is better accessed using neuropsychological testing than with screening tests although the former is cumbersome and require expertise and patience on the part of the subjects. Key words: HIV, neurocognitive disorder, sub-Saharan Africa, dementia tests, neuropsychology.
We sought to understand the impact that state-level marijuana policy changes had on marijuana use behaviors among people with HIV (PWH), including patterns of use (e.g., frequency, modality), access, goals for use, use of other substances, and perceived health effects. We conducted 1:1 interviews at 3 U.S. HIV clinics with PWH aged ≥18 reporting weekly or more marijuana use; 2 clinics were in states that legalized recreational marijuana use. We coded interviews based on sub-topic areas of clinical interest. Among PWH (n=29, 80% cisgender male; mean age=50; 66% non-white), one-third reported increased use of marijuana products since legalization in their state, primarily related to exploring products for therapeutic needs. In legalized states, PWH reported easier product access. The most-cited therapeutic goals for use included relaxation/sleep (66%), appetite stimulation (41%), stress/anxiety relief (31%), and pain relief (28%), among others. Additionally, some reported marijuana helped maintain sobriety from other substances. In legalized settings, increased product diversity and attribute labeling facilitated decision-making, allowing individuals to tailor use to specific goals. Concern over the long-term impact of smoking marijuana was limited to respiratory effects, with no concerns regarding potential cognitive impacts of use, or effects from using edible formulations. Among a sample of PWH who use marijuana, the broad variety and availability of products following legalization increased use for a third of participants from affected states and was consistently described as offering a means for facilitating decision-making for targeted therapeutic use, including as an aid for sleep, anxiety, appetite, and pain, as well as minimization of craving alcohol and ‘harder’ substances. While the short-term benefits of using marijuana were clearly described, concern over long-term health effects was limited. Key words: Marijuana use, HIV care, health beliefs.
Despite the achievements of Anti-retroviral Treatment (ART) scale-up programmes for HIV/AIDS, retention remains a challenge. Achievements of the “90-90-90” HIV targets for the sustainable development goals hinges on adherence. Despite the importance of indefinite retention of patients in care, 33% of HIV patients in Cameroon are still lost-to-follow-up, thereby compromising scale-up initiatives. This study analyses data of patients on ART in Treatment Centres (TCs) and the associated loss-to-follow-up factors and proposes measures to address them. This research was a retrospective analysis of data from selected HIV/AIDS TCs. After obtaining consent, questionnaires were filled by participating TCs. Collected data were analysed using SPSS and figures were expressed as bar charts, and histograms. Five out of seven TCs participated, giving a participation rate of 71.4%. Of the 12,165 patients, 11,852 (97.4%) were adults (28.0% males and 69.4% females) while 313 (2.6%) were children. A total of 232 (1.9%) were lost-to-follow-up and 38 died within six to twelve months. Possible causes of loss-to-follow-up included poor treatment and adherence counselling, ignorance, stigmatisation, financial hardship and traditional and religious beliefs. All TCs reported transfer into and out of their centre, caused by distance, nature of job, and overcrowding. Concerns of attrition rates throughout the continuum of care from diagnosis to long-term retention are corroborated by other studies. Such attrition compromises gains from ART scale-up, leading to poorer health outcomes and wastage of limited resources. Therefore, instituting sustained counselling and education services, addressing social determinants and building on social support factors provide measures to improve retention Key words: Retention, anti-retroviral therapy, treatment, loss-to-follow-up.
Clinic absence or lost to follow-up is still a big challenge in West Africa, especially in Guinea-Bissau, where retention in care is lower compared to all other low- or middle-income countries. The study aims to explore the reasons for clinic absence among HIV-infected patients in Guinea-Bissau, and to evaluate whether the telephone tracing is associated with patients returning to clinic follow-up. A prospective cohort analysis was conducted. Data were collected through telephone calls in which patients or their contact persons were asked for reasons for non-attendance. A total of 3,668 patients, who had been considered as clinic absent were enrolled in this study; 1,883 (51.3%) on antiretroviral treatment (ART) and 1,785 (48.7%) without ART. The median time between patients last clinic visit to time of calling was 203 days (interquartile range (IQR) 59 - 360 days). 748 (20.4%) patients and additional 364 (9.9%) contact persons were successfully reached. Reasons for clinic absence included traveling 346 (31.1%), death 211 (19.0%), and still having medicine 186 (16.7%). After tracing, 555 (49.9%) of the traced patients returned to the clinic. Nineteen percent of the absent HIV-infected patients had died by the time of calling, underscoring the need to improve patient follow-up in Guinea-Bissau. Telephone calls provide an important tool to address reasons for clinic absence and may lead to patients returning to clinical follow-up. Key words: Clinic Absence, Loss to follow-up, Return, HIV, ART, Telephone, Sub Saharan Africa.
As a relatively novel testing algorithm, the experience with 4th generation HIV testing and linkage to care outcomes is limited. The purpose of this study is to report descriptive outcomes regarding patients with acute HIV infection who received antigen/antibody (Ag/Ab) reactive results and linkage to care services. HIV testing and linkage data from four AIDS Healthcare Foundation (AHF) Wellness Centers in Los Angeles County, CA were retrospectively reviewed from January 15, 2016 to May 26, 2018. Patients were screened using the INSTI® HIV-1/HIV-2 Rapid Antibody Test (bioLytical, Richmond, BC). A negative result reflexed to an HIV test on the Abbott Architect Ag/Ab Assay (Abbott Laboratories, Lake Bluff, IL). Out of the total 11,173 patient specimens processed on the Architect platform, 56 received preliminary reactive results and 42 returned for confirmatory viral load testing. Twenty-seven (64%) of the 42 patients were confirmed to be acutely infected with HIV. All 27 patients acutely infected with HIV were linked into care: 22 were linked into AHF’s primary care and the remaining five sought care with a primary care provider external to AHF. Despite low positivity, the 27 acutely HIV-infected patients would have otherwise been missed if the patients had only received the standard-of-care rapid antibody test. Curbing HIV incidence in the United States will require multiple innovative approaches. Detecting acute infections through 4th generation testing is one of the many valuable tools that organizations can utilize in the new decade. Key words: Acute HIV infection, testing algorithms, linkage to care, HIV antigen and antibody combination test, HIV antigen and antibody combination test, Abbott Architect.
