Background Second‐generation HIV‐1 integrase strand transfer inhibitors (INSTIs)—bictegravir (BIC), cabotegravir (CAB), and dolutegravir (DTG)—are leading components of highly potent antiretroviral therapy, and CAB is also used for long‐acting chemoprevention. Rapid detection of clinically relevant INSTI concentrations could support point‐of‐care assessment and real‐time clinical decision‐making. We developed a lateral flow assay (LFA) that detects BIC, CAB, and DTG in whole blood and plasma and evaluated its performance against predefined concentration thresholds and high‐performance liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). Methods A single LFA cassette design was developed using a monoclonal antibody to distinguish BIC, CAB, and DTG concentrations below trough, at minimal‐to‐moderate trough, and at ideal concentrations. LFA results were read visually at 20 min and were compared with LC‐MS/MS–quantified INSTI concentrations for 124 clinical plasma specimens. Results For 24 plasma samples from US participants receiving treatment involving one of the three INSTIs, the LFA interpretations matched all LC‐MS/MS results except for one DTG specimen, which was interpreted by LFA as 1.0–1.6 μg/mL but measured 2.1 μg/mL by LC‐MS/MS. Among 100 plasma remnants from routine national surveillance in Eswatini, the LFA correctly interpreted DTG concentrations in 95 specimens. Four specimens had DTG LC‐MS/MS concentrations slightly above the LFA‐determined range, differing by ≤ 0.1 μg/mL, and one specimen measured at 1.20 μg/mL by LC‐MS/MS was interpreted as ≥ 1.6 μg/mL by LFA. In total, 6 of 124 specimens (4.8%) had LFA‐interpreted INSTI concentrations that varied slightly from the LC‐MS/MS results, with no statistically significant difference in overall performance by Wilcoxon signed‐rank test ( W = 8.00, p = 0.94, one‐tailed). Conclusions The LFA design successfully provided clinically useful interpretations of BIC, CAB, and DTG concentrations with minor discrepancies in < 5% of samples. Importantly, all low‐concentration samples of < 1 μg/mL were correctly interpreted by LFA. The assay shows promise as a point‐of‐care tool for assessing clinically relevant INSTI concentrations.
Background Depression is common among older adults living with HIV (OLHIV) and is associated with poor antiretroviral adherence and higher viral load. Despite the importance of addressing psychological health issues in older people living with HIV, there is a paucity of tailored depression interventions for low‐resource settings. Although the stepped‐care task‐sharing (SCT) intervention model is effective for depression in low‐resource settings, it has not been applied to this population. This study examined preimplementation requirements for piloting a SCT model for depression among OLHIV in a government‐funded clinic in Southwest Nigeria. Methods We conducted a qualitative preimplementation study, guided by the Consolidated Framework for Implementation Research (CFIR), to assess the contextual fit and feasibility of integrating a SCT intervention for depression into routine HIV services. In‐depth interviews were conducted with healthcare providers and older adults with HIV at the Infectious Disease Institute, Ibadan, Nigeria. Data were analyzed using rapid qualitative methods to identify CFIR‐informed barriers, facilitators, and adaptation needs to guide intervention refinement prior to pilot testing. Results Twenty‐two interviews were conducted with healthcare providers ( n = 11) and OLHIV ( n = 11), each lasting 30–45 min. Findings indicated that the SCT intervention was perceived as feasible, supported by staff willingness and existing clinic structures that could be leveraged during pilot testing. Key barriers to implementation included high workload, limited provider training, stigma, discontinuity of care, and financial constraints. Facilitators included organizational readiness and high acceptability among service users. Conclusion The SCT model is perceived as acceptable and potentially feasible for integrating depression care into HIV services for OLHIV. However, it requires adaptation into existing workflows, provider capacity, and patient follow‐up routines. Findings provide insights to refine the intervention processes in preparation for pilot testing and integration of psychological healthcare into HIV services.
Background People living with HIV (PLWHA) may experience increased vulnerability to SARS‐CoV‐2 infection and severe COVID‐19 due to immune dysregulation, comorbidities, and treatment adherence challenges. Kenya has over 1.4 million PLWHA. However, only a few have been reported with severe COVID‐19, suggesting potential protective roles of antiretroviral therapy (ART), management of comorbidities, and COVID‐19 vaccination. Methods This study was conducted across high HIV‐prevalence regions in Kenya (Nakuru, Malindi/Mariakani, and Kisumu). A cross‐sectional survey evaluates clinical characteristics and self‐reported COVID‐19 vaccination outcomes among 303 PLWHA. Quantitative data were collected through structured questionnaires and clinical records. Associations between ART, immune markers (CD4/CD8 counts; viral load), COVID‐19 vaccination, and SARS‐CoV‐2 infection and severity were tested using Chi‐square and Fisher’s exact tests. Results An analysis of 303 participants (70.6% female, median age 40) revealed an 86.5% COVID‐19 vaccination rate and 94.1% ART adherence. Only 9.2% reported prior SARS‐CoV‐2 infection, mostly mild, potentially indicating underreporting or asymptomatic cases. Interestingly, missing ART doses were significantly associated with contracting SARS‐CoV‐2 ( p = 0.03). Furthermore, all participants reporting or demonstrating SARS‐CoV‐2 infection were vaccinated, compared to 85.1% of uninfected participants ( p = 0.014). Due to incomplete health records, data for CD4 counts were available for only 7.6% of participants ( n = 23), limiting conclusions regarding immune dysregulation. Conclusion Low COVID‐19 rates were observed. All cases occurred in vaccinated participants, likely reflecting health‐seeking bias rather than vaccine failure. Missing ART doses were significantly associated with infection. Optimal risk mitigation requires integrated strategies prioritizing both high vaccine coverage and strict ART adherence.
Introduction Sustained adherence to antiretroviral therapy (ART) is critical for managing HIV, yet side effects and food insecurity present significant barriers in resource‐limited settings. While the role of formal support is recognized, the use of indigenous knowledge and food‐based coping mechanisms remains an underdocumented facet of self‐management. This study explored how individuals in Ghana utilize local foods and cultural knowledge to manage ART side effects and support adherence. Methods A qualitative descriptive study was conducted at the Cape Coast Teaching Hospital. Through semistructured in‐depth interviews ( n = 20) and one focus group discussion ( n = 5) with adults on ART for at least 6 months, we collected rich, experiential data. Participants were purposively sampled, and data collection continued until thematic saturation was achieved. Thematic analysis was employed to identify patterns and themes related to food‐based coping strategies. Results Analysis revealed that participants strategically employed indigenous knowledge, using specific local foods as active agents to manage side effects. Ginger tea was used to combat nausea, while avocado and groundnuts served as a protective stomach buffer. The timing of medication was often deliberately aligned with meals, with participants delaying doses if food was unavailable to avoid distress. These practices were deeply pragmatic, relying on affordable staples like gari (cassava flour) and yams, and were seamlessly integrated into daily routines. While these strategies demonstrated significant patient agency and resilience, they were also born from necessity, often representing suboptimal adaptations to food insecurity and poverty. Conclusion Indigenous knowledge provides a crucial, culturally resonant toolkit for managing ART side effects and facilitating adherence. Healthcare systems should move beyond generic instructions to formally recognize, validate, and integrate these patient‐derived strategies into adherence counseling and peer support, fostering a more holistic and effective model of HIV care that bridges biomedical and indigenous knowledge systems.
Until now, human immunodeficiency virus type 1 infection monitoring is based on plasma viral load and cluster of differentiation (CD)4-positive cells from thymus (CD4+ T cells) count. However, it is increasingly accepted that this biological monitoring should be strengthened with other markers that would reinforce the management. Therefore, we addressed this task by assessing the risk associated with therapeutic failure/success linked to the dynamic of immunological parameters in people living with HIV-1 (PLHIV-1) and on antiretroviral therapy (ART) in order to identify their prognostic values. Ninety enrolled PLHIV-1 were classified according to their therapeutic status. Twenty healthy persons were also recruited as a control group. Serum cytokine levels and immune cell frequencies were determined, and the risk of therapeutic failure associated with immunological parameters was assessed. We observed low frequencies of CD4+ T, natural killer (NK), natural killer T (NKT) cells, classical monocytes, nonclassical monocytes, granulocytes, and high frequency of CD8+ T cells in all PLHIV-1 groups in treatment failure under dolutegravir (DTG) and efavirenz (EFV) regimens compared to control participants. Moreover, interferon-gamma (IFN-γ) levels decreased in PLHIV-1 with therapeutic success under the DTG regimen, while interleukin-4 (IL-4) increased in treatment success under the EFV regimen. Proinflammatory tumor necrosis factor-alpha (TNF-α), IL-6, and IL-7 significantly increased in therapeutic failure groups under both regimens. IL-5 concentrations increased in all PLHIV-1, while IL-13 levels did not change. Logistic regression analysis revealed a positive correlation between the risk of treatment failure and proinflammatory cytokines IFN-γ, TNF-α, IL-6, IL-7, eosinophils, and CD8+ T cells in PLHIV-1 under EFV and DTG regimes. In contrast, the risk of therapeutic failure decreased with increasing numbers of CD4+ T cells, neutrophils, and the anti-inflammatory IL-4 in PLHIV-1 treated with the same antiretroviral molecules. Collectively, these results indicated that pro- and anti-inflammatory cytokines and immune cells could serve as prognostic factors for monitoring HIV-1 disease progression and response to ART. However, further studies with a larger sample size would be needed to confirm our data.
