Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 7 Articles
Background: Despite progress in the development of combined antiretroviral therapies (cART), HIV infection\r\nremains a significant challenge for human health. Current problems of cART include multi-drug-resistant virus\r\nvariants, long-term toxicity and enormous treatment costs. Therefore, the identification of novel effective drugs is\r\nurgently needed.\r\nMethods: We developed a straightforward screening approach for simultaneously evaluating the sensitivity of\r\nmultiple HIV gag-pol mutants to antiviral drugs in one assay. Our technique is based on multi-colour lentiviral\r\nself-inactivating (SIN) LeGO vector technology.\r\nResults: We demonstrated the successful use of this approach for screening compounds against up to four HIV\r\ngag-pol variants (wild-type and three mutants) simultaneously. Importantly, the technique was adapted to Biosafety\r\nLevel 1 conditions by utilising ecotropic pseudotypes. This allowed upscaling to a large-scale screening protocol\r\nexploited by pharmaceutical companies in a successful proof-of-concept experiment.\r\nConclusions: The technology developed here facilitates fast screening for anti-HIV activity of individual agents from\r\nlarge compound libraries. Although drugs targeting gag-pol variants were used here, our approach permits\r\nscreening compounds that target several different, key cellular and viral functions of the HIV life-cycle. The modular\r\nprinciple of the method also allows the easy exchange of various mutations in HIV sequences. In conclusion, the\r\nmethodology presented here provides a valuable new approach for the identification of novel anti-HIV drugs....
Background. Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective. This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods. A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self-completed questionnaires. QOL was assessed by the WHOQOL-HIV BREF. Outcomes were assessed at day 15, at 1, 2, and 3 months after start of treatment for treatment-naive patients and at 3 months after study enrollment for treatment-experienced patients. Results. A total of 103 treatment-naive and 93 treatment-experienced HIV/AIDS patients were consecutively recruited. Results show that a phone call intervention could maintain high self-reported adherence among both treatment-naive and treatment-experienced patients. After three months, significant QOL improvements were observed in domains of physical health ( P = 0.003), level of independence (P = 0.018), environment (P = 0.002), and spirituality/religion/personal beliefs (P = 0.021), mong treatment-naive patients. Conclusion. A mobile phone call intervention to patients could maintain high adherence rates although no statistically significant differences were found. A phone call could improve some domains of QOL among treatment-naive patients....
This observational analysis examined the clinical outcomes of patients receiving etravirine-(ETR-) based therapy, particularly with\nprotease inhibitors (PIs) other than darunavir (DRV) and with raltegravir (RAL). Data included treatment-experienced adults in\nthe HIV ResearchNetworkwho began ETR-containing antiretroviral regimens in 2008ââ?¬â??2010.Theprimary objective was to assess 6-\nmonth outcomes (durability, i.e., still on an ETR-containing regimen; change in CD4+ cell count and HIV-1 RNA <400 copies/mL).\nThe cohort included 587 patients receiving ETR; 42% of ETR use was in patients not on DRV/ritonavir (r). Patients receiving ETR\nplus DRV/r had longer durability versus those on ETR plus a PI other than DRV/r at months 6 (91.2% versus 85.5%) and 12 (77.4%\nversus 65.2%), respectively. Patients on regimens with a PI other than DRV/r were the least likely to be receiving ETR at month\n6 (85.5%) versus patients on other ETR-based regimens. Patients on regimens without a PI and without RAL had lower virologic\nsuppression (month 6, 54.2%; month 12, 63.2%) versus patients on other ETR-based regimens. In a clinical care, nontrial setting,\nETR was used in regimens without DRV/r. In this population, the 6-month response rates were similar and durable across all\nregimens, except when ETR was used without RAL and without a PI....
Introduction. There have been no scales specifically developed to assess physician-patient communication behaviors (PPCB) in\r\nthe sub-Saharan population. Aim. We revised an existing PPCB scale and tested its psychometric properties for HIV patients in\r\nKenya. Methods. 17 items (five-point scale) measuring PPCB were initially adopted from the Matched Pair Instrument (MPI).\r\nBetween July and August 2011, we surveyed a convenient sample of 400 HIV adult patients, attending three Academic Model\r\nProviding Healthcare program (AMPATH) clinics in Eldoret, Kenya. Of these 400, eight also participated in cognitive interviews,\r\nand 200 were invited to return after one week for follow-up interviews; 134 (67%) returned and were interviewed. Construct and\r\ncontent validity were established using an exploratory factor analysis, bivariate analyses, internal consistency, test-retest reliability\r\nand cognitive interviews. Results. Construct and content validity supported a one-dimensional measure of 13 PPCB items. Items\r\nassessed physiciansââ?¬â?¢ effort to promote a favorable atmosphere for interaction with HIV patients. Biases associated with encoding\r\nand comprehension of specific terms, such as ââ?¬Å?discussion, involvement or concerns,ââ?¬Â were noted. Internal consistency (Cronbachââ?¬â?¢s\r\nalpha = .81) and one-week retest reliability scores (.82) supported the reliability of the 13-item scale. Discussion. The revised PPCB\r\nscale showed acceptable validity and reliability in Kenya....
Background. Clinical benefits of ART are well documented, but less is known about its effects on economic outcomes such as work status and income in sub-Saharan Africa. Methods. Data were examined from 482 adult clients entering HIV care (257 starting ART; 225 not yet eligible for ART) in Kampala, Uganda. Self-reported data on work status and income were assessed at baseline, months 6 and 12. Multivariate analysis examined the effects of ART over time, controlling for change in physical health functioning and baseline covariates. Results. Fewer ART patients worked at baseline compared to non-ART patients (25.5% versus 34.2%); 48.8% of those not working at baseline were now working at month 6, and 50% at month 12, with similar improvement in both the ART and non-ART groups. However, multivariate analysis revealed that the ART group experienced greater improvement over time. Average weekly income did not differ between the groups at baseline nor change significantly over time, among those who were working; being male gender and having any secondary education were predictive of higher income. Conclusions. ART was associated with greater improvement in work status, even after controlling for change in physical health functioning, suggesting other factors associated with ART may influence work....
A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services\r\nestablished through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women�s HIV testing and\r\ngeneral utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants\r\nthrough strengthened referral and operational linkages amongst health facilities/services and community-based support interventions\r\nfor PLHIV.The study was conducted in one operational district where the intervention was piloted and for comparative\r\npurposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved\r\ncollaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing\r\nthrough integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued\r\nby families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering\r\nPLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision.\r\nChallenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst\r\nnon-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission....
Background: The benefits of antiretroviral therapy (ART) cannot be experienced if they are not taken as prescribed.\r\nYet, not all causes of non-adherence are dependent on the patient. Having to pay for medication reduces\r\nadherence rates. Non- adherence has severe public health implications which must be addressed locally and\r\nglobally. This paper seeks to describe the trends in adherence rates reported in Cameroon and to investigate the\r\ndeterminants of adherence to ART in the Cameroon Mobile Phone SMS (CAMPS) trial.\r\nMethods: We conducted a systematic review of electronic databases (PubMed, Google Scholar, Web of Science,\r\nCINAHL, EMBASE and PSYCINFO) for publications on adherence to ART in Cameroon (from January 1999 to May\r\n2012) and described the trend in reported adherence rates and the factors associated with adherence. Data were\r\nextracted in duplicate. We used multivariable analyses on the baseline data for 200 participants in the CAMPS trial\r\nto determine the factors associated with adherence in four models using different measures of adherence (more\r\nthan 90% or 95% on the visual analogue scale, no missed doses and a composite measure: 100% on the visual\r\nanalogue scale, no missed doses and all pills taken on time).\r\nResults: We identified nine studies meeting our inclusion criteria. Adherence to ART in Cameroon has risen steadily\r\nbetween 2000 and 2010, corresponding to reductions in the cost of medication. The factors associated with\r\nadherence to ART in Cameroon are grouped into patient, medication and disease related factors. We also identified\r\nfactors related to the health system and the patient-provider relationship. In the CAMPS trial, education, side effects\r\nexperienced and number of reminder methods were found to improve adherence, but only using multiple\r\nreminder methods was associated with better adherence in all the regression models (Adjusted Odds Ratio [AOR]\r\n4.11, 95% Confidence Interval [CI] 1.89, 8.93; p<0.001; model IV).\r\nConclusions: Reducing the cost of ART is an important aspect of ensuring adequate adherence rates. Using\r\nmultiple reminder methods may have a cumulative effect on adherence to ART, but should be investigated further....
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