Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 6 Articles
Background: Over the last decade, Ethiopia adopted different strategies of prevention of mother to child transmission\nof HIV (PMTCT). Prior to implementation of Option A in 2011, there was no provision of prophylaxis for PMTCT.\nWith ââ?¬Ë?Option Aââ?¬â?¢, PMTCT interventions relied on maternal CD4 count. In early 2013, ââ?¬Ë?ââ?¬Ë?Option B+ââ?¬â?¢Ã¢â?¬â?¢ has been started; with\nthis option, antiretroviral therapy is started and continued for life to any HIV positive pregnant mother irrespective\nof CD4 count with an enhanced treatment for the baby. Though there are a number of studies which evaluated the\neffectiveness of PMTCT interventions, the current study assessed the real-world effectiveness of PMTCT options in a\nsetting where there is limitation of resources.\nObjective: This study tried to address three questions: what proportion of babies tested by DNA-PCR are HIV infected\nin the first 2 months of life? How does the type of PMTCT intervention affect presence of HIV infection at this age?\nWhat are the factors affecting HIV transmission, after controlling for type of PMCT-HIV intervention?\nMethods: We assessed records of 624 registered HIV exposed infants and 412 mothers who were delivered at Bishoftu\nHospital from May 2006 to August 2014. Presence of HIV infection at 6ââ?¬â??8 weeks of age was assessed from the\nrecords. Maternal and infant risk factors for infection at this age were analyzed. Data were collected using standard\ndata abstraction format and were analyzed using SPSS version 20.\nResults: Among all the infants who were delivered at the hospital during the study period, 624/936 (66.7 %) had\nundergone early infant diagnosis at 6ââ?¬â??8 weeks. Twenty-seven (4.3 %) were positive for HIV DNA PCR at the age of\n6ââ?¬â??8 weeks. None of the infants who received ââ?¬Ë?ââ?¬Ë?Option B+ââ?¬â?¢Ã¢â?¬â?¢ had a positive HIV DNA PCR result. HIV infection rate was\nhighest among those who took either no prophylaxis or single dose Nevirapine (11.5 and 11.1 % respectively). Those\nwho took single dose Nevirapine and Zidovudine had HIV positivity rate of 3.9 %. Many of the covariates which were\nshown to be predictors on bivariate analysis were found not to be independent predictors on multivariate analysis.\nConclusion: PMTCT ââ?¬Ë?ââ?¬â?¢Option B+ââ?¬â?¢Ã¢â?¬â?¢ resulted in zero HIV infection rates among the included infants. There was a high\nloss to follow up rate at 6ââ?¬â??8 weeks of age. The authors recommend that a better strategy of linkage to care and treatment\nshould be devised for HIV exposed infants...
Background. Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts\nhave been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low. Methods. A\ncross-sectional survey was performed across 26 communities in Cameroon, Cote dââ?¬â?¢Ivoire, South Africa, and Zambia. Women\nwho reported a pregnancy within two years were enrolled. Participant responses were used to construct the PMTCT cascade with\nall of the following steps required for completion: at least one antenatal visit, HIV testing performed, HIV testing result received,\ninitiation of maternal prophylaxis, and initiation of infant prophylaxis. Factors associated with cascade completion were identified\nusing multivariable logistic regression modeling. Results. Of 976 HIV-infected women, only 355 (36.4%) completed the PMTCT\ncascade. Although most women (69.2%) did not know their partnerââ?¬â?¢s HIV status; awareness of partner HIV status was associated\nwith cascade completion (aOR 1.4, 95% CI 1.01ââ?¬â??2.0). Completion was also associated with receiving an HIV diagnosis prior to\npregnancy compared with HIV diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2ââ?¬â??38.6). Conclusions. Pregnant women\nwith HIV infection in Africa who were aware of their partnerââ?¬â?¢s HIV status and who were diagnosed with HIV before pregnancy\nwere more likely to complete the PMTCT cascade....
Background: In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain\nrisk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be\ndue to high levels of sero-discordant couples and increasing transmission from male to female partners over time.\nMethods: All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh\nprovince in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information\nwas extracted from patients� records, and a structured questionnaire was used to collect social, demographic and\neconomic data.\nResults: Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was\navailable were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was\nsignificantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had\nspouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU)\nhistory, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations.\nHigh sero-concordance was associated with college/university education.\nConclusion: The sero-discordance was significantly higher among married males than married females. Other factors\nalso related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential\nlocations. In contrast, college/university education and female sex were significantly related to low sero-discordance.\nTo contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among\nsero-discordant couples....
Aims: The aim of this study was to validate the Greek translation of the University of\nCalifornia, Los Angeles Loneliness Scale (UCLA) in Greek adults with HIV. Methods:\nThe UCLA Loneliness scale (version 3) was administered to 140 people with\nHIV. Participants also completed the Greek Hospital Anxiety and Depression Scale\n(G-HADS). Validity and reliability analyses were performed. Results: The Cronbachâ��s\n�± coefficient for the total UCLA score was 0.9. Test-retest reliability analysis in\na subgroup of patients (n = 40) revealed good short-term stability over a 2-week interval\n(ICC 0.8 - 0.9, p < 0.0005). Exploratory factor analysis generated a three factors\nstructure for the Greek translation. Convergent validity was supported through the\nscaleâ��s high correlations with G-HADS anxiety (0.382, p < 0.01) and depression\n(0.524, p < 0.005). Conclusion: The Greek UCLA Loneliness scale (version 3) is a valid\nand reliable instrument that can be usefully implemented into clinical practice in\norder to diagnose and treat loneliness among the Greek HIV positive patients....
Elevated alanine aminotransferase (ALT) levels in Human Immunodeficiency Virus\n(HIV) infected people is a major concern in the world and especially in Africa. It\nmay lead to liver failure and even death. Certain antiretroviral (ARV) drugs, such as\nnevirapine and efavirenz, are known to cause toxicity. Other causes of elevated ALT\nare viral hepatitis, the HIV virus itself and other drugs such as anti-tu- berculosis\ndrugs and alcoholism. The study aimed at determining the prevalence of elevated\nALT levels in HIV positive patients on antiretroviral therapy during the period 2013\nto 2014. This was a retrospective study which included 267 patient records from\nKatutura and Windhoek Central hospitals in Windhoek, Namibia. The subjects� ages\nranged from 21 to 82 years. The patients enrolled were on the first line treatment and\ntheir ALT levels were recorded at each monitoring period. ALT levels, viral hepatitis\nresults and the antiretroviral therapy (ART) regimen were the most important aspects\nincluded in the study. Out of 267 patients, 18% had ALT elevation associated\nwith grade 1 to 4 toxicity levels. The study found that 1.4% of patients developed severe\nliver toxicity (grade 3 and 4 toxicity). Toxicity occurred throughout the treatment\nperiod but was the highest at six months of treatment. Patients on nevirapine\nbased regimens had lower toxicity compared to those receiving efavirenz based regimens.\nPatients who had HIV and viral hepatitis co-infection had high toxicity although\nthe study found no severe hepatotoxicity in these patients....
The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five\nmain steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps\ninclude diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression.\nAlthough the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with\nHIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the\ncontinuum for a period of time and regress to an earlier stage. The proportion of PLWH decreases at each successive\nstep of the cascade, beginning with an estimated 86% who are diagnosed and dropping dramatically to approximately\n30% of PLWH who are virally suppressed in the United States (US). In this current issues review, we describe\neach step in the cascade, discuss targeted interventions that address weak points in the continuum, review domestic\nand international policies that help shape and direct HIV care strategies, and conclude with recommendations and\nfuture directions for HIV providers and policymakers. While we primarily examine issues related to domestic HIV care\nin the US, we also discuss international applications of the continuum in order to provide broader context....
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