Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background.Antiretroviral medications are key for prevention ofmother-to-child transmission (PMTCT) of HIV, and transmission\nmitigation is affected by service delivery, adherence, and retention. Methods.We conducted a cluster-randomized controlled study in\n26 facilities inNyanza, Kenya, to determine the efficacy of SMStext messages onPMTCT outcomes.Therelative risk and confidence\nintervalswere estimated at the facility level using STATA. Results. 550 women were enrolled, fromJune 2012 to July 2013.Themedian\nage was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261\n(97.3%) versus 241/242 (99.6%) at 34ââ?¬â??36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants,\n199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77ââ?¬â??1.14); 88% versus 88.6% were tested for HIV at 6 weeks,\nwith 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased\nin both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), ...
Background: Early HIV diagnosis and access to treatment is one of the most effective ways to prevent its further\nspread and to protect the health of those living with the virus. However, delay in diagnosis is the major risk factor\nfor uptake of and response to antiretroviral therapy.\nMethods: Institution-based unmatched case-control study design was used in the study. The study was conducted\nin Debre-Markos and Finote-Selam Hospitals, Northwest Ethiopia. Cases were people living with HIV who had CD4\ncount <350cells/mm3 or WHO clinical stage III and IV regardless of the CD4 count at first presentation and controls\nwere those who had CD4 count ââ?°Â¥350cells/mm3 or WHO clinical stage I and II. If both criteria were available, the\nCD4 count was used in the study as World Health Organization recommended. A total of 392 respondents (196 cases\nand 196 controls) were recruited and selected systematically. The data were collected by trained nurses using chart\nreview and interviewer administered structured questionnaire. Binary Logistic Regression Model was used to identify\nthe factors associated with late HIV diagnosis.\nResults: About 95.9 % of study participants provided complete response. Having no understanding, compared to\nhaving understanding, about HIV/AIDS (AOR = 1.7, 95 %CI = 1.08ââ?¬â??2.79) and ART (AOR = 2.1, 95 %CI: 1.25ââ?¬â??3.72), being\ntested as a result of symptoms/ illness, compared to being tested for risk exposure (inverted AOR =2.5, 95 %CI: 1.64ââ?¬â??4.\n76), and acquiring HIV through sexual contact, compared to acquiring it through other modes (AOR = 2.5, 95 %CI = 1.\n52ââ?¬â??4.76) were positively and independently associated with late HIV diagnosis.\nConclusions: Unlike perceived HIV stigma, having no understanding about HIV and ART, being tested for presence of\nsymptoms/illness, and acquiring HIV through sexual contact were independent and significant factors for late HIV\ndiagnosis....
Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS\n(PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects\nsubsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was\nconducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663\nparticipants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers\nand the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4\nT-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less, ...
Background: The prevalence of HIV and sexually transmitted infections (STIs) among key populations in Cambodia\ncontinues to rise. To address this issue, KHANA, the largest national HIV organization in the country developed and\nimplemented the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project. This study aims to\ndetermine the impacts of the SAHACOM on sexual behaviors and the uptake of HIV/STI services among men who\nhave sex with men (MSM) in Cambodia.\nMethods: We compared outcome indicators at midterm (n = 352) and endline (n = 394). Surveys were conducted\nin 2012 and 2014 in Battambang and Siem Reap provinces. A two-stage cluster sampling method was employed to\nselect the study sample for structured interviews.\nResults: The midterm and endline samples were similar. The average number of sexual partners in the past three\nmonths decreased significantly from 6.2 to 4.0 (p = 0.03). The proportion of MSM who reported paying for sex with men\nin the past three months also decreased significantly from 19.0 % to 9.7 % (OR = 2.0, 95 % CI = 1.3-3.0). No significant\nchange was found in condom and lubricant use in all types of relationships. Regarding STIs, 28.1 % of MSM at midterm\nreported having at least one STI symptom in the past three months compared to 6.1 % at endline (OR = 4.6, 95 % CI = 2.\n9ââ?¬â??7.4); out of them, 14.1 % of MSM at midterm sought treatment compared to 20.7 % at endline (OR = 2.6, 95 %\nCI = 1.1ââ?¬â??6.9). The proportion of MSM who reported using illicit drugs in the past three months also decreased\nsignificantly from 12.2 % to 5.1 % (OR = 2.4, 95 % CI = 1.4ââ?¬â??4.2). However, the proportion of MSM who reported having\nbeen tested for HIV in the past six months decreased significantly from 94.1 % to 77.1 % (OR = 2.9, 95 % CI = 1.8ââ?¬â??3.6).\nConclusions: Findings from this study indicate that the SAHACOM was effective in improving sexual behaviors and\nrelated health outcomes among MSM under the project. However, it could not increase condom use and HIV testing\nrates among this key population. Tailored intervention programs are needed to improve condom use and HIV testing\namong MSM in Cambodia....
This study aimed to assess the prevalence and determinants of Complementary and AlternativeMedicine (CAM) use among People\nLiving with HIV and AIDS (PLWHA) in Lebanon and to identify related issues that may affect patient care. A cross-sectional survey\ndesign was used to interview 116 PLWHA in Beirut.The questionnaire addressed sociodemographic and disease characteristics as\nwell as CAM use. The main outcome of the study was CAM use since diagnosis. Data analysis included descriptive statistics and\nlogistic regression analyses. Overall, 46.6% of participants reported using one or more CAM therapies, with herbs and herbal\nproducts being the most commonly used (63%). A higher education level was associated with a 3-fold increase in the odds of\nCAM use. Among users, 20% used CAM as alternative to conventional treatment, 48% were not aware of CAM-drug interactions,\n89% relied on non health care sources for their choice of CAM, and 44% did not disclose CAM use to their physician. CAM use is\nprevalent among Lebanese PLWHA. Findings of this study highlighted the need to educate health care practitioners to have an open\ncommunication and a patient-centered approach discussing CAM use during routine care and to enhance awareness of PLWHA\non safe use of CAM....
The priority of The Gambia government is to eliminate maternal to child transmission\nof HIV and in line with this priority, the country implemented an antiretroviral\ntherapy (ART) program. With this, all HIV infected pregnant and breastfeeding\nmothers and infants have access to ARV drugs. This study aims to determine the\nprevalence of vertical transmission of HIV among women receiving the ARV drugs.\nDried blood spot samples were collected from 109 HIV-exposed infants enrolled in\n13 PMTCT sites across the country. A qualitative detection of proviral-DNA of HIV-\n1 was performed using the RealTime Abbott PCR assay. Data from 105 mothers were\nanalyzed using SPSS version 16.0 and association of risk factors to PCR results were\nanalyzed using (Crosstabs) Pearson Chi-Square. The p-value of significant was set at\np < 0.05. This study has found that the prevalence of vertical transmission of HIV is\n0.0% (0/64) among women that received the ARV prophylaxis then started ART,\n7.1% (2/28) among mothers that received HIV prophylaxis only, and 38.4% (5/13)\namong women who neither receive HIV-prophylaxis nor ART during pregnancy or\nbreastfeeding. Other risk factors of vertical transmission such as late initiation of\ntreatment, default during treatment and first born of twins were found to be significantly\nassociated with vertical transmission p = 0.001, p = 0.022 and p = 0.000 respectively.\nThis study has found that the early intervention of ART at the onset of\npregnancy through breastfeeding can eliminates Maternal to Child transmission of\nHIV-1and a high risk of vertical transmission was found among women who neither\nreceive prophylaxis nor ART. If the effectiveness of the antiretroviral therapy is\nmaintain, The Gambia, in the near future will attain the WHO�s goal to eliminate\nmaternal to child transmission of HIV....
Background: The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare\ninterventions can be successfully delivered even in fragile health systems. Documenting the success factors in\nthe scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for\nchanging population health needs. This study describes changing demographic and clinical characteristics of adult\npre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya.\nMethods: We conducted a retrospective cohort analysis of data on HIV infected adults (ââ?°Â¥15 years) enrolling in\npre-ART care between January 2004 and September 2015. Attrition (loss to program) was defined as those who died\nor were lost to follow-up (having no contact with the facility for at least 6 months). We used Kaplan-Meier survival\nanalysis to determine time to event for the different modes of transition, and Cox proportional hazards models to\ndetermine predictors of pre-ART attrition.\nResults: Over the 12 years of observation, there were increases in the proportions of young people (age 15 to\n24 years); and patients presenting with early disease (by WHO clinical stage and higher median CD4 cell counts),\np = 0.0001 for trend. Independent predictors of attrition included: aHR (95% CI): male gender 1.98 (1.69ââ?¬â??2.33),\np = 0.0001; age 20ââ?¬â??24 years 1.80 (1.37ââ?¬â??2.37), p = 0.0001), or 25ââ?¬â??34 years 1.22 (1.01ââ?¬â??1.47), p = 0.0364; marital status\nsingle 1.55 (1.29ââ?¬â??1.86), p = 0.0001) or divorced 1.41(1.02ââ?¬â??1.95), p = 0.0370; urban residency 1.83 (1.40ââ?¬â??2.38),\np = 0.0001; CD4 count of 0ââ?¬â??100 cells/Ã?¼l 1.63 (1.003ââ?¬â??2.658), p = 0.0486 or CD4 count >500 cells/Ã?¼l 2.14(1.46ââ?¬â??3.14),\np = 0.0001.\nConclusions: In order to optimize the impact of HIV prevention, care and treatment in resource scarce settings,\nthere is an urgent need to implement prevention and treatment interventions targeting young people and patients\nentering care with severe immunosuppression (CD4 cell counts <100 cells/Ã?¼l). Additionally, care and treatment programmes\nshould strengthen inter-facility referrals and linkages to improve care coordination and prevent leakages in\nthe HIV care continuum....
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