Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 7 Articles
Background: Adhering 95% and above of antiretroviral therapy reduces the rate of disease progression and death\namong peopleââ?¬â?¢s living human immunodeficiency virus. Though manifold factors have reported as determinant factors\nof antiretroviral therapy adherence status, perhaps determinants of non-adherence differ up on the activities of\npatients in the study setting.\nMethods: An institution based unmatched caseââ?¬â??control study was conducted in Aksum town. Individuals who\nhad a 6-month follow-up with complete individual information were included in the study. Document review and\ninterviewer based techniques were used to collect the data. Binary logistic regression analysis was used to identify the\ndeterminant factors of non-adherence.\nResults: A total of 411 (137 cases and 274 control) study participants were included in the study. The majority of\nthem were male in sex. Having 2 years and above duration on ART [AOR = 7, 95% CI (2.2, 22.6)], history of adverse\neffect [AOR = 6.9, 95% CI (1.4, 32.9)], substance use [AOR = 5.3, 95% CI (1.4, 20.0)], living with parents [AOR = 3.4, 95%\nCI (1.2, 10.3)], having depression symptom [AOR = 3.3, 95% CI (1.4, 7.5)], <350 cells/mm3 cluster of differentiation 4\ncount [AOR = 3.2, 95% CI (1.8, 5.8)] and low dietary diversity [AOR = 2, 95% CI (1.1, 3.7)] were found significant determinants\nof non-adherence to antiretroviral drug.\nConclusion: Program, social and individual related factors showed a statistically significant associated with nonadherence\nto antiretroviral therapy. Managing lifestyle by developing self-efficacy of individuals and treating related\nthreat to improve adherence status of antiretroviral therapy is recommended in this study....
Background: Human Immunodeficiency Virus (HIV) pandemic has exacerbated tuberculosis disease especially in\nSub-Saharan African countries. The World Health Organization (WHO) and Joint United Nations Program on HIV/\nAIDS (UNAIDS) have recommended Isoniazid Preventive Therapy (IPT) for HIV infected patients to reduce the\nburden of tuberculosis (TB). Ethiopia has been implementing IPT since 2007. However, effectiveness of IPT in\naverting occurrence of active tuberculosis among HIV infected patients has not been assessed.\nMethods: Retrospective cohort study was employed using secondary data from public health institutions of Addis\nAbaba. Descriptive statistics and Generalized Linear Model based on Poisson regression was used for data analysis.\nResults: From 2524 HIV infected patients who were followed for 4106 Person-Years, a total of 277 incident\nTuberculosis (TB) cases occurred. TB Incidence Rate was 0.21/100 Person-Year, 0.86/100 Person-Year & 7.18/100\nPerson-Year among IPT completed, in-completed and non-exposed patients, respectively. The adjusted Incidence\nRate Ratio (aIRR) among IPT completed vs. non-exposed patients was 0.037 (95% CI, 0.016-0.072). Gender, residence\narea, employment status, baseline WHO stage of the disease (AIDS) and level of CD4 counts were identified as risk\nfactors for TB incidence. The aIRR among patients who took Highly Active Anti- Retroviral Therapy (HAART) with IPT\ncompared to those who took HAART alone was 0.063 (95% CI 0.035-0.104). IPT significantly reduced occurrence of\nactive TB for 3 years.\nConclusions: IPT significantly reduced tuberculosis incidence by 96.3% compared to IPT non-exposed patients.\nMoreover concomitant use of HAART with IPT has shown a significant reduction in tuberculosis incidence by 93.7%\nthan the use of HAART alone. Since IPT significantly protected occurrence of active TB for 3 years, its\nimplementation should be further strengthened in the country....
Background: Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the\nCD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious\ncomorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP\nand HIV + EP, respectively), and compare them to matched HIV-negative control participants from a communitybased\ncohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in\nHIV patients.\nMethods: We performed a matched cohort study including HIV + LP and HIV + EP among people attending the\nModena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative\nparticipants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of â�¥2 NICM.\nLogistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity.\nResults: We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The\nmean age was 46 �± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the\nHIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated\nwith increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after\nadjusting for age, multimorbidity, and antiretroviral costs.\nConclusions: LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and\nmultimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently\nneeded....
Parenting skill is one of the crucial needs that parents must have in caring\nadolescents� sexual health risk behavior. Present study aims to determine predictors\nof parenting skills in preventing adolescents� sexual health risk behavior.\nA cross sectional study was conducted among adolescents� parents who\nattended government health clinics in a semi-urban district, West Malaysia.\nData were collected by systematic random sampling using validated questionnaire\nfrom eight government health clinics based on routine daily out-patient\nservices. There were 386 respondents participated with 98.9% of response\nrate. Parental skill is categorized as appropriate or inappropriate based\non Trans-Theoretical Model (TTM) staging. Eighteen independent variables\nwere used: parental socioeconomic status, adolescent characteristic, parenting\nstyle, parent-adolescent communication, parental stress, perception on adolescent\nsexual risk, comfortable in discussing sexual issues, knowledge in sexual\nreproductive health (SRH) and knowledge in HIV/AIDS. Assessment of\nparenting skills using the TTM stage showed 139 respondents (36%) had inappropriate\nparenting skills, in which they were in pre contemplation, contemplation\nor preparedness stages, while 247 respondents (64%) showed appropriate\nparenting skills when they were in action and maintenance stages of\nTTM. Older parent, late adolescent, low parental education level, extended\nfamily living arrangement, comfortable in discussing sexual issues, good parent-\nadolescent communication and higher knowledge in HIV/AIDS were found\nsignificant in bivariate analysis. Multivariate logistic regression analysis identified\nolder parent (AOR = 1.927, 95% CI = 1.889 - 1.966, p < 0.001), lower\nparental education (AOR = 2.394, 95% CI = 1.348 - 4.254, p = 0.003), comfortable\nin discussing sexual issues (AOR = 3.810, 95% CI = 1.622 - 8.948, p =\n0.002), good parent-adolescent communication (AOR = 4.741, 95% CI = 2.478\n- 9.071, p � 0.001) and having higher knowledge on HIV/AIDS (AOR = 2.804,\n95% CI = 1.528 - 5.147, p = 0.001) as significant predictors for appropriate\nparenting skills in preventing adolescent sexual health risk behavior. In conclusion,\nmore than one third of parents were still not ready in preventing ado-lescent sexual risk behavior. Targeting the young parents and those having\ndifficulty in communicating sexual issues with theirs adolescents should be\nemphasized in early intervention program for parents. Self-assessment using\nTTM stage questionnaire will help parents to identify their parenting skills in\npreventing adolescent sexual health risk behavior....
Background. Decentralization of care and treatment for HIV infection in Africa makes services available in local health facilities.\nDecentralization has been associated with improved retention and comparable or superior treatment outcomes, but patient\nexperiences are not well understood. Methods.We conducted a qualitative study of patient experiences in decentralized HIV care in\nPlateau State, north central Nigeria. Five decentralized care sites in the Plateau State Decentralization Initiative were purposefully\nselected.Ninety-three patients and 16 providers at these sites participated in individual interviews and focus groups. Data collection\nactivities were audio-recorded and transcribed. Transcripts were inductively content analyzed to derive descriptive categories\nrepresenting patient experiences of decentralized care. Results. Patient participants in this study experienced the transition to\ndecentralized care as a series of ââ?¬Å?trade-offs.ââ?¬Â Advantages cited included saving time and money on travel to clinic visits, avoiding\ndangers on the road, and the ââ?¬Å?family-like atmosphereââ?¬Â found in some decentralized clinics. Disadvantages were loss of access to\nancillary services, reduced opportunities for interaction with providers, and increased risk of disclosure. Participants preferred\ndecentralized services overall. Conclusion. Difficulty and cost of travel remain a fundamental barrier to accessing HIV care outside\nurban centers, suggesting increased availability of community-based services will be enthusiastically received....
Background: Early diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure\nof biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed\nincreasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagnosis\nof HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI).\nMethods: A retrospective cohort study design was used among HIV patients with associated lymphoma patients\nattending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for\ninformation on TB treatment, socio-demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate\ndehydrogenase) and clinical presentation using a semi structured data extraction form.\nResults: A total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28ââ?¬â??45). Fifty\nsix (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1ââ?¬â??5.3) months.\nIn multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89ââ?¬â??10.58, p < 0.001) and\nstage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08ââ?¬â??9.63, p < 0.037) for possible misdiagnosis of lymphoma\nas TB.\nConclusion: A high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and\ntreated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdiagnosis\nof lymphoma as TB....
Background: The development of a vaccine against hepatitis B virus (HBV)\nhas been a major achievement in terms of prevention of HBV infection. To\nevaluate the immunological status against HBV of dental-profession students,\nwe analysed the long-term immunogenicity and effectiveness of HBV vaccination\nin Italian dental students with different work seniorities, determining\nthe influence of epidemiological variables on the immune response. Methods:\nThis study, carried out from January 2014 to April 2016, involved 361 underand\npost-graduate dental students attending the Second University of Naples.\nHBV serum markers were determined and multivariate logistic regression\nanalysis was used to identify factors associated with the level of long-term\nimmunogenicity. Results: Of the 361 subjects evaluated, 15 (4.2%) declared\nno history of vaccination. All vaccinated subjects were HBsAg/anti-HBc negative,\nwith 86 (24.9%) having an anti-HBs titre <10 IU/L. The latter were\nyounger, more likely to be attending undergraduate dental school, and more\nlikely to have been vaccinated in infancy. Conclusion: The findings of this\nstudy suggest that assessment of HBV serum markers in workers potentially\nexposed to hospital infections is useful to identify small numbers of unvaccinated\nsubjects or vaccinated subjects with low antibody titre, all of whom\nshould be referred for a booster series of vaccinations....
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