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Mugo C, Adedokun O, Alo OD, Ezeokafor N, Adeyemi S, Kpamor Z, Madueke L, James E, Adebajo SB, Semo BW. Effects of the COVID-19 pandemic on HIV service delivery and viral suppression: Findings from the SHARP program in Northern Nigeria. PLoS One 2024; 19:e0300335. [PMID: 38564514 PMCID: PMC10986928 DOI: 10.1371/journal.pone.0300335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
During the COVID-19 pandemic, HIV programs scaled up differentiated service delivery (DSD) models for people living with HIV (PLHIV). We evaluated the effects of COVID-19 on HIV service delivery and viral suppression in facilities in Northern Nigeria, and determined factors associated with viral suppression among adolescents and adults. We analysed a cross-sectional survey data from facility heads, and retrospective, routinely collected patient data from 63 facilities for PLHIV ≥10 years old in care between April 2019-March 2021, defining study periods as "pre-COVID-19" (before April 2020) and "during COVID-19" (after April 2020). For the pre-COVID and the COVID-19 periods we compared uptake of antiretroviral therapy (ART) refills of ≥3 months (MMD3), and ≥6 months (MM6), missed appointments, viral load (VL) testing, VL testing turnaround time (TAT) and viral suppression among those on ART for ≥6 months using two proportions Z-test and t-tests. We fit a multivariable logistic regression model to determine factors associated with maintaining or achieving viral suppression. Of 84,776 patients, 58% were <40 years, 67% were female, 55% on ART for >5 years, 93% from facilities with community-based ART refill, a higher proportion were on MMD3 (95% versus 74%, p<0.001) and MMD6 (56% versus 22%, p<0.001) during COVID-19 than pre-COVID-19, and a higher proportion had VL testing during COVID-19 (55,271/69,630, [84%]) than pre-COVID-19 (47,747/68,934, [73%], p<0.001). Viral suppression was higher during COVID-19 pandemic compared to the pre-COVID era (93% [51,196/55,216] versus 91% [43,336/47,728], p<0.001), and there was a higher proportion of missed visits (40% [28,923/72,359] versus 39% [26,304/67,365], p<0.001) and increased VL TAT (mean number of days: 38 versus 36, p<0.001) during COVID-19 pandemic and pre-COVID period respectively. Factors associated with maintaining or achieving suppression during COVID-19 were receiving MMD3 and MMD6 refills (OR: 2.8 [95% CI: 2.30-3.47] and OR: 6.3 [95% CI: 5.11-7.69], respectively) and attending clinics with community-based ART refill (OR: 1.6 [95% CI: 1.39-1.87]). The program in Northern Nigeria demonstrated resilience during the COVID-19 pandemic and adoption of MMD had a positive impact on HIV care. Though VL TAT and missed clinic visits slightly increased during the pandemic, VL testing improved and viral suppression moved closer to 95%. Adoption of MMD and community-based models of care at scale are recommended for future pandemic preparedness.
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Affiliation(s)
- Cyrus Mugo
- Kenyatta National Hospital, Nairobi, Kenya
| | - Oluwasanmi Adedokun
- Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC) – University of Maryland, Abuja, Nigeria
| | - Oluwafemi David Alo
- Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC) – University of Maryland, Abuja, Nigeria
| | - Nnenna Ezeokafor
- Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC) – University of Maryland, Abuja, Nigeria
| | | | | | | | - Ezekiel James
- United States Agency for International Development, Abuja, Nigeria
| | - Sylvia Bolanle Adebajo
- Center for International Health, Education, and Biosecurity (CIHEB), Maryland Global Initiatives Corporation (MGIC) – University of Maryland, Abuja, Nigeria
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Zainal-Abidin A, Miptah H, Ariffin F, Razali S, Badlishah-Sham S. Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley. Heliyon 2024; 10:e25740. [PMID: 38380003 PMCID: PMC10877255 DOI: 10.1016/j.heliyon.2024.e25740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Background As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy. Objectives This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence. Methods This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression. Results A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence. Conclusion This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.
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Affiliation(s)
- A.N.I. Zainal-Abidin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - H.N. Miptah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - F. Ariffin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - S. Razali
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - S.F. Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
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Musanje K, Kamya MR, Kasujja R, Vanderplasschen W, Sinclair DL, Baluku MM, Odokonyero RF, Namisi CP, Mukisa J, White RG, Camlin CS. The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial. J Int Assoc Provid AIDS Care 2024; 23:23259582241236260. [PMID: 38446992 PMCID: PMC10919136 DOI: 10.1177/23259582241236260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | | | | | - Martin M. Baluku
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | | | - Charles P. Namisi
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
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Tran BX, Bui TM, Do AL, Boyer L, Auquier P, Nguyen LH, Nguyen AHT, Van Ngo T, Latkin CA, Zhang MWB, Ho CSH, Ho RCM. Changes in Quality of life Outcomes of Patients with HIV/AIDS Under a Theory-based Mobile Health Intervention. AIDS Behav 2023; 27:3905-3915. [PMID: 37306845 DOI: 10.1007/s10461-023-04105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
This study examined the effectiveness of a theory-based mHealth intervention on the quality of life (QOL) of people living with HIV. A randomized controlled trial was performed at two outpatient clinics in Hanoi, Vietnam. There were 428 patients with HIV/AIDs in selected clinics and were divided into the intervention arm (receiving HIV-assisted smartphone application and usual care) and the control arm (receiving only usual care). The WHOQOLHIV-BREF instrument was utilized to measure QOL. An intention-to-treat approach using Generalized Linear Mixed Model analysis was performed. The trial showed significant improvements in Physical health, Psychological health, and Level of Dependence among patients in the intervention arm compared to the control arm. However, the Environment and Spirituality/Personal beliefs improvements would require additional interventions, both individual, organizational, or governmental. This study explored the utility of a smartphone mobile application for individuals with HIV, and how the resultant application could improve the overall QOL.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Thu Minh Bui
- Bach Mai Medical College, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Anh Linh Do
- Institute of Health Economics and Technology, Hanoi, 100000, Vietnam
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, Marseille cedex 05, 13385, France
| | - Pascal Auquier
- Research Centre on Health Services and Quality of Life, Aix Marseille University, 27, boulevard Jean-Moulin, Marseille cedex 05, 13385, France
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, 17177, Sweden
| | | | - Toan Van Ngo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Melvyn W B Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 50 Nanyang Ave, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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5
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Musanje K, Kamya MR, Kasujja R, Hooper N, Katahoire AR, White RG, Kimera E, Getahun M, Sinclair DL, Ojiambo D, Camlin CS. Acceptability of an adapted mindfulness and acceptance-based intervention to support adolescents with HIV: A qualitative study with Ugandan health care providers. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 29:160-168. [PMID: 37519920 PMCID: PMC10373499 DOI: 10.1016/j.jcbs.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
While the adaptation of evidence-based psychosocial support tailors the intervention components to the targeted context, minimizing the associated costs of developing new interventions for low-income contexts, the acceptability of such adapted interventions is important for augmenting successful implementation and sustainability. Given that psychosocial support to persons living with HIV is mostly rendered by healthcare providers, their acceptance of adapted interventions before implementation is crucial. This study explored healthcare providers' acceptance of an adapted mindfulness and acceptance-based intervention supporting adolescents with HIV. Ten healthcare providers at two urban clinics in Kampala, Uganda attended a three-day training on using the adapted intervention and gave feedback on its appropriateness during in-depth interviews conducted thereafter. Semi-structured interviews were based on the Theoretical Framework of Acceptability and findings were analyzed abductively within the seven components of the framework. Overall, the adapted intervention was perceived to be acceptable and appropriate for use with adolescents. Benefits included the intervention offering support beyond a focus on adherence to drugs, refocusing adolescents on aspects in their lives that matter most, and being easy to integrate into providers' work processes. Providers however expressed concern about the time the intervention requires and the possibility of increasing their workload. These findings will support further adaptation and implementation.
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Affiliation(s)
- Khamisi Musanje
- Department of Educational, Social and Organizational Psychology, Makerere University, Uganda
- Clinical Epidemiology Unit, Makerere University, Uganda
| | | | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, UK
| | | | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Emanuel Kimera
- Department of Public Health, Mountain of the Moon University, Uganda
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | | | - Deborah Ojiambo
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences. University of California, San Francisco, USA
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Musanje K, Camlin CS, Kamya MR, Vanderplasschen W, Louise Sinclair D, Getahun M, Kirabo H, Nangendo J, Kiweewa J, White RG, Kasujja R. Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001605. [PMID: 36963093 PMCID: PMC10021405 DOI: 10.1371/journal.pgph.0001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | | | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Hope Kirabo
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - John Kiweewa
- Fairfield University, Fairfield, Connecticut, United States of America
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
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Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
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Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
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8
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Pugh LE, Roberts JS, Viswasam N, Hahn E, Ryan S, Turpin G, Lyons CE, Baral S, Hansoti B. Systematic review of interventions aimed at improving HIV adherence to care in low- and middle-income countries in Sub-Saharan Africa. J Infect Public Health 2022; 15:1053-1060. [PMID: 36063721 PMCID: PMC10117278 DOI: 10.1016/j.jiph.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Long-term adherence to antiretroviral medication continues to present as a challenge along the continuum of the HIV care cascade. HIV interventions and support programs are significantly threatened in resource-limited settings by challenges in maintaining long-term follow-up for ART adherence. We sought to complete a systematic review to comprehensively examine ART adherence and retention in care interventions in Sub-Saharan Africa and to report on the implementation of interventions in real-world settings to inform future health investments in HIV care. Interventions were grouped according to their impact on individual, community, and health-systems levels. While a vast majority of studies evaluated a combination of interventions, those studies that incorporated the community as a resource were most successful. In addition, providing education and behavior reminders proved effective and should be accompanied by community and peer efforts for best results. Multi-level interventions, such as combining individual and community-level interventions showed promising results for long term ART adherence.
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Affiliation(s)
- Laura E Pugh
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jacob S Roberts
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hahn
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sophia Ryan
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ghilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Nyirenda M, Mnqonywa N, Tutshana B, Naidoo J, Kowal P, Negin J. An analysis of the relationship between HIV risk self-perception with sexual behaviour and HIV status in South African older adults. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:277-286. [PMID: 36102066 DOI: 10.2989/16085906.2022.2090395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/17/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
Objective: To examine how older adults perceive their own risk of acquiring HIV; and how this perception correlates with their sexual behaviour and HIV status.Methods: We used cross-sectional survey data for 435 adults aged 50 years and older from South Africa. All participants completed a questionnaire on their basic socio-demographic and economic factors, self-reported health, sexual behaviour, HIV knowledge and attitudes, and self-perceived risk of HIV acquisition. In addition, anthropometrical measurements (weight, height, blood pressure, cholesterol) and HIV testing were conducted. Multinomial logistic regressions were used to determine the association between self-perceived HIV risk (categorised as "not at risk", at "low risk", at "high risk" and "didn't know") and being sexually active and testing HIV-positive, controlling for socio-demographic, behavioural and health-related factors.Results: Of the 435 respondents, 9.4% perceived themselves as at high risk of HIV infection, 18.9% as at low risk and 53.6% believed they were not at risk of HIV. Most respondent who perceived themselves as at low risk or not-at-risk at all of HIV were not sexually active. Older adults that were sexually active were more likely to consider themselves as at high risk of acquiring HIV (relative risk ratio [RRR] 2.05; 95% confidence interval (CI) 1.05-4.00; p = 0.036), as well as to test HIV positive (RRR 10.5; 95% CI 3.8-29.1; p < 0.001). Self-perceived HIV risk was significantly associated with age, sex, population group, and a greater awareness about HIV and how it is transmitted.Conclusions: Older persons who perceived themselves as at high risk of HIV were closely associated with sexual activity and testing HIV positive. Therefore, there is an urgent need for older persons, particularly those who remain sexually active, to screen and test for HIV routinely. Furthermore, there should be policy and programme interventions, such as the development of a simple risk-assessment tool for older adults to determine their risk for HIV. Older persons have been neglected in sexual health and HIV programmes. There is, therefore, a need to encourage older persons to take up appropriate HIV risk reduction and prevention behaviours.
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Affiliation(s)
- Makandwe Nyirenda
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa
- University of KwaZulu-Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa
| | - Nonzwakazi Mnqonywa
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Bomkazi Tutshana
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Jayganthie Naidoo
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Paul Kowal
- International Health Transitions, Canberra, Australia
| | - Joel Negin
- The University of Sydney, School of Public Health, Sydney, Australia
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Ndenkeh JJN, Nji AM, Yumo HA, Rothe C, Kroidl A. Depression management and antiretroviral treatment outcome among people living with HIV in Northwest and East regions of Cameroon. BMC Infect Dis 2022; 22:732. [PMID: 36100890 PMCID: PMC9469586 DOI: 10.1186/s12879-022-07711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several interventions have shown benefits in improving mental health problems such as depression which is common in people living with HIV. However, there is a paucity of evidence on the effect of these interventions in improving HIV treatment outcomes. This study aimed at bridging this evidence gap and guiding the integration of depression and HIV management, particularly in rural health settings of Cameroon.
Materials and methods
We carried out a cluster-randomized intervention study targeting persons aged 13 years and above who had been on antiretroviral treatment for 6–9 months. Participants were followed up for 12 months during which those in the intervention group underwent routine screening and management of depression. Comparisons were done using the two-way ANOVA and Chi-squared test with significance set at 5%.
Results
Overall, 370 participants with a median age of 39 years (IQR: 30–49) were enrolled in this study. Of these, 42 (11.3%) were screened with moderate to severe depressive symptoms and 41 (11.1%) had poor treatment adherence. There was a significant drop in depression scores in the intervention group from 3.88 (± 3.76) to 2.29 (± 2.39) versus 4.35 (± 4.64) to 3.39 (± 3.0) in controls (p < 0.001) which was accompanied by a drop in the prevalence of moderate to severe depressive symptoms in the intervention group from 9% to 0.8% (p = 0.046). Decreased depression scores were correlated with better adherence scores with correlation coefficients of − 0.191, − 0.555, and − 0.513 at baseline, 6 months, and 12 months of follow-up respectively (p < 0.001) but there was no significant difference in adherence levels (p = 0.255) and viral suppression rates (p = 0.811) between groups.
Conclusion
The results of this study suggest that considering routine screening and management of depression as an integral component of HIV care could positively impact HIV treatment outcomes. However, there is a need for more research to identify the best combinations of context-specific and cost-effective strategies that can impactfully be integrated with HIV management.
Trial registration Trial registration Number: DRKS00027440. Name of Registry: German Clinical Trials Register. Date registration: December 10, 2021 (‘retrospectively registered’). Date of enrolment of the first participant: 05/08/2019
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11
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Núñez I, Crabtree-Ramirez B, Shepherd BE, Sterling TR, Cahn P, Veloso VG, Cortes CP, Padgett D, Gotuzzo E, Sierra-Madero J, McGowan CC, Person AK, Caro-Vega Y. Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors. Int J Infect Dis 2022; 122:469-475. [PMID: 35768025 PMCID: PMC9851270 DOI: 10.1016/j.ijid.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the incidence, clinical characteristics, and risk factors of late-onset opportunistic infections (LOI) in people who live with HIV (PWLHA) within the Caribbean, Central and South America network for HIV epidemiology. METHODS We performed a retrospective cohort study including treatment-naive PWLHA enrolled at seven sites (Argentina, Brazil, Chile, Peru, Mexico, and two sites in Honduras). Follow-up began at 6 months after treatment started. Outcomes were LOI, loss to follow-up, and death. We used a Cox proportional hazards model and a competing risks model to evaluate risk factors. RESULTS A total of 10,583 patients were included. Median follow up was at 5.4 years. LOI occurred in 895 (8.4%) patients. Median time to opportunistic infection was 2.1 years. The most common infections were tuberculosis (39%), esophageal candidiasis (10%), and Pneumocystis jirovecii (P. jirovecii) pneumonia (10%). Death occurred in 576 (5.4%) patients, and 3021 (28.5%) patients were lost to follow-up. A protease inhibitor-based regimen (hazard ratio 1.25), AIDS-defining events during the first 6 months of antiretroviral-treatment (hazard ratio 2.12), starting antiretroviral-treatment in earlier years (hazard ratio 1.52 for 2005 vs 2010), and treatment switch (hazard ratio 1.31) were associated with a higher risk of LOI. CONCLUSION LOI occurred in nearly one in 10 patients. People with risk factors could benefit from closer follow-up.
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Affiliation(s)
- Isaac Núñez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Valdiléa G Veloso
- Instituto Nacional de Infectología Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Denis Padgett
- Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Juan Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | | | - Anna K Person
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México.
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12
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Zoungrana-Yameogo WN, Fassinou LC, Ngwasiri C, Samadoulougou S, Traoré IT, Hien H, Bakiono F, Drabo M, Kirakoya-Samadoulougou F. Adherence to HIV Antiretroviral Therapy Among Pregnant and Breastfeeding Women, Non-Pregnant Women, and Men in Burkina Faso: Nationwide Analysis 2019-2020. Patient Prefer Adherence 2022; 16:1037-1047. [PMID: 35444410 PMCID: PMC9013679 DOI: 10.2147/ppa.s354242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since the scale-up of antiretroviral therapy (ART) services in Burkina-Faso, achieving an AIDS-free generation depends on optimal ART adherence. However, no data exists on the population group differences on the level of ART adherence in Burkina-Faso. This study analyzes ART adherence among pregnant-and breastfeeding-women, non-pregnant women, and men in Burkina-Faso. METHODS From December 2019 to March 2020, a cross-sectional study among adult HIV-infected patients in Burkina-Faso, belonging either to the active file or the Prevention of Mother-To-Child Transmission programs was conducted. An analysis was performed and adherence was measured based on the number of times, patients did not meet the number of doses prescribed and did not take the ART treatment in the month prior to the survey. Logistic-regression models were used to identify factors associated with poor ART adherence and the adjusted odds ratios (aORs) with their 95% confidence intervals (95% CI) were reported. RESULTS The prevalence of good adherence was higher in the group of pregnant-and breastfeeding-women (86.6%, n = 112) compared to the other groups (73.1%, n=1017 in non-pregnant women and 72.0%, n = 318 in men). No association was found between ART adherence and the socio-demographic, clinical, and therapeutic characteristics of pregnant-and breastfeeding-women and men groups. However, non-pregnant women with a high level of education (aOR = 1.70; 95% CI: 1.16-2.49), having ever belonged to a support group (aOR= 1.47; 95% CI: 1.07-2.04), not having income-generating occupations (aOR= 1.53; 95% CI: 1.11-2.12), and in advanced clinical stage (aOR= 1.42; 95% CI: 1.06-1.91) were more susceptible to have poor adherence compared to their pairs. CONCLUSION Findings showed a large difference in ART adherence among pregnant-and breastfeeding-women, non-pregnant women and men and highlight the need for differentiated healthcare delivery according to population while specifically considering addressing the interest in early initiation of treatment and the benefit of support groups meeting.
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Affiliation(s)
| | - Lucresse Corine Fassinou
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
- Correspondence: Lucresse Corine Fassinou, Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso, Email
| | - Calypse Ngwasiri
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Sekou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Quebec, QC, G1V 4G5, Canada
- Centre for Research on Planning and Development (CRAD), Université Laval, Quebec, QC, G1V 0A6, Canada
| | - Isidore Tiandiogo Traoré
- Service d’information et d’épidémiologie, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Hervé Hien
- Service d’information et d’épidémiologie, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Fidèle Bakiono
- Secrétariat Permanent du conseil national de lutte contre le SIDA et les infections sexuellement transmissible, ministère de la santé, Ouagadougou, Burkina Faso
| | - Maxime Drabo
- Département biomédical et santé publique, Institut de recherche en sciences de la santé, Ouagadougou, Burkina Faso
- Laboratoire de santé publique de l’Ecole doctorale des sciences de la santé (ED2S), Université Joseph Ki Zerbo Ouagadougou, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
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13
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Berner-Rodoreda A, Ngwira E, Alhassan Y, Chione B, Dambe R, Bärnighausen T, Phiri S, Taegtmeyer M, Neuhann F. "Deadly", "fierce", "shameful": notions of antiretroviral therapy, stigma and masculinities intersecting men's life-course in Blantyre, Malawi. BMC Public Health 2021; 21:2247. [PMID: 34893060 PMCID: PMC8665632 DOI: 10.1186/s12889-021-12314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stigma and masculinity represent persistent barriers in delivering successful HIV interventions to men. Our study examined community perceptions of HIV and anti-retroviral therapy (ART) and their implications for men on ART across the life course in Blantyre, Malawi. METHODS Our qualitative study is based on 72 face-to-face semi-structured interviews. Participants were selected purposively and included men on ART (with suppressed and unsuppressed viral loads), adult male community members irrespective of HIV status and other HIV stakeholders such as health personnel and program implementers. Interviews were conducted in Chichewa and English, transcribed verbatim and analyzed thematically in NVivo 12. We applied the socio-ecological model as our theoretical framework as well as a "life-course" perspective. RESULTS Our findings highlight lingering negative perceptions towards ART in general and towards PLHIV irrespective of viral load suppression. With intersecting notions of masculinity and stigma, men's descriptions of anticipated stigma in their relationships and when visiting health facilities dominated. Stigma was experienced at the personal, interpersonal, facility and community level. Yet, men living with HIV were perceived differently throughout the life-course, with young sexually active men seen as the most stigmatized group and older men seen as drawing resilience from a greater range of masculine norms. Some men of all ages displayed "transformative" masculinities independent of stigma and community expectations. CONCLUSIONS We propose the "life-course" as a useful concept for studies on masculinity, HIV and stigma. Considering gendered constructions of "respectable" midlife-older age vis-à-vis younger age, and how they influence stigma as well as uptake and adherence to ART might lead to more targeted services for men that build on "transformative masculinities".
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Affiliation(s)
| | - Esther Ngwira
- Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Yussif Alhassan
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- The Lighthouse Trust, Blantyre, Malawi
| | - Miriam Taegtmeyer
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florian Neuhann
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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14
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Kamkwalala AR, Garg A, Roy U, Matthews A, Castillo-Mancilla J, Lake JE, Sebastiani G, Yin M, Brown TT, Kamer AR, Jabs DA, Ellis RJ, Boffito M, Greene M, Schmalzle S, Siegler E, Erlandson KM, Moore DJ. Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2021; 37:807-820. [PMID: 34405689 DOI: 10.1089/aid.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.
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Affiliation(s)
| | - Ankita Garg
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Upal Roy
- Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Avery Matthews
- Department of Psychiatry, South Texas Veteran Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose Castillo-Mancilla
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jordan E. Lake
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Michael Yin
- Department of Infectious Disease, Columbia University, New York, New York, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Marta Boffito
- Department of HIV Services, Chelsea and Westminster Hospital, London, United Kingdom
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah Schmalzle
- Department of Infectious Disease, University of Maryland, Baltimore, Maryland, USA
| | - Eugenia Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kristine M. Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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15
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Kalichman SC, Katner H, Hill M, Ewing W, Kalichman MO. Perceived sensitivity to medicines and the experience of side-effects: understanding intentional medication nonadherence among people living with HIV. PSYCHOL HEALTH MED 2021; 27:2261-2272. [PMID: 34319180 DOI: 10.1080/13548506.2021.1960391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patient initiated decisions to forgo taking medications (i.e. intentional nonadherence) pose significant challenges to managing chronic health conditions. Identifying factors and their underlying mechanisms that impede medication adherence is essential to designing treatment improvement interventions. This study tested a conceptual model that posits the effects of perceived sensitivity to medicines on adherence can be explained by the experience of side-effects, leading to intentionally nonadherent behaviors. Patients receiving HIV care in the southern United States (N = 209) completed measures of perceived sensitivity to medicines, antiretroviral therapy (ART) side-effects, intentional nonadherence and overall adherence. Patients also provided consent to access their electronic medical records to collect subsequent reports of HIV viral load tests. Results indicated that more than one in four participants were intentionally nonadherent to ART. Mediation modeling showed that perceived sensitivity to medicines was associated with greater experience of ART side-effects and intentional nonadherence, which impacted overall ART adherence and HIV viral load. There were also significant indirect effects of perceived sensitivity to medicines on HIV viral load through side-effects and intentional nonadherence. Patients with increased perceived sensitivity to medicines are at risk for poor treatment outcomes and these negative outcomes are partly explained by experiencing greater side-effects and intentional nonadherence.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Harold Katner
- Department of Medicine, Mercer University Medical School
| | - Marnie Hill
- Department of Medicine, Mercer University Medical School
| | - Wendy Ewing
- Department of Medicine, Mercer University Medical School
| | - Moira O Kalichman
- Institute for Collaborative Health Intervention and Policy, University of Connecticut, Storrs, CT, USA
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Nyamaruze P, Cowden RG, Padgett RN, Govender K. Body image and antiretroviral therapy adherence among people living with HIV: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e045700. [PMID: 34233973 PMCID: PMC8264875 DOI: 10.1136/bmjopen-2020-045700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/18/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) remains a key challenge to achieving the fast-track goal of ending the HIV epidemic by 2030. To provide a more comprehensive indication of whether interventions designed to promote ART adherence might benefit from targeting body image perceptions, we aim to conduct a systematic review to synthesise existing evidence on the association between body image and ART adherence. METHODS AND ANALYSIS A systematic review of peer-reviewed observational studies and randomised controlled trials that have investigated the association between body image and adherence to ART will be performed. JSTOR, PsycARTICLES, PsycINFO, PubMed, ScienceDirect and Web of Science databases will be searched from 1 January 2000 to 31 March 2021. Eligible records will consider body image as either an independent variable or a mediator, whereas ART adherence will be assessed as an outcome variable. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed using relevant tools developed by the National Institute of Health. If sufficient data are available, a meta-analysis will be conducted. Effect size estimates will be aggregated using a random effects meta-analysis approach. Publication bias and its impact will be evaluated through the use of a funnel plot and the trim-and-fill method. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to report on the overall quality of evidence. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review protocol. Findings of the proposed systematic review will be disseminated through conference presentations and publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020212597.
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Affiliation(s)
- Patrick Nyamaruze
- Psychology, University of KwaZulu-Natal College of Humanities, Durban, Kwazulu Natal, South Africa
| | - Richard Gregory Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - R Noah Padgett
- Department of Educational Psychology, Baylor University, Waco, Texas, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu Natal, Durban, KwaZulu-Natal, South Africa
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Abstract
PURPOSE OF REVIEW To highlight recent data on antiretroviral adherence in older people living with HIV (PLWH), describe the most relevant pharmacokinetic antiretroviral studies, and identify critical research gaps in this population. RECENT FINDINGS Overall, studies have found that older PLWH are more likely to be adherent to antiretroviral therapy (ART). Although multiple methods to measure adherence are available (self-report, pharmacy refills, electronic device monitors, drug concentrations), there is currently no 'gold standard' adherence measure or sufficient evidence to suggest a preferred method in older patients. Recently, studies evaluating antiretroviral concentrations in hair and dried blood spots in older patients identified no major differences when compared with younger individuals. Similarly, although pharmacokinetic studies in older PLWH are scarce, most data reveal no significant pharmacokinetic differences in the aging population. Furthermore, no specific guidelines or treatment recommendations regarding ART dose modification or long-term toxicity in aging PLWH are available, mostly because of the exclusion of this population in clinical trials. SUMMARY How aging influences adherence and pharmacokinetics remains poorly understood. As the population of older PLWH increases, research focusing on adherence, toxicity, drug--drug interactions, and the influence of comorbidities is needed.
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Johnson C, Kumwenda M, Meghji J, Choko AT, Phiri M, Hatzold K, Baggaley R, Taegtmeyer M, Terris-Prestholt F, Desmond N, Corbett EL. 'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi. BMC Public Health 2021; 21:650. [PMID: 33812381 PMCID: PMC8019342 DOI: 10.1186/s12889-021-10573-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. METHODS We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. RESULTS Midlife-older adults (30-74 years of age) associated their age with respectability and identified HIV as "a disease of youth" that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying "lack of wisdom". These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. CONCLUSIONS Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.
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Affiliation(s)
- Cheryl Johnson
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland. .,Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Moses Kumwenda
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Helse Nord TB Initiative, College of Medicine, Blantyre, Malawi
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Augustine T Choko
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
| | | | - Karin Hatzold
- Population Services International, Johannesburg, South Africa
| | - Rachel Baggaley
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fern Terris-Prestholt
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth L Corbett
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
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19
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Schatz E, Knight L, Mukumbang FC, Teti M, Myroniuk TW. 'You Have to Withstand That Because You Have Come for What You Have Come for': Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:624-641. [PMID: 33682928 DOI: 10.1111/1467-9566.13243] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing - stigma, finances and family dynamics - impact access to ART. Qualitative interviews with 23 persons aged 50-plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age-related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre-existing co-morbidities. Key age-related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Department of Global Health, The Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh, University of Washington, Seattle, WA, USA
| | - Michelle Teti
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Tyler W Myroniuk
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
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20
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Moucheraud C, Paul-Schultz J, Mphande M, Banda BA, Sigauke H, Kumwenda V, Dovel K, Hoffman RM. A Multi-Dimensional Characterization of Aging and Wellbeing Among HIV-Positive Adults in Malawi. AIDS Behav 2021; 25:571-581. [PMID: 32880762 PMCID: PMC7855286 DOI: 10.1007/s10461-020-03020-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is relatively little research on aging with HIV and wellbeing in sub-Saharan Africa. A cross-sectional survey was implemented in Malawi; eligible respondents were ≥ 30 years old and on ART for ≥ 2 years. Univariate and multiple regression analyses were stratified by age (younger adults: aged 30-49; older adults: aged ≥ 50) and gender. The median age was 51 years (total sample n = 134). Viral suppression was less common among older respondents (83.7% versus 93.0% among younger respondents) although not significant in adjusted models. Despite exhibiting worse physical and cognitive functioning (any physical functioning challenge: aOR 5.35, p = 0.02; cognitive functioning score difference: - 0.89 points, p = 0.04), older adults reported less interpersonal violence and fewer depressive symptoms (mild depression: aOR 0.23 p = 0.002; major depression: aOR 0.16, p = 0.004); in gender-stratified models, these relationships were significant only for females. More research is needed to disentangle the interplay between aging, gender and HIV in high-burden contexts and develop interventions to support comprehensive wellbeing in this population.
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Affiliation(s)
| | | | | | | | | | | | - Kathryn Dovel
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Risa M Hoffman
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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21
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Chimbetete C, Mudzviti T, Shamu T. Profile of elderly patients receiving antiretroviral therapy at Newlands Clinic in 2020: A cross-sectional study. South Afr J HIV Med 2020; 21:1164. [PMID: 33354366 PMCID: PMC7736656 DOI: 10.4102/sajhivmed.v21i1.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) face new challenges such as accelerated ageing and higher rates of comorbidities including cardiovascular, renal and metabolic diseases as they age. Objectives To profile the demographic and clinical characteristics of elderly patients receiving HIV care at Newlands Clinic (NC), Harare, Zimbabwe, as of 01 October 2019. Methods A cross-sectional analysis was conducted using clinic data. All patients who were 50 years and older on 01 October 2019 were enrolled. Descriptive statistics (medians, interquartile ranges [IQRs] and proportions) were used to describe patient demographic and clinical characteristics. Results Out of 6543 patients undergoing care at NC, 1688 (25.8%) were older than 50 years. The median duration of antiretroviral therapy (ART) was 10.9 years (IQR: 7.1–13). Over 90% of all patients had an HIV viral load below 50 copies/mL. Women were more likely than men to be overweight and obese (32% and 25% vs. 18% and 7%, respectively). Hypertension (41.2%), arthritis (19.9%) and chronic kidney disease (11.6%) were common comorbidities differently distributed based on sex. The most common malignancy diagnosed in women was cervical intra-epithelial neoplasia (68% of cancer burden in women) and Kaposi sarcoma was the leading malignancy in men (41% of cancer burden in men). Nearly 20% of patients had at least two chronic non-communicable comorbidities and 5.6% had at least three. Conclusion A high burden of comorbidities was observed amongst HIV-positive elderly patients receiving ART. Age-appropriate monitoring protocols must be developed to ensure optimum quality of care for elderly HIV-positive individuals.
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Affiliation(s)
| | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe.,School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tinei Shamu
- Newlands Clinic, Harare, Zimbabwe.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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22
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Matthews LT, Orrell C, Bwana MB, Tsai AC, Psaros C, Asiimwe S, Amanyire G, Musinguzi N, Bell K, Bangsberg DR, Haberer JE. Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12-month cohort study in urban South Africa and rural Uganda. J Int AIDS Soc 2020; 23:e25586. [PMID: 32820622 PMCID: PMC7441010 DOI: 10.1002/jia2.25586] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. METHODS We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status. RESULTS In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3 ). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV-RNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women. CONCLUSIONS Women in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.
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Affiliation(s)
- Lynn T Matthews
- Department of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
- Department of MedicineMassachusetts General HospitalBostonMAUSA
| | | | | | - Alexander C Tsai
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
- Harvard Center for Population and Development StudiesBostonMAUSA
| | - Christina Psaros
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Stephen Asiimwe
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
- Kabwohe Clinical Research Center (KCRC)KabwoheUganda
| | - Gideon Amanyire
- Makerere‐Mbarara Universities Joint AIDS Program (MJAP)MbararaUganda
| | - Nicholas Musinguzi
- Mbarara University of Science and TechnologyMbararaUganda
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
| | - Kathleen Bell
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
| | - David R Bangsberg
- School of Public HealthOregon Health and Science University/Portland State UniversityPortlandORUSA
| | - Jessica E Haberer
- Department of MedicineMassachusetts General HospitalBostonMAUSA
- Center for Global HealthMassachusetts General HospitalBostonMAUSA
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23
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Bhatta M, Nandi S, Dutta N, Dutta S, Saha MK. HIV Care Among Elderly Population: Systematic Review and Meta-Analysis. AIDS Res Hum Retroviruses 2020; 36:475-489. [PMID: 32027170 DOI: 10.1089/aid.2019.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Elderly people living with HIV are increasing. At present in the United States, nearly half of newly diagnosed HIV-infected people are aged >50 years. Diagnosis and treatment of HIV-infected elderly patients tends to be delayed by several health care factors as several life-threatening diseases are common in elderly people. This study aimed to find the pooled HIV prevalence in elderly population and the present situation of continuum care for the elderly HIV patients through systematic review and meta-analysis. All previously published articles from 2000 to 2018 are retrieved using MEDLINE, PUBMED, Cochrane Library, EMBASE, and Google Scholar. DerSimonian and Laird Random Effects model are used to critically appraise articles. STATA 13.0 is used to perform the meta-analysis and quantum-geographic information system (Q-GIS) is used to prepare desired map. I2 statistics has been used to test heterogeneity and publication biases. Results have been presented using forest plots. A total of 28 studies are included in this meta-analysis. Present analysis revealed pooled prevalence of HIV in elderly population as 15.79% with a lower rate of viral suppression as 11.524% (95% confidence interval, CI: 11.199-11.855), where a moderate number 38.643% (95% CI: 38.289-38.997) of elderly patients received antiretroviral therapy (ART) globally. The ART retention rate was 12.769% (95% CI: 12.540-13.001) with 6.15% (95% CI: 6.089-6.212) mortality. Despite successful administration of ART in developing part of the world that have relatively higher retention rates among HIV-infected elderly patients only a small percentage are virally suppressed, largely due to elderly drugs interact with ART and several comorbidities reduce the life span of the elderly people.
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Affiliation(s)
- Mihir Bhatta
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Srijita Nandi
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Nalok Dutta
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- Divisions of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Malay Kumar Saha
- Divisions of Virology and ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
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Mugisha Okello J, Nash S, Kowal P, Naidoo N, Chatterji S, Boerma T, Seeley J. Survival of people aged 50 years and older by HIV and HIV treatment status: findings from three waves of the SAGE-Wellbeing of Older People Study (SAGE-WOPS) in Uganda. AIDS Res Ther 2020; 17:17. [PMID: 32410634 PMCID: PMC7226937 DOI: 10.1186/s12981-020-00276-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background Data on the survival status of older adults on antiretroviral treatment (ART) are scarce in sub-Saharan Africa. The objective of this study was to determine the survival status of people aged 50 years and older who were HIV-negative, HIV-positive not on ART, and HIV-positive on ART. Methods We used three waves of data from the World Health Organisation Study on Global Ageing and adult health- Well Being of Older People Study cohort in Uganda, conducted in 2009, 2012–2013 and 2015–2016. The cohort included HIV-negative and HIV-positive persons aged 50 years and older recruited from multiple rural and peri-urban sites in Uganda. Data were collected using interviewer-administered questionnaire. Time-dependent ART data were collected from medical records using a data-abstraction form. This study was conducted before the universal test and treat policy came into effect. We fitted Cox survival models to estimate hazard ratios to compare the risk of death between groups, adjusted for age, sex, marital status and hypertension. Results Of 623 participants, 517 (82.9%) of respondents had follow-up data and were included in this analysis. We observed 1571 person-years of follow-up from 274 people who were HIV-negative, and 1252 from 243 who were HIV-positive. The estimated mortality adjusted hazard ratio (aHR) was 1.89 (95% CI 1.0–3.4; p = 0.04) among people living with HIV compared to HIV-negative people. The aHR for mortality among people receiving ART compared with HIV-negative people was 1.75 (95% CI 0.9–3.5). People who were HIV-positive and not receiving ART had the greatest risk of death (aHR = 2.09, 95% CI 1.0–4.4 compared with HIV negative participants). The aHR for HIV-positive people not receiving ART, compared to those who were on treatment, was 1.19 (95% CI 0.6–2.5). Conclusion Older adults living with HIV on ART had a risk of mortality that was nearly twice as high as HIV-negative adults. Further analyses of longitudinal data should be done to understand factors that affect the survival of older adults on ART.
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