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Batool R, Yousafzai MT, Mir F, Muhammad S, Shaikh SA, Memon S, Qamar FN. Longevity of serologic responses following a single dose of typhoid conjugate vaccine among children living with HIV in Pakistan: A prospective cohort study. Vaccine 2024:S0264-410X(24)00625-X. [PMID: 38811267 DOI: 10.1016/j.vaccine.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND This study aimed to assess the longevity of serologic response and seroconversion rates at several time points following TCV vaccination among children living with HIV aged 6 months to 15 years in Pakistan. METHODS From November 20, 2020, to January 2, 2021; 336 children were enrolled and followed up prospectively for 12 months. Blood samples were collected before the administration of TCV and at 4-6 weeks, 6 months, and 1 year after administration of a single dose (0.5 ml) of intramuscular Typbar TCV®. Samples were analyzed for anti-Vi-IgG antibodies using ELISA. Geometric mean titers (GMTs), seroconversion rates (fourfold rise in anti-Vi-IgG from baseline), and factors associated with sustained seroconversion at 1 year were evaluated using generalized linear mixed models. FINDINGS The seroconversion rates were significantly lower in children aged 6 months to 5 years compared to children > 5 years; (127/216 (58·8%)) versus (81/111 (73·0%)) at 6 months and (110/217 (50·7%)) versus (78/109 (71·6%)) at 1 year, only two-third; 188/326 (57·7%) remained seroconverted at 1 year. The GMTs (95 % CI) were significantly lower in children aged 6 months to 5 years compared to children > 5 years, 9·6 (7·6, 12·0) versus 28·9 (20·2, 41·4) at 6 months, and 6·6 (5·4, 8·0) versus 23·1 (16·4, 32·5) at 1 year time point. The odds of sustained seroconversion significantly decreased with time (adjusted odds ratio (aOR): 0·232; 95 % CI: 0·136,0·396). The odds of sustained seroconversion following 1 year of TCV vaccination were significantly higher among children with non-severe HIV clinical disease (aOR: 10·6; 95 % CI: 1·5, 73·9) and children in elder age group (aOR: 7·45; 95 % CI: 11·2, 47·0). CONCLUSIONS There was a decline in seroconversion after one year of TCV in children living with HIV. The decline was significant in children with severe or advanced HIV disease. A significant decrease in seroconversion rates was observed among children living with HIV following one year of TCV administration.
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Affiliation(s)
- Rabab Batool
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500, Karachi 74800, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Mohammad Tahir Yousafzai
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500, Karachi 74800, Pakistan
| | - Fatima Mir
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500, Karachi 74800, Pakistan
| | - Sajid Muhammad
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500, Karachi 74800, Pakistan
| | - Saqib Ali Shaikh
- Director Health Services Karachi, Division, Civic Centre, 06th Floor, Hassan Square, Karachi, Karachi, Pakistan
| | - Sikander Memon
- New Secretariat Building, 6th Floor, Sindh Kamal Atta Turk Road, Shahrah-e-Kemal Ataturk, Burns Road, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500, Karachi 74800, Pakistan.
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Ayub M, Bin Ali Zubairi M, Ghanchi N, Awan S, Jabeen K, Zubairi A. Pneumocystis pneumonia in HIV-positive and non-HIV patients: a retrospective comparative study from a lower-middle income country. Monaldi Arch Chest Dis 2024. [PMID: 38572694 DOI: 10.4081/monaldi.2024.2810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
In this study, we compared the predisposing factors, key demographic and clinical characteristics, clinical outcomes, and factors associated with poor prognosis in pneumocystis pneumonia (PCP) infection among the human immunodeficiency virus (HIV)-positive and non-HIV patient populations. This retrospective analysis was conducted at the Aga Khan University Hospital, Karachi, via the collection and analysis of patient records with a diagnosis of "pneumocystosis" between January 2015 and October 2020. Additionally, the laboratory database was evaluated, and patients with a laboratory-confirmed diagnosis of PCP were included. During the study period, 52 laboratory-confirmed hospitalized PCP patients were identified. Of these, 23 and 29 patients were diagnosed using microscopy and polymerase chain reaction, respectively. 34.6% of our patients were HIV positive, with a median CD4 count of 20.5 cells/mm3 (range: 10.7-50.5). Other conditions identified were corticosteroid use, autoimmune diseases, malignancy, radiation, and chemotherapy. On chest imaging, consolidation was found in 30%, ground-glass opacities in 24%, and nodular infiltrates in 20% of the cases. HIV-positive patients had a lower hemoglobin level and a higher level of β-D-glucan at the time of admission, whereas non-HIV patients were found to have more co-morbid conditions than HIV patients. We observed no difference in clinical outcomes between the two populations. Factors associated with a poor prognosis among our patients included concomitant infections at the time of diagnosis, the need for invasive mechanical ventilation, and a longer duration of stay in the hospital as well as the intensive care unit.
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Affiliation(s)
- Maaha Ayub
- Department of Medicine, Aga Khan University, Karachi, Sindh.
| | | | - Najia Ghanchi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh.
| | - Safia Awan
- Department of Medicine, Aga Khan University, Karachi, Sindh.
| | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Sindh.
| | - Ali Zubairi
- Department of Medicine, Aga Khan University, Karachi, Sindh.
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Ajmal H, Irfan H. Rising Threat: Tuberculosis and HIV Co-Infection in Resource-Limited Pakistan. Asia Pac J Public Health 2024; 36:266-267. [PMID: 38205709 DOI: 10.1177/10105395231226276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Hafsa Ajmal
- Department of Public Health and Community Medicine, King Edward Medical University, Lahore, Pakistan
| | - Hamza Irfan
- Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical & Dental College, Lahore, Pakistan
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Capelastegui F, Trickey A, Thompson LH, Reza T, Emmanuel F, Cholette F, Blanchard JF, Archibald C, Vickerman P, Lim AG. Risk factors of HIV and variation in access to clean needles among people who inject drugs in Pakistan. Pathog Glob Health 2023; 117:696-707. [PMID: 36950726 PMCID: PMC10614703 DOI: 10.1080/20477724.2023.2191234] [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] [Indexed: 03/24/2023] Open
Abstract
We identified key risk factors for HIV among people who inject drugs (PWID) in Pakistan and explored access to free clean needles. Multivariable logistic regression was used to investigate associations between HIV prevalence and demographic, behavioral, and socio-economic characteristics of PWID. Data came from the Government of Pakistan's Integrated Biological and Behavioral Surveillance (IBBS) Round 5 (2016-17; 14 cities). A secondary analysis investigated associations with reported access to clean needles. Unweighted HIV prevalence among 4,062 PWID (99% male) was 21.0%. Longer injecting duration (Odds ratio [OR] 1.06 [95% confidence interval: 1.02-1.10]; per year), higher injecting frequency (OR 1.67 [1.30-2.13]; per unit increase), and injecting heroin (OR 1.90 [1.11-3.25]) were positively associated with HIV prevalence. There was no association between using a used syringe at last injection and HIV. Having>10 years of education had lower odds of HIV than being illiterate (OR 0.58 [0.35-0.95]). Having a regular sexual partner (OR 0.74 [0.57-0.97]) or paying for sex with the opposite sex (OR = 0.62 [0.45-0.85]) had lower odds of HIV than not. Conversely, PWID paying a man/hijra for sex had higher odds of HIV (OR 1.20 [1.00-1.43]). Receipt of clean needles varied by city of residence (0-97% coverage), whilst PWID with knowledge of HIV service delivery programs had higher odds of receiving clean needles (OR 4.58 [3.50-5.99]). Injecting behaviors were associated with HIV prevalence among PWID, though risks related to paying for sex remain complicated. Geographical variation in access to clean needles suggests potential benefits of more widely spread public health services.
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Affiliation(s)
- Fernando Capelastegui
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura H. Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Tahira Reza
- Canada-Pakistan HIV/AIDS Surveillance Project, Centre for Global Public Health, Islamabad, Pakistan
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
- Canada-Pakistan HIV/AIDS Surveillance Project, Centre for Global Public Health, Islamabad, Pakistan
| | - Francois Cholette
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - James F. Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Chris Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G. Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Hussain HU, Kumar KA, Rehan ST, Khan Z, Hashmi MR, Khabir Y, Fatir CA, Tahir MJ, Ahmed A, Shrateh ON, Huda MN. Odds of HIV among incarcerated drug users: a systematic review and meta-analysis of Asian countries. Ann Med Surg (Lond) 2023; 85:5584-5592. [PMID: 37915701 PMCID: PMC10617921 DOI: 10.1097/ms9.0000000000001242] [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: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background HIV makes up a large portion of infectious diseases globally. People injecting drugs in prisons are at high risk for contracting HIV infection. Prisons house ~10.2 million people globally, making them a high-risk setting for HIV transmission. This systematic review summarizes the available data on the odds of developing HIV infection among imprisoned people who inject drugs (PWIDs) in Asian regions. Methods The authors electronically assessed published studies from January, 2000 to December, 2022, including studies that investigated the odds of HIV in imprisoned PWIDs. We extensively searched PubMed, ERIC, and Cochrane Central and Google Scholar with no constraints in language or time. All the observational studies evaluating the chances of HIV in Asian prisoners with an exposure group of PWIDs and a control group of non-injecting-drug users were included in our analysis. Results The databases search yielded 254 potential studies, 10 observational studies of which having a total of 17 333 participants were included. A low or moderate risk of bias was reported in all the studies except one case-control. The pooled analysis showed a significant association between PWIDs and the chances of contracting HIV infection (Odds ratio=6.40; 95% CI=3.89-10.52; P<0.00001; I2=53%). Conclusion This study found a vital correlation between injecting-drug usage during imprisonment and HIV transmission speed. The results of this meta-analysis support the need to prevent HIV and conducting treatment programs in high-risk settings like prisons.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Oadi N. Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Md. Nazmul Huda
- School of Medicine
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, Australia
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Ahmed A, Dujaili JA, Chuah LH, Hashmi FK, Le LKD, Chatha ZF, Khanal S, Awaisu A, Chaiyakunapruk N. Cost-Effectiveness Analysis of Pharmacist Adherence Interventions in People Living with HIV/AIDS in Pakistan. Healthcare (Basel) 2023; 11:2453. [PMID: 37685487 PMCID: PMC10487586 DOI: 10.3390/healthcare11172453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost-effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan.
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Affiliation(s)
- Ali Ahmed
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Swansea University Medical School, Singleton Campus, Swansea University, Wales SA1 8EN, UK
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, University of Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan
| | - Long Khanh Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Zeenat Fatima Chatha
- Department of Community Medicine and Global Health, University of Oslo, 0318 Oslo, Norway
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
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Aizaz M, Abbas FA, Abbas A, Tabassum S, Obeagu EI. Alarming rise in HIV cases in Pakistan: Challenges and future recommendations at hand. Health Sci Rep 2023; 6:e1450. [PMID: 37520460 PMCID: PMC10375546 DOI: 10.1002/hsr2.1450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) is a retrovirus that suppresses the immune system by reducing the CD4+ T lymphocytes level. It has become a global challenge with fast prevalence ratio. Like other developing countries, Pakistan is also struggling for overcoming this viral disease since very first reported case in 1987. Aim To update the society on the alarming rise in HIV cases in Pakistan: challenges and future recommendations at hand. Materials and Methods The review paper utilized different search engines such pubmed central, scopus, web of science, google scholar etc. to conduct this review paper. Results Lack of awareness, low literacy rate, practice of unhygienic equipment in healthcare departments, unstable economy, and unsafe sexual practices are the major factors behind the increasing rate of AIDS in Pakistan. Conclusion By regulating healthcare practices and policies, promoting psychological counseling to HIV positive patients, educating the society and minimizing commercial sex practices, Pakistan can overcome this viral disease.
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Affiliation(s)
- Muhammad Aizaz
- Shandong Provincial Key Laboratory of Animal Resistance BiologyCollege of Life Sciences, Shandong Normal UniversityJinanShandongChina
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Abid MA, Khani MK, Abid MB. Pakistan’s battle against HIV. Int J STD AIDS 2023:9564624231166433. [PMID: 36997477 DOI: 10.1177/09564624231166433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Muhammad Abbas Abid
- Department of Pathology and Laboratory Medicine, 9615The Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Bilal Abid
- Divisions of Hematology / Oncology and Infectious Diseases, BMT and Cellular Therapy Program, Department of Medicine, 5506Medical College of Wisconsin, Milwaukee, WI, USA
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Anjum A, Rehman AU, Siddique H, Rabaan AA, Alhumaid S, Garout M, Almuthree SA, Halwani MA, Turkistani SA, Qutob H, Albayat H, Aljeldah M, Shammari BRA, Alshahrani FS, Alghamdi AS, Alduwaihi SM, Alibraheem AA, Zeb S, Zeshan B. Evaluation of Hematological, Biochemical Profiles and Molecular Detection of Envelope Gene (gp-41) in Human Immunodeficiency Virus (HIV) among Newly Diagnosed Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010093. [PMID: 36676716 PMCID: PMC9860646 DOI: 10.3390/medicina59010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
The Human Immunodeficiency Virus (HIV) is a highly morphic, retrovirus that rapidly evolves through mutation as well as recombination. Because of the immunocompromised status in HIV patients, there is often a higher chance of acquiring different secondary infections followed by liver cirrhosis, hepatitis B & C, and HIV-associated nephropathy. The current study was conducted to see the prevalence of secondary infections, hematological and biochemical markers for liver and renal associated diseases, and to detect the envelope gene (GP41) in newly diagnosed HIV patients. A total of 37 samples were collected from HIV-positive patients registered in different hospital settings under the National AIDS control program. The collected samples were processed for hepatitis B, hepatitis C, hematological analysis, and biochemical analysis. To identify the envelope gene in newly diagnosed HIV patients, polymerase chain reaction (PCR) was performed using four gene-specific primers. The HIV infections were seen more in male as compared to females. A significant decrease in complete blood count was observed in HIV patients when compared to healthy individuals. There was a significant increase in aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine observed in HIV patients. No significant difference was observed in alkaline phosphatase (ALP), total bilirubin, and albumin levels when compared to healthy control. Anemia was observed in 59.4% of HIV patients. A total of three (8.1%) patients were found to be co-infected with hepatitis B and one (2.7 %) was co-infected with hepatitis C. Out of these 37 tested samples, a total of four showed the successful amplification of the envelope gene. This study provides platform for the health care facilitators to regularly monitor the signs, symptoms and clinical biomarkers of HIV-associated infections to prevent toxicity at an early stage to improve the quality of life (QoL) and minimize the mortality rate in HIV patients. Envelope gene mutating frequently results in drug resistance, and thus future research on polymorphism analysis will reveal points of substitutions to improve drug designing.
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Affiliation(s)
- Asfa Anjum
- Department of Medical Education, University of Lahore, Lahore 54590, Pakistan
| | - Abaid ur Rehman
- Department of Medical Education, Sheikh Zayed Medical College, Rahim Yar Khan 06426, Pakistan
| | - Hina Siddique
- Department of Medical Education, Fatima Jinnah Medical University, Lahore 54000, Pakistan
| | - Ali A. Rabaan
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Correspondence: (A.A.R.); (B.Z.)
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Souad A. Almuthree
- Department of Infectious Disease, King Abdullah Medical City, Makkah 43442, Saudi Arabia
| | - Muhammad A. Halwani
- Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia
| | | | - Haitham Qutob
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Rabigh 25732, Saudi Arabia
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Basim R. Al Shammari
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Fatimah S. Alshahrani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia
- Diagnostic Laboratory, Prince Sultan Military Medical City, Riyadh 12477, Saudi Arabia
| | - Ali S. Alghamdi
- Diagnostic Laboratory, Prince Sultan Military Medical City, Riyadh 12477, Saudi Arabia
| | - Sami M. Alduwaihi
- Diagnostic Laboratory, Prince Sultan Military Medical City, Riyadh 12477, Saudi Arabia
| | - Adil A. Alibraheem
- ENT Department, Prince Sultan Military Medical City, Riyadh 12477, Saudi Arabia
| | - Shah Zeb
- Department of Microbiology, Faculty of Biomedical and Health Science, The University of Haripur, Haripur 22610, Pakistan
| | - Basit Zeshan
- Department of Microbiology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan
- Faculty of Sustainable Agriculture, University Malaysia Sabah, Sandakan Campus, Locked Bag No. 3, Sandakan 90509, Sabah, Malaysia
- Correspondence: (A.A.R.); (B.Z.)
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HIV in Pakistan: Challenges, efforts and recommendations. Ann Med Surg (Lond) 2022; 84:104797. [PMID: 36353449 PMCID: PMC9638784 DOI: 10.1016/j.amsu.2022.104797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
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Rangwala HS, Anwar Z, Ovais MH, Fatima H, Siddiq MA. Rising HIV cases in Pakistan: Start of a pandemic? Ann Med Surg (Lond) 2022; 82:104791. [PMID: 36268456 PMCID: PMC9577945 DOI: 10.1016/j.amsu.2022.104791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | | | - Mohammad Arham Siddiq
- Corresponding author.
- Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, Pakistan.
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Junaid K, Akram I, Daood M, Khan A. Validity of the patient health questionnaires (phq-2 and phq-9) for screening depression among human immunodeficiency virus patients in Lahore, Pakistan. World J Virol 2022; 11:341-351. [PMID: 36188737 PMCID: PMC9523320 DOI: 10.5501/wjv.v11.i5.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments.
AIM To determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients.
METHODS A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed.
RESULTS The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998).
CONCLUSION Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population.
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Affiliation(s)
- Khunsa Junaid
- Department of Community Medicine, King Edward Medical University, Lahore 54000, Punjab Province, Pakistan
| | - Iqra Akram
- Department of Pulmonology, General Hospital, Lahore 54000, Punjab Province, Pakistan
| | - Muhammad Daood
- Department of Community Medicine, King Edward Medical University, Lahore 54000, Punjab Province, Pakistan
| | - Amjad Khan
- Department of Public Health and Nutrition, the University of Haripur, Haripur 22781, Khyber Pakhtunkhwa, Pakistan
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Marfani WB, Khan HA, Sadiq M, Outani O. The rise in HIV cases in Pakistan: Prospective implications and approaches. Ann Med Surg (Lond) 2022; 81:104492. [PMID: 36106067 PMCID: PMC9464852 DOI: 10.1016/j.amsu.2022.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
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Khan MD. Access to COVID-19 vaccination for transgender community in Multan, Punjab, Pakistan. Health Care Women Int 2022:1-14. [PMID: 35147488 DOI: 10.1080/07399332.2022.2029864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given the discrimination, harassment, and lack of adequate healthcare facilities, the transgender community members find it hard to access the COVID-19 vaccination. The COVID-19 pandemic has exacerbated the disparities in access to healthcare for the transgender community. In November 2020, on the topic of 'COVID-19 and Disaster Vulnerability in Pakistan: A Human Rights Based Analysis', a co-published report from the UNDP and Ministry of Human Rights Pakistan, reflected concerns on the challenges of access to healthcare for the transgender community in Pakistan. The report demanded the government to amplify its response to further protect the transgender community. In this paper, I aim at developing a theoretical framework for providing indiscriminate access to the COVID-19 vaccination for the transgender community as a part of right to health by reporting the first-hand knowledge about the challenges of access to vaccination facilities using qualitative research methods.
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Affiliation(s)
- Muhammad Danyal Khan
- Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan
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15
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Ahmed A, Dujaili JA, Jabeen M, Umair MM, Chuah LH, Hashmi FK, Awaisu A, Chaiyakunapruk N. Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan. Front Pharmacol 2022; 12:807446. [PMID: 35153763 PMCID: PMC8832364 DOI: 10.3389/fphar.2021.807446] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 01/30/2023] Open
Abstract
Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Musarat Jabeen
- ART Centre, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad, Pakistan
| | - Malik Muhammad Umair
- National AIDS Control Programme, National Institute of Health, Islamabad, Pakistan
| | - Lay-Hong Chuah
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Ahmed A, Saqlain M, Umair MM, Hashmi FK, Saeed H, Amer M, Blebil AQ, Dujaili JA. Stigma, Social Support, Illicit Drug Use, and Other Predictors of Anxiety and Depression Among HIV/AIDS Patients in Pakistan: A Cross-Sectional Study. Front Public Health 2021; 9:745545. [PMID: 34660521 PMCID: PMC8514983 DOI: 10.3389/fpubh.2021.745545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 01/30/2023] Open
Abstract
Introduction: Anxiety and depression in people living with HIV/AIDS (PLWHA) can lead to non-adherence to antiretroviral therapy (ART), morbidity, and mortality. Therefore, assessing the stigma, social support, and other determinants of anxiety and depression in PLWHA are important for developing further interventions. Methods: An institution-based cross-sectional study was conducted in 505 PLWHA, approached through systematic sampling, who paid routine visits to the ART center, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Data was collected by pretested validated hospital anxiety and depression scale (HADS). Version 26 of the SPSS was used to apply Logistic regression analysis to identify determinants, and the 95% confidence interval (CI) adjusted odds ratio (AOR) was calculated to assess the magnitude of the relationships. Results: In PLWHA, the prevalence of co-morbid depression and anxiety was 80%. Separately, 89.9% had depression, and 80.3% had anxiety. Use of illicit drugs [AOR = 1.87, 95% CI (1.01, 3.27)], low social support [AOR = 1.21, 95% CI (1.02, 2.25)], being male [AOR = 2.21, 95% CI (1.11, 5.49)], and HIV related stigma [AOR = 2.48, 95% CI (1.25, 6.02)] were significant predictors of depression. Having detectable viral load [AOR = 3.04, 95% CI (1.04, 8.86)], young age [AOR = 5.31, 95% CI (1.19, 29.39)], no formal education [AOR = 21.78, 95% CI (4.03, 117.62)], low [AOR = 1.70, 95% CI (1.12, 6.93)] or moderate [AOR = 2.20, 95% CI (1.79, 6.09)] social support, illicit drugs addiction [AOR = 1.17, 95% CI (1.03, 2.55)], and HIV stigma [AOR = 54.3, 95% CI (21.20, 139.32)] had a remarkable association with anxiety. Conclusions: Given the high prevalence of anxiety and depression among PLWHA, the Pakistan Ministry of Health should focus more on monitoring mental health, expanding mental health services, and developing interventions based on identified factors to treat depression and anxiety among PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid i Azam University Islamabad, Islamabad, Pakistan
| | - Malik Muhammad Umair
- National AIDs Control Program, Prime Minister Health Complex, Islamabad, Pakistan
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal, Lahore, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Allama Iqbal, Lahore, Pakistan
| | - Muhammad Amer
- Department of Pharmacy, The University of Lahore, Islamabad, Pakistan
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
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Coronavirus disease 2019 (COVID-19) is a healthcare dilemma for human immunodeficiency virus (HIV)-positive individuals in Pakistan. Infect Control Hosp Epidemiol 2021; 43:1735-1736. [PMID: 34412723 PMCID: PMC8410737 DOI: 10.1017/ice.2021.376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Ahmed A, Abdulelah Dujaili J, Rehman IU, Lay Hong AC, Hashmi FK, Awaisu A, Chaiyakunapruk N. Effect of pharmacist care on clinical outcomes among people living with HIV/AIDS: A systematic review and meta-analysis. Res Social Adm Pharm 2021; 18:2962-2980. [PMID: 34353754 DOI: 10.1016/j.sapharm.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care. OBJECTIVE This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA. METHODS We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994). RESULTS Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low. CONCLUSION The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
| | - Alice Chuah Lay Hong
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, 54000, Lahore, Pakistan.
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Ahmed A, Saqlain M, Bashir N, Dujaili J, Hashmi F, Mazhar F, Khan A, Jabeen M, Blebil A, Awaisu A. Health-related quality of life and its predictors among adults living with HIV/AIDS and receiving antiretroviral therapy in Pakistan. Qual Life Res 2021; 30:1653-1664. [PMID: 33582967 PMCID: PMC8178128 DOI: 10.1007/s11136-021-02771-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is considered to be the fourth 90 of UNAIDS 90-90-90 target to monitor the effects of combination antiretroviral therapy (ART). ART has significantly increased the life expectancy of people living with HIV/AIDS (PLWHA). However, the impact of chronic infection on HRQoL remains unclear, while factors influencing the HRQoL may vary from one country to another. The current study aimed to assess HRQoL and its associated factors among PLWHA receiving ART in Pakistan. METHODS A cross-sectional descriptive study was conducted among PLWHA attending an ART centre of a tertiary care hospital in Islamabad, Pakistan. HRQoL was assessed using a validated Urdu version of EuroQol 5 dimensions 3 level (EQ-5D-3L) and its Visual Analogue Scale (EQ-VAS). RESULTS Of the 602 patients included in the analyses, 59.5% (n = 358) reported no impairment in self-care, while 63.1% (n = 380) were extremely anxious/depressed. The overall mean EQ-5D utility score and visual analogue scale (EQ-VAS) score were 0.388 (SD: 0.41) and 66.20 (SD: 17.22), respectively. Multivariate linear regression analysis revealed that the factors significantly associated with HRQoL were: female gender; age > 50 years; having primary and secondary education; > 1 year since HIV diagnosis; HIV serostatus AIDS-converted; higher CD 4 T lymphocytes count; detectable viral load; and increased time to ART. CONCLUSIONS The current findings have shown that PLWHA in Pakistan adherent to ART had a good overall HRQoL, though with significantly higher depression. Some of the factors identified are amenable to institution-based interventions while mitigating depression to enhance the HRQoL of PLWHA in Pakistan. The HRQoL determined in this study could be useful for future economic evaluation studies for ART and in designing future interventions.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University Islamabad, Islamabad, Pakistan
| | - Naila Bashir
- HIV Treatment Center, Pims, National AIDs Control Programme, Islamabad, Pakistan
| | - Juman Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Furqan Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università Di Milano, 20157 Milan, Italy
| | - Amjad Khan
- Department of Pharmacy, Quaid-I-Azam university, Islamabad, Pakistan
| | | | - Ali Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
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20
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HIV incidence and associated risk factors in female spouses of men who inject drugs in Pakistan. Harm Reduct J 2021; 18:51. [PMID: 33964932 PMCID: PMC8106847 DOI: 10.1186/s12954-021-00497-1] [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: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence. We investigated HIV prevalence and incidence among female spouses of MWID registered at Nai Zindagi Trust (NZT), Pakistan, between 2012 and 2019. Methods NZT registration and service provision data for female spouses who participated in HIV testing and counselling calculated HIV prevalence and incidence using the person years (PY) method. Cox proportional hazards models identified factors associated with incident infection. Results Overall HIV prevalence among female spouses of MWID was 8.5%. Among 3478 HIV-negative female spouses, 109 incident infections were observed, yielding an incidence rate of 1.5/100PY (95% CI 1.2–1.8). Independent predictors of incident infection were registration in Punjab province (AHR 1.73 95% CI 1.13–2.68, p = 0.012) and 1–5 years of education (AHR 1.89 95% CI 1.22–2.93, p = 0.004). Knowledge of HIV at registration was protective against infection (AHR 0.51, 95% CI 0.26–0.99, p = 0.047), along with a MWID spouse who had initiated antiretroviral therapy (ART) (AHR 0.25, 95% CI 0.16–0.38, p < 0.001), while incident infection was inversely associated with number of children (≥ 5 children AHR 0.44 95% CI 0.22–0.88, p = 0.022). Conclusions Additional efforts are needed to reduce HIV transmission among female spouses of MWID, including targeted provision of HIV education and access to HIV screening. Interventions that target MWID are also required, including evidence-based drug treatment and access to ART, including support to maximize adherence. Finally, consideration should be given to making HIV pre-exposure prophylaxis available to female spouses at high risk of HIV transmission, particularly young women and those whose husbands are not receiving, or have difficulty adhering to, ART.
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Ahmed A, Saqlain M, Akhtar N, Hashmi F, Blebil A, Dujaili J, Umair MM, Bukhsh A. Translation and cross-cultural adaptation of WHOQOL-HIV Bref among people living with HIV/AIDS in Pakistan. Health Qual Life Outcomes 2021; 19:48. [PMID: 33557861 PMCID: PMC7871412 DOI: 10.1186/s12955-021-01693-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Reliable Health-Related Quality of Life (HRQoL) assessment will be useful in identifying health issues and in identifying health care actions. Due to the lack of a psychometrically valid tool in Urdu, we aim to translate and examine the psychometric and cross-cultural adaptation of WHOQOL HIV Bref among people living with HIV/AIDS (PLWHA) in Pakistan. METHODS The standard forward-backwards translation technique was used to convert English version of the WHOQOL HIV Bref into Urdu. After cognitive debriefing, final Urdu version of instrument was developed. Based on the principle of at least 5 subjects for each item, a sample of 182 patients was used using a universal random sampling technique from the Pakistan Institute of Medical Sciences, Islamabad. The Cronbach's alpha and intra-class correlation coefficients (ICC) were estimated to assess internal validity and reliability of the translated version. Exploratory factor analysis was carried out to determine the factor structure and independent associations between the instrument domains and CD-4T-cell count were assessed using multivariable linear regression RESULTS: High Cronbach alpha 0.93 was found for all WHOQOL HIV Bref facets. The test-retest reliability demonstrated a statistically significant ICC ranged from 0.88 to 0.98 (p < 0.001). In known group validity, lower CD-4 lymphocytes count was significantly related to poor scores for all six domains (p < 0.001). Similarly, symptomatic subjects had significantly lower scores compared to asymptomatic subjects on the physical, psychological, social relationship and independence domains (p < 0.05). Statistically significant positive correlation of all six domains of instrument with CD4 cells count (p < 0.001), exhibiting patients with higher CD-4 cells will have higher mean scores of all domains. Factor analysis revealed 5 domains, including physical health, psychological health, social relationship, environmental, and spiritual health. Multivariable linear regression analysis reported; only physical, psychological health and environment health domains were found significantly associated with higher CD-4 lymphocytes count (Beta = 0.121, p < 0.001, Beta = 0.103, p = 0.002, and Beta = 0.032, p = 0.032). CONCLUSION Findings suggested that the Urdu version of WHOQOL HIV Bref is a psychometrically valid and culturally well-adapted HRQoL measurement tool for PLWHA in Pakistan.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway , 47500, Subang Jaya, Selangor, Malaysia.
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University Islamabad, Islamabad, Pakistan
| | - Nasim Akhtar
- Infectious Diseases Department, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Furqan Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Ali Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway , 47500, Subang Jaya, Selangor, Malaysia
| | - Juman Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway , 47500, Subang Jaya, Selangor, Malaysia
| | | | - Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway , 47500, Subang Jaya, Selangor, Malaysia.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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22
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Din M, Anwar F, Ali M, Yousaf M, Ahmad B, Abdullah. Chemiluminescent-microparticle-immunoassay-based detection and prevalence of human immunodeficiency virus infection in Islamabad, Pakistan. Arch Virol 2021; 166:581-586. [PMID: 33416997 DOI: 10.1007/s00705-020-04897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022]
Abstract
An advanced detection assay is important for clinical diagnosis of human immunodeficiency virus (HIV) infection in asymptomatic individuals. The first step in timely treatment and management of the infection is the early detection of HIV. In this study, we determined the prevalence of HIV in Islamabad for the first time using a chemiluminescent microparticle immunoassay (CMIA), which is an advanced serological diagnostic technique. A total of 3659 samples were obtained from the general public in Islamabad, Pakistan, and 85 of them were found to be positive for HIV infection (2.32% prevalence). Of the positive subjects, 78.82% (67/85) were male, 10.6% (9/85) were female, and 10.6% (9/85) were of unidentified gender. The results revealed a significant relationship between age groups and HIV status. The age group of 21- to 30-year-olds was found to have the highest rate of HIV infection, and the rate of HIV infection in males was higher than in females.
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Affiliation(s)
- Misbahud Din
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Faheem Anwar
- Department of Genetics, Hazara University Mansehra, Mansehra, Pakistan.
| | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.
| | - Muhammad Yousaf
- Department of Statistics, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
| | - Bilal Ahmad
- Department of Bioinformatics and Biotechnology, International Islamic University Islamabad, Islamabad, Pakistan
| | - Abdullah
- Department of Microbiology and Biotechnology, Abasyn University Peshawar, Peshawar, Pakistan
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Patil S, Rao A, Pathak P, Kurle S, Mane A, Nirmalkar A, Singhal AK, Verma V, Singh MK, Reddy DCS, Shete A, Singh M, Gangakhedkar R, Panda S. Unsterile injection equipment associated with HIV outbreak and an extremely high prevalence of HCV-A case-control investigation from Unnao, India. PLoS One 2020; 15:e0243534. [PMID: 33275646 PMCID: PMC7717531 DOI: 10.1371/journal.pone.0243534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/23/2020] [Indexed: 01/30/2023] Open
Abstract
The integrated counseling and testing center (ICTC) located in the district hospital, Unnao in the northern state of Uttar Pradesh (UP), India witnessed an increased detection of HIV among its attendees in July 2017. Subsequently, health camps were organized by the UP State AIDS Control Society in the villages and townships contributing to such detection. We conducted a case-control study to identify factors associated with this increased detection; 33 cases and 125 controls were enrolled. Cases were individuals, detected HIV sero-reactive during November 2017-April 2018 from three locations namely Premganj, Karimuddinpur and Chakmeerapur in the Bangarmau block of the district of Unnao. Controls hailed from the same geographical setting and tested HIV sero-nonreactive either in health camps or at ICTC centers from where the cases were detected. Misclassification bias was avoided by confirming HIV sero-status of both cases as well as controls prior to final analysis. Study participants were interviewed on various risk practices and invasive treatment procedures. They were also tested for HIV and other bio-markers reflecting unsafe injecting and sexual exposures such as hepatitis B surface antigen (HBsAg), anti-HCV antibody (HCV Ab), anti-herpes simplex-2 Immunoglobulin G (HSV-2 IgG) and rapid plasma regain (RPR) test for syphilis. Secondary data analysis on three time points during 2015 through 2018 revealed a rising trend of HIV among attendees of the ICTCs (ICTC-Hasanganj, ICTC-Unnao district hospital and ICTC- Nawabganj) catering to the entire district of Unnao. While there was a seven fold rise of HIV among ICTC attendees of Hasanganj (χ2 value for trend 23.83; p < 0.001), the rise in Unnao district hospital was twofold (χ2 value for trend 4.37; p < 0.05) and was tenfold at ICTC-Nawabganj (χ2 value for trend 5.23; p < 0.05) indicating risk of infection prevailing throughout the district. Primary data was generated through interviews and laboratory investigations as mentioned above. The median age of cases and controls was 50 year (minimum 18 –maximum 68; IQR 31–57) and 38 year (minimum 18 –maximum 78; IQR 29–50) respectively. Thirty six percent of the cases and 47% of controls were male. A significantly higher proportion of cases (85%) had HCV Ab compared to controls (56%; OR 4.4, 95% CI 1.5–12.1); none reported injection drug use. However, cases and controls did not differ significantly regarding presence of HSV-2 IgG (6% versus 8% respectively). Neither any significant difference existed between cases and controls in terms of receiving blood transfusion, undergoing invasive surgical procedures, tattooing, tonsuring of head or skin piercing. In multivariate logistic regression model, ‘unsafe injection exposure during treatment-seeking’(AOR 6.61, 95% CI 1.80–24.18) and ‘receipt of intramuscular injection in last five years’ (AOR 7.20, 95% CI 1.48–34.88) were independently associated with HIV sero-reactive status. The monophyletic clustering of HIV sequences from 14 cases (HIV-1 pol gene amplified) indicated a common ancestry. Availability of auto-disabled syringes and needles, empowerment of the local communities and effective regulatory practices across care settings would serve as important intervention measures in this context.
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Affiliation(s)
- Sandip Patil
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - Amrita Rao
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - Preety Pathak
- Uttar Pradesh State AIDS Control Society, Lucknow, Uttar Pradesh, India
| | - Swarali Kurle
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - Arati Mane
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - Amit Nirmalkar
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - A. K. Singhal
- Community Health Centre, Department of Medical & Health, Government of Uttar Pradesh, Bangarmau, India
| | - Vinita Verma
- National AIDS Control Organization, New Delhi, India
| | - Mukesh Kumar Singh
- Community Health Centre, Department of Medical & Health, Government of Uttar Pradesh, Bangarmau, India
| | - D. C. S. Reddy
- Technical Resource Group, National AIDS Control Organization, New Delhi, India
| | - Ashwini Shete
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
| | - Manjula Singh
- Indian Council of Medical Research Headquarter, New Delhi, India
| | | | - Samiran Panda
- Indian Council of Medical Research-National AIDS Research Institute, Pune, Maharashtra, India
- Indian Council of Medical Research Headquarter, New Delhi, India
- * E-mail: , ,
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Khan A, Tahir A, Sohail Afzal M, Kamran Shabbir RM, Saleem S, Ahmed H. HIV is an emerging health challenge in Pakistan: risk factors and management strategies. Trop Doct 2020; 51:135-136. [PMID: 32956027 DOI: 10.1177/0049475520957897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aisha Khan
- PhD Student, Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Ayesha Tahir
- Master Student, Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Muhammad Sohail Afzal
- Associate professor, Department of Life Sciences, School of Science, University of Management & Technology (UMT), Lahore, Pakistan
| | - Rana Muhammad Kamran Shabbir
- PhD Student, Department of Zoology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Sadia Saleem
- PhD Student, Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
| | - Haroon Ahmed
- Assistant Professor, Department of Biosciences, COMSATS University Islamabad (CUI), Islamabad, Pakistan
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Haq I, Ullah R, Din M, Ahmad S, Anwar F, Ali M, Khan HU. Unrecognized HIV infection in asymptomatic volunteer blood donors at district Peshawar, Khyber Pakhtunkhwa, Pakistan. New Microbes New Infect 2020; 35:100685. [PMID: 32454980 PMCID: PMC7235641 DOI: 10.1016/j.nmni.2020.100685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/04/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Acquired immunodeficiency syndrome (AIDS) is a global epidemic that impacts the lives of many individuals each year. Human immunodeficiency virus (HIV) is a retrovirus that infects human CD4+ T helper cells and macrophages thereby causing severe immune disease. The current study aimed to examine the prevalence of HIV among the blood donors of Khyber Pakhtunkhwa at Peshawar. In this study, a total of 8634 volunteers who donated blood were carefully screened for HIV using ELISA and RT-PCR techniques. Among the volunteers (n = 8634), 63 were positive by both ELISA and RT-PCR; which shows a prevalence of 0.73%. Both diagnostic techniques exhibited similar results. All the positive individuals were informed immediately and advised to start treatment to control the progression of the infection. It was concluded that HIV is on the rise in Peshawar, and routine screening and preventive measures are immediately required to address the urgent situation of HIV infection.
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Affiliation(s)
- I Haq
- Department of Genetics, Hazara University Mansehra, Pakistan
| | - R Ullah
- Department of Biotechnology, University of Malakand, Pakistan
| | - M Din
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Pakistan
| | - S Ahmad
- Department of Biotechnology, University of Malakand, Pakistan
| | - F Anwar
- Department of Genetics, Hazara University Mansehra, Pakistan
| | - M Ali
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Pakistan
| | - H Ullah Khan
- Khyber Medical College, Peshawar, Pakistan.,Khyber Teaching Hospital, Peshawar, Pakistan
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Mallhi TH, Khan YH, Khan A, Alotaibi NH, Alzarea AI, Hashmi FK. The association of HIV and easy access to narcotics in Pakistan; calling drug policy makers. J Pharm Policy Pract 2019; 12:37. [PMID: 31867113 PMCID: PMC6918682 DOI: 10.1186/s40545-019-0199-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/21/2019] [Indexed: 01/30/2023] Open
Abstract
HIV in Pakistan is concentrated to people who inject drugs (PWID) and easy accessibility of narcotics to this population cannot be disregarded as a risk factor of growing encumbrance of AIDS in the country. All the narcotics and other medications having high potential of abuse are stratified into Schedule G of Punjab Drug Rules 2017. According to these rules, drugs in Schedule G shall be sold in pharmacy under the direct supervision of qualified pharmacist. However, Schedule G is not implemented in Punjab due to continuous resistance from pharmaceutical stakeholders including medical store owners (who are barred to sell drugs from schedule G). Since 1.6 million PWID reported misuse of prescription opioids for non-medical use, delayed implementation of schedule G is attributing to the unabated sale of narcotics without prescription and for non-medical purposes, which is further contributing to the staggering number of PWID in the country. Implementing schedule G will not only curb the existing situation of HIV but will also mitigate the contribution of PWID towards the future events.
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Affiliation(s)
- Tauqeer Hussain Mallhi
- 1Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf Kingdom of Saudi Arabia
| | - Yusra Habib Khan
- 1Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf Kingdom of Saudi Arabia
| | - Amjad Khan
- 2Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Nasser Hadal Alotaibi
- 1Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf Kingdom of Saudi Arabia
| | - Abdulaziz Ibrahim Alzarea
- 1Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf Kingdom of Saudi Arabia
| | - Furqan Khurshid Hashmi
- 3University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
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