Is there an association between viral load, CD4 count, WHO staging, and dental caries in HIV-positive children?

Evaluation of the pediatric antiretroviral therapy service in Gondar city public health facilities-A case study design with mixed methods

BACKGROUND

The pediatric antiretroviral therapy (ART) service is introduced to save lives, restore mental and physical functions, and improve the quality of life of children living with HIV/AIDS. This evaluation aimed to assess the implementation status of the pediatric ART service provision in Gondar city administration health facilities to promote evidence-based decision-making for program improvement.

METHODS

An institutional-based single case-study design with concurrent mixed methods were applied. The service was evaluated by the availability of essential resources, compliance of health providers with the standard guideline, and caregivers' satisfaction dimensions. Document review, key informant interviews, observations, and interviewer-administered exit-interview were conducted. The quantitative data were analyzed in descriptive and analytical, while the qualitative data were transcribed, translated, and thematically analyzed. A logistic regression analysis was performed to identify factors associated with caregivers' satisfaction.

RESULTS

The overall implementation of pediatric ART service was 75.32%. The availability, compliance, and satisfaction were 68.96%, 74.44%, and 84.64%, respectively. Trained healthcare professionals, essential ART drugs, registers, and basic laboratory diagnostic equipment were reasonably available. However, the lack of opportunistic infection medications and adequate rooms were significant gaps in service provision. Respondents noted a shortage of drugs and rooms for consultation and service provision. Short travel distance (AOR = 2.87), low viral load (AOR = 3.15), and sex of caregivers (AOR = 4.98) were significantly associated with good satisfaction.

CONCLUSIONS

The overall implementation of pediatric ART service is well based on the pre-determined judgment criteria. The health facilities and policymakers are advised to focus on availing medications to treat opportunistic infections and expanding the health facility to have enough space for consultation and service provision. Furthermore, particular emphasis should be given to caregivers who come from long distances and patients with a high viral load to increase caregivers' satisfaction.

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

HIV infection and undernutrition remain significant public health concerns for infants and children. In infants and children under these conditions, undernutrition is one of the leading causes of death. Proper management of nutrition and related nutrition complications in these groups with increased nutrition needs are prominent challenges, particularly in HIV-prevalent poor-resource environments. Several studies support the complexity of the relation between HIV infection, nutrition, and the immune system. These elements interact and create a vicious circle of poor health outcomes. Recent studies on the use of probiotics as a novel approach to manage microbiome imbalance and gut-mucosal impairment in HIV infection are gaining attention. This new strategy could help to manage dysbiosis and gut-mucosal impairment by reducing immune activation, thereby potentially forestalling unwanted health outcomes in children with HIV. However, existing trials on HIV-infected children are still insufficient. There are also conflicting reports on the dosage and effectiveness of single or multiple micronutrient supplementation in the survival of HIV-infected children with severe acute malnutrition. The WHO has published guidelines that include time of initiation of antiretroviral therapy for HIV-pregnant mothers and their HIV-exposed or HIV-infected children, micronutrient supplementation, dietary formulations, prevention, and management of HIV therapy. However, such guidelines need to be reviewed owing to recent advances in the field of nutrition. There is a need for new intervention studies, practical strategies, and evidence-based guidelines to reduce the disease burden, improve adherence to treatment regimen, and enhance the nutrition, health, and well-being of HIV-infected infants and children. This review provides up-to-date scientific information on current knowledge and existing challenges for nutrition therapy in HIV-infected infants and children. Moreover, it presents new research findings that could be incorporated into current guidelines.