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Antinori A, Vergori A, Ripamonti D, Valenti D, Esposito V, Carleo MA, Rusconi S, Cascio A, Manzillo E, Andreoni M, Orofino G, Cappuccio A, Reale L, Marini MG, Mancusi D, Termini R, Uglietti A, Portaro M. Investigating coping and stigma in people living with HIV through narrative medicine in the Italian multicentre non-interventional study DIAMANTE. Sci Rep 2023; 13:17624. [PMID: 37848464 PMCID: PMC10582167 DOI: 10.1038/s41598-023-44768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
Antiretroviral therapy (ART) significantly reduced Human Immunodeficiency Virus (HIV) morbidity and mortality; nevertheless, stigma still characterises the living with this condition. This study explored patients' coping experience by integrating narrative medicine (NM) in a non-interventional clinical trial. From June 2018 to September 2020 the study involved 18 centres across Italy; enrolled patients were both D/C/F/TAF naïve and previously ART-treated. Narratives were collected at enrolment (V1) and last visit (V4) and then independently analysed by three NM specialist researchers through content analysis. One-hundred and fourteen patients completed both V1 and V4 narratives. Supportive relationships with clinicians and undetectable viral load facilitated coping. Conversely, lack of disclosure of HIV-positive status, HIV metaphors, and unwillingness to narrate the life before the diagnosis indicated internalised stigma. This is the first non-interventional study to include narratives as patient reported outcomes (PROs). Improving HIV awareness and reducing the sense of guilt experienced by patients helps to overcome stigma and foster coping.
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Affiliation(s)
- A Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - A Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - D Ripamonti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Valenti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Esposito
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - M A Carleo
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - S Rusconi
- DIBIC Luigi Sacco, University of Milan, Milan, Italy
- Infectious Diseases Unit, Legnano Hospital ASST Ovest Milanese, Legnano, Italy
| | - A Cascio
- Infectious Diseases Clinic, AOU Policlinico "P.Giaccone", Palermo, Italy
| | - E Manzillo
- Infectious Disease and Infectious Emergencies, Azienda Ospedaliera dei Colli, Naples, Italy
| | - M Andreoni
- Infectious Diseases Clinic, Foundation Policlinico Tor Vergata University Hospital, Rome, Italy
| | - G Orofino
- Amedeo di Savoia Hospital Unit of Infectious Diseases Torino, Turin, Italy
| | | | - L Reale
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - M G Marini
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - D Mancusi
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - R Termini
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - A Uglietti
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - M Portaro
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy.
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Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MM, Hine P. Accuracy of measures for antiretroviral adherence in people living with HIV. Cochrane Database Syst Rev 2022; 7:CD013080. [PMID: 35871531 PMCID: PMC9309033 DOI: 10.1002/14651858.cd013080.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Good patient adherence to antiretroviral (ART) medication determines effective HIV viral suppression, and thus reduces the risk of progression and transmission of HIV. With accurate methods to monitor treatment adherence, we could use simple triage to target adherence support interventions that could help in the community or at health centres in resource-limited settings. OBJECTIVES To determine the accuracy of simple measures of ART adherence (including patient self-report, tablet counts, pharmacy records, electronic monitoring, or composite methods) for detecting non-suppressed viral load in people living with HIV and receiving ART treatment. SEARCH METHODS The Cochrane Infectious Diseases Group Information Specialists searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, African-Wide information, and Web of Science up to 22 April 2021. They also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included studies of all designs that evaluated a simple measure of adherence (index test) such as self-report, tablet counts, pharmacy records or secondary database analysis, or both, electronic monitoring or composite measures of any of those tests, in people living with HIV and receiving ART treatment. We used a viral load assay with a limit of detection ranging from 10 copies/mL to 400 copies/mL as the reference standard. We created 2 × 2 tables to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS We screened studies, extracted data, and assessed risk of bias using QUADAS-2 independently and in duplicate. We assessed the certainty of evidence using the GRADE method. The results of estimated sensitivity and specificity were presented using paired forest plots and tabulated summaries. We encountered a high level of variation among studies which precluded a meaningful meta-analysis or comparison of adherence measures. We explored heterogeneity using pre-defined subgroup analysis. MAIN RESULTS We included 51 studies involving children and adults with HIV, mostly living in low- and middle-income settings, conducted between 2003 and 2021. Several studies assessed more than one index test, and the most common measure of adherence to ART was self-report. - Self-report questionnaires (25 studies, 9211 participants; very low-certainty): sensitivity ranged from 10% to 85% and specificity ranged from 10% to 99%. - Self-report using a visual analogue scale (VAS) (11 studies, 4235 participants; very low-certainty): sensitivity ranged from 0% to 58% and specificity ranged from 55% to 100%. - Tablet counts (12 studies, 3466 participants; very low-certainty): sensitivity ranged from 0% to 100% and specificity ranged from 5% to 99%. - Electronic monitoring devices (3 studies, 186 participants; very low-certainty): sensitivity ranged from 60% to 88% and the specificity ranged from 27% to 67%. - Pharmacy records or secondary databases (6 studies, 2254 participants; very low-certainty): sensitivity ranged from 17% to 88% and the specificity ranged from 9% to 95%. - Composite measures (9 studies, 1513 participants; very low-certainty): sensitivity ranged from 10% to 100% and specificity ranged from 49% to 100%. Across all included studies, the ability of adherence measures to detect viral non-suppression showed a large variation in both sensitivity and specificity that could not be explained by subgroup analysis. We assessed the overall certainty of the evidence as very low due to risk of bias, indirectness, inconsistency, and imprecision. The risk of bias and the applicability concerns for patient selection, index test, and reference standard domains were generally low or unclear due to unclear reporting. The main methodological issues identified were related to flow and timing due to high numbers of missing data. For all index tests, we assessed the certainty of the evidence as very low due to limitations in the design and conduct of the studies, applicability concerns and inconsistency of results. AUTHORS' CONCLUSIONS We encountered high variability for all index tests, and the overall certainty of evidence in all areas was very low. No measure consistently offered either a sufficiently high sensitivity or specificity to detect viral non-suppression. These concerns limit their value in triaging patients for viral load monitoring or enhanced adherence support interventions.
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Affiliation(s)
- Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Nathan Ford
- Department of HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Catherine Orrell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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HIV Disclosure to Family Members and Medication Adherence: Role of Social Support and Self-efficacy. AIDS Behav 2020; 24:45-54. [PMID: 30863978 DOI: 10.1007/s10461-019-02456-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although antiretroviral therapy (ART) is vital to people living with HIV (PLWH) by suppressing the virus and in turn preventing onward HIV transmission and reducing AIDS-related morbidity and mortality, the rates of optimal ART adherence continuously remain low. Disclosure of HIV status is considered to be a critical predictor of ART adherence. However, few studies have explored the mechanisms underlying the association between disclosure and medication adherence. The current study aims to examine the mediating role of social support and self-efficacy underlying the relationship between HIV disclosure to family members and ART adherence. PLWH in China provided data on HIV disclosure, ART adherence, perceived social support on medication adherence, adherence self-efficacy, and social-demographic information. The path analyses revealed that disclosure to family members had significant indirect effects on adherence via social support and self-efficacy. Our findings suggested that HIV disclosure might positively affect ART adherence through two psychosocial pathways: social support and self-efficacy. Future intervention to improve medication adherence among PLWH should consider targeting these two factors.
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Pagan-Ortiz ME, Goulet P, Kogelman L, Levkoff SE, Weitzman PF. Feasibility of a Texting Intervention to Improve Medication Adherence Among Older HIV+ African Americans: A Mixed-Method Pilot Study. Gerontol Geriatr Med 2019; 5:2333721419855662. [PMID: 31276016 PMCID: PMC6598320 DOI: 10.1177/2333721419855662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
Antiretroviral therapy (ART) is the primary treatment for HIV, and adherence to it is crucial to addressing health disparities. Approximately half of individuals in the United States living with HIV are African Americans, and those over 45 years of age are more likely to die early from HIV/AIDS than their White counterparts. This mixed-method pilot study evaluated the feasibility of a text-based mobile phone intervention designed to improve ART adherence among older African Americans with HIV. Feasibility was assessed via implementation, participant adherence, acceptability, and satisfaction, as well as short-term impact on medication adherence, adherence-related self-efficacy, and positive affect. The intervention utilized pill reminder, motivational, and health educational texts. Participants (N = 21) ranged in age from 50 to 68 years. Outcomes were evaluated via quantitative results from self-report measures and qualitative data from four focus groups. Attrition to the study was 100%. After 8 weeks, participants reported statistically significant improvements in medication adherence, but not in self-efficacy or affect scores. Qualitative findings highlight the psychologically supportive potential of the intervention, challenges to adherence, as well as suggestions for improvement. The study demonstrates that a text messaging intervention may be feasible for older African Americans with HIV, and helpful in supporting ART adherence.
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Affiliation(s)
| | | | | | - Sue E. Levkoff
- Environment and Health Group, Cambridge, MA, USA
- University of South Carolina, Columbia, USA
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Ségéral O, Nerrienet E, Neth S, Spire B, Khol V, Ferradini L, Sarun S, Mom C, Ngin S, Charpentier C, Men P, Mora M, Mean Chhi V, Ly P, Saphonn V. Positive Virological Outcomes of HIV-Infected Patients on Protease Inhibitor-Based Second-Line Regimen in Cambodia: The ANRS 12276 2PICAM Study. Front Public Health 2018; 6:63. [PMID: 29662875 PMCID: PMC5890147 DOI: 10.3389/fpubh.2018.00063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background Assessment of virological outcomes among HIV-infected patients receiving protease (PR) inhibitor-based second-line regimen are uncommon in Cambodia. The objective of this study is to assess the virological effectiveness of this regimen as well as impact of adherence boosting for patients experiencing virological failure. Methods The 2PICAM study (Clinicaltrial: NCT01801618) is a cross-sectional study of HIV-infected adults on PR inhibitor-based second-line regimen since at least 6 months, conducted in 13 representative sites, comprising more than 90% of the target population. Adults with HIV RNA above 250 copies/mL (threshold of the assay) at inclusion received boosted adherence counseling during 3 months followed by HIV RNA control. For confirmed virological failure, genotype resistance test was performed and expert committee used results for therapeutic decision. Results Among the 1,317 adults enrolled, the median duration of second-line regimen was 5 years. At inclusion, 1,182 (89.7%) patients achieved virological success (<250 copies/mL) and 135 (10.3%) experienced a virological failure (>250 copies/mL). In multivariable analysis, factors associated with virological success were: CD4 cell count between 201 and 350/mm3 (OR: 4.66, 95% CI: 2.57–8.47, p < 0.0001) and >350/mm3 (OR: 6.67, 95% CI: 4.02–11.06, p < 0.0001), duration of PI-based regimen >2 years (OR: 1.64, 95% CI: 1.03–2.62, p = 0.037), ATV-containing regimen (0R: 1.65, 95% CI: 1.04–2.63, p = 0.034) and high level of adherence (OR: 2.41, 95% CI: 1.07–5.41, p = 0.033). After adherence counseling, 63 (46.7%) patients were rescued while 72 (53.3%) were not. For the 54 patients with genotype resistance tests available, high or intermediate levels of resistance to lopinavir, atazanavir, and darunavir were reported for 13 (24%), 12 (22.2%), and 2 (3.7%) patients, respectively. Change to an alternative PR inhibitor-based regimen was recommended for 17 patients and to third-line regimen, including integrase inhibitors for 12. Conclusion This study reports high rate of virological suppression of second-line regimen and importance of adherence boosting prior to deciding any change of ART regimen. Genotype resistance tests appear necessary to guide decisions. Such information was of great importance for National HIV Program to adapt guidelines and program needs for third-line regimen.
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Affiliation(s)
- Olivier Ségéral
- French Agency for Research on AIDS and Viral Hepatitis (ANRS), Paris, France.,University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Eric Nerrienet
- Institut Pasteur, Paris, France.,France Expertise Internationale, Paris, France
| | - Sansothy Neth
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | | | - Saramony Sarun
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Chandara Mom
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | - Sopheak Ngin
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
| | - Charlotte Charpentier
- INSERM, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Bichat, Laboratoire de Virologie, Paris, France
| | | | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Vun Mean Chhi
- University of Health Sciences (UHS), Phnom-Penh, Cambodia
| | - Penhsun Ly
- National Center for HIV/AIDS, Dermatology and STD (NCHADS), Phnom Penh, Cambodia
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Bernier A, Yattassaye A, Beaulieu-Prévost D, Otis J, Henry E, Flores-Aranda J, Massie L, Préau M, Keita BD. Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention. PATIENT EDUCATION AND COUNSELING 2018; 101:248-255. [PMID: 28789863 DOI: 10.1016/j.pec.2017.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to assess the short-term effects of Gundo-So-a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management. METHODS A pre-experimental study with two measures (one week before and four weeks after Gundo-So) was carried out. A 35-item questionnaire was administered to a convenience sample of 210 WLHIV. Six outcomes were considered: ability to decide whether or not to disclose HIV status, self-efficacy to keep HIV status a secret, self-efficacy to disclose HIV status, feeling crushed by the weight of secrecy, perceived physical health, and perceived psychological health. For each outcome, temporal changes associated with the intervention were assessed using linear regressions with random intercepts. RESULTS Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures. Furthermore, several variables were associated with the baseline levels of the outcomes and the intervention effect. CONCLUSION The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management, thus improving their perceived physical and psychological health. PRACTICAL IMPLICATIONS These results highlight the need for programs to empower WLHIV regarding serostatus disclosure, so that WLHIV can make free and informed decisions regarding serostatus disclosure.
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Affiliation(s)
| | | | | | - Joanne Otis
- Sexology department, Université du Québec à Montréal, Montréal, Canada
| | | | | | - Lyne Massie
- Sexology department, Université du Québec à Montréal, Montréal, Canada
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The Effect of Education Based on Health Promotion Model (HPM) on Adherence to Antiretroviral Therapy (ART) in HIV- Infected Patients. HEALTH SCOPE 2017. [DOI: 10.5812/jhealthscope.62592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Li X, Zhao Z, Ma J, Cui S, Yi M, Guo H, Wan Y. Extracting Neural Oscillation Signatures of Laser-Induced Nociception in Pain-Related Regions in Rats. Front Neural Circuits 2017; 11:71. [PMID: 29062273 PMCID: PMC5640783 DOI: 10.3389/fncir.2017.00071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/15/2017] [Indexed: 01/11/2023] Open
Abstract
Previous studies have shown that multiple brain regions are involved in pain perception and pain-related neural processes by forming a functionally connected pain network. It is still unclear how these pain-related brain areas actively work together to generate the experience of pain. To get a better insight into the pain network, we implanted electrodes in four pain-related areas of rats including the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), primary somatosensory cortex (S1) and periaqueductal gray (PAG). We analyzed the pattern of local field potential (LFP) oscillations under noxious laser stimulations and innoxious laser stimulations. A high-dimensional feature matrix was built based on the LFP characters for both experimental conditions. Generalized linear models (GLMs) were trained to classify recorded LFPs under noxious vs. innoxious condition. We found a general power decrease in α and β bands and power increase in γ band in the recorded areas under noxious condition. After noxious laser stimulation, there was a consistent change in LFP power and correlation in all four brain areas among all 13 rats. With GLM classifiers, noxious laser trials were distinguished from innoxious laser trials with high accuracy (86%) using high-dimensional LFP features. This work provides a basis for further research to examine which aspects (e.g., sensory, motor or affective processes) of noxious stimulation should drive distinct neural activity across the pain network.
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Affiliation(s)
- Xuezhu Li
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Zifang Zhao
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Jun Ma
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Shuang Cui
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Ming Yi
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Huailian Guo
- Department of Neurology, People's Hospital, Peking University, Beijing, China
| | - You Wan
- Neuroscience Research Institute, Peking University, Beijing, China.,Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China.,Key for Neuroscience, Ministry of Education/National Committee of Health and Family Planning of China, Peking University, Beijing, China
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9
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Sagaon-Teyssier L, Mmadi Mrenda B, Khol V, Ferradini L, Mam S, Ngin S, Mora M, Maradan G, Vun Mean C, Ségéral O, Nerrienet E, Saphonn V, Spire B. Adherence to PI-based 2nd-line regimens in Cambodia is not simply a question of individual behaviour: the ANRS 12276 2PICAM study. Trop Med Int Health 2017; 22:1428-1435. [PMID: 28905466 DOI: 10.1111/tmi.12975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia. METHODS The ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART. RESULTS A total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence. CONCLUSIONS Our results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital.
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Affiliation(s)
- Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bakridine Mmadi Mrenda
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Vohith Khol
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | | | - Sovatha Mam
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sopheak Ngin
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Chhi Vun Mean
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.,University of Health Sciences, Phnom-Penh, Cambodia
| | - Olivier Ségéral
- University of Health Sciences, Phnom-Penh, Cambodia.,French Agency for Research on AIDS and Viral Hepatitis, Paris, France
| | | | - Vonthanak Saphonn
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.,University of Health Sciences, Phnom-Penh, Cambodia
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Abstract
Supplemental Digital Content is Available in the Text. Background: As test and treat rolls out, effective interventions are needed to address the determinants of outcomes across the HIV treatment continuum and ensure that people infected with HIV are promptly tested, initiate treatment early, adhere to treatment, and are virally suppressed. Communication approaches offer viable options for promoting relevant behaviors across the continuum. Conceptual Framework: This article introduces a conceptual framework, which can guide the development of effective health communication interventions and activities that aim to impact behaviors across the HIV treatment continuum in low- and medium-income countries. The framework includes HIV testing and counseling, linkage to care, retention in pre-antiretroviral therapy and antiretroviral therapy initiation in one single-stage linkage to care and treatment, and adherence for viral suppression. The determinants of behaviors vary across the continuum and include both facilitators and barriers with communication interventions designed to focus on specific determinants presented in the model. At each stage, relevant determinants occur at the various levels of the social–ecological model: intrapersonal, interpersonal, health services, community, and policy. Effective health communication interventions have mainly relied on mHealth, interpersonal communication through service providers and peers, community support groups, and treatment supporters. Discussion: The conceptual framework and evidence presented highlight areas across the continuum where health communication can significantly impact treatment outcomes to reach the 90-90-90 goals by strategically addressing key behavioral determinants. As test and treat rolls out, multifaceted health communication approaches will be critical.
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11
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Gebrezgabher BB, Kebede Y, Kindie M, Tetemke D, Abay M, Gelaw YA. Determinants to antiretroviral treatment non-adherence among adult HIV/AIDS patients in northern Ethiopia. AIDS Res Ther 2017; 14:16. [PMID: 28331527 PMCID: PMC5359813 DOI: 10.1186/s12981-017-0143-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/11/2017] [Indexed: 11/26/2022] Open
Abstract
Background Adhering 95% and above of antiretroviral therapy reduces the rate of disease progression and death among people’s living human immunodeficiency virus. Though manifold factors have reported as determinant factors of antiretroviral therapy adherence status, perhaps determinants of non-adherence differ up on the activities of patients in the study setting. Methods An institution based unmatched case–control study was conducted in Aksum town. Individuals who had a 6-month follow-up with complete individual information were included in the study. Document review and interviewer based techniques were used to collect the data. Binary logistic regression analysis was used to identify the determinant factors of non-adherence. Results A total of 411 (137 cases and 274 control) study participants were included in the study. The majority of them were male in sex. Having 2 years and above duration on ART [AOR = 7, 95% CI (2.2, 22.6)], history of adverse effect [AOR = 6.9, 95% CI (1.4, 32.9)], substance use [AOR = 5.3, 95% CI (1.4, 20.0)], living with parents [AOR = 3.4, 95% CI (1.2, 10.3)], having depression symptom [AOR = 3.3, 95% CI (1.4, 7.5)], <350 cells/mm3 cluster of differentiation 4 count [AOR = 3.2, 95% CI (1.8, 5.8)] and low dietary diversity [AOR = 2, 95% CI (1.1, 3.7)] were found significant determinants of non-adherence to antiretroviral drug. Conclusion Program, social and individual related factors showed a statistically significant associated with non-adherence to antiretroviral therapy. Managing lifestyle by developing self-efficacy of individuals and treating related threat to improve adherence status of antiretroviral therapy is recommended in this study.
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Disclosure of HIV Status Beyond Sexual Partners by People Living with HIV in France: A Call for Help? Results from the National Cross-Sectional Survey ANRS-VESPA2. AIDS Behav 2017; 21:196-206. [PMID: 27614877 DOI: 10.1007/s10461-016-1549-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV status disclosure remains a complex issue for most people living with HIV (PLWH). We analyzed PLWH disclosure behaviors in France, where treatment is free and where the social image of HIV has improved in the general population. Analyses focused on disclosure to the social network excluding sexual partners (close family, other relatives, friends, colleagues). The study sample comprised 3016 participants from the nationally representative survey ANRS-VESPA2. Three PLWH clusters were identified using hierarchical classification ("high disclosure level": 28.2 %, "medium disclosure level": 27.5 %, and "low disclosure level": 44.3 %). In multivariable analyses, the variable "not living in a couple but psychological social support needed" was independently associated with medium (AOR [95 % CI] 1.8 [1.4; 2.3]) and high levels of disclosure (1.4 [1.1; 1.8]) (multinomial regression models). For PLWH living alone, HIV status disclosure may reveal a need for psychological social support, a key component to treatment adherence and positive prevention.
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Mukui IN, Ng’ang’a L, Williamson J, Wamicwe JN, Vakil S, Katana A, Kim AA. Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012. PLoS One 2016; 11:e0167465. [PMID: 27907114 PMCID: PMC5131960 DOI: 10.1371/journal.pone.0167465] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Understanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya. Methods The Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012–2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15–64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence. Results A total of 648 (5.6%; CI 4.9–6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8–53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2–76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9–13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15–29 years (AOR 8.39; CI 2.26–31.22, p = 0.002) compared to aged 30–64 years, rural residence (AOR 5.87; CI 1.39–25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30–26.70, p = 0.022). Conclusion Overall, less than 10% of Kenyans aged 15–64 years on ART were not adhering to their HIV medication, highlighting the success of the Kenyan national ART program. Our findings, however, point to the need for targeted interventions particularly for young persons, those in rural areas to improve adherence outcomes, as well as delivery of treatment programs that include psychosocial support as a preventative measure to minimize substance abuse and the risk of treatment failure.
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Affiliation(s)
- Irene N. Mukui
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
- * E-mail:
| | - Lucy Ng’ang’a
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Williamson
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joyce N. Wamicwe
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Shobha Vakil
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Connor JJ, Lund SM, Ciesinski A, Finsaas M, Bichanga T, Robinson B“BE. The East African HIV prevention model: Perspectives from HIV-positive male immigrants living in the USA. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1175402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Jennifer Jo Connor
- Department of Community Psychology, Counseling, and Family Therapy, St. Cloud State University, B 210 EB 210 720 4th Avenue South, Saint Cloud, MN 56301, USA
| | - Sharon M. Lund
- Global Public Health Innovations Inc., 332 Minnesota Street, Suite W-2525, Saint Paul, MN 55101, USA
| | - Amanda Ciesinski
- Department of Kinesiology and Health Science, Concordia University, 275 Syndicate Street North, Saint Paul, MN 55104-5436, USA
| | - Megan Finsaas
- Department of Psychology, Stony Brook University, 7 Harborview Road, Stony Brook, New York, NY 11790, USA
| | - Tom Bichanga
- Aliveness Project, 3808 Nicollet Avenue South, Minneapolis, MN 55409, USA
| | - Beatrice “Bean” E. Robinson
- Department of Family Medicine & Community Health, University of Minnesota Medical School, 1300 South 2nd Street, Suite 180, West Bank Office Building, Minneapolis, MN 55454, USA
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Orne-Gliemann J, Larmarange J, Boyer S, Iwuji C, McGrath N, Bärnighausen T, Zuma T, Dray-Spira R, Spire B, Rochat T, Lert F, Imrie J. Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal. BMC Public Health 2015; 15:209. [PMID: 25880823 PMCID: PMC4351958 DOI: 10.1186/s12889-015-1344-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/02/2015] [Indexed: 12/21/2022] Open
Abstract
Background The Universal HIV Test and Treat (UTT) strategy represents a challenge for science, but is also a challenge for individuals and societies. Are repeated offers of provider-initiated HIV testing and immediate antiretroviral therapy (ART) socially-acceptable and can these become normalized over time? Can UTT be implemented without potentially adding to individual and community stigma, or threatening individual rights? What are the social, cultural and economic implications of UTT for households and communities? And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services? The answers to these research questions will be critical for routine implementation of UTT strategies. Methods/design A social science research programme is nested within the ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomised trial in rural South Africa. The programme aims to inform understanding of the (i) social, economic and environmental factors affecting uptake of services at each step of the continuum of HIV prevention, treatment and care and (ii) the causal impacts of the TasP intervention package on social and economic factors at the individual, household, community and health system level. We describe a multidisciplinary, multi-level, mixed-method research protocol that includes individual, household, community and clinic surveys, and combines quantitative and qualitative methods. Discussion The UTT strategy is changing the overall approach to HIV prevention, treatment and care, and substantial social consequences may be anticipated, such as changes in social representations of HIV transmission, prevention, HIV testing and ART use, as well as changes in individual perceptions and behaviours in terms of uptake and frequency of HIV testing and ART initiation at high CD4. Triangulation of social science studies within the ANRS 12249 TasP trial will provide comprehensive insights into the acceptability and feasibility of the TasP intervention package at individual, community, patient and health system level, to complement the trial’s clinical and epidemiological outcomes. It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation. Trial registration Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1344-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanna Orne-Gliemann
- INSERM/University of Bordeaux, ISPED, Centre Inserm U897- Épidemiologie-Biostatistique, Bordeaux, France.
| | - Joseph Larmarange
- Centre Population et Développement (CEPED UMR 196 Université Paris Descartes Ined IRD), Paris, France. .,Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
| | - Sylvie Boyer
- INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France.
| | - Collins Iwuji
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
| | - Nuala McGrath
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa. .,Academic Unit of Primary Care and Population Sciences, and Department of Social statistics and Demography, University of Southampton, Southampton, UK.
| | - Till Bärnighausen
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa. .,Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
| | - Thembelile Zuma
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Research Team in social epidemiology, F-75013, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, F-75013, Paris, France.
| | - Bruno Spire
- INSERM-IRD-Aix-Marseille University, Faculty of Medicine, Aix-Marseille School of Economics (AMSE), SESSTIM-UMR 912, 13006, Marseille, France.
| | - Tamsen Rochat
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
| | - France Lert
- Centre de recherche en Épidémiologie et Santé des Populations (CESP, Inserm Unité 1018), Villejuif, France.
| | - John Imrie
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa. .,Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, Faculty of Population Health Sciences, University College London, London, UK.
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"Was it a mistake to tell others that you are infected with HIV?": factors associated with regret following HIV disclosure among people living with HIV in five countries (Mali, Morocco, Democratic Republic of the Congo, Ecuador and Romania). Results from a community-based research. AIDS Behav 2015; 19:311-21. [PMID: 25533922 DOI: 10.1007/s10461-014-0976-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study examined regret following HIV serostatus disclosure and associated factors in under-investigated contexts (Mali, Morocco, Democratic Republic of the Congo, Ecuador and Romania). A community-based cross-sectional study was implemented by a mixed consortium [researchers/community-based organizations (CBO)]. Trained CBO members interviewed 1,500 PLHIV in contact with CBOs using a 125-item questionnaire. A weighted multivariate logistic regression was performed. Among the 1,212 participants included in the analysis, 290 (23.9 %) declared that disclosure was a mistake. Female gender, percentage of PLHIV's network knowing about one's seropositivity from a third party, having suffered rejection after disclosure, having suffered HIV-based discrimination at work, perceived seriousness of infection score, daily loneliness, property index and self-esteem score were independently associated with regret. Discrimination, as well as individual characteristics and skills may affect the disclosure experience. Interventions aiming at improving PLHIV skills and reducing their social isolation may facilitate the disclosure process and avoid negative consequences.
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HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings. J Int AIDS Soc 2015; 18:19033. [PMID: 25598476 PMCID: PMC4297925 DOI: 10.7448/ias.18.1.19033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 10/11/2014] [Accepted: 10/30/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. Methods We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review. Results and Discussion Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Conclusions Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.
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