The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

Isoniazid preventive therapy completion and factors associated with non-completion among patients on antiretroviral therapy at Kisenyi Health Centre IV, Kampala, Uganda

BACKGROUND

Isoniazid preventive therapy (IPT) is given to HIV patients to reduce the risk of active tuberculosis (TB). However, treatment completion remains suboptimal among those that are initiated. This study aimed to determine the completion level of IPT and the factors associated with non-completion among patients on antiretroviral therapy (ART) at Kisenyi Health Center IV in Kampala, Uganda.

METHODS

A mixed-methods facility-based retrospective cohort study utilizing routinely collected data from 341 randomly selected HIV patients initiated on IPT was conducted. Data extracted from the registers was used to determine IPT completion. Robust Poisson regression was conducted to determine the associated factors of IPT non-completion, while in-depth interviews were conducted to explore barriers to IPT completion from the patient's perspective.

RESULTS

A total of 341 patients who started on isoniazid (INH) were retrospectively followed up, with 69% (236/341) being female. Overall IPT completion was 83%. Multivariate analysis revealed the prevalence of IPT non-completion among males was 2.24 times the prevalence among females (aPR 2.24, 95% CI: 1.40-3.58, p = 0.001). The prevalence of IPT non-completion among patients with a non-suppressed HIV viral load was 3.00 times the prevalence among those with a suppressed HIV viral load (aPR 3.00, 95% CI: 1.44-6.65, p = 0.007). The prevalence of IPT non-completion among patients who were married, or cohabiting was 0.31 times the prevalence among those who were single (aPR 0.31, 95% CI: 0.17-0.55, p<0.000). Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion.

CONCLUSION

IPT completion was found to be 83% among the cohort studied. However, lower completion levels persist among males and HIV-virally non-suppressed patients. Lack of IPT-related health education, pill burden, distance to the health facility, and patient relocation were reported as barriers to IPT completion. Interventions that target these groups of people need to be intensified.

COVID-19 associated changes in HIV service delivery over time in Central Africa: Results from facility surveys during the first and second waves of the pandemic

INTRODUCTION

The COVID-19 pandemic has impacted population health around the globe, directly and indirectly. The objective of this study was to document changes in HIV care associated with the COVID-19 pandemic at selected clinics in Central Africa, along with clinic-level strategies for minimizing disruptions in HIV care and treatment for people with HIV (PWH).

METHODS

A 51-item questionnaire on COVID-19 pandemic-associated changes in HIV service delivery was completed by clinicians involved in HIV care at 21 clinics in five countries participating in Central Africa International epidemiology Databases to Evaluate AIDS (CA-IeDEA). The survey was completed at two timepoints: June-July 2020 and October 2020 to February 2021. Descriptive statistics were used to characterize changes in HIV care and related services.

RESULTS

While 81% of sites reported at least one negative consequence of COVID-19 for clinic operations during the first survey, none reported suspending antiretroviral therapy (ART) initiation services for new patients, and 24% reported adopting telemedicine. In the follow-up survey, fewer sites (48%) reported at least one disruption to clinic operations, and more sites reported mitigation strategies, including expanding rapid ART initiation services and providing extra supplies of ART medications to reduce visit frequency. In the follow-up survey, more sites, especially in Rwanda, reported stockouts of commodities, including HIV and viral load testing and HIV pre-exposure prophylaxis. More than one-fifth of sites reported stockouts of second- or third-line ART at each survey timepoint.

CONCLUSIONS

While the initial wave of the COVID-19 pandemic resulted in concerning disruptions to HIV service delivery at CA-IeDEA sites, most of these disruptions attenuated over time, and many sites introduced measures to help PWH avoid frequent visits to the clinic for care and medications. The impact of HIV commodity stockouts and clinic mitigation strategies on treatment outcomes needs to be assessed.

HTLV-1 Coinfection among Patients Attending a Large HIV Treatment Centre in Trinidad

Studies have shown that HIV-1/HTLV-1 coinfected patients tend to have higher CD4+ counts than HIV singly infected patients. Two chart reviews were conducted at initial enrolment among patients attending a large HIV Clinic in Trinidad, one to determine the prevalence of HIV-1/HVLV-1 coinfection and another to compare the CD4+ counts and opportunistic infections among HIV-1/HTLV-1 coinfected patients compared to a randomly selected comparison group of HIV-1 singly infected patients. Sociodemographic, clinical and laboratory data were collected and analysed using SPSS Version 25. During the period April 2002−December 2018, 8916 HIV-1 patients were enrolled at the clinic; 159 were HIV-1/HTLV-1 coinfected; the age range was 18−81 years; the median age was 40 years; 87 (54.7%) were females; and the median CD4+ count and median HIV-1 viral load at enrolment were 300 cells/mm3 and 128,543 copies/mL, respectively, with an HTLV-1 seroprevalence of 1.78%. Among the 477 HIV-1 singly infected patients, the age range was 18−71 years; the median age was 33 years; 248 (52.0%) were males; and the median CD4+ count and the median HIV viral load were 295 cells/mm3 and 23,369 copies/mL, respectively. Opportunistic infections (OIs) were diagnosed in 59 (37.1%) of the coinfected patients versus 48 (10.1%) among those HIV singly infected (p < 0.001). HIV-1/HTLV-1 coinfected patients had higher HIV-1 viral loads (p < 0.001) and more OIs, suggesting a worse prognosis though there were no statistically significant differences in CD4+ counts (p = 0.96) as compared to the HIV-1 mono-infected patients.

Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad

Background

Syphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.

Methods

A cross-sectional study was conducted during the period September 2020-June 2021 among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.

Results

Two hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33 years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264) and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI, 1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.

Conclusion

There is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission dynamics of T pallidum infection in this population, thus urgent public health prevention interventions are warranted.

Retention in Care among Patients Attending a Large HIV Clinic in Nigeria Who Were Treated for Tuberculosis

A retrospective study of 2764 patients was conducted at an HIV clinic in Nigeria to evaluate retention in care in patients treated for TB. At 6 and 12 months after commencement of TB treatment, 1842(66.6%) and 1624(58.8%) participants remained in care. Of the 922 and 1140 not in care at 6 and 12 months, 814(88.3%) and 1006(88.2%) respectively were lost to follow-up (LTFU). VL < 1000copies/ml was associated with higher odds of retention in care at 6 and 12 months (OR  =  2.351 and 2.393) than VL > 1000 copies/ml. HAART use was associated with high likelihood of being in care at 12 months (OR  =  3.980). CD4 counts of 200–350 and >350 cells/mm³ were associated with increased odds of remaining in care at 12 months compared with CD4 < 200 cells/mm³ (p  =  0.005 and p  =  0.001). Targeted interventions such as early HAART and close follow-up for high risk groups are likely to improve retention in care.

Updated estimated incidence and prevalence of serious fungal infections in Trinidad and Tobago

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There is an extensive burden of serious fungal infections in Trinidad and Tobago

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Serious fungal infections among PLHIV include PCP, histoplasmosis, and cryptococcosis

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Increased availability of diagnostics and drugs is needed to reduce mortality

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A national surveillance system for fungal infections should be implemented

Objective

: To estimate the incidence and prevalence of serious fungal infections in Trinidad and Tobago (T&T), with a population of 1 394 973 million.

Methods

: The medical literature was searched to obtain published data on the incidence and prevalence of fungal infections in the Caribbean. If data were unavailable, estimations were performed using the frequencies of fungal infection in populations at risk. Asthma and pulmonary tuberculosis rates were used to derive the prevalence of allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization (SAFS), and chronic pulmonary aspergillosis (CPA).

Results

: The estimated annual burden of fungal infections was 46 156 persons (3.3% of the population), including 21 455 women with recurrent vulvovaginal candidiasis, 118 persons with invasive aspergillosis, 3637 adults with ABPA, 4800 with SAFS, and 178 with CPA. Annually, we estimated 70 cases of candidemia and 14 647 cases of tinea capitis in children. Of the 11 000 persons living with HIV/AIDS, it was estimated that there were 40 cases of cryptococcal meningitis, 88 cases of disseminated histoplasmosis, and 124 cases of Pneumocystis pneumonia.

Conclusion

: There seems to be an extensive burden of fungal infections in T&T. Hence, targeted interventions are required to improve clinical and laboratory diagnosis and a national surveillance system should be implemented.