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Muzumbukilwa TW, Ghislain MR, Mushebenge AGA, Vagiri RV, Nlooto M. Assessing the pertinence and usefulness of HIV and AIDS indicators for evaluating clinical care quality: Perspectives of health care professionals. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2024:1-13. [PMID: 39392595 DOI: 10.2989/16085906.2024.2358758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Following a systematic review of quality indicators employed in the evaluation of clinical care for individuals with HIV and AIDS, we performed "an exploratory study" that aims to assess the clinical significance and practical applicability of these indicators from the perspective of health care professionals (HCPs) specialising in HIV and AIDS care. Twenty-five HCPs filled out two questionnaires. From the initial list of 88 quality indicators, 50 were identified as the most relevant and useful in HIV and AIDS clinical care. Analysis was conducted on the individual indicators, and the outcomes were categorised into seven domains for clinical relevance and practical usefulness. Health care professionals deemed the functional organisational structure and the therapy domain to have the most pertinent and useful indicators among the seven different clinical domains, followed by the prevention domain.
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Affiliation(s)
- Tambwe Willy Muzumbukilwa
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, University Road, Durban 4001, South Africa
| | - Manimani Riziki Ghislain
- Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Aganze Glory-Aime Mushebenge
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, University Road, Durban 4001, South Africa
| | - Rajesh Vikram Vagiri
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, University Road, Durban 4001, South Africa
- Department of Pharmacy, School of Health Care Sciences/Faculty of Health Sciences, University of Limpopo
| | - Manimbulu Nlooto
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, University Road, Durban 4001, South Africa
- Department of Pharmacy, School of Health Care Sciences/Faculty of Health Sciences, University of Limpopo
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Admasu N, Jihad M, Kebede A, Getnet M. Incidence and predictors of opportunistic infections among HIV-infected children on antiretroviral therapy at public health facilities of Southwest Ethiopia People Regional State, 2023: a multicenter retrospective follow-up study. BMC Pediatr 2024; 24:653. [PMID: 39394104 DOI: 10.1186/s12887-024-05117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 09/26/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Opportunistic infections (OIs) pose a significant threat to children infected with HIV. Despite advancements in antiretroviral therapy (ART), these infections continue to be a public health concern. However, there is limited evidence regarding the incidence and predictors of OIs among HIV-infected children in Ethiopia, particularly in the study area. Therefore, the objective of this study was to assess the incidence and predictors of OIs among HIV-infected children on ART at public health facilities of Southwest Ethiopia People Regional State. METHODS The study employed an institution-based retrospective cohort design, conducted from July 1, 2018 to July 31, 2023, among HIV-infected children aged less than 15 years. Data were extracted using the national ART intake and follow-up forms. KoboCollect version 2023.2.4 and STATA version 14.0 were used for data collection and analysis, respectively. The Kaplan-Meier survival curve was used to estimate the probability of OI-free survival time. Variables with P-value < 0.25 in the bivariable Cox proportional hazard model were selected as candidates. In multivariable analysis, P-value < 0.05 and adjusted hazard ratio (AHR) with 95% confidence interval (CI) were used to declare statistically significant predictors. RESULTS Of the total 409 HIV infected children, 122(29.8%) developed at least one OI, contributing to 954.95 person-years of risk. The overall incidence rate was 12.8 (95% CI: 10.7, 15.2) per 100 person-years. The OI-free survival probability at the end of the follow-up period was 0.277(95% CI: 0.139, 0.434). The commonest OI was pulmonary tuberculosis, 30.33% (95% CI: 22.7, 39.2). Non-disclosing HIV status (AHR: 2.56, 95% CI: 1.42, 4.63), children aged 10-14 years (AHR: 2.34, 95% CI: 1.10, 4.95), no history of prevention of mother-to-child transmission of HIV (AHR: 2.33, 95% CI: 1.48, 3.66), hemoglobin level < 10 mg/dL (AHR: 2.26, 95% CI: 1.37, 3.75), fair or poor adherence to ART (AHR: 1.74, 95% CI: 1.09, 2.79), and having past history of OIs (AHR: 1.61, 95% CI: 1.03, 2.55) were statistically significant predictors of OIs. CONCLUSION AND RECOMMENDATIONS The incidence of OIs was high in the study area. Hence, health facilities need to regularly monitor hemoglobin, enhance ART adherence, provide OI prophylaxis for at-risk children, reinforce PMTCT programs for early OI detection and management, and encourage timely and age-appropriate HIV status disclosure. Caregivers of HIV-infected children are also required to oversee and assist their children in adhering to the ART.
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Affiliation(s)
- Nigatu Admasu
- Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP), Jimma University, Jimma, Ethiopia.
- Public Health Institute, Southwest Ethiopia People Regional Health Bureau, Tarcha, Ethiopia.
| | - Mohammed Jihad
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Abeje Kebede
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Bekolo C, Ndeso S, Gougue C, Moifo L, Mangala N, Tchendjou P, Mboh E, Ateudjieu J, Tendongfor N, Nsagha D, Halle-Ekane G, Choukem S. The effect of the Universal Test and Treat policy uptake on CD4 count testing and incidence of opportunistic infections among people living with HIV infection in Cameroon: a retrospective analysis of routine data. DIALOGUES IN HEALTH 2023; 2:100120. [PMID: 38515498 PMCID: PMC10954022 DOI: 10.1016/j.dialog.2023.100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/05/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2024]
Abstract
Background Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. UTT has shown inconsistent results elsewhere and has not yet been assessed in Cameroon. We aimed to evaluate the effectiveness of this novel approach on the quality of care and health outcomes of people living with HIV (PLHIV). Methods A retrospective cohort design was conducted at The Nkongsamba Regional Hospital, using routine clinical service delivery data to measure uptake levels of UTT and CD4 testing, and to compare the incidence of opportunistic infections (OI) between PLHIV initiated on ART based on the "Universal Test and Treat" strategy and those initiated on ART based on the standard deferred approach between 2002 and 2020. Kaplan Meier plots and log-rank tests were used to compare OI events between the pre-UTT and post-UTT eras. The Cox regression model was used to screen for factors independently associated with the risk of acquisition of OI. Results The uptake of UTT ranged from 39.1% to 92.8% while baseline CD4 count testing reduced drastically from 89.4% to 0.4% between 2016 to 2020 respectively. The median delay in ART initiation declined significantly from 21 days (IQR: 9 - 113) in the pre-UTT era to the same day of diagnosis (IQR: 0 - 2) in the UTT era (p < 0.001). The incidence of all OI events reported was over five times higher during the UTT era than in the pre-UTT era [aHR = 5.55 (95% CI: 3.18 - 9.69), p < 0.001]. Conclusion The UTT policy has been effectively rolled out and has contributed to improved access to rapid and immediate ART initiation, but a higher incidence of OIs was observed with a rollback of baseline CD4 testing. We advocate for a return to routine baseline CD4 measurement to identify PLHIV who should benefit from interventions to prevent OIs for optimal outcomes under the UTT approach.
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Affiliation(s)
- C.E. Bekolo
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - S.A. Ndeso
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - C.P. Gougue
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - L.L. Moifo
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - N. Mangala
- Department of Gynaecology and Obstetrics, University of Douala, Douala, Cameroon
| | - P. Tchendjou
- Elizabeth Glaser Pediatric AIDS Foundation, EGPAF Yaounde, Yaounde, Cameroon
| | - E. Mboh
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - J. Ateudjieu
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - N. Tendongfor
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - D.S. Nsagha
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - G.E. Halle-Ekane
- Department of Obstetrics and Gynaecology, University of Buea, Buea, Cameroon
| | - S.P. Choukem
- Department of Internal Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Getaneh Y, Getnet F, Rashid A, Kang L, Chu Q, Li S, Yi F, Shao Y. The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia. Emerg Microbes Infect 2023; 12:2271065. [PMID: 37824698 PMCID: PMC10614708 DOI: 10.1080/22221751.2023.2271065] [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: 08/30/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
ABBREVIATIONS AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University.
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Affiliation(s)
- Yimam Getaneh
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fentabil Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- T.H. Chan School of Public Health, Boston, MA, USA
| | - Abdur Rashid
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Li Kang
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Qingfei Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Sisi Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Feng Yi
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yiming Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
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Odubela O, Odunukwe N, Peer N, Musa AZ, Salako BL, Kengne AP. Prevalence of hypertension among antiretroviral therapy naïve patients in Lagos, Nigeria. Clin Hypertens 2023; 29:29. [PMID: 37908015 PMCID: PMC10619289 DOI: 10.1186/s40885-023-00253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The gains from successful antiretroviral therapy (ART) roll-out could be compromised by the increasing burden of non-communicable diseases, particularly cardiovascular diseases among people living with HIV (PLWH). Hypertension remains a significant contributor to cardiovascular diseases. This study aims to determine the prevalence and determinants of hypertension among ART-naïve PLWH in a large ART clinic in Lagos, Nigeria. MATERIALS AND METHODS This study uses data collected from adult ART-naïve PLWH enrolled at an ART clinic over ten years. Participants aged 18 years and older, not pregnant, and not accessing care for post-exposure prophylaxis were included in the study. Hypertension was defined as systolic and diastolic blood pressure greater than or equal to 140 mmHg and 90 mmHg, respectively. Logistic regressions were used to investigate the factors associated with hypertension. RESULTS Among the 10 426 participants included in the study, the majority were females (66%) and aged 25-49 years (84%). The crude prevalence of hypertension was 16.8% (95%CI 16.4 - 17.2) while the age and sex standardised prevalence rate was 21.9% (95%CI 20.7 - 23.2), with males (25.8%, 95%CI 23.5 - 28.0) having a higher burden compared with females (18.3%, 95%CI 17.0 - 19.6). Increasing age, male gender, overweight or obesity, co-morbid diabetes mellitus or renal disease, and CD4 count ≥ 201 cells/μL were significantly associated with prevalent hypertension. CONCLUSION There was a substantial burden of hypertension among ART-naïve PLWH, which was associated with the traditional risk factors of the condition. This highlights the need to integrate screening and care of hypertension into routine HIV management for optimal care of PLWH.
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Affiliation(s)
- Oluwatosin Odubela
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
| | - Nkiruka Odunukwe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Nasheeta Peer
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Adesola Zaidat Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Monitoring and Evaluation Unit, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Babatunde Lawal Salako
- Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South Africa Medical Research Council, Cape Town, South Africa
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Tegegne AS. Quality of Life and Associated Factors of HIV Patients Under Treatment with First Line Regimens in Public Hospitals in Amhara Region, North-West Ethiopia. Patient Prefer Adherence 2023; 17:1347-1359. [PMID: 37287512 PMCID: PMC10243354 DOI: 10.2147/ppa.s413192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Background The availability of medication related to HIV treatment in the world is one of the substantial improvements for reaching USAID's 90-90 targets. Among the 90% of patients who have awareness about their disease, 90% are accessing their treatment and patients who received appropriate treatment have a suppressed viral load and improved CD4 cell count. Therefore, the main objective of the current study was to investigate the quality of life and associated factors of people living with HIV receiving first-line regimens at public hospitals in the Amhara region, Ethiopia. Methods A retrospective cohort study was conducted on 700 adult HIV-infected patients under treatment with first-line regimens, who were followed-up in 17 public hospitals in the Amhara region. A multivariate linear regression analysis was used for the current study. Results Of the 700 patients included in the current analyses, 59.5% (n=358) reported no impairment in self-care, while 63.1% (n=380) were extremely anxious/depressed. The overall expected EQ-5D utility score and visual analog scale (EQ-VAS) scores were 0.388 0.41 and 66.20 17.22 respectively. The current study indicated that the covariates sex, age of patient, level of education, appointment frequency, disclosure status of the disease, and substance use significantly affected the quality of life of people living with HIV and under treatment with first-line regimens. Hence, higher CD4 cell count and less detectable viral load lead to good quality of life of people living with HIV. Conclusion This study indicates that certain covariates have been identified as statistically significant predictors of the study variable "quality of life" of HIV-positive people. The findings obtained in the current investigation can help policy-makers to revise the current directives. The result obtained in this study can also help health staff to conduct health-related education during the treatment of HIV patients.
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Woldegeorgis BZ, Zekarias Z, Adem BG, Obsa MS, Kerbo AA. Prevalence and determinants of opportunistic infections among HIV-infected adults receiving antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1087086. [PMID: 36873895 PMCID: PMC9978215 DOI: 10.3389/fmed.2023.1087086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background Reliable data on the burden of opportunistic infections (OIs) after the initiation of antiretroviral therapy (ART) is critical for planning health services and reducing OI-related morbidity and mortality. Nevertheless, there has been no nationally representative information on the prevalence of OIs in our country. Therefore, we have undertaken this comprehensive systematic review and meta-analysis to estimate the pooled prevalence, and identify factors associated with the development of OIs in Human Immunodeficiency Virus (HIV)-infected adults receiving ART in Ethiopia. Methods Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. The random-effect meta-analysis model was used to estimate the pooled effect. The statistical heterogeneity of the meta-analysis was checked. Subgroup and sensitivity analyses were also performed. Publication bias was examined in funnel plots and the nonparametric rank correlation test of Begg and the regression-based test of Egger. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI). Results A total of 12 studies with 6,163 study participants were included. The pooled prevalence of OIs was 43.97% [95% CI (38.59, 49.34)]. Poor adherence to ART [OR, 5.90, 95% CI (3.05, 11.40)], under nutrition [OR, 3.70, 95% CI (2.01, 6.80)], CD4 T lymphocyte count <200 cells /μL [OR, 3.23 95% CI (2.06, 5.07)], and advanced World Health Organization (WHO) HIV clinical stages [OR, 4.84 95% CI (1.83, 12.82)] were determinants of OIs. Conclusion The pooled prevalence of OIs among adults taking ART is high. Poor adherence to ART, under nutrition, a CD4 T lymphocyte count <200 cells /μL, and advanced WHO HIV clinical stages were factors associated with the development of OIs.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Zewdineh Zekarias
- Wolaita Sodo University Comprehensive Specialized Hospital, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Bulcha Guye Adem
- Department of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mohammed Suleiman Obsa
- Department of Anesthesia, College of Health Sciences and Medicine, Arsi University, Assela, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Puplampu P, Asamoah I, Asare BO, Berko KP, Oladele O, Amankwa E, Lambert F, Afriyie AT, Ganu V. Cryptococcal meningitis among perinatally HIV-infected adolescents: Case series on presentation and management challenges. Clin Case Rep 2023; 11:e6995. [PMID: 36852119 PMCID: PMC9958000 DOI: 10.1002/ccr3.6995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Diagnosis and management of cryptococcal meningitis in HIV-infected adolescents is challenging in poor resource settings. A high index of suspicion based on clinical presentation is critical for early identification and treatment. This report sought to describe the clinical presentation and outcomes of HIV-associated cryptococcal meningitis in adolescents.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Isabella Asamoah
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Bismark O. Asare
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Kofi P. Berko
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | | | - Frempong Lambert
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | - Vincent Ganu
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
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Woldegeorgis BZ, Diro CW, Yohannes B, Kerbo AA, Asgedom YS. Incidence and predictors of opportunistic infections in adolescents and adults after the initiation of antiretroviral therapy: A 10-year retrospective cohort study in Ethiopia. Front Public Health 2022; 10:1064859. [PMID: 36589962 PMCID: PMC9797664 DOI: 10.3389/fpubh.2022.1064859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022] Open
Abstract
Background Opportunistic infections (OIs) are the leading cause of morbidity and mortality in people living with the human immunodeficiency virus (PLHIV). However, there are few robust recent data on the rates of OIs and the risk factors that contribute to their occurrence. Therefore, the current study sought to determine the incidence of OIs and identify predictors among adolescents and adults after the initiation of antiretroviral therapy (ART) at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Southern Ethiopia. Methods A retrospective cohort study design was employed. The study population was adolescents and adults who initiated ART between 1 January 2012 and 31 December 2021. A simple random sampling technique was used to select 537 participants' records. We reviewed the medical records of the sampled individuals from 1 May 2022 to 15 June 2022. KoboCollect version 2021.2.4 and STATA version 14.0 software were used for data collection and analysis, respectively. We calculated the incidence rate per 100 person-years of observation (PYO) with 95% confidence intervals (CIs) for the occurrence of any OIs. The Weibull regression model was fitted after the goodness-of-fit test for the Cox proportional hazard model was deemed inadequate. An adjusted hazard ratio (AHR) with 95% CI was used to identify a significant predictor of OIs. The statistical significance was made at a 5% significance level. Results A total of 515 participants contributed to 1,829 person-years of risk, of whom 164 (31.84%) exhibited at least one OI. The overall incidence rate of OIs was 8.97 cases (95% CI: 7.69, 10.44) per 100 PYO. The independent predictors of OIs were being female [AHR: 1.65 (95% CI (1.15, 2.36), P = 0.007)], individuals classified as World Health Organization (WHO) HIV clinical stage III [AHR: 1.98 (95% CI (1.12, 3.51), P = 0.019)], individuals who did not take cotrimoxazole preventive therapy (CPT) [AHR: 2.58 (95% CI (1.62, 4.11), P < 0.001)], mild malnutrition [AHR: 1.62 (95% CI (1.06, 2.54), P = 0.035)], and poor adherence to ART [AHR: 4.21 (95% CI (2.39, 7.44), P < 0.001)]. Conclusion The rate of OIs after the initiation of ART was still high. Moreover, being female, not taking CPT, poor adherence to ART, mild malnutrition, and advanced HIV disease at presentation were found to increase the hazards of developing OIs.
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Affiliation(s)
| | - Chala Wegi Diro
- Department of Epidemiology and Biostatistics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Bereket Yohannes
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatistics, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Wolf T, Rosengarten J, Härtel I, Stitz J, Barbe S. A Hydrodynamic Approach to the Study of HIV Virus-Like Particle (VLP) Tangential Flow Filtration. MEMBRANES 2022; 12:membranes12121248. [PMID: 36557156 PMCID: PMC9783767 DOI: 10.3390/membranes12121248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 05/12/2023]
Abstract
Emerging as a promising pathway to HIV vaccines, Virus-Like Particles (VLPs) have drawn considerable attention in recent years. A challenge of working with HIV VLPs in biopharmaceutical processes is their low rigidity, and factors such as shear stress, osmotic pressure and pH variation have to be reduced during their production. In this context, the purification and concentration of VLPs are often achieved by means of Tangential Flow Filtration (TFF) involving ultrafiltration hollow fiber modules. Despite the urgent need for robust upscaling strategies and further process cost reduction, very little attention has been dedicated to the identification of the mechanisms limiting the performance of HIV VLP TFF processes. In this work, for the first time, a hydrodynamic approach based on particle friction was successfully developed as a methodology for both the optimization and the upscaling of HIV VLP TFF. Friction forces acting on near-membrane HIV VLPs are estimated, and the plausibility of the derived static coefficients of friction is discussed. The particle friction-based model seems to be very suitable for the fitting of experimental data related to HIV VLP TFF as well as for upscaling projections. According to our predictions, there is still considerable room for improvement of HIV VLP TFF, and operating this process at slightly higher flow velocities may dramatically enhance the efficiency of VLP purification and concentration. This work offers substantial guidance to membrane scientists during the design of upscaling strategies for HIV VLP TFF.
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Affiliation(s)
- Tobias Wolf
- Research Group Process Engineering, Faculty of Applied Natural Sciences, TH Köln—University of Applied Sciences, Campusplatz 1, 51379 Leverkusen, Germany
- Institute of Technical Chemistry, Leibniz University Hannover, Callinstraße 5, 30167 Hannover, Germany
- Correspondence:
| | - Jamila Rosengarten
- Institute of Technical Chemistry, Leibniz University Hannover, Callinstraße 5, 30167 Hannover, Germany
- Research Group Pharmaceutical Biotechnology, Faculty of Applied Natural Sciences, TH Köln—University of Applied Sciences, Campusplatz 1, 51379 Leverkusen, Germany
| | - Ina Härtel
- Research Group Process Engineering, Faculty of Applied Natural Sciences, TH Köln—University of Applied Sciences, Campusplatz 1, 51379 Leverkusen, Germany
| | - Jörn Stitz
- Research Group Pharmaceutical Biotechnology, Faculty of Applied Natural Sciences, TH Köln—University of Applied Sciences, Campusplatz 1, 51379 Leverkusen, Germany
| | - Stéphan Barbe
- Research Group Process Engineering, Faculty of Applied Natural Sciences, TH Köln—University of Applied Sciences, Campusplatz 1, 51379 Leverkusen, Germany
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Widiyanti M, Adiningsih S. The demographic and clinical characteristics of women living with HIV and the opportunistic infections they experience in Manokwari Regency, West Papua. BIO WEB OF CONFERENCES 2022. [DOI: 10.1051/bioconf/20225400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The number of women living with HIV (WLHIV) in Indonesia, especially Papua, is increasing yearly, along with the increasing number of men who transmit HIV to their partners. WLHIV are susceptible to opportunistic infections, leading to increased morbidity and mortality. This study, aiming to identify the characteristics and opportunistic infections among WLHIV in Manokwari Regency, West Papua, was descriptive with a cross-sectional study design involving 70 WLHIV who routinely received antiretroviral treatment at the VCT of RSUD Manokwari as respondent. Data on demographic and clinical variables were obtained through interviews using structured questionnaires. Data were analyzed by fisher exact tests to measure the association of opportunistic infections with demographic and clinical variables. The results showed that the demographic characteristics of WLHIV: aged18-35 years (47.1%), high school education (42.9%), private employment (47.1%), married (65.7%), ethnic Papuan (65.7%), and heterosexual risk factor (97.1%). Meanwhile, their clinical characteristics were clinical stage III (62.9%), CD4+ ≥350 cell/mm3 (62,9%), detectable viral load (55,7%), and underweight (38.6%). The most opportunistic infections among them were pulmonary tuberculosis (58.6%). The clinical stage of HIV and CD4+ cells was significantly associated with opportunistic infections among WLHIV. For these reasons, it is necessary to intervene by applying antiretroviral administration strategies and specific antimicrobial therapy.
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