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Mouinga-Ondeme A, Longo-Pendy NM, Moussadji Kinga IC, Ngoubangoye B, Moussavou-Boundzanga P, Boundenga L, Diane A, Sica J, Mfouo-Tynga IS, Ngoungou EB. Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa. Viruses 2024; 16:85. [PMID: 38257785 PMCID: PMC10819398 DOI: 10.3390/v16010085] [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: 10/19/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 01/24/2024] Open
Abstract
The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is still one of the main causes of death in sub-Saharan Africa. Antiretroviral therapies (ARTs) have significantly improved the health conditions of people living with HIV/AIDS (PLWHA). Consequently, a significant drop in morbidity and mortality, along with a reduced incidence of opportunistic infections (OIs), has been observed. However, certain atypical and biological profiles emerge in ART patients post-examination. The objective of this study was to identify the risk factors that contributed to the onset of OIs in HIV patients undergoing ART in Gabon. Epidemiological and biological data were obtained from medical records (2017 to 2019) found at the outpatient treatment centre (CTA) of Franceville in Gabon. Samples for blood count, CD4, and viral load analysis at CIRMF were collected from PLWHA suffering from other pathogen-induced conditions. A survey was carried out and data were analysed using Rstudio 4.0.2 and Excel 2007 software. Biological and socio-demographic characteristics were examined concerning OIs through both a univariate analysis via Fisher's exact tests or chi2 (χ2), and a multivariate analysis via logistic regression. Out of the 300 participants initially selected, 223 were included in the study, including 154 (69.05%) women and 69 (30.95%) men. The mean age was 40 (38.6; 41.85), with individuals ranging from 2 to 77 years old. The study cohort was classified into five age groups (2 to 12, 20 to 29, 30 to 39, 40 to 49, and 50 to 77 years old), among which the groups aged 30 to 39 and 40 to 49 emerged as the largest, comprising 68 (30.5%) and 75 (33.6%) participants, respectively. It was noted that 57.9% of PLWHA had developed OIs and three subgroups were distinguished, with parasitic, viral, and bacterial infections present in 18%, 39.7%, and 55.4% of cases, respectively. There was a correlation between being male and having a low CD4 T-cell count and the onset of OIs. The study revealed a high overall prevalence of OIs, and extending the study to other regions of Gabon would yield a better understanding of the risk factors associated with the onset of these infections.
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Affiliation(s)
- Augustin Mouinga-Ondeme
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Neil Michel Longo-Pendy
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
| | - Ivan Cyr Moussadji Kinga
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Barthélémy Ngoubangoye
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Pamela Moussavou-Boundzanga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Larson Boundenga
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
- Département d’Anthropologie, Université de Durham, South Road, Durham DH1 3LE, UK
| | - Abdoulaye Diane
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Jeanne Sica
- Centre de Traitement Ambulatoire, Franceville BP 277, Gabon;
| | - Ivan Sosthene Mfouo-Tynga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Edgard Brice Ngoungou
- Département d’Epidémiologie, Biostatistiques et Informatique Médicale (DEBIM)/Unité de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement (UREMCSE), Faculté de Médecine, Université des Sciences de la Santé, Libreville-Owendo BP 18231, Gabon;
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Júnior AD, Rabêlo PPC, Lopes MVDO, Rodrigues LDS, Lopes CT, Silva RARD. Clinical validation of the nursing diagnosis "Ineffective health self-management" in people living with HIV. Int J Nurs Knowl 2023; 34:13-20. [PMID: 35451576 DOI: 10.1111/2047-3095.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Check diagnostic accuracy of the defining characteristics of the nursing diagnosis "Ineffective health self-management" in people living with HIV. METHODS Methodological study conducted in a specialized public service for people living with HIV in Northeastern Brazil, between February and April 2021, with a sample of 203 people. Latent class analysis was used to calculate the accuracy measurements of the defining characteristics, as well as the sensitivity and specificity values with their respective 95% confidence intervals. The likelihood ratio test (G2 ) was applied to evaluate the adequacy of the fit of the models obtained (p > 0.05). RESULTS The prevalence of Ineffective health self-management estimated through the latent class model was 67.5%. "Exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal" had the highest sensitivity values (0.80-0.9429). "Exhibits disease sequelae," "inattentive to diseases signs," and "inattentive to disease symptoms" had the highest specificity values (0.9999-1.0000). CONCLUSIONS The useful characteristics for discriminating PLHIV with and without diagnosis are "exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal." The diagnosis can be confirmed by the indicators "exhibits disease sequelae", "inattentive to diseases signs," and "inattentive to disease symptoms." IMPLICATIONS FOR NURSING PRACTICES The study demonstrates the levels of importance of the defining characteristics of "Ineffective health self-management" in people living with HIV contributes to suspicion and accurate diagnostic identification of nurses and researchers.
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Affiliation(s)
- Aurean D'Eça Júnior
- Federal University of Maranhão, Nursing Department, São Luís, Maranhão, Brazil
| | | | | | | | - Camila Takáo Lopes
- Federal University of São Paulo, Nursing Department, São Paulo, São Paulo, Brazil
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Human T-Cell Leukemia Virus Type 1-Related Diseases May Constitute a Threat to the Elimination of Human Immunodeficiency Virus, by 2030, in Gabon, Central Africa. Viruses 2022; 14:v14122808. [PMID: 36560812 PMCID: PMC9785256 DOI: 10.3390/v14122808] [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: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The Joint United Nations Program on HIV/AIDS (UNAIDS) has adopted the Sustainable Development Goals (SDGs) to end the HIV/AIDS epidemic by 2030. Several factors related to the non-suppression of HIV, including interruptions of antiretroviral therapy (ART) and opportunistic infections could affect and delay this projected epidemic goal. Human T-Cell leukemia virus type 1 (HTLV-1) appears to be consistently associated with a high risk of opportunistic infections, an early onset of HTLV-1 and its associated pathologies, as well as a fast progression to the AIDS phase in co-infected individuals, when compared to HIV-1 or HTLV-1 mono-infected individuals. In Gabon, the prevalence of these two retroviruses is very high and little is known about HTLV-1 and the associated pathologies, leaving most of them underdiagnosed. Hence, HTLV-1/HIV-1 co-infections could simultaneously imply a non-diagnosis of HIV-1 positive individuals having developed pathologies associated with HTLV-1, but also a high mortality rate among the co-infected individuals. All of these constitute potential obstacles to pursue targeted objectives. A systematic review was conducted to assess the negative impacts of HTLV-1/HIV-1 co-infections and related factors on the elimination of HIV/AIDS by 2030 in Gabon.
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Brown MJ, Wu M, Zeng C, Harrison S, Haider MR, Li X. Racial disparities in the association between resilience and ART adherence among people living with HIV: the mediating role of depression. AIDS Care 2022; 34:1555-1564. [PMID: 35254174 PMCID: PMC9448828 DOI: 10.1080/09540121.2022.2049194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2022] [Indexed: 01/26/2023]
Abstract
Research examining the mediating role of depressive symptoms in the association between resilience and antiretroviral therapy (ART) adherence is lacking. Therefore, this study aims to examine the mediating role of depression between resilience and ART adherence, as well as to explore whether this relationship varies across racial background. A total of 327 people living with HIV and on ART in South Carolina were surveyed about their ART adherence and mental health, including resilience and depressive symptoms. Path analyses were conducted to determine the direct and indirect effects between resilience, depressive symptoms, and ART adherence. After adjusting for age, gender, income, education, employment and time since diagnosis, among Black individuals, resilience was negatively associated with depressive symptoms (β = --0.248, p < 0.001); depressive symptoms were negatively associated with ART adherence (β = -0.166, p = 0.020); however, resilience was not significantly associated with ART adherence. Among White individuals, there was no statistically significant association. The indirect effect between resilience and ART adherence through depressive symptoms was statistically significant (β = 0.041, p = 0.040) for Black individuals, while not statistically significant for White individuals (β = 0.024, p = 0.578). Interventions aimed at improving ART adherence, which attenuate depressive symptoms through accentuating resilience may be especially beneficial for Black populations living with HIV.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Miao Wu
- Nanjing Medical University, Jiangsu, China
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Psychology, College of Arts and Sciences, University of South Carolina
| | - Mohammad Rifat Haider
- Health Policy and Management, College of Public Health, University of Georgia, Athens GA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Keene CM, Ragunathan A, Euvrard J, English M, McKnight J, Orrell C. Measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study. J Int AIDS Soc 2022; 25:e26025. [PMID: 36285618 PMCID: PMC9597383 DOI: 10.1002/jia2.26025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. METHODS We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. RESULTS AND DISCUSSION We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. CONCLUSIONS Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.
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Affiliation(s)
- Claire M. Keene
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Ayesha Ragunathan
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mike English
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jacob McKnight
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Catherine Orrell
- Department of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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Mouinga-Ondémé A, Boundenga L, Koumba Koumba IP, Idam Mamimandjiami A, Diané A, Engone-Ondo JD, Djuicy DD, Sica J, Mombo LE, Gessain A, Aghokeng Fobang A. Human T-Lymphotropic virus type 1 and human immunodeficiency virus co-infection in rural Gabon. PLoS One 2022; 17:e0271320. [PMID: 35867643 PMCID: PMC9307203 DOI: 10.1371/journal.pone.0271320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Human T-cell lymphotrophic virus type-1 (HTLV-1) and human immunodeficiency virus (HIV-1) co-infection occur in many populations. People living with HIV-1 and infected with HTLV-1 seem more likely to progress rapidly towards AIDS. Both HTLV-1 and HIV-1 are endemic in Gabon (Central Africa). We investigated HTLV-1 and HIV-1 co-infection in the Haut-Ogooué province, and assessed factors that may favor the rapid evolution and progression to AIDS in co-infected patients. Methods Plasma samples from HTLV-1 patients were tested using ELISA, and positive samples were then tested by western blot assay (WB). We used the polymerase chain reaction to detect HTLV-1 Tax/Rex genes using DNA extracted from the buffy coat of ELISA-positives samples. Results We recruited 299 individuals (mean age 46 years) including 90 (30%) men and 209 (70%) women, all of whom are under treatment at the Ambulatory Treatment Centre of the province. Of these, 45 were ELISA HTLV-1/2 seropositive. According to WB criteria, 21 of 45 were confirmed positive: 20 were HTLV-1 (44%), 1 was HTLV-1/2 (2%), 2 were indeterminate (4%) and 22 were seronegative (49%). PCR results showed that 23 individuals were positive for the Tax/Rex region. Considering both serological and molecular assays, the prevalence of HTLV-1 infection was estimated at 7.7%. Being a woman and increasing age were found to be independent risk factors for co-infection. Mean CD4+ cell counts were higher in HTLV-1/HIV-1 co-infected (578.1 (± 340.8) cells/mm3) than in HIV-1 mono-infected (481.0 (± 299.0) cells/mm3) Individuals. Similarly, the mean HIV-1 viral load was Log 3.0 (± 1.6) copies/ml in mono-infected and Log 2.3 (± 0.7) copies/ml in coinfected individuals. Conclusion We described an overall high prevalence of HTLV-1/HIV-1 co-infection in Gabon. Our findings stress the need of strategies to prevent and manage these co-infections.
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Affiliation(s)
- Augustin Mouinga-Ondémé
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- * E-mail:
| | - Larson Boundenga
- Groupe Evolution et Transmission Inter-espèces des Pathogènes (GETIP), Département de Parasitologie, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Ingrid Précilya Koumba Koumba
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | - Antony Idam Mamimandjiami
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Abdoulaye Diané
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Jéordy Dimitri Engone-Ondo
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Delia Doreen Djuicy
- Unité des Infections Rétrovirales et Pathologies Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Jeanne Sica
- Centre de Traitement Ambulatoire, Franceville, Gabon
| | - Landry Erik Mombo
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | - Antoine Gessain
- Unité d’Epidémiologie et de Physiopathologie des Virus Oncogènes (EPVO), et CNRS UMR3569, Institut Pasteur de Paris, Paris, France
| | - Avelin Aghokeng Fobang
- Unité Mixte de Recherche sur le VIH et les Maladies Infectieuses Associées, Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- MIVEGEC, Université de Montpellier, CNRS, IRD – Montpellier, Montpellier, France
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