An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu­Natal, South Africa

The World Health Organization (WHO) recom mends same day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi square=10.59; P value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi square=10.18; P value=0.015. There was a significant association between staff provision in a facility and SDI (chi square=7.51; P value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi square=11,29; P value=0.003). Implementation of the Universal Test and Treat program varies by facility indi cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

Lived experience of people living with HIV in Blantyre, Malawi: an exploratory qualitative study

Background People living with the Human Immunodeficiency Virus (HIV) encounter a range of complex challenges that impact their physical, psychological, and social well-being. The combined effects of these challenges significantly impact their daily functioning. Despite the relatively high prevalence of HIV in Malawi, there is limited knowledge on how the challenges experienced by people living with HIV correlate with their societal participation and performance of activities. Objectives This study aimed to explore the lived experience of people living with HIV and how the challenges experienced impact societal participation and activity performance. Method: A qualitative exploratory study design was used. Fourteen participants were purposefully selected for the study, with an equal number of males and females. The data was gathered through semi-structured interviews and manually analyzed using thematic analysis. Results It was found that participants faced discrimination, stigma, depression, anxiety, and worries. The study participants associated their taking of antiretroviral therapy with physical impairments such as dizziness, leg pain, yellow eyes, and fatigue. The physical impairments hampered participants' ability to walk, work, conduct business, perform household chores, and care for children. Conclusion This study identified the difficulties that people living with HIV faced in their communities and how these challenges impact societal participation and performance in activities. There is a need for a holistic approach to managing these challenges and making referrals to specialized professionals.

Evolution des indicateurs d'alerte précoce de la résistance aux antirétroviraux au Burkina Faso entre 2014 et 2017 / Progression antiretroviral therapy therapy resistance warning indicator indicator in Burkina Faso between 2014 and 2017

Résumé:l'utilisation des antirétroviraux (ARV) à grande échelle aux personnes vivant avec le VIH (PVVIH) s'accompagne d'un développement de résistance au VIH (R-ARV). Nous avons déterminé la performance de trois indicateurs d'alerte précoce (IAP) associés à un risque élevé d'émergence de R-ARV au Burkina Faso à travers une étude transversale répétée entre 2014 et 2017. Nous avons analysé l'évolution des IAP de l'émergence de R-ARVau cours de cette période. Il s'agissait de l'IAP1 (Retrait des ARV dans les délais),l'IAP2 (Rétention sous traitement ARV «TARV¼ à 12 mois) et de l'IAP4 (pratiques de prescription des ARV).Au total, 27 sites ont été évalués. La médiane des patients qui ont retiré le TARV dans les délais était respectivement de 61% en 2015, 60% en 2016 et à 58% en 2017. Aucun site n ́a atteint le seuil d'au moins 95% dans les cohortes de 2014 et 2015. Les médianes de la rétention sous TARV à 12 mois pour les cohortes de 2014, 2015 et 2016 ont été de 70%, 69% et 65% respectivement. Le seuil de rétention dans le TARV à 12 mois d'au moins 85% n'a été atteint que dans deux sites. Même si la prescription des ARV est conforme aux directives nationales, la qualité des soins offerts aux PVVIH a régressé de 2014 à 2017 avec un risque élevé d'émergence de R-ARV. Pour minimiser ce risque, l'éducation thérapeutique des patients et le système de recherche des perdus de vue doivent être renforcés.

The widespread use of antiretrovirals (ARVs) to people living with HIV (PLHIV) is accompanied by the development of HIV resistance (R-ARV). We determined the performance of three early warning indicators (EWIs) associated with a high risk of R-ARV emergence in Burkina Faso through a repeated cross-sectional study between 2014 and 2017. We analyzed the evolution of the DPIs of R-ARV emergence over this period. These were DPI1 (Timely withdrawal of ARVs), DPI2 (Retention on ARV treatment "TARV" at 12 months) and DPI4 (ARV prescription practices). A total of 27 sites were evaluated. The median number of patients who withdrew ART on time changed from 61% in 2015, 60% in 2016 and 58% in 2017, respectively. No site reached the threshold of at least 95% in the 2014and 2015 cohorts. The medians of retention on ART at 12 months for the 2014, 2015 and 2016 cohorts were 70%, 69% and 65% respectively. The 12-month ART retention threshold of at least 85% was only reached at two sites. Although ARV prescribing is in line with national guidelines, the quality of care offered to PLHIV regressed from 2014 to 2017 with a high risk of R-ARV emergence. To minimize this risk, therapeutic patient education and the system for tracking lost patients need to be strengthened.

Adolescents infectés par le VIH au cours de la transition des soins pédiatriques aux soins pour adultes dans un hôpital de référence à Abidjan (Côte d'Ivoire). Etudes des caractéristiques cliniques / Hiv-infected adolescents during the transition from paediatric to adult care in a referral hospital in abidjan (cote d'ivoire). Clinical characteristics study

Les adolescents vivant avec le VIH ont de moins bons résultats que les adultes en matière de soins, en particulier lors de la transition entre les soins pédiatriques et les soins aux adultes. L' Objectif était de décrire les particularités socio familiales, cliniques, para cliniques et thérapeutiques des adolescents au cours de cette phase charnière de leur prise en charge. Méthodes. Il s'agissait d'une étude rétrospective à visée descriptive qui s'est déroulé du 1er au 31 mars 2020 (1 mois) sur la cohorte d'enfants vivant avec le VIH suivi au CHU de Cocody (Abidjan) de novembre 2005 à mars 2020 (15 ans). Résultats. Trente-huit adolescents en phase de transition ont été inclus. L'âge moyen était de 17 ans avec des extrêmes de 15 et 20 ans. Le sex ratio était de 1,37. La majorité des enfants étaient scolarisé (81,57%) avec un retard scolaire chez plus de la moitié (58%). Près de la moitié des cas était orphelin d'un ou des 2 parents (47,4%). Les conditions socioéconomiques étaient modestes ou défavorable (73,7%). Près de la moitié des adolescents était suivi depuis plus de 10 ans (42%). Un surpoids a été retrouvé dans 21% des cas. On notait un échec immunologique dans 10,5% des cas et un échec virologique dans un tiers des cas (31,6%). L'observance était moyenne ou mauvaise chez près de la moitié des adolescents (44,7%). La majorité des adolescents (94,7%) n'avait jamais eu de contact avec un médecin d'adulte. Conclusion. La transition des soins pédiatriques aux soins pour adulte est un processus au cours duquel l'adolescent est confronté à des diffi cultés socio familiale et scolaire, a l'inobservance avec échec thérapeutique qui doit être repéré de façon précoce. Le succès de cette étape nécessite également le rapprochement entre pédiatres et médecins d'adultes pour une prise en charge optimal des patients.

Le taux de lymphocytes T CD4 au diagnostic de la séropositivité au virus de l'immunodéficience humaine à Libreville, 2022 / CD4 T lymphocyte count at diagnosis of human immunodeficiency virus seropositivity in Libreville, 2022

Introduction. L'efficacité du traitement antirétroviral dans la restauration immunitaire dépend fortement du stade de l'infection et du taux de lymphocyte TCD4 au moment de l'introduction du traitement. Nous avons évalué le taux de lymphocytes TCD4 à la découverte de la séropositivité au VIH pour caractériser le niveau d'infection de chaque patient. Matériel et méthodes. C'est une étude transversale et descriptive qui s'est déroulée dans le laboratoire de virologie de la faculté de médecine de Libreville. Nous avons analysé les données de la cohorte DERIRADO. Résultats. Nous avons inclus 133 patients. L'âge médian était de 45 ans (Q1-Q3 :37 ; 52). La médiane de LTCD4 était de 388 cellules/mm3 (Q1-Q3 : 250 ; 556). Le diagnostic était avancé chez 112 (84%) patients. Conclusion. La découverte de la séropositivité au Virus de l'Immunodéficience Humaine est faite à un stade d'immunodépression avancé chez la majorité des patients. Ce constat relève la nécessité de mettre en route les politiques de sensibilisation pour cibler les populations clés et amener le plus grand nombre au dépistage de l'infection par le Virus de l'Immunodéficience Humaine si l'on veut diminuer la courbe de transmission.

Introduction. The effectiveness of antiretroviral therapy in immune restoration largely depends on the stage of infection and the TCD4 lymphocyte count at the time of treatment initiation. We evaluated the rate of TCD4 lymphocytes at the discovery of HIV seropositivity to characterize the level of infection of each patient. Methods. This was a cross sectional descriptive and analytic study whose setting was the laboratory of virology of the faculty of medicine of Libreville. Our data source was DERIRADO cohort. Results. We included 133 patients. The median age was 45 (Q1- Q3:37;52). The median LTCD4 was 388 cells/mm3 (Q1-Q3: 250; 556). The diagnosis was advanced in 112 (84%) patients. Conclusion. The diagnosis of seropositivity to the Human Immunodeficiency Virus is made at a stage of immunosuppression in the majority of patients. This highlights the need to implement sensitization policies to target key populations and bring as many people as possible to screening in order to reduce the transmission curve

Hypertension and associated factors among patients attending HIV clinic at KorleBu Teaching Hospita

Objectives: This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH). Design: A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling. Setting: Study participants were recruited from the HIV clinic at the KBTH. Participants: A total of 311 Persons Living with HIV were recruited as study participants Interventions: Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data. Results: The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2 , total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure. Conclusions: This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH,associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic.

Opportunistic Infections and associated factors among HIV infected patients on anti-retroviral treatment at Bombo Hospital in Tanga Region, Tanzania

Background: A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. Materials And Methods: A cross­sectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients' files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results : The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 ­ 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 ­ 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value ­ 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 ­ 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 ­ 3.4, p ­ value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 ­ 33.7, p ­ value 0.007) respectively were found to be associated with OIs to PLHIV.CONCLUSION : The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.

Correlates of hypertension among persons living with HIV at Livingstone Central Hospital: A cross sectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertension in PLWH were increasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment of hypertension among PLWH.

Challenges encountered by human immunodeficiency virus positive pregnant women on taking antiretrovirals in a public health unit of the Manzini region, Swaziland

In Swaziland, the Ministry of Health adopted the prevention of mother-to-transmission (PMTCT) Option A as a feasible and less costly way to expand the PMTCT services nationwide. Despite major success since the programme started, some barriers, such as the challenge of follow-up care for human immunodeficiency virus (HIV)-positive pregnant mothers still exist. The present study aimed to describe the challenges that HIV-positive pregnant mothers encountered on taking antiretrovirals (ARVs) in a health unit of the Manzini region, Swaziland. A qualitative, exploratory and descriptive research design was used, and data were collected through semi-structured individual interviews and field notes. Purposive sampling was used to select the study site and the population. Permission was requested from the participants to record the interviews. The study population were HIV-positive pregnant mothers, aged between 18 and 40 years, which were enrolled in the PMTCT B+ programme. The PMTCT B+ programme was perceived as preventing the transfer of HIV transmission from mother to child. It boosts the mother's immune system, prevents opportunistic infections and prolongs life. Challenges of taking ARVs emerged as a theme. The participants displayed knowledge and understanding of the programme, yet discrimination and no support from families and partners were mentioned. (Afr J Reprod Health 2022; 26[5]: 41-49).

Family APGAR and treatment outcomes among HIV patients at two ART Centers in Kumasi, Ghana

objectives: This study aimed to examine the association between Family Adaptability, Partnership, Growth, Affection and Resolve (Family APGAR) and HIV treatment outcomes. Design: A cross-sectional study using the Family APGAR questionnaire Setting: The study was conducted in Kumasi, Ghana, at the Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology Hospital Participants: Consenting HIV-positive patients who had been on treatment for at least 12 months were recruited. Main outcome measures: The Family APGAR questionnaire was administered, and relevant data were extracted from hospital records and analysed using STATA® software. The relationship between Family APGAR and treatment outcomes was determined using Chi-squared tests or Fisher's exact test. Results: Approximately 70.1% of 304 participants were females with a mean age of 41.8 years (±9.9). At treatment initiation, 47.4% of the patients presented at World Health Organisation (WHO) clinical stages I and II and had a CD4 count ≥ 200 cells/mm3 . Females were less likely (Odds Ratio= 0.52; 95% CI=0.31 ­ 0.90, p = 0.018) to report late for treatment compared with the males. After 12 months of treatment, approximately 70% recorded undetectable viral load. Patients with functional families constituted 70.4%, which had a statistically significant relationship with viral load (p = 0.041). Conclusion: HIV care providers should incorporate family functionality evaluation into clinical practice and provide early essential support to enhance treatment outcomes

Barriers and facilitators to adherence for antiretroviral therapy the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa

Introduction. Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives: The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods: A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results: A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion: Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers

Evolution clinique et biologique des enfants infectés par le VIH sous traitement antirétroviral à Lubumbashi, République Démocratique du Congo

Introduction: en 2014, moins de 3 enfants sur dix (823 000 enfants environ) vivant avec le VIH avaient accès à un traitement antirétroviral (TAR), contre plus de quatre adultes sur dix. En conséquence, les enfants survivants qui ont une chance d´accéder au TAR sont traités souvent tardivement, à un stade avancé de la maladie. À Lubumbashi (RDC), les études sur l´évaluation du TAR chez l´enfant sont quasi nulles. Cette étude avait comme objectif décrire les caractéristiques sociodémographiques, cliniques, immunologiques et thérapeutiques des enfants infectés par le VIH et sous TAR et identifier les facteurs associés à un échec thérapeutique. Méthodes: il s'agit d'une étude transversale, réalisée du 1er janvier au 31 mars 2015 et portant sur une cohorte d'enfants de moins de 15 ans infectés par le VIH, suivis dans le service de Pédiatrie de l´hôpital Jason Sendwe. Résultats: 62 enfants âgés de moins de 15 ans infectés par le VIH ont été mis sous TAR. Les filles étaient prédominants (54,8%). 83,9% étaient à un stade clinique avancé (3 ou 4) lors de l´initiation au TAR. Notre étude montre que l´échec thérapeutique était significativement associé à l´âge ≥10 ans lors de l´évaluation de la prise en charge. Conclusion: l´étude a permis de montrer le retard avec lequel la prise en charge de l´enfant infecté VIH à Lubumbashi s´effectue; suggérant ainsi un renforcement du programme de la PTME et un dépistage précoce en vue d´une prise en charge précoce et la mise en place d´un mécanisme de rétention des enfants suivis

Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa

Background: Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care.Aim: This study investigated whether patients' needs were being met, described which needs were met, which were not and how such needs could be met.Setting: The study took place at four ART clinics in eThekwini district public hospitals.Methods: This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients' needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers' observations.Results: All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution.Conclusion: To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes 'patients' needs'. The results reflect patients' willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs

How accurately do routinely reported HIV viral load suppression proportions reflect progress towards the 90-90-90 target in the population on antiretroviral treatment in Khayelitsha, South Africa?

Background. The Joint United Nations Programme on HIV/AIDS (UNAIDS) third 90-90-90 target requires 90% of patients on antiretroviral treatment (ART) to be virally suppressed (<1 000 copies/mL). In Khayelitsha, Cape Town, South Africa viral load (VL) suppression of <400 copies/mL was reported as 89% in 2016, but only 56% of patients had a result recorded in routine data. We conceived a VL 'cascade' to represent the steps required for an expected VL to be reported as complete in routine data and thus contribute to reported VL suppression: among those for whom a VL is 'expected', a sample must be collected and tested ('done'), a result must be 'filed' in the patient folder, 'noted' by a clinician and electronically 'captured'. The low reported completion suggested gaps along the VL cascade and cast doubt on the validity of reported suppression.Objectives. To assess the validity of routinely reported VL suppression and identify barriers to VL completion. Methods. A retrospective cohort study between 1 July 2015 and 30 June 2016, which included all Khayelitsha patients receiving ART, with a routine VL expected, was conducted. We obtained data routinely captured on site and VL data from the laboratory system. A sample of 1 035 patient folders was reviewed. VL suppression was calculated using laboratory data, including all tests done, and compared with reported suppression based on on-site captured electronic data. Successful progression through each step on the VL cascade was estimated. We used logistic regression to identify factors associated with laboratory data and reported VL testing.Results. Of 22 991 patients for whom a routine VL test was due, 84% were done, 79% filed, 76% noted and 55% captured. Using all laboratory data, VL suppression was estimated as 82%, 87%, 89% and 91% at the 50, 200, 400 and 1 000 copies/mL thresholds, respectively, but reported suppression using captured results was 80%, 86%, 88% and 89% at those thresholds. Routine VL testing is more likely to be done in children <15 years old (adjusted odds ratio (aOR) 1.89, 95% confidence interval (CI) 1.45 - 2.48) and pregnant women (aOR 1.90, 95% CI 1.28 - 2.81) than in men, adjusted for facility. Conclusions. Despite a low reported completion, VL testing completion was high. Reported suppression using captured data was similar to suppression calculated using all laboratory data, which provided an accurate measure of progress towards the 90-90-90 target. More work is needed to reach the 16% of patients missed by routine testing

Investigating client satisfaction with antiretroviral treatment services in South-South Nigeria

Client satisfaction is a key method of evaluating the quality of healthcare services. This research investigated client satisfaction with anti-retroviral treatment services in selected outpatient facilities in Rivers State. This study was a qualitative study carried out in four antiretroviral treatment (ART) facilities in Rivers State, Nigeria. Researchers conducted nine Key Informant Interviews (KIIs), 25 In-depth interviews (IDIs) and eight Focus Group Discussion (FGDs) among 73 Persons Living with HIVs (PLHIVS) consisting of 31 males and 42 females, using a topic guide. Interviews were recorded, transcribed and analysed using thematic content analysis. Majority of study participants interviewed reported being very satisfied with confidentiality, health worker attitude, interpersonal communication, counselling, and availability of drugs. The major sources of dissatisfaction included overcrowding, long waiting time and inadequate/expensive laboratory services. Suggestions proffered for improving the quality of care at the centres included increasing staff strength at the treatment centres, improving the quality and cost of laboratory services, and infrastructure upgrade. This study demonstrates the role health workers and facility processes play in satisfaction with services at HIV treatment centres. Health workers, programme officers, and managers in HIV prevention, care and treatment need to pay attention to these issues if they would be successful in improving the quality of care for PLHIVs

Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province

Background: Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems.Objectives: This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape.Methods: A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge.Results: The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence.Conclusion: Training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice

The relationship between zidovudine, lamivudine and nevirapine plasma drug levels and antiretroviral treatment outcomes in Nigeria children living with HIV

Plasma concentrations of antiretrovirals are significant and important determinants of treatment failure and toxicity. The relationship between antiretroviral pharmacokinetic exposures and immunovirological outcomes has not been extensively studied in our setting. The aim of this study was to investigate the relationship between antiretroviral plasma concentrations and virological and immunological treatment outcomes in children living with human immunodeficiency virus (HIV) A retrospective collection of demographic, clinical , laboratory data and a prospective determination of plasma drug concentrations in 120 children aged 2-14 years after two years of receiving fixed dose zidovudine, lamivudine and nevirapine tablets using a simple, rapid, sensitive and validated method of high performance liquid chromatography with UV detection for simultaneous quantification of zidovudine, lamivudine and nevirapine in human plasma. All analyses were performed using graph pad prism version 5.0. A perfect agreement (p<.001) was found between nevirapine drug levels and prescriptionrefill visit adherence records (Kappa 0.093). Plasma zidovudine, lamivudine and nevirapine concentrations were not statistically associated with virological success (Viral load <400copies/µl ) and immunological success (CD4 cells >100 cells/mm3). At 2 years zidovudine, lamivudine and nevirapine therapeutic levels, zidovudine supra therapeutic levels ,and nevirapine subtherapeutic levels were respectively significantly associated with immunologic success (CD4%>15 %). Low nevirapine levels can be used to identify those that require adherence counseling. Despite good virological and immunological outcomes, plasma concentrations of zidovudine, lamivudine and nevirapine were not significantly associated with virological and immunological outcomes (Absolute CD4 counts) but was significantly associated with immunological outcomes (CD4%). Plasma drug levels may be good surrogates of adherence but not of treatment outcomes. Monitoring CD4% remains important to optimize paediatric HIV treatment

Predictors of time to first line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town, Southern Ethiopia

BACKGROUND: Antiretroviral therapy is a proven medication given for Human Immunodeficiency Virus positive individuals. However, first-line antiretroviral treatment failure becomes a public health issue and early detection of treatment failure is crucial for timely actions. Therefore, this study aimed to identify the predictors of time to first-line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town. METHODS: Institution-based retrospective cohort study was employed among 396 adult patients that were selected using simple random sampling. The data on relevant variables were extracted from patient medical cards. Bi-variable and multi-variable Cox proportional hazard regression analyses were used to identify predictors. RESULTS: The median survival time was 21 months. Substance use (AHR=2.94, 95% CI=1.62 to 5.32), disclosure status (AHR=1.98, 95% CI=1.03 to 3.79), time since HIV diagnosis (AHR=2.19 95% CI=1.01 to 4.79), WHO clinical stage (AHR=2.02, 95% CI=1.02 to 4.00), opportunistic infection (AHR=2.27, 95% CI=1.23 to 4.19), nutritional status (AHR=3.78, 95% CI=1.99 to 7.17), functional status (AHR=2.71 95% CI=1.33 to 5.51), CD4 count (AHR=1.99, 95% CI=1.05 to 3.75), and adherence level (AHR=1.99, 95% CI=1.05 to 3.76) were independent predictors of time to first line ART treatment failure. CONCLUSION: History of substance use, lack of disclosure status, time since HIV diagnosis, advanced WHO clinical staging, low CD4 counts, opportunistic infection, functional status, poor adherence to ART and under-nutrition affect the time to first-line treatment failure among adult patients living with HIV. Therefore, preventive interventions, and information and counseling focusing on high risk groups of HIV infected adult are very important

Infection à VIH-2 au Sénégal: échecs virologiques et résistances aux antirétroviraux (ARV)

Introduction: le VIH-2, endémique en Afrique de l'Ouest, est naturellement résistant aux inhibiteurs non nucléosidiques de la rétro transcriptase, ce qui rend difficile la prise en charge dans les pays en développement. Objectifs: déterminer la prévalence de l'échec virologique au 12éme et 24éme mois (M12 et M24) de traitement antirétroviral de première ligne chez les patients infectés par le VIH-2 et d'en décrire les résistances génotypiques associées.Méthodes: il s'agit d'une étude descriptive longitudinale et prospective, durant la période de Novembre 2005 à Juin 2017. L'échec virologique a été défini comme toute charge virale supérieure à 50 copies/ml après 6 mois de traitement ARV à deux reprises. La recherche de mutations de résistance a été réalisée dans les régions codantes de la protéase et de la transcriptase inverse. Résultats: au total 110 patients ont été colligés, d'âge médian de 46 ans (Extrêmes 18-67) avec un ratio F/H de 2,54. A l'inclusion, la charge virale était détectable dans 44% des cas avec une médiane de 935cp/ml (Extrêmes 17-144038). Le schéma antirétroviral associait 2 INTI à 1IP dans 94% des cas. La durée médiane de suivi était estimée à 1200 jours (Extrêmes 1-3840). 94 puis 76 patients ont respectivement complété leur bilan à M12 et M24. Au suivi M24, 39 patients étaient en échec virologique soit une prévalence de 39% estimée à 33% à M12 et 11% à M24. 45% des patients avaient des résistances aux INTI, 41% des résistances aux IP et 30% des multi résistances aux INTI et IP.Conclusion: il est impératif de rendre accessibles les nouvelles classes thérapeutiques pourle traitement de sauvetage des patients infectés par le VIH-2 dans les pays à ressources limitées