Medication adherence and health-related quality of life amongst HIV patients receiving care at umuebule cottage hospital, etched, Rivers State

HIV treatment is available, free, and accessible for individuals who are infected. The study is aimed at determining the levels of medication adherence and health related quality of life (HRQOL) among HIV patients receiving care at Umuebule Cottage Hospital, Etche, Rivers State.Method: This cross-sectional study recruited 430 adult clients who have been on ART for at least one year using a convenient sampling method. An average of 10 patients visits the facility on clinic days. After explaining the purpose of study and obtaining consent,patients who met the eligibility criteria were recruited on each clinic day for a period of 12 weeks, until the sample size was reached. Data was collected using semi-structured interviewer administered validated questionnaire; Morisky Medication Adherence Questionnaire (MMAS-8) and WHO-Quality of Life-BREF(WHOQOL-BREF), after a pilot study on 30 PLHIV from Okomoko general hospital, Etche. Data was analyzed with IBM-SPSS Version 25. The mean age of respondents was 35.9±10.9 years, 59.3% of the respondents' last viral load was suppressed, 19.1% had low level viremia, while (21.6%) were virally unsuppressed. Medication adherence levels were observed to be good (67.7%), poor (32.3%) respectively, while HRQOL of respondents were found to be poor (56.9%) and good (43.1%).Conclusion:A significant proportion of the respondents adhere to their medication whereas most of them had poor HRQOL. There is need for hospital management to collaborate with social welfare organizations to support PLHIV to set up means of earning to enable them to provide their basic needs for improved HRQOL

COVID-19 impact on newly initiated and restarted antiretroviral treatment patients in the Eastern Cape, South Africa

Background: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. Aim: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. Setting: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. Methods: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. Results: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. Conclusion: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. Contribution: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa.

The correlates of health facility-related stigma and health-seeking behaviors of people living with HIV

Objective@#This study aims to assess the presence of stigma in health facilities and health-seeking behaviors of persons living with HIV (PLHIV).@*Methods@#This study utilized a cross-sectional design employing self-report questionnaires answered online. A total of 100 PLHIV participants were recruited using the respondent-driven sampling method.@*Results@#Results revealed that most participants are young adult men who have been diagnosed with HIV within the last five years. Overall, participants display moderate health-seeking behavior (M = 2.94, SD = 0.54), and moderate experience of health facility-related stigma (M = 2.21, SD = 0.87). Further, there is a negative correlation between age and health-seeking behavior (r = −0.2796, p = 0.049). The type of facility is significantly correlated with HIV stigma (r = 0.4050, p = 0.036).@*Conclusion@#A sustained linkage to care is essential for a PLHIV to remain engaged on his health and well-being. Necessary strategies should be implemented to improve the health-seeking behaviors of PLHIV. Public Rural Health Units are considered to be the most stigmatizing health facility. The presence of health facility-related stigma requires immediate action of the government to reinvigorate these catchment centers as providers of stigma-free and nondiscriminatory primary health care.

Stigma kills

@#Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.

Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh

Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence. Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospi-tal. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and ad-herence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS. Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found signifi-cant were sex of the patient, the education, the socioeconomic status, financial constraints, family sup-port, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors, having less than college education, WHO stage IV at diagnosis, alcohol intake and lack of family support were found to be predictors of non-adherence. Conclusions: Family support, treatment of alcohol addiction improving education and job opportunities for these patients will improve adherence in HIV positive patients.

Depression Among PLHIV On ART, Attending Drop-In Centre Run by Positive People Network: A Cross Sectional Study in Surat, India

Background: PLHIV often suffer from depression and anxiety during their quest to adjust to the diagno-sis and face the difficulties of living with a chronic illness, of which permanent cure is yet to be discov-ered. Positive people network linkages should be established by each ART centre for its respective locali-ty. The objective of the study is to assess depression among HIV positive beneficiaries registered with Network of Surat People Living with HIV (NSP+) in Surat. Methods: A cross sectional study was conducted among 30 PLHIV on ART from Network of Surat People Living with HIV (NSP+). Beck Depression Inventory was applied to assess depression. Results: The mean BDI score among male and female participants was 25.6 (± 11.39) and 23 (± 12) re-spectively, 9 male participants were having moderate depression, 3 as severe, and 2 as extreme depres-sion. Among females 4 participants were found to having mild mood disturbance while 4 were classified as having moderate depression, whereas only 1 participant was classified as having extreme depression (score of 53). Pearson’s correlation between CD4 count and BDI score was found to be -0.35. Conclusion: Though majority of the participants are in WHO clinical stage 1, yet all the participants had borderline to extreme depression. Males had lower CD4 count, higher proportion of OI and higher mean score of BDI. Lower the CD4 count higher the severity of depression.

Assessment Of Quality of Life Among PLHIV Attending the FIART Clinic of Bankura Sammilani Medical College, West Bengal

Introduction: People Living with HIV (PLHIV) are facing increasing challenges pertaining to the disease as life expectancy is gradually rising. This study was conducted to assess the quality of life (QOL) in vari-ous domains among PLHIV and to find out its’ associated factors. Methods: A descriptive, cross-sectional study was conducted in Facility Integrated Antiretroviral Thera-py (FIART) clinic of Bankura Sammilani Medical College & Hospital (BSMCH) among 99 PLHIV from 01/07/2019 to 30/06/2020. Data were collected by interviewing PLHIV aged within 18-60 years using pre-designed, pre-tested, and semi-structured questionnaire incorporating WHO Quality of Life for HIV (WHOQOL-HIV) - BREF version to assess the QOL of the study subjects in various domains.Results: 44% participants rated their QOL as good, 79% satisfied with their health. Among all other do-mains, QOL score (median- 17.0, IQR- 4) was found highest in physical domain, while it was lowest (me-dian- 14.0, IQR- 2) in spiritual domain. Overall QOL was significantly higher in males, rural residents, joint family and higher socio-economic class. Multiple linear regression revealed statistically significant relation of overall QOL with residence, family type and socio-economic status. Conclusion: Psychological and spiritual well-being of PLHIVs is an area of concern and requires clinical attention.

Hope and Quality of the life of People living with HIV: A Cross-Sectional Study at ART Center, Bagalkot, Karnataka

Background: HIV/AIDS emerged as the most important public health issue of the late twentieth and early twenty-first centuries. Hope & Quality of life (QoL) of People living with HIV/AIDS are affected by multiple socio-demographic variables as a major predictor of Hope & QoL. Methods: This cross-sectional descriptive survey research design included a sample of 430 PLHIV attending the ART centre, District Government Hospital, Bagalkot. Data were collected using the self-report method and Hospital records by socio-demographic questionnaire, Herths Hope Scale and WHO QOLHIV-BREF scale. Pearson's Correlations, chi-square test and multiple linear regression analysis were used. Results: A significant positive association was found between Hope and QoL among PLHIV (r= 0.483, p<0.001). A significant regression equation (F429, 42= 1.842, R2=0.167, p<0.01). Married status i.e. married, Occupation i.e. doing Labor work has positively and 3rd and 4th clinical-stage have negatively predicted Hope of PLHIV. A Non significant regression equation (F429,42=1.37, R2=0.13, p<0.05). Being a private employee had positively and Heterosexual had negatively predicted and remained determinants have not predicted QoL among PLHIV and there was a significant association found between marital status and remained variables are not associated with Hope. There was a significant negative relationship found between Family monthly income and a positive relationship found between the duration of HIV and QoL. Marital status is significantly associated with QoL. Conclusions: The overall findings reveals that a significant positive correlation between Hope and QoL among PLHIV. There was a significant association found between marital status with Hope. There was a significant negative relationship found between Family monthly income and positive relationship found Duration of HIV and QoL.

Quality of life of people living with HIV/AIDS before and after receiving antiretroviral therapy

Background- HIV/AIDS is a chronic illness. Besides having serious morbidities, opportunistic infections, it also adversely affects quality of life of People Living with HIV/AIDS (QOL- PLHIV). Early and prompt initiation of antiretroviral therapy (ART) might improve quality of life of PLHIV in various domains like psychological, physical, environment level of independence, social relationship and spirituality/religion/personal beliefs. Material and methods- The study was conducted at a medical institute of North India. Patients attending ART centre of the institute for the treatment of HIV/AIDS were interviewed on WHOQOL-HIV questionnaire. Aim and objectives- To assess and compare quality of life of people living with HIV/AIDS at initiation and after 6 months of receiving antiretroviral therapy. Result- QOL-PLHIV was improved in various domains when assessed after six months of receiving ART. For physical domain mean score increased from 12.83 to 13.85, for psychological domain from 12.54 to 14.31, for level of independence from 12.95 to 13.21, for social relationship from 12.46 to 14.15, for environment domain from 11.98 to 13.15 and for spirituality/religion/personal belief mean score increased from 11.41 to 11.96. Respective standard deviation was decreased when compared from before initiation of ART to six months after receiving ART. Conclusion – Quality of life of people living with HIV/AIDS was improved significantly after receiving ART.

Manifestations cardiovasculaires au cours de l'infection à VIH à Libreville: étude comparative de patients séropositifs et séronégatifs / Cardiovascular Manifestations during HIV infection in Libreville: Comparative study of seropositive and seronegative patients

Introduction. Le spectre des atteintes cardiovasculaires au cours de l'infection à VIH a été modifi é par la trithérapie antirétrovirale. L'objectif de ce travail était de décrire le profi l des manifestations cardiovasculaires chez les patients vivants avec le VIH en le comparant à celui de patients séronégatifs. Méthodes. Il s'est agi d'une étude cas-témoins des dossiers de patients respectivement séropositifs et séronégatifs hospitalisés pour une pathologie cardiovasculaire au service de cardiologie du Centre Hospitalier Universitaire de Libreville de janvier 2015 à décembre 2018. L'analyse statistique a été réalisée à l'aide du logiciel Statview 5.0. Lestests de Chi-2 de Pearson ou Exact de Ficher ont été utilisés pour la comparaison des proportions. Résultats. L'étude a porté sur sur l'analyse de 82 et 150 dossiers de patients respectivement séropositifs et séronégatifs. Un âge inférieur à 50 ans était retrouvé chez 70,7% des séropositifs et 43,3% des séronégatifs (p<0,01). Le taux de CD4 moyen des séropositifs était de 189±170/mm3 et 45,1% d'entre eux étaient sous trithérapie antiretrovirale.La cardiomyopathie dilatée était l'atteinte cardiaque la plus fréquente chez les séropositifs (42,7%) et chez les séronégatifs (52,7%) (p=0,14). La maladie thromboembolique veineuse était relevée chez 7(8,5%) séropositifs et 14 (8,8%) séronégatifs (p=0,93). Une péricardite était diagnostiquée chez 25,6% des séropositifs avec une étiologie tuberculeuse dans 85,7% des cas. Les pathologies vasculaires athéromateuses étaient plus fréquentes chez les séronégatifs (23,1%) comparés aux séropositifs (6,1%) (p<0,01). La mortalité des séropositifs était principalement due aux péricardites (71,4%). Conclusion. les manifestations cardiovasculaires liées à l'immunodépression persistent chez les personnes vivant avec le VIH à Libreville. Un dépistage précoce de ces atteintes permettrait de réduire la mortalité.

Introduction. The spectrum of cardiovascular damage during HIV infection has been modified by triple antiretroviral therapy. The objective of this study was to describe the profile of cardiovascular manifestations in patients living with HIV by comparing it to the one of seronegative patients. Methods. This was a case-control study which focused on the files of patients hospitalized for a cardiovascular pathology in the cardiology department of the Center Hospitalier Universitaire de Libreville from january 2015 to december. 2018. Results. In total, there was on the analysis of the files of 82 seropositive patients and 150 seronegative patients. The age found was less than 50 years old in 70.7% of seropositives and 43.3% of seronegatives (p <0.01). The mean CD4 count in seropositives was 189 ± 170 /mm3 and 45.1% of them were on triple antiretroviral therapy. Dilated cardiomyopathy was the most common cardiac disease in HIVpositive (42.7%) and HIV-negative (52.7%) (p = 0.14). Venous thromboembolic disease was noted in 7 (8.5%) seropositives and 14 (8.8%) seronegatives (p=0.93).Pericarditis was diagnosed in 25.6% of seropositives patients with a tuberculous etiology in 85.7% of cases. Atheromatous vascular pathologies were more frequent in seronegative (23.1%) compared to seropositive (6.1%) (p <0.01). Mortality among seropositive was mainly due to pericarditis (71.4%)

A VIVÊNCIA DO PRECONCEITO APÓS A REVELAÇÃO DA SOROPOSITIVIDADE PARA O HIV / EXPERIENCE PREJUDICE AFTER THE DISCLOSURE OF SEROPOSITIVITY FOR HIV

Este estudo teve por objeto o processo de diagnóstico da soro positividade para o HIV e por objetivos: descrever processo de revelação do diagnóstico positivo para HIV e discutir a vivência do preconceito e suas consequências para vida cotidiana. Método: Entrevistas com 49 pessoas que vivem com HIV (PVHIV). Técnica de análise de conteúdo lexical, com auxílio do software Iramuteq 0.7 alpha 2. Resultados: As condições de vida de pessoas que vivem com HIV são permeadas pelo estigma, preconceito e discriminação. A revelação do diagnóstico para a sociedade não é uma tarefa fácil e nem sempre ocorre. Após impacto inicial do diagnóstico, a vida segue com mudanças cotidianas, os sentimentos de desespero e medo são aplacados com o tempo, entretanto o preconceito persiste. Conclusão: Os resultados mostram complexo cenário de se (con) viver com o vírus e /ou com a síndrome. A descoberta do diagnóstico, aceitação, decisão sobre revelação, reunir meios de enfrentamento do preconceito e prosseguir vivendo, exige que PVHIV tenham suporte e se reprogramem para enfrentar desafios diários.

This study had as its object the process of diagnosing serum positive for HIV and its objectives: to describe the process of disclosing the positive diagnosis for HIV and to discuss the experience of prejudice and its consequences for everyday life. Method: Interviews with 49 people living with HIV (PLHIV). Lexical content analysis technique, with the aid of the Iramuteq 0.7 alpha 2 software. Results: The living conditions of people living with HIV are permeated by stigma, prejudice and discrimination. Disclosing the diagnosis to society is not an easy task and does not always occur. After the initial impact of the diagnosis, life continues with daily changes, the feelings of despair and fear are appeased over time, however prejudice persists. Conclusion: The results show a complex scenario of (con) living with the virus and / or the syndrome. The discovery of diagnosis, acceptance, decision on disclosure, gathering means to face prejudice and continue living, requires that PLHIV have support and reprogram themselves to face daily challenges.

Interventions to Reduce HIV-related Stigma in the Healthcare Settings: A Scoping Systematic Review

@#HIV-related stigma will discourage the efforts in preventing new infections and engaging people to receive treatment, care and support programmes. Identifying the valuable interventions programmes to reduce HIV-related stigma in a healthcare setting is vital in order to deliver the best health services. A scoping systematic review was conducted. Articles were searched based on Pubmed and ScienceDirect search engines. The key words used were HIV stigma, intervention and healthcare. Published English articles in the past ten years involving HIV stigma intervention studies, and studies that involved healthcare workers in a healthcare setting were included. Reviewed articles, systematic review and meta-analysis articles were excluded. Primary screening of titles and abstract of 85 articles were done. Secondary screening of 19 articles resulted in 8 articles, included in this manuscript. Most of the reviewed articles showed, application of the Integrated Theoretical Model in the intervention programme as a guide and utilising combined intervention components are effective tools in delivering the intervention programme. The stigma reduction-intervention programme should focus on the intervention components as a whole including training of HCW, role plays, group discussions, games, sharing of information and contacts with PLHIV as well presentations and lectures. An integrative model of behavioural prophecy is perceived and it is particularly essential for interventions that focus on creating and fortifying the aim in conducting the chosen behaviour.

Improving survival with tuberculosis & HIV treatment integration: A mini-review

Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/?l. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.

A qualitative exploration among the staff of an antiretroviral therapy center in (central) India regarding factors associated with job satisfaction, patient satisfaction and treatment success

Background: Perception of the staff of an Anti Retroviral Therapy Center (ARTC) was explored regarding the organizational culture of the center with special reference to its effectiveness and efficiency.Methods: This qualitative exploration was conducted in the ARTC, RDGMC Ujjain. Data were collected during April 2016 and March 2018 by means of 35 self-administered-open-ended questionnaires as well as interviews (3 Focus Group Discussions and 5 Face to Face In-Depth Interviews). Data consisting of the text of the questionnaire responses and transcripts of the interview-sound files were subjected to thematic (content) analysis method.Results: Several praiseworthy features as well as deficiencies were identified, most important among them were related to counseling, behavior and management of investigations as well as treatment. Emphasis was on finding out effective and efficient ways to prevent LTFUs/ defaults/ delays. In the process of analysis of the data, three themes emerged. These are: theme 1 “general domains for attention and emphasis”; theme 2 “specific areas identified for further improvement” and theme 3 “suggestions for improvement and conclusions of the analysis of the situation”. Several measures were suggested in the interest of the PLHIV and the institution as well as for achievement of the global and national targets.Conclusions: For improvement in treatment coverage and success, escalation of certain inputs within a timeframe is essential while aiming at certain outputs is also urgently needed simultaneously. Among these, improving the staffing of the ART center in quality and quantity, the job satisfaction of the staff and patient satisfaction are extremely important.

A study of knowledge and attitude of health care providers working at tertiary care hospitals of Lahore, Pakistan (having HIV/AIDS treatment facility) towards HIV/AIDS

A very few health care providers look after HIV/AIDS people because of their poor knowledge and either their lack of positive attitude or usually both. The rationale of this study was to evaluate the knowledge and attitudes of health care providers (tertiary care hospitals in Lahore, having HIV/AIDS Treatment Facility) towards patients with HIV/AIDS. In this cross sectional study, a random sample of 180 healthcare providers was assessed for their knowledge and attitudes. In the questionnaire of knowledge, items were measured in the form of dichotomous scale. Whereas in the five domains of attitudes, items were measured as a five-point likert scale ranging from strongly disagree to strongly agree. Results were discussed in the outlook of two variables which showed that the presence of negative attitude and lack of awareness increase the level of stigma and discrimination. HIV in our country needs positive attitude of rendering care and effective control measures by creating awareness in the community. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial.

background & objectives: Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV’s QOL, justifying an evaluation. Methods: In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/μl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval. Results: Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation (p=0.016); 12 per cent for physical (p=0.004), 11 per cent psychological (p=0.023) and 9 per cent level of independence (p=0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains. Conclusions: A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

Predictors of Sexual Abstinence and Attitude towards PLHIV among Undergraduate Students in a Privately Owned University in South West Nigeria.

Background: Universities in the high prevalence nations of sub-Saharan Africa have significant proportions of their students and staff being infected with HIV. The prevalence of risk behaviors for HIV/AIDS continues to rise especially among university students. The objective of this study is to identify predictors of sexual abstinence and attitude towards PLHIV among Babcock University students. Methods: A cross-sectional study of 1225 undergraduates selected by multistage sampling technique was conducted in a privately University in Nigeria. Data were collected using structured self-administered questionnaire. Results: All the participants were aware of HIV/AIDS. About one-quarter (24.1%) of the students had ever had sex. Knowledge about HIV/AIDS was very high as 87.7% of them had very good knowledge. Between 74.1% and 89.8% of the students demonstrated correct attitude towards the various attitude questions about PLHIV. Students who were less than 21 years (AOR=1.64), do not take alcohol (AOR=1.94), those with good knowledge of HIV/AIDS (AOR=2.15) were more likely to abstain from sex than their counterparts respectively. Male participants (AOR=0.64) were less likely to abstain from sex than females. The likelihood of having poor attitude towards PLHIV was less in those with good knowledge (AOR=0.16) and more in those with self-reported poor knowledge (AOR=2.97) than their respective counterparts. Conclusions: This study has identified the factors that promote sexual abstinence and reduce HIV-related stigmatization among young people. Many factors are involved. Hence, an integrated multi-sectoral and multidirectional approach is recommended for the provision of relevant HIV/AIDS knowledge, comprehensive abstinence sexuality education to young persons.

Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India.

Background & objectives: National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: sSuboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665) , on ART for less than 6 months (OR-1.540, CI- 1.280-1.853), male gender (OR for females -0.807, CI- 0.662-0.982), tribals (OR-2.246, CI-1.134-4.447), on efavirenz (EFA) regimen (OR- 1.479, CI - 1.190 - 1.837), presence of anxiety (OR- 1.375, CI - 1.117 - 1.692), non-disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039), not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756), neglect from friends (OR-1.368, CI-1.069-1.751), frequent change of residence (OR- 3.373, CI - 2.659 - 4.278), travel expenses (OR- 1.364, CI - 1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019). Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.

HIV-related stigma and discrimination: a study of health care workers in Banda Aceh, Indonesia.

Background: The aim of this study was to identify the level of stigmatized and discriminatory attitudes towards people living with HIV (PLHIV) among health care workers (HCWs) and the factors that influenced these attitudes. Methods: This research was conducted at Dr. Zainoel Abidin General Hospital Banda Aceh, Indonesia. A cross-sectional study design was adopted for this research. Eighty nine HCWs were included in this study and they were selected purposively. Correlation analysis, analysis of variance and independent sample t test analysis was used according to the type of data. Finally, a multiple linear regression model was used to identify the predictor factor for stigmatized and discriminatory attitudes. Results: We found that the level of stigmatized and discriminatory attitudes was high. Bivariate analysis showed that type of HCW, education, marital status, knowledge on transmission and prevention of HIV and irrational fear of HIV transmission were significant related with stigmatized attitudes (p < 0.05). Type of HCW, marital status, age, knowledge on transmission and prevention of HIV and irrational fear of HIV transmission indicated significant (p < 0.05) differences in the levels of discriminatory attitudes. A multiple linear regression model identified type of HCW and irrational fear of HIV transmission correlated with stigmatized attitudes (R2 = 0.230) and knowledge on transmission and prevention of HIV correlated with discriminatory attitudes (R2 = 0.119). Conclusion: Irrational fear of HIV transmission and type of HCW are significant predictors to stigmatized attitudes; knowledge on transmission and prevention of HIV is a predictor to discriminatory attitudes towards PLHIV among HCWs.

The role of traditional medicine practitioners in managing HIV and AIDS related-sicknesses in two provinces of Papua New Guinea

The HIV/AIDS epidemic requires mobilization of existing and potential resources of health systems for coordinated effort from the grassroots to national level. In this context, the role of traditional medicine practitioners in the management of HIV/AIDS-related illnesses was investigated. The experiences, perceptions and beliefs of People Living with HIV/AIDS (PLHIV) who access traditional medicine practitioners (TMPs), and the existing linkages between herbalists and other agencies working with PLHIV were also investigated. Specifically designed separate sets of questionnaires containing both closed and open ended questions were administered to herbalists, PLHIV, health workers and members of the community in the Provincial towns of Alotau and Popondetta and clusters of villages beside them. The findings indicate that conditions such as weight loss, diarrhoea, and opportunistic infections in general were believed to respond better to herbal medicines than hospital medicine and many herbalists were able to effectively treat these conditions in PLHIV. TMPs also provided other services such as counseling, advice on diet and healthy lifestyle. The existing linkage between TMPs and other sectors was weak as 80.3% indicated there was little or no collaboration. While 49% of the PLHIV responded better to herbal than hospital medicine, 15% did not, and 21% were not sure. The most common suggestions made were to include TMPs in the health care management for PLHIV and to provide them training in primary health care and HIV management. One general conclusion from many of the specific findings indicates that herbalists are providing positive support in alleviating suffering from HIV/AIDS patients, and may be a potential key to scaling up comprehensive care for HIV/AIDS in PNG as in other parts of the world.