Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

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

HIV in the Eastern Cape province of South Africa threatens farm employment and food security

Introduction: Human immunodeficiency virus' (HIV's) threat to food security is highest in areas with high poverty levels. The OR Tambo district in the Eastern Cape province has the highest poverty rate in South Africa (80.4%); HIV prevalence is 11.4%. Objective: The purpose of the study was to describe the threat that HIV poses to farm employment and food security in the Eastern Cape province of South Africa. Methods: A multi-method approach was used. The quantitative component was a cross-sectional design and the qualitative component was a narrative design. The study population comprised approximately 7 000 smallholder farmers from the five local municipalities in the OR Tambo district. Participants for both the qualitative and quantitative aspects of the study were selected using convenience sampling. Quantitative data were collected using questionnaires and qualitative data were collected from face-to-face interviews. Quantitative data were analysed using descriptive statistics and the chi-square test. Qualitative data were analysed using Tesch's eight-step procedure for thematic content analysis. Results: Five hundred and ninety-three farmers completed the questionnaire. Most agreed that HIV affects food security (n = 486, 72.0%), that HIV negatively affects food security (n = 454, 76.6%), that people living with HIV are excluded from farming activities (n = 426, 71.8%), and that HIV affects farming skills (n = 495, 83.5%). A significantly larger proportion of farmworkers older than 60 years than those who were younger perceived the threat to food security. Twenty participants described the effect of HIV on farm workers in interviews, and highlighted that HIV impacts farm skills and labour due to ill health and lost income from farming, which threatens food security. Conclusion: HIV threatens food security among smallholder farmers in the OR Tambo district due to farmworkers' diminished capacity to work and consequent reduced income, which affects their ability to secure food.

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.

Immunological CD4+ T-cell recovery and prognostic influencing factors in elderly HIV/AIDS patients of different genders after antiviral therapy / 中国热带医学

@#Objective　To investigate the prognostic influencing factors and recovery of CD4+ T lymphocytes in elderly HIV/AIDS patients after antiviral therapy by analyzing basic data and clinical follow-up data of elderly HIV/AIDS patients. Methods　The clinical data of 3 618 elderly AIDS patients aged ≥50 yeas who received antiretroviral therapy (ART) at HIV ART sites in Liuzhou City from 2005-2015 were collected. The data, including basic information, CD4+ T cell count, WHO clinical stage, infection route and follow-up, were retrospectively analyzed. Kaplan-Meier method was used to compare the differences in patient survival, multivariate Cox regression to analyze the independent influencing factors influencing the risk of death, and to compare the recovery of CD4+ T cell counts during follow-up of patients of different genders. Results　During the follow-up period, the 5-year cumulative survival rate up to the observation endpoint was 0.82 (female) and 0.66 (male). Multivariate logistic regression analysis showed that the risk factors affecting the effect of antiviral treatment were age (OR=1.909, 95%CI:1.474-2.464, P<0.001), body mass index (BMI) (OR=0.744, 95%CI: 0.574-0.965, P=0.026), opportunistic infections (OI) (OR=1.223, 95%CI:1.028-1.454, P=0.023), gender (OR=0.692, 95%CI:0.503-0.952, P=0.023) and baseline CD4+ T lymphocytes count (OR=0.563, 95%CI:0.429-0.739, P<0.001). Recovery of CD4+ T lymphocyte counts showed when baseline CD4+ T lymphocyte counts were less than 200 cells/mm3, older women with HIV/AIDS had higher CD4+ T lymphocytes than men at all times of ART treatment (P<0.05). Conclusions　Older women have a higher survival rate than older men after five years of antiviral therapy. Age, BMI, gender, OI and baseline CD4+T lymphocyte count may be important indicators that affect the survival of elderly HIV/AIDS patients. Older women showed better recovery of CD4+ T lymphocytes than older men during the 4-year follow-up period after ART.

Condições de vulnerabilidades de pessoas idosas vivendo com o Vírus da Imunodeficiência Humana (HIV) / Conditions of vulnerability of elderly people living with the Human Immunodeficiency Virus (HIV) / Condiciones de vulnerabilidades de personas ancianas que viven con el Virus de la Inmunodeficiencia Humana (HIV)

Estudo com objetivo de descrever as condições de vulnerabilidades de pessoas idosas ao Vírus da Imunodeficiência Humana (HIV). Trata-se de um estudo qualitativo e que utilizou como método a história oral temática, realizado no Serviço de Atendimento Especializado, com seis idosos com 65 anos ou mais. A coleta de dados se deu por uma entrevista em profundidade com questões sobre vulnerabilidades individuais, sociais e programáticas e os dados foram explorados por meio da análise de conteúdo temática. Entre as condições encontradas estão a ausência de preservativo nas relações sexuais; baixo grau de conhecimento e de procura por consultas e exames de rotina; presença do preconceito e discriminação; ruptura no convívio familiar; descoberta tardia do HIV e baixa capacitação da equipe de saúde. Enfrentar essas condições de vulnerabilidade pressupõe um debate sobre as políticas e normativas do cuidado às pessoas com HIV e a reconfiguração do modelo de cuidado focado na prevenção. (AU)

The aim of this study was to describe the conditions of vulnerability to HIV among older people. Using the thematic oral history method, we conducted a qualitative study in the SAE with six people aged 65 and over. The data were collected using in-depth interviews covering issues related to individual, social and programmatic vulnerabilities. The data were analyzed using content analysis. Vulnerability conditions included not using a condom, low level of knowledge of appointments and tests and health-seeking behavior; prejudice and discrimination; family break-ups; late diagnosis of HIV; and limited capacity of health teams. To tackle these vulnerability conditions, it is necessary to promote a debate about policies and regulations geared towards the care of people with HIV and reshape the prevention-based care model. (AU)

Estudio con el objetivo de describir las condiciones de vulnerabilidades de personas ancianas al VIH. Un estudio cualitativo, usando como método la historia oral temática, realizado en el SAE, con seis ancianos de 65 años o más, y la colecta de datos fue realizada mediante una entrevista en profundidad con preguntas sobre vulnerabilidades individuales, sociales y programáticas. Se realizó el análisis de contenido temático. Entre las condiciones encontradas están la ausencia de preservativo en las relaciones sexuales, bajo grado de conocimiento y de búsqueda de consultas y exámenes de rutina, presencia de prejuicios y discriminación, ruptura en la convivencia familiar, descubrimiento tardío del VIH y la baja capacitación del equipo de salud. El enfrentamiento de esas condiciones de vulnerabilidad presupone un debate con relación a las políticas y normativas del cuidado con las personas con VIH y la reconfiguración del modelo de cuidado enfocado en la prevención. (AU)

Metabolic Syndrome in People Living with Antiretroviral Therapy: A Cross-Sectional Investigation from Pune, India

Background: Improved longevity of people living with HIV on highly active antiretroviral therapy and accelerated aging processes are considered contributory to Metabolic Syndrome. Objectives: The current study investigated metabolic syndrome (MetS) in people living with HIV (PLH) who were receiving antiretroviral therapy (ART) under the ongoing National AIDS Control Program. Methods: Clinic attendees(n = 3088) who were on ART for more than 6 months constituted the sampling frame, from which 378 study participants were randomly drawn and included in the analysis following the eligibility check. One hundred and fifty‑nine clinic attendees, initiated on ART in ≤6 months, provided an opportunity to estimate the prevalence of MetS in them. Sixty‑two PLH from this smaller group were enrolled. Results: MetS was found among 19% (73/378; 95% confidence interval [CI] 15.5%–23.7%) PLH who were on ART >6 months compared with 24% (15/62; 95% CI 14.2%–36.7%) in those who were on ART for ≤6 months based on harmonization criteria for the Asian population; the confidence intervals overlapped and apparently observed difference was not statistically significant. Adjusted for age, body mass index (BMI), protease inhibitor (PI)‑based ART regimen, duration of ART, insulin resistance (IR), reported family history of hypertension and residential setting, factors independently associated with MetS were PI containing ART regimen, IR, duration of ART intake and BMI. In the adjusted model, the odds of MetS were three times higher among PLH on PI containing ART regimen (95% CI of adjusted odds ratio; aOR 1.27–8.51) and those having IR (95% CI of aOR 1.48–5.07). The odds of MetS among PLH with BMI ≥23 kg/m2 was 4 (95% CI of aOR 2.08–6.81) times higher than those with lower BMI. Conclusions: MetS in PLH requires the attention of health‑care workers in India. Appropriate screening would help initiate early management.

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.

Mediating antiretroviral treatment for HIV during COVID-19: lessons from implementation in Gomba District, Uganda

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda's early response to HIV yet were lacking in the COVID-19 context.

Knowledge of final year undergraduate nursing students about HIV and AIDS in Eswatini

Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are overwhelming health issues globally. They have caused many devastating and draining health issues, which have escalated a critical need for a well-trained and sustainable healthcare workforce in order to meet the needs of people living with HIV and AIDS (PLWHA). Health science students are the future healthcare providers who will implement proper preventive measures, as well as health educational and promotional sessions to promote information and knowledge among the public regarding HIV and AIDS in Eswatini. Methods: A quantitative cross-sectional study was conducted on 140 final-year undergraduate nursing students in three nursing universities in Eswatini. A questionnaire adapted from Othman and Ali in Malaysia with closed-ended questions was modified and used to collect data. The questionnaire consisted of questions on the virus structure, transmission, prevention and management of HIV and AIDS. Statistical Package for the Social Sciences (SPSS) version 20 was utilised to analyse the data. Results: The level of knowledge about HIV and AIDS was high, as evidenced by a mean score and standard deviation of (91.02 ± 5.00). However, there were low scores on questions related to the transmission of the disease. Conclusion: Across all three universities in Eswatini, there were good nursing education programs on HIV and AIDS, evidenced by the high knowledge level about HIV and AIDS. However, there are still some knowledge gaps on HIV and AIDS transmission and management that need to be attended to contribution: This study contributed by providing knowledge of undergraduate nursing students' HIV and AIDS training and management of PLWHA.

Estigma relacionado ao HIV entre jovens em transição para a clínica de adultos num hospital público no Rio de Janeiro, Brasil / HIV-related stigma among young people living with HIV transitioning to an adult clinic in a public hospital in Rio de Janeiro, Brazil

Resumo Neste estudo investigamos como vivências de estigma do HIV se expressam entre jovens soropositivos, em transição para a clínica de adultos, no serviço de saúde, na família e nas interações afetivos-sexuais e sua relação com as desigualdades e hierarquias sociais. O estudo envolveu 31 jovens (idade mediana 21) em transição para a clínica de adultos (G1) e 12 jovens (idade mediana 30) que já fizeram essa transição (G2), ambos atendidos num serviço de saúde do Rio de Janeiro. Dentre os 43 jovens, 70% eram mulheres e 65% foi infectado por transmissão vertical. Os jovens responderam a questionários e participaram de grupos focais sobre estigma da aids e passagem para a vida adulta. A maioria relatou situações de discriminação associadas ao estigma do HIV na vida cotidiana e no cuidado em saúde. Os jovens do G1 revelaram maior preocupação com as consequências da revelação do HIV e dificuldades com o tratamento. Os relatos do G2 sugerem que a constituição de relações conjugais, incluindo parceiro/a e filhos soronegativos e o acesso ao tratamento, possibilitaram resignificar o receio da estigmatização. Os achados visam orientar a formação e ação de profissionais envolvidos na prevenção e cuidado de jovens vivendo com HIV.

Abstract This study analyzes how experiences of HIV-related stigma are expressed among HIV-positive young people transitioning to an adult clinic, the health service, the family, the affective-sexual interactions, and their relationship with inequalities and social hierarchies. This research included 31 young people (median age 21) transitioning to an adult clinic (G1) and 12 young people (median age 30) who had already made this transition (G2), both monitored at a health service in Rio de Janeiro. Seventy percent of the 43 young people were women and 65% were infected by mother-to-child transmission. Young people answered questionnaires and participated in focus groups on AIDS stigma and transition to adulthood. Most reported discrimination associated with HIV stigma in daily life and health care. G1 young people showed more significant concern about the consequences of HIV disclosure and difficulties with treatment. The G2 accounts suggest that establishing marital relationships, including HIV-negative partners and children, linked to treatment access allowed resignifying the fear of stigmatization. The findings aim to guide the training and action of professionals involved in the prevention and care of young people living with HIV.

Risk factors for leptospirosis and brucellosis in people living with human immunodeficiency virus who attended a referral hospital in southeastern Brazil

Abstract INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.

Análise da estigmatização no contexto do HIV/AIDS: concepções de pessoas que vivem com HIV/AIDS / Analysis of stigmatization in the context of HIV/AIDS: concepts of people living with HIV/AIDS

A presente pesquisa buscou identificar as concepções acerca do estigma social entre pessoas vivendo com o HIV/AIDS. Participaram 44 soropositivos, com idade entre 23 e 67 anos (M = 41,00; DP = 10,60), que estavam em acompanhamento no centro de testagem e aconselhamento (CTA) da Secretária da Saúde da Prefeitura Municipal de Parnaíba/PI. Utilizou-se entrevista semiestruturada e questionário sociodemográfico para caracterização da amostra. Constatou-se que, apesar de quase três décadas passadas da epidemia e da sua mudança epidemiológica, as pessoas que convivem com HIV/AIDS ainda sofrem e internalizam estigmas, que são construções históricas, culturais e sociais, que giram em torno da doença, assim demonstrando medo do julgamento moral da sociedade. Espera-se que esses dados possam subsidiar futuras intervenções em saúde coletiva que possam contribuir para atenuar as vivências de estigma social no contexto da soropositividade para o HIV/AIDS.

The current research sought to identify the conceptions about the social stigma among people living with HIV/AIDS. Participated 44 HIV-positive individuals, aged between 23 and 67 years (M = 41,00, SD = 10,60), who were being monitored at the testing and counseling center (CTA) of the Secretary of Health of the Municipality of Parnaíba/PI, Brazil. Semi-structured interview and sociodemographic questionnaire were used to characterize the sample. It was found that, despite almost three decades after the epidemic and its epidemiological change, people living with HIV/AIDS still suffer and internalize stigmas, which are historical, cultural and social constructions, revolving around the disease, as well showing fear of the moral judgment of society. It is expected that these data may support future public health interventions that can contribute to alleviate the experiences of social stigma in the context of HIV/AIDS seropositivity.

Therapeutic Approach To Concurrent Pcp And Pulmonary Tb In People Living With Hiv/Aids With Various Drug Hypersensitivity Reactions

Pneumocystis Carinii Pneumonia (PCP) and Pulmonary Tuberculosis (PTB) are the most frequent Opportunistic Infection (OI) in People living with HIV/AIDS (PLWHA), especially whose CD4 counts<200 cells/mL. There is no pathognomonic sign and symptom of pneumocystis, radiographic imaging (chest radiograph) and blood examination. An intractable microorganism cannot be isolated or sustained in culture. The diagnosis of PCP is complicated, based on the presumptive diagnosis. PCP should be treated optimally as soon as possible in order not to be fatal. We report a complicated case of a female 26 y-old, diagnosed with HIV infection on Highly Active Anti Retro Viral Therapy (HAART), PTB on Anti Tuberculosis Drugs (ATD) concurrent with PCP. She also has a history of various Drug Hypersensitivity Reactions (DHR) include Rifampycin, Ciprofloxacin and Cotrimoxazole. DHR is unpredictable, and Clindamycin and Primaquin are the recommended alternative drugs for PCP, the strategic therapy is by Desensitization Protocols.

Factors affecting disclosure of HIV-positive serostatus among people living with HIV/AIDS attending an antiretroviral therapy center of Eastern India

Background: HIV serostatus disclosure plays an important role in reducing the risk of HIV transmission. However, its negative effects may include rejection, assault, separation, divorce, stigma, and discrimination. Objectives: This study was undertaken to find out the proportion of HIV-positive serostatus disclosure to any family member and different factors influencing disclosure among people living with HIV/AIDS (PLWHA). Methods: A cross-sectional study was conducted among all patients aged 18� years with confirmed HIV infection registered at the antiretroviral therapy center of a tertiary care hospital in eastern part of Uttar Pradesh, India, for the duration of 1 year, from July 2017 to June 2018. Results: Most of the respondents were aged 30� years (79.9%), male (63.2%), married (85.4%), rural residents (60.4%), Hindu (96.5%), literate (84%), employed/driver (61.8%), and belonged to lower/lower middle class (62.6%). The rate of disclosure of HIV-positive status to any family member was quite high in this study (238/288 or 82.6%), among which 92.9% (221/238) to the spouse only. The number of sexual partners before disclosure, educational status, and socioeconomic status of the respondents were found to be independent predictors of disclosure of HIV-positive status to any family member (P < 0.05). Conclusions: This study indicates the need of giving more emphasis on creating awareness regarding the importance of HIV serostatus disclosure to any family member, especially to spouse, and encourage all PLWHA in the community to disclose their status. Effective strategies also need to be evolved that will target those not likely to disclose their status to anybody.

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.

Predictors of adherence to antiretroviral therapy among PLHIV

Adherence to antiretroviral therapy (ART) is of paramount importance to achieve the optimum control of viral load and progression of disease among people living with HIV (PLHIV). An overview of systematic reviews to summarize the factors influencing adherence to ART was not found in the literature; hence, the systematic review of systematic reviews was conducted to provide global view of factors influencing adherence to ART. Systematic reviews ever published till May 2018 were searched and retrieved between May 2015 and May 2018 from Cochrane and PubMed databases. Among 88 studies initially chosen based on inclusion and exclusion criteria, 22 were selected for further analysis. Qualitative analysis of included reviews was made through narrative synthesis approach. Results of the study show that among the 60 factors enlisted, 5 were most highly significant, 7 were highly significant, 19 were moderately significant, and 29 were emerged as significant factors. Substance abuse, financial constraints, social support, HIV stigma, and depressive symptoms were the most highly significant factors influencing the adherence, whereas age, employment status, long distance, side effects of drugs, pill burden, education, and mental health were regarded as highly significant factors influencing ART. Fatigue, away from home, being too busy in other things, simply forgot, and beliefs about the necessity of ART emerged as significant factors. The study concludes that findings from the overview give global insight into the factors determining adherence to ART which would further influence the innovations, program, and policy-making to mitigate the problem of nonadherence.

Diagnostic yield of cartridge based nucleic acid amplification test in Mycobacterium tuberculosis in a tertiary care medical college and hospital of Southern Odisha, India

Background: Tuberculosis is the ninth leading cause of death worldwide. India contributes to about one fifth of global TB burden. It is very important to diagnose early and treat tuberculosis to cut down transmission of tuberculosis.Methods: Author conducted a retrospective study in Department of Pulmonary Medicine SLN Medical College, Koraput, Odisha to analyze the utility and yield of CBNAAT. Study period was from April 2018 to March 2019. Inclusion criteria was all patients whose samples were subjected to CBNAAT were included in our study.  Sputum samples from pulmonary tuberculosis patients, and extra pulmonary samples (pleural fluid, ascitic fluid, CSF, synovial fluid and gastric lavage etc. were included in our study population. Exclusion criteria was patients who were under anti tubercular therapy for pulmonary, extra pulmonary and MDR TB were excluded from this study. Data were collected from Pulmonary Medicine Department, ART center, DOTS center and CBNAAT center. Total number of samples tested for CBNAAT, different sample collection sites, age and sex distribution of patients, HIV status of all patients, result of smear microscopy for AFB and CBNAAT and Rifampicin resistance status were analyzed.The detail statistical analysis was done in tabulation form.Results: A total of 2621 samples were tested in CBNAAT during the study period. Mean age of the study population was 38.03 years. 1881 tested were negative and 740 samples were positive for CBNAAT. Of these 2621 samples, 2526 were pulmonary samples (sputum, pleural fluid samples) and 95 were extra pulmonary samples. Author found rifampicin resistance rate of 0.54% (4/740)) in pulmonary tuberculosis cases. There was no rifampicin resistance detected in extra pulmonary samples. CBNAAT could identify 536 cases (23.2%) that were smear negative. Author found TB- HIV co-infection rate of 6.22%.Conclusions: CBNAAT is an important diagnostic modality especially in sputum negative patients for early diagnosis and treatment. In our study it detected Mycobacterium tuberculosis in 23.2% of patients with negative smear for microscopy. Rifampicin resistance rate detected was very low compared to other studies.

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.