Gestação, Vírus da Imunodeficiência Adquirida (HIV) e COVID-19: desafios na assistência ao pré-natal / Embarazo, virus de la inmunodeficiencia adquirida y COVID-19: desafíos en la atención prenatal / Pregnancy, acquired immunodeficiency virus and COVID-19: challenges in prenatal care

Objetivo: evidenciar os desafios existentes durante o pré-natal em mulheres grávidas soropositivas para o Vírus da Imunodeficiência Adquirida durante um período pandêmico. Método: Trata-se de uma pesquisa quantitativa exploratória de caráter descritivo, utilizando-se de levantamento de dados através de entrevistas em campo com 19 gestantes com Vírus da Imunodeficiência Adquirida de um serviço de assistência especializada, entre julho de 2021 e julho de 2022. Resultados: apontaram dificuldades para agendar consultas, realizar exames e acesso aos resultados, dificuldades para conseguir transporte devido a distância da unidade de infectologia e dificuldade para agendar consultas na unidade básica de saúde. Conclusão:o serviço de assistência especializada realizou a reorganização da assistência para diminuir os desafios presentes, que foram dificuldade de acesso a unidade, marcação e acesso a resultado de exames pré-natal.

Objectives: to highlight the existing challenges during prenatal care in pregnant women seropositive for the Acquired Immunodeficiency Virus during a pandemic period. Method: This is a descriptive exploratory quantitative research, using data collection through field interviews with 19 pregnant women with Acquired Immunodeficiency Virus from a specialized assistance service, between July 2021 and July 2022. Results: they pointed out difficulties in scheduling consultations, performing tests and accessing the results, difficulties in getting transportation due to the distance from the infectology unit and difficulty in scheduling consultations at the basic health unit. Conclusion: the specialized assistance service carried out the reorganization of assistance to reduce the present challenges, which were difficulty in accessing the unit, scheduling and access to prenatal exam results.

Objetivos:resaltar los desafíos existentes durante la atención prenatal en gestantes seropositivas para el Virus de la Inmunodeficiencia Adquirida en período de pandemia. Método: Se trata de una investigación cuantitativa exploratoria descriptiva, utilizando la recolección de datos a través de entrevistas de campo con 19 gestantes con Virus de la Inmunodeficiencia Adquirida de un servicio de asistencia especializada, entre julio de 2021 y julio de 2022. Resultados:señalaron dificultades en la programación de consultas, realización de pruebas y acceso a los resultados, dificultades para conseguir transporte debido a la distancia de la unidad de infectología y dificultad para programar consultas en la unidad básica de salud. Conclusión: el servicio de asistencia especializada realizó la reorganización de la asistencia para reducir los desafíos presentes, que fueron la dificultad de acceso a la unidad, la programación y el acceso a los resultados del examen prenatal.

Condições de vida de pessoas vivendo com HIV em um município do Estado do Rio de Janeiro, Brasil / Life conditions of people living with HIV in a city of the state of Rio de Janeiro, Brazil / Condiciones de vida de las personas que viven con el VIH en un municipio del estado de Río de Janeiro, Brasil

Objetivo: discorrer sobre as condições de vida das pessoas vivendo com HIV em um município do estado do Rio de Janeiro, Brasil. Método: estudo do tipo transversal, descritivo, de natureza qualitativa. A coleta de dados foi através de entrevistas, sendo os achados submetidos à técnica de análise de conteúdo. A amostra foi composta por pessoas vivendo com HIV que eram abordados no momento que compareciam ao serviço de assistência especializada, sendo definida uma amostra de 20 participantes por técnica de saturação. Resultado: emergiram categorias com base nos temas abordados na entrevista relacionados à qualidade de vida (condição de alimentação, atividade física, lazer, religião e satisfação com a vida sexual) e à experiência de viver com HIV. Conclusão: as pessoas vivendo com HIV, em tratamento antirretroviral, podem usufruir de boas condições de vida tendo como principal fator impeditivo o medo de vivenciar situações de estigma e discriminação.

Objectives: investigate the implications for the life conditions of people living with HIV in a city of the State of Rio de Janeiro, Brazil. Method: cross-sectional, descriptive, and qualitative study. Data collection was conducted through interviews, and the findings were subjected to the content analysis technique. The sample comprised people living with HIV that were approached at the time they attended the specialized assistance service, and a sample of 20 participants was defined by saturation technique. Result: categories emerged based on the topics addressed in the interview related to quality of life (food condition, physical activity, leisure, religion, and satisfaction with sexual life) and the experience of living with HIV. Conclusion: people living with HIV in antiretroviral treatment can enjoy good living and the preventing potential factor is the fear of experiencing situations of stigma and discrimination.

Objetivos: conocer las implicaciones para las condiciones de vida de las personas que viven con el VIH en un municipio del Estado de Río de Janeiro, Brasil. Método: estudio de tipo transversal, descriptivo, de naturaleza cualitativa. La recolección de datos se realizó a través de entrevistas, y los hallazgos fueron sometidos a la técnica de análisis de contenido. La muestra se compuso por personas que viven con el VIH que fueron abordadas en el momento en que vinieron al servicio de asistencia especializada, y se definió una muestra de 20 participantes por la técnica de saturación. Resultado: emergieron categorías basadas en los temas abordados en la entrevista relacionados con la calidad de vida (condición alimentaria, actividad física, ocio, religión, y satisfacción con la vida sexual) y la experiencia de vivir con VIH. Conclusión: las personas que viven con el VIH en tratamiento antirretroviral pueden disfrutar de buenas condiciones de vida y salud, y el principal impedimento y el temor de experimentar situaciones de estigma y discriminación.

Cotidiano de pessoas que vivem com VIH em Bissau, Guiné-Bissau: perspectivas, desafios e vulnerabilidades / Vida diaria de las personas que viven con VIH en Bissau, Guinea-Bissau: perspectivas, desafíos y vulnerabilidades / The daily life of people living with HIV in Bissau, Guinea-Bissau: perspectives, challenges and vulnerabilities

RESUMO Objetivo compreender as perspectivas e desafios no cotidiano de pessoas após a descoberta do viver com VIH em Bissau, Guiné-Bissau, tendo em vista diferentes contextos de vulnerabilidade. Método estudo exploratório-descritivo, que utilizou entrevista semiestruturada com 16 pessoas vivendo com VIH, acompanhadas em um hospital de Bissau. Empregou-se técnica de análise de conteúdo temática. Os relatos dos participantes foram analisados a partir de duas categorias empíricas: A descoberta, os impactos e os desafios de viver com VIH; e Experiência com o antirretroviral: recomeço e perspectivas. Resultados sinalizaram que os desafios iniciam com a revelação do diagnóstico que, geralmente, desperta uma diversidade de sentimentos e comportamentos. O estigma e a discriminação estimulam a adoção do sigilo sobre o status sorológico, resultando na fragilidade de suporte emocional no enfrentamento à soropositividade. A terapia antirretroviral foi vislumbrada como esperança para o enfrentamento da doença. A vulnerabilidade social foi a dimensão que mais se destacou, e violações dos direitos humanos foram constatadas. Conclusão e implicações para a prática o estudo permite compreender as perspectivas, desafios e vulnerabilidades de pessoas que vivem com VIH. O viver com VIH merece atenção especial por parte dos profissionais de saúde que atuam no cuidado dessas pessoas, destacando-se como contribuição a relevância de um cuidado de saúde integral, em que a ética e a subjetividade estejam presentes.

RESUMEN Objetivo este estudio cualitativo tuvo como objetivo comprender perspectivas y desafíos en la vida cotidiana de las personas que viven con VIH en Bissau, Guinea-Bissau, considerando diferentes contextos de vulnerabilidad. Método estudio exploratorio-descriptivo, que utilizó una entrevista semiestructurada con 16 personas que viven con el VIH, seguido en un hospital de Bissau. Se utilizó la técnica de análisis de contenido temático. Los informes de los participantes se analizaron a partir de dos categorías empíricas: El descubrimiento, los impactos y los desafíos de vivir con el VIH; y La experiencia antirretroviral: un nuevo comienzo y perspectivas. Resultados los resultados indicaron que los desafíos comienzan con la divulgación del diagnóstico, que generalmente suscita una diversidad de sentimientos y conductas. El estigma y la discriminación fomentan la adopción del secreto sobre el estado serológico, lo que resulta en un apoyo emocional débil para hacer frente a la seropositividad. La terapia antirretroviral es una esperanza para hacer frente a la enfermedad. La vulnerabilidad social fue la dimensión que más se destacó y se encontraron violaciones a sus derechos humanos. Conclusión e implicaciones para la práctica el estudio permite comprender las perspectivas, los desafíos y las vulnerabilidades de las personas que viven con el VIH. Vivir con VIH merece especial atención por parte de los profesionales de la salud que actúan en el cuidado de estas personas, destacando como aporte la relevancia de la atención integral en salud, en la que la ética y la subjetividad están presentes.

ABSTRACT Objective to understand perspectives and challenges in the daily lives of people after the discovery of living with HIV in Bissau, Guinea-Bissau, considering different contexts of vulnerability. Method an exploratory-descriptive study conducted through semi-structured interviews with sixteen people living with HIV attending a hospital in the city of Bissau. We used the thematic content analysis technique. Participants' reports were analyzed following two empirical categories: Discovery, impacts and challenges of living with HIV; and Experience with antiretroviral therapy: new beginning and perspectives. Results the results indicate that the challenges start with the disclosure of diagnosis, which arouses a diversity of feelings and behaviors. Stigma and discrimination encourage the adoption of confidentiality about serological status, which increases the fragility of emotional support in coping with seropositivity. Antiretroviral therapy was seen as a hope for coping with the disease. Social vulnerability was the dimension that stood out the most, and human rights violations involving people living with HIV were verified. Conclusion and implications for practice the study makes it possible to understand the perspectives, challenges and vulnerabilities of people living with HIV. Living with HIV deserves special attention from health professionals who work in the care of these people, highlighting as a contribution the relevance of comprehensive health care, in which ethics and subjectivity are present.

Uptake of HIV voluntary counseling and testing and associated factors among students in the Higher Institutions of Learning in Kigali, Rwanda: A cross-sectional study

Background HIV/AIDS remains a significant global public health challenge with youth bearing the brunt of the burden. One essential method for preventing and accessing AIDS care is through Voluntary Counselling and Testing (VCT). Regardless of this, youth population continues to have low utilization of VCT services. Objective To assess the uptake of HIV VCT services and associated factors among university students in Kigali. Methods A cross-sectional study among 374 students recruited using stratified sampling was conducted. A structured questionnaire was used to gather information. A multivariable logistic regression analysis was used to assess the independent factors associated with VCT uptake. Results The prevalence of VCT uptake was 59.9%. The logistic regression revealed that being Catholic (AOR = 11.99, 95%CI: 5.44-26.41) and Moslem (AOR = 37.34, 95%CI: 2.67-128.36) compared to Protestant, as well as availability of VCT services (AOR = 5.15, 95%CI: 3.11 - 8.541) favored the use VCT. On the other hand, being aged 20 to 24 years (AOR = 0.112, 95%CI: 0.04 - 0.29) had low likelihood of using VCT than those more than 24 years of age. Conclusion VCT uptake was significantly positively associated with religion and VCT services availability, and negatively associated with age 20-24 years in the campus. Therefore, targeted actions of disseminating information on benefits of VCT and enhancing accessibility of VCT services among students are necessary for the increased VCT uptake to be attained.

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.

Exploring a community's understanding of HIV vaccine-induced seropositivity in a South African research setting

Background. The high HIV prevalence and incidence in South Africa makes it suitable for recruitment of participants for large-scale HIV preventive vaccine trials. However, fear of vaccine-induced seropositivity (VISP) may be a barrier for community acceptability of the trial, for volunteers to participate in HIV preventive vaccine trials and for uptake of an efficacious vaccine. Prior to 2015, when the first phase 1 safety HIV vaccine trial was undertaken at Setshaba Research Centre, Soshanguve, the local community stakeholders and healthcare workers were naive about HIV vaccine research and HIV preventive vaccines. Objective. To explore knowledge and perceptions regarding VISP among community stakeholders and healthcare workers in peri-urban Soshanguve, Tshwane.Methods. Using a quantitative-qualitative mixed-methods study design, surveys (n=50) and in-depth interviews (n=18) were conducted during July - August 2015. Participants included community stakeholders, community advisory board members and healthcare workers, who were >18 years old and had attended community educational workshops during September 2014 - May 2015. Audio recordings of interviews were transcribed verbatim and coded using content thematic analysis. Data were further analysed by sex, age and educational level.Results. Of a maximum score of 2 on knowledge on VISP, the 50 survey participants (mean age 33.78 years; 45 females) obtained an average of 0.88 (44%). Of 17 in-depth interviewees (one interview could not be transcribed; mean age 30.9 years; 12 females), 8 (47%) displayed some knowledge about VISP, of whom only 5 defined VISP correctly. Women were more knowledgeable about VISP than men; 5 of 12 women (42%) came close to defining VISP correctly, while none of the 5 men did so. The main fear of trial participation expressed by most participants (n=6) was testing HIV-positive as a result of the vaccine. While some participants believed that the community's perceptions of VISP would negatively affect HIV vaccine trial support and recruitment efforts, others noted that if trial participants understand the concept of VISP and are part of support groups, then they would have the information to combat negative attitudes within their community. Conclusion. Most participants had an inaccurate and incomplete understanding of VISP. Many feared testing HIV-positive at clinics; therefore, education on improving a basic understanding of how vaccines work and why VISP occurs is essential. In addition, assessing participant understanding of HIV testing, transmission and VISP is critical for recruitment of participants into HIV vaccine trials and may improve acceptability of an HIV preventive vaccine

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

Midwives' perceptions of and attitudes towards prevention of mother-to-child-transmission of HIV

Background: Prevention of mother-to-child transmission (PMTCT) of HIV services has become an integral part of antenatal services. Prevention of mother-to-child transmission was introduced in all the regions of Ghana, but mother-to-child transmission (MTCT) continued to increase. Objectives: To explore and describe midwives' perceptions and attitudes towards PMTCT of HIV services. Method: Quantitative research approach and descriptive cross-sectional design were used. The population includes all midwives between the ages of 21 and 60 years who work in antenatal care (ANC) clinics in 11 district hospitals in the Central Region of Ghana where the study was conducted. Forty-eight midwives were interviewed using a census sample process. Data were analysed using the Statistical Package for the Social Sciences version 21. Correlation analysis was performed to find the relationships between the attitudes and the perceptions of the midwives on PMTCT of HIV services. Results: Seventy percent of midwives had positive perceptions of PMTCT of HIV services and 85% had positive attitudes towards the provision of PMTCT of HIV services. Midwives were screening all pregnant women who visited the ANCs and referring those who tested positive to other institutions where they can be monitored. Some of the concerns considered were views on retesting HIV-infected pregnant women throughout their pregnancy. There was a positive correlation between attitudes and perceptions of midwives on PMTCT of HIV services. Conclusion: Midwives had positive perceptions and positive attitudes towards the PMTCT of HIV services that they were providing to antenatal attendees. Also, as the attitudes of the midwives towards PMTCT of HIV services improved, their perceptions of PMTCT services also improved. Contribution: Decentralisation of PMTCT of HIV services to community-based health facilities is appropriate to enable sub-district health facilities to test for HIV and provide counselling services to pregnant women.

Sintomas depressivos em angolanos com HIV em período pré-pandêmico / Depressive symptoms in Angolans with HIV in the pre-pandemic period / Síntomas depresivos en angoleños con VIH en el período prepandemia

Objetivo: conhecer os níveis de depressão e sintomas depressivos em angolanos com HIV. Método: estudo descritivo e misto, com estratégia exploratória sequencial, em período pré-pandêmico em um hospital público de Angola. Realizou-se entrevistas semiestruturadas, com aplicação do Inventário de Depressão de Beck. Para fins de análise, considerou o conceito de depressão a partir da classificação internacional de doenças. Resultados: prevaleceu depressão leve a moderada para ambos os sexos e estado civil. No G1, a maioria além da tristeza ou infelicidade não conseguem suportar a angústia, alguns verbalizam ter consciência de que os choros não os levará a ter vida anterior desta realidade. Agora se sentem irritados o tempo todo e não sentem mais prazer nas coisas como antes. No G2, expressaram ideias e sentimentos suicidas, estavam desanimados quanto ao futuro, percebem-se fracassados mais do que uma pessoa sem a doença, e adiam a tomada de decisão mais do que o costume. Conclusão: embora não tenha prevalecido formas severas (graves) de depressão, a ocorrência de sintomas negativos em variadas esferas da vida pode evoluir, especialmente no contexto angolano.

Objective:to know the levels of depression and depressive symptoms in Angolans with HIV. Method: descriptive and mixed study, with sequentialexploratory strategy, in the pre-pandemic period in a public hospital in Angola. Semi-structured interviews were carried out, with the application of the Beck Depression Inventory. For analysis purposes, it considered the concept of depression from the international classification of diseases. Results: mild to moderate depression prevailed for both sexes and marital status. In G1, the majority, in addition to sadness or unhappiness, cannot bear the anguish, some verbalize being aware that crying will not lead them to have a previous life in this reality. Now they feel irritable all the time and they don't enjoy things the way they used to. In G2, they expressed suicidal ideas and feelings, were discouraged about the future, perceived themselves as failures more than a person without the disease, and postponed decision-making more than usual. Conclusion: although severe forms of depression have not prevailed, the occurrence of negative symptoms in various spheres of life can evolve, especially in the angolan context.

Objetivo:conocer los niveles de depresión y síntomas depresivos en angoleños con VIH. Método:estudo descriptivo y misto, con estratégia exploratória secuencial, en el período pré-pandêmico en un hospital público de Angola. Se realizaron entrevistas semiestructuradas, con la aplicación del Inventario de Depresión de Beck. Para efectos de análisis, se consideró el concepto de depresión de la clasificación internacional de enfermedades. Resultados:predominó la depresión leve a moderada para ambos sexos y estado civil. En G1, la mayoría, además de la tristeza o la infelicidad, no pueden soportar la angustia, algunos verbalizan siendo conscientes de que el llanto no los llevará a tener una vida anterior en esta realidad. Ahora se sienten irritables todo el tiempo y no disfrutan las cosas como antes. En G2 expresaron ideas y sentimientos suicidas, estaban desanimados sobre el futuro, se percibían como fracasados más que una persona sin la enfermedad y postergaban la toma de decisiones más de lo habitual. Conclusión:aunque no han prevalecido formas severas de depresión, la aparición de síntomas negativos en diversas esferas de la vida puede evolucionar, especialmente en el contexto angoleño.

Risk factors for seroconversion of HIV among children exposed in the State of Santa Catarina, 2007-2017 / Fatores de risco para a soroconversão de crianças expostas ao HIV no Estado de Santa Catarina, 2007-2017

Abstract Objectives: to estimate the proportion of seroconversion cases among infants exposed to HIV and verify the risk factors associated. Methods: this was a historical cohort study conducted in the State of Santa Catarina between 2007 and 2017. The data were obtained from the Notifable Diseases Information System (SINAN - Portuguese acronym) that records HIV-infected pregnant women and HIV-exposed infants. The public health service monitored the infants from birth to 18 months of age to determine whether HIV seroconversion occurred. Results: a total of 5,554 HIV-infected pregnant women were included in the study (mean age 26.7±6.5 years). They were predominantly white, with poor education level, and were diagnosed with HIV until the 2nd trimester of pregnancy. A total of 4,559 records of HIV-exposed infants were screened, of which 130 cases (2.9%) of seroconversion were confrmed. Non-use of antiretroviral drugs during pregnancy (OR=9.31, CI95%=5.97-14.52; p<0.001) and breastfeeding (OR=3.10, CI95%=1.34-7.20; p=0.008) were independent risk factors for seroconversion. Conclusions: these data demonstrate gaps in prenatal care, regarding adherence to treatment and monitoring of HIV-infected mothers, resulting in new cases of HIV among children, which could be avoided.

Resumo Objetivos: estimar a proporção de soroconversão da criança exposta ao HIV e verificar os fatores de risco associados, no período de 2007-2017 em Santa Catarina. Métodos: o delineamento utilizado foi de coorte histórica e os dados obtidos no Sistema de Informação de Agravos de Notificação (SINAN) que registra as gestantes infectadas e as crianças expostas ao HIV. As crianças foram acompanhadas pelo serviço de saúde desde o nascimento até o 18º mês de vida, para determinar a ocorrência de soroconversão pelo HIV. Resultados: foram identificadas 5.554 gestantes infectadas pelo HIV com média de idade de 26,7±6,5 anos, predomínio da raça branca, baixa escolaridade e que receberam o diagnóstico para o HIV até o 2º trimestre gestacional. Foram incluídas 4.559 fichas de crianças expostas ao HIV, das quais 130 casos (2,9%) de soroconversão foram confrmados. O não uso de antirretroviral durante a gestação (OR=9,31, IC95%=5,97-14,52; p<0,001) e aleitamento materno (OR=3,10, IC95%=1,34-7,20; p=0,008) foram fatores de risco independentes para a soroconversão. Conclusões: esses dados demonstram lacunas na assistência pré-natal, quanto a adesão ao tratamento e acompanhamento de mães infectadas pelo HIV, resultando em casos novos de HIV entre crianças, que poderiam ser evitados.

Cuidados de enfermagem e manifestações clínicas de gestantes HIV positivo: revisão da literatura / Nursing care and clinical manifestations of hiv positive pregnant women: literature review / Atención de enfermería y manifestaciones clínicas de mujeres embarazadas positivas al vih: revisión de la literatura

Objetivo: identificar os cuidados de enfermagem necessários às gestantes com HIV partindo das manifestações clínicas encontradas em revisão da literatura. Método: revisão na literatura realizada na Biblioteca Virtual de Saúde e na Medline/Pubmed, entre abril e junho do ano 2021.Resultados: quanto aos cuidados de enfermagem 24(50%) referiram acompanhar e orientar no tratamento da terapia antirretroviral; 14(29,2%) orientar quanto aos cuidados; principal manifestação clínica/alteração com 13(27%) foi o medo do julgamento, transmissão vertical, efeitos da terapia antirretroviral, de morrer, de infecções oportunistas, estigma, discriminação, complicação obstétrica. Quanto aos diagnósticos de enfermagem destaca-se o medo relacionado a cenário pouco conhecido evidenciado por apreensão, sensação de medo e foco direcionado para a fonte do medo. Conclusão: os cuidados de enfermagem direcionados a gestante diagnosticada com HIV contribuirão para uma assistência mais assertiva, eficaz, inclusiva e respeitosa.

Objective: to identify the necessary nursing care for pregnant women with HIV based on clinical manifestations found in a literature review. Method: literature review conducted in the Virtual Health Library and Medline/Pubmed, between April and June 2021. Results: regarding nursing care, 24 (50%) reported following and guiding the treatment of antiretroviral therapy; 14(29.2%) provide guidance regarding care; main clinical manifestation/alteration with 13 (27%) was fear of judgment, vertical transmission, effects of antiretroviral therapy, dying, opportunistic infections, stigma, discrimination, obstetric complications. As for the nursing diagnoses, the fear related to a little-known scenario, evidenced by apprehension, feeling of fear and focus directed to the source of fear stands out. Conclusion: nursing care aimed at pregnant women diagnosed with HIV will contribute to a more assertive, effective, inclusive and respectful care.

Objetivo: identificar los cuidados de enfermería necesarios para la gestante con VIH, a partir de las manifestaciones clínicas encontradas en una revisión de la literatura. Método: revisión de la literatura realizada en la Biblioteca Virtual en Salud y Medline / Pubmed, entre abril y junio de 2021. Resultados: en el cuidado de enfermería, 24 (50%) refirieron seguir y orientar el tratamiento de la terapia antirretroviral; 14 (29,2%) brindan orientación sobre la atención; La principal manifestación / alteración clínica con 13 (27%) fue miedo al juicio, transmisión vertical, efectos de la terapia antirretroviral, muerte, infecciones oportunistas, estigma, discriminación, complicaciones obstétricas. En cuanto a los diagnósticos de enfermería, destaca el miedo relacionado con un escenario poco conocido, evidenciado por aprensión, sentimiento de miedo y enfoque dirigido a la fuente del miedo. Conclusión: la atención de enfermería dirigida a la gestante diagnosticada con VIH contribuirá a una atención más asertiva, eficaz, inclusiva y respetuosa.

Recency of HIV infection, antiretroviral therapy use and viral loads among symptomatic sexually transmitted infection service attendees in South Africa

Background. Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections. Objectives. To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa. Methods. In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) ≤200 copies/mL were considered virally suppressed. Results. Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed. Conclusions. In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission

An evaluation of challenges with the South African PMTCT HIV programme seen from the perspective of HIV-positive children admitted to the PICU

Background. Mother-to-child transmissions (MTCT) accounts for 90% of the 370 000 new HIV-positive children, globally. Despite progress in the prevention of mother-to-child transmission (PMTCT) of HIV, children still acquire HIV infection. Objective. To identify and describe the prevalence of maternal, infant and/or health system-related risk factors gleaned from the literature for HIV transmission in HIV-positive children admitted to the paediatric intensive care unit (PICU) at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa. Method. A retrospective electronic chart review identifying all HIV-positive children under 2 years admitted to the PICU at IALCH between January 2017 and December 2019 was undertaken. Individual patient records were analysed using a standardised template. Results. Of the 80 mothers and children with HIV enrolled in the present study, 38.8% (n=31/80) of mothers were diagnosed prior to pregnancy, 42.5% (n=34/80) were diagnosed during pregnancy (unsure when exactly transmission occurred), and 18.8% (n=15/80) of mothers were diagnosed after delivery. The median (range) time of antiretroviral treatment (ART) was 225 (30 - 365) days for mothers. More than half of mothers (56.3%, n=45/80) whose babies became HIV-positive had poor adherence to antiretroviral drugs (HIV viral load >1 000 copies/mL). An HIV-positive diagnosis in the children of these mothers occurred throughout infancy and early childhood, especially in the first 6 months (87.5%, n=70/80). A third of mothers practised mixed feeding. Health system deficiency, mainly via cancellation of tests without notifying healthcare workers, was typical in infants (33%; n=26/80) and mothers (68.8%, n=55/80). All others (100%) were not counselled about the importance of PMTCT and 93.8% of mothers were not counselled about the importance of follow-up. Almost all HIV-positive infants (95%, n=76) presented with severe respiratory illness, mainly severe acute respiratory distress syndrome (62.5%, n=50/80) and pneumonia with hypoxic respiratory failure (32.5%, n=26/80). The overall mortality of the cohort was 22.5% (n=18/80), and most deaths were associated with cytomegalovirus (CMV), Pneumocystis jirovecii pneumonia (PJP) or both (61.1%, n=11/18). Conclusion. This present study confirmed that a new diagnosis of HIV positivity occurs throughout pregnancy and early childhood in infants. Poor adherence to ART in mothers and their infants, poor counselling, failure to attend antenatal and postnatal care, mixed feeding, and challenged laboratory services were common modifiable factors that need addressing.

Infant feeding knowledge and practice among HIVpositive mothers attending HIV treatment centres in Lagos

Background: Twenty five to forty percent of children will be infected with HIV in the absence of any form of intervention which is Prevention of Mother to Child Transmission (PMTCT). Objectives: This study determined the infant feeding knowledge and practices among HIV positive mothers attending HIV treatment centers in Lagos. Methods: A descriptive crosssectional design was used for the study. A multistage sampling technique was used to select / recruit 290 HIV positive mothers with babies between the ages of 2weeks to 18months, attending PMTCT services into the study Pre-tested interviewer administered structured questionnaire was used to collect data and analysis was done using Epi-info software. Chi-square and Fischer exact tests were used to determine association between the dependent and independent variables. The pvalue was set at 0.05. Results: Majority of the respondents (58.9%) were within the age range of 31 ­ 40 years and about half had a secondary school level of education. Exclusive formula feeding (40.3%) and exclusive breast feeding (42.4%) were feeding options known by the majority of the respondents. More than half (55.5%) of the mothers had a good knowledge of infant feeding options. Exclusive breastfeeding (EBF) was practiced by majority (55.5%) of the respondents, 21.4% practiced exclusive formula feeding (EFF) while only 6% practiced mixed feeding (MF). Knowledge of infant feeding options and the attitude towards exclusive breast feeding being enough in the first 6 months of life were associated with infant feeding options practiced; those with good knowledge of infant feeding options did not practice MF (9.7%) (p = 0.013). Conclusion: knowledge of infant feeding options was good and poor knowledge was associated with exclusive formula feeding. Majority practiced EBF. Educational programmes targeted at improving the knowledge of HIV and infant feeding options as well as strengthening of counseling sessions at PMTCT clinic would help reduce the risk of HIV transmission to the child.

Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa

Background. Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression. Objectives. To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother's confidence in her competence as caregiver, and demographic and medical variables, were also examined. Methods. Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment. Results. The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being 'able to laugh and see the funny side of things' and 'looking forward with enjoyment to things' at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant. Conclusion. This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.

Bitter kola and kola nut use and their effect on treatment outcome on People Living with HIV at a Military Hospital in Benue state Nigeria: Bitter kola (Garcinia) and Cola nut (Cola nitida among PLWHIV

Introduction Bitter Kola (Garcinia Kola) and kola nut, contains substances attributed to numerous effects on humans including anti-inflammatory, anti-allergic properties, anti-infective and caffeinism. This study explores Bitter kola and kola nut use and its impact on treatment outcome on People Living with HIV (PLWHIV). Methods: The study was conducted at a Military Hospital in Nigeria. An analytical cross-sectional study was done using questionnaire among 700 HIV-positive clients selected using simple random sampling. Data were collected by researcher and three trained assistants. Chi-square test and binary logistic regression were used for identifying associations and predictors, respectively. The level of significance was set at p < 0.05. Results: Findings show that 260 (63.6%) and 179 (25.6%) have ever and currently used Bitter kola/Kola nut, respectively. Also, 14 (7.8%) used Bitter kola/Kola nut alone while 165 (92.2%) used it in addition to other substances, especially with alcohol 123 (68.7%). Bitter kola use was associated with age (p = 0.037), gender (p < 0.001), occupation (p = 0.001), and number of children (p < 0.011). Identified predictors were being a female (AOR 0.79; 95% CI 0.08-0.92) and earning <18,000 Naira (AOR 2.91; 95% CI 2.03-21.54). There was no association of Bitter kola/kola nut use with CD4 count and viral load suppression. Conclusion: Though Kola nut and Bitter kola use was high as in the general population we have not found any effect on treatment outcome among PLWHIV. This calls for more research to ascertain if there are other possible beneficial effects on PLWHIV.

Quantifying the relationship of HIV infection with clinicopathological spectrum and outcome among patients with colorectal cancer in a South African population

Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic, Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates

Maternal outcomes among HIV positive pregnant mothers and birth outcomes of HIV exposed newborns in Nyahururu County Referral Hospital, Kenya

Background Approximately 37 million people were living with HIV by the end of 2015. This led to high morbidity and mortality among women of childbearing age, especially in SubSaharan Africa which was the epicentre of this global pandemic. Strengthening and implementing prevention of mother-to-child (PMTCT) services could reduce the incidence of vertical transmission and improve quality of life. We aimed to determine maternal and birth outcomes among HIV-positive pregnant mothers and HIV-exposed newborns in Nyahururu county referral hospital, Laikipia, Kenya. Main Outcomes Measures Reduce maternal morbidity and mortality and other birth-related complications. In addition, this will also reduce infant mortality and morbidity among HIV-exposed infants. Materials And Methods This was a hospital-based descriptive prospective study conducted at the PMTCT department at the Nyahururu County referral hospital. A sample of 180 HIV-positive pregnant women enrolled at the PMTCT consented to participate in the study. We monitored them until delivery and labour complications were addressed. Babies were scored against the APGAR scale, weighed and spot dried blood samples taken before breastfeeding; and started on prophylactic antiretroviral therapy. RESULTS Out of 180 participants, only 17 did not complete the study. Our findings indicate that 97.5 % of the mothers delivered in the hospital, had labour lasting less than 12 hours, 92.6% had a normal delivery and 94.9% had no complications during the labour period. About 2.5 % of the women had misoprostol administration. The majority of exposed babies had an average weight of between 2.51 - 3.00kg. No neonatal asphyxia was evident among exposed babies. Conclusions: The majority of the respondents delivered in the hospital; no neonatal asphyxia was evidenced and there was a significant correlation between APGAR scores and infant weight. There is a need for active follow-up and monitoring of HIV pregnant women and their unborn babies until delivery.

Pratiques alimentaires et état nutritionnel des nourrissons exposés au VIH dans un centre de santé à Abidjan / Feeding practices and nutritional satus of infants exposed to HIV in a health center in Abidjan

Introduction. L'objectif de notre étude était de décrire les pratiques alimentaires des nourrissons nés de mères infectées par le VIH ainsi que leur état nutritionnel. Méthodes. Il s'agit d'une étude transversale à visée descriptive et analytique sur une période de 2 mois (01 juin au 03 Août 2016) portant sur 101 nourrissons nés de mères séropositives âgés de 6 à 24 mois au moment de l'enquête. Des informations sur les pratiques alimentaires et l'état nutritionnel des nourrissons ont été recueillies. Résultats. L'âge moyen des nourrissons était de 14,5 mois et le sex ratio de 0,71. Plus de 3/4 des nourrissons étaient eutrophiques à la naissance (77,2%). Le budget alimentaire des ménages était compris entre 2000 f/CFA et 3000 f/CFA (45,54 %). L'allaitement maternel a été réalisé chez 73,3% des nourrissons. La prévalence de l'AME était de 65,4%. L'âge à l'arrêt de l'allaitement était de 6 mois chez plus de la moitié (52,7%) des nourrissons. la majorité des nourrissons (99,0%) avait une fréquence de repas adaptée à leur âge. L'âge d'introduction d'aliments de complément était inadapté chez un tiers des nourrissons (30,6%), l'âge d'introduction au repas familial était inapproprié chez 64,9 % des nourrissons et plus de la moitié des nourrissons (53,3%) avait une fréquence de repas lactés inadaptée. le score de diversifi cation alimentaire était ≥ 4 aliments chez 18,8% des cas. Les céréales et les tubercules ont été le plus souvent consommés par les nourrissons (97 %) contrairement aux fruits et légumes riches en vitamines A (20%) et aux œufs (14%). Une émaciation a été relevée dans 9,9% des cas. Les pratiques alimentaires associés à la malnutrition étaient l'âge d'introduction d'aliments solides, semis liquides et mous inadapté p=0,001, l'âge d'introduction au repas familial inadapté p=0,015, la fréquence alimentaire minimale inadaptée p=0,001 et le minimum alimentaire acceptable insuffi sant p=0,012. La prévalence du VIH était de 5,9% Conclusion. Les nourrissons nés de mères séropositives sont vulnérables à la malnutrition. Les acteurs des services de PTME doivent insister dans leurs pratiques sur la prise en charge nutritionnelle de ces nourrissons.