Does timing of antiretroviral treatment influence treatment outcomes of visceral leishmaniasis in Northwest Ethiopia?

Background: Visceral leishmaniasis (VL) patients with HIV co-infection should receive antiretroviral treatment (ART). However, the best timing for initiation of ART is not known. Among such individuals, we assessed the influence of ART timing on VL outcomes. Methods: A retrospective cohort study was conducted in Northwest Ethiopia among VL patients starting ART between 2008 and 2015. VL outcomes were assessed by the twelfth month of starting ART, within 4 weeks of VL diagnosis or thereafter. Results: Of 213 VL-HIV co-infected patients with ART initiation, 96 (45.1%) had moderate to severe malnutrition, 53 (24.9%) had active TB and 128 (60.1%) had hemoglobin levels under 9 g/dL. Eighty-nine (41.8%) were already on ART before VL diagnosis, 46 (21.6%) started ART within 4 weeks, and 78 (36.6%) thereafter. Definitive cure in those starting ART within 4 weeks 59% (95% CI 43-75%) and those starting thereafter 56% (95% CI 44-68%) was not significantly different. Those starting ART before primary VL had higher 12-months mortality compared to those starting later (RR 0.6; 95% CI 0.4-0.9; p=0.012). Conclusions: VL-HIV patients are severely ill and with serious additional comorbidities. Outcomes of HIV-VL management are unsatisfactory and early ART initiation was associated with higher mortality. Further research on the optimal timing of ART initiation, and ensuring earlier diagnosis of VL patients, with improved management of comorbidities are needed.

Quality of life domains relevant to people living with HIV and AIDS who are on antiretroviral therapy in Swaziland.

Quality of life (QOL) domains that are context specific to people living with HIV and AIDS (PLWHA) who are on antiretroviral therapy (ART) in Swaziland are unknown. This presents a problem when research has to be conducted on QOL of PLWHA who are on ART. As a result, this study was conducted to identify, validate and describe domains necessary to assess QOL of PLWHA, who are on ART in Swaziland. A qualitative, explorative, descriptive, and contextual design was used for this study. The first phase dealt with a review of fifty existing QOL definitions and the identification of the common domains amongst them. Findings from this review revealed that the most common domains of QOL are the physiological, psychological, spiritual and socio-economic domains. The second phase was the validation of the above common domains identified from the examined QOL definitions to make them context specific to PLWHA who are on ART in Swaziland. A workshop was used to validate the domains with expert nurses involved in the care of PLWHA in Swaziland. The experts in ART care were trained on ART and had more than a year's experience of working with PLWHA who are on ART. The validation process revealed that the essential context specific domains to consider when assessing QOL of PLWHA who are on ART are, (1) physiological domain, (2) psychological domain, (3) spiritual domain, (4) socio-economic domain, (5) cognitive domain, and (6) environmental domain. The process of validation of the domains was important as two extra domains were revealed, which were not initially recognised by the researcher during literature review.