Effects of Maternal Suicidal Ideation on Child Cognitive Development: A Longitudinal Analysis.

This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother-child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference - 6.1; 95% CI - 10.3 to - 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.

Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study.

Setting: Government health centres and hospitals (six urban and 20 rural) providing tuberculosis (TB) treatment for people living with the human immunodeficiency virus (PLHIV) in central and western Uganda. Objective: To identify and quantify modifiable factors that limit TB treatment success among PLHIV in rural Uganda. Design: A retrospective cross-sectional review of routine Uganda National Tuberculosis and Leprosy Programme clinic registers and patient files of HIV-positive patients who received anti-tuberculosis treatment in 2014. Results: Of 191 rural patients, 66.7% achieved treatment success compared to 81.1% of 213 urban patients. Adjusted analysis revealed higher average treatment success in urban patients than in rural patients (OR 3.95, 95%CI 2.70-5.78, P < 0.01, generalised estimating equation model). Loss to follow-up was higher and follow-up sputum smear results were less frequently recorded in TB clinic registers among rural patients. Patients receiving treatment at higher-level facilities in rural settings had greater odds of treatment success, while patients receiving treatment at facilities where drug stock-outs had occurred had lower odds of treatment success. Conclusion: Lower reported treatment success in rural settings is mainly attributed to clinic-centred factors such as treatment monitoring procedures. We recommend strengthening treatment monitoring and delivery.

Contexte: L'étude a été réalisée dans des centres de santé et des hôpitaux publics, six urbains et 20 ruraux, fournissant un traitement de la tuberculose (TB) aux personnes vivant avec le VIH (PVVIH) dans le centre et l'ouest de l'Ouganda.Objectif: Identifier et quantifier les facteurs modifiables qui limitent le succès du traitement de la TB parmi les PVVIH dans l'Ouganda rural.Schéma: Une revue rétrospective transversale des registres cliniques et des dossiers de patients du Programme national tuberculose et lèpre d'Ouganda pour les patients VIH positifs qui ont reçu un traitement de TB en 2014.Résultats: Parmi 191 patients ruraux, 66,7% ont eu un bon résultat de leur traitement, tandis que parmi 213 patients urbains, 81,1% ont eu un bon résultat. Une analyse ajustée a révélé un succès thérapeutique moyen plus élevé chez les patients urbains comparés aux patients ruraux (OR 3,95 ; IC95% 2,70­5,78 ; P < 0,01 ; modèle d'équation d'estimation généralisée). Les pertes de vue ont été plus élevées et les résultats de frottis de crachats de suivi ont été moins souvent enregistrés dans les registres des centres TB pour les patients ruraux. Les patients recevant un traitement dans des structures de plus haut niveau, toujours en zone rurale, avaient plus de chances d'avoir un succès thérapeutique. Les patients recevant leur traitement dans des structures où étaient survenues des ruptures de stock de médicaments avaient moins de chances de succès thérapeutique.Conclusion: Les taux plus faibles de succès du traitement rapportés en zone rurale sont en majorité attribués à des facteurs liés aux centres de santé, comme les procédures de suivi du traitement. Nous recommandons le renforcement de la fourniture et du suivi du traitement.

Marco de referencia: El estudio se llevó a cabo en centros de salud y hospitales del sector público, seis en entornos urbanos y 20 en medio rural y consistió en suministrar el tratamiento antituberculoso a las personas positivas frente al virus de la inmunodeficiencia humana (VIH) en la región central y occidental de Uganda.Objetivo: Determinar y cuantificar los factores modificables que limitan la eficacia del tratamiento antituberculoso en las personas positivas frente al VIH en las zonas rurales de Uganda.Método: Fue este un estudio transversal retrospectivo de análisis de los registros corrientes y las historias clínicas de los pacientes positivos frente al VIH, en los consultorios del Programa Nacional contra la Tuberculosis y la Lepra de Uganda en el 2014.Resultados: De los 191 pacientes de entornos rurales, el 66,7% logró un tratamiento eficaz y en los 213 pacientes en medio urbano esta proporción fue 81,1%. Un análisis ajustado reveló un promedio de éxito terapéutico más alto en los pacientes urbanos en comparación con los pacientes rurales (OR 3,95; IC95% de 2,70 a 5,78; P < 0,01, según un modelo de ecuaciones de estimación generalizadas). En medio rural, se observó una mayor pérdida durante el seguimiento y se consignaban con menor frecuencia los resultados de las baciloscopias de seguimiento en los registros de tuberculosis de los consultorios. Los pacientes que recibían tratamiento en los establecimientos de nivel de atención más alto en medio rural tenían mayores posibilidades de éxito terapéutico. Los pacientes que recibían tratamiento en centros que presentaban desabastecimientos de medicamentos tuvieron menos probabilidades de lograr un tratamiento eficaz.Conclusión: La menor proporción de éxito terapéutico notificada en los entornos rurales se debe en su mayor parte a factores que dependen del consultorio, como los procedimientos de supervisión del tratamiento. Se recomienda reforzar la supervisión y el suministro del tratamiento antituberculoso.

Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment.

OBJECTIVES: Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. METHODS: The study involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index <18.5 kg/m2 ) and requiring ART. The relationship of grip strength to nutritional, infectious and demographic factors was assessed by multivariable linear regression at referral for ART (n = 1742) and after 12 weeks (n = 778) and 2-3 years of ART (n = 273). RESULTS: In analyses controlled only for sex, age and height, most nutrition and infection-related variables were associated with grip strength. However, in multivariable analyses, consistent associations were seen for fat-free mass index, mid-upper arm circumference, haemoglobin and systolic blood pressure, and a variable association with fat mass index in men. C-reactive protein and CD4 count had limited independent effects on grip strength, while receiving tuberculosis treatment was associated with weaker grip strength. CONCLUSIONS: In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment and management and could use grip strength as a functional indicator of improving nutrition.

Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?

METHODS: Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. RESULTS: In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. CONCLUSIONS: Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.

A longitudinal study of systemic inflammation and recovery of lean body mass among malnourished HIV-infected adults starting antiretroviral therapy in Tanzania and Zambia.

BACKGROUND/OBJECTIVES: The effects of inflammation on nutritional rehabilitation after starting antiretroviral therapy (ART) are not well understood. We assessed the relationship between inflammation and body composition among patients enrolled in the Nutritional Support for African Adults Starting Antiretroviral therapy (NUSTART) trial in Tanzania and Zambia from 2011 to 2013. SUBJECTS/METHODS: HIV-infected, ART-eligible adults with body mass index (BMI) of <18.5 kg/m(2) enrolled in the NUSTART trial were eligible for this study. Anthropometric and body composition data were collected at recruitment and 6 and 12 weeks post ART and C-reactive protein (CRP) was measured at recruitment and 6 weeks. The relationships between CRP and body composition were assessed using multiple regression. RESULTS: Of the 1815 trial participants, 838 (46%) had baseline and 6-week CRP measurements. Median age was 36 years, 55% were females and median CD4 count was 135 cells/µl. A one-log reduction in CRP at 6 weeks was associated with increased mid-upper arm circumference (0.45 cm; 95% CI: 0.30, 0.61), calf circumference (0.38 cm; 0.23, 0.54), waist circumference (0.98 cm; 0.59, 1.37), BMI (0.37 kg/m(2); 0.24, 0.50) and fat-free mass (0.58 kg; 0.26, 0.91), but not with fat mass (0.09 kg; -0.17, 0.34). Fat-free mass gains persisted at 12 weeks and were more closely associated with 6-week CRP values than with baseline values. CONCLUSIONS: Reduction in CRP shortly after ART initiation was associated with higher fat-free mass gains. Further studies are warranted to determine whether interventions to reduce systemic inflammation will enhance gains in fat-free mass.