Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

Abstract There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

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Pediatric Access and Continuity of HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000001213 ◽

2016 ◽

Vol 35 (9) ◽

pp. 981-986 ◽

Cited By ~ 3

Author(s):

Mathieu Bastard ◽

Elisabeth Poulet ◽

Nathalie Nicolay ◽

Elisabeth Szumilin ◽

Suna Balkan ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan

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Accessing antiretroviral therapy for children: Caregivers' voices

Health SA Gesondheid ◽

10.4102/hsag.v21i0.987 ◽

2016 ◽

Vol 21 ◽

pp. 331-338

Author(s):

Margaret Williams ◽

Dalena R.M. Van Rooyen ◽

Esmeralda J. Ricks

Keyword(s):

Antiretroviral Therapy ◽

Tertiary Care ◽

Scale Up ◽

Target Population ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Eastern Cape ◽

Care Facilities ◽

Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

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Feasibility and acceptability of financial incentives and peer-led life skills training for improving adherence to antiretroviral therapy among adolescents living with HIV in Rwanda: A pilot study

10.21203/rs.3.rs-23345/v1 ◽

2020 ◽

Author(s):

Majdi Osman ◽

Simon Pierre Niyonsenga ◽

Manasi Sharma ◽

Rebecca Hope ◽

Shannon Milroy ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Pilot Study ◽

Financial Incentives ◽

Life Skills ◽

Skills Training ◽

Sub Saharan Africa ◽

Hiv Care ◽

Art Adherence ◽

Life Skills Training ◽

Sub Saharan

Abstract Background The Human Immunodeficiency Virus (HIV) is the leading cause of death among adolescents in sub-Saharan Africa. Despite the long-term benefits of antiretroviral therapy (ART), adherence remains low among adolescents due to challenges related to cost, acquisition, and treatment regimen. Sub-optimal adherence to ART is associated with the development of viral resistance, treatment failure, and increased morbidity and mortality. Financial incentives and life skills training interventions have shown early promise in motivating protective behaviors, however, gaps still remain around effective and innovative ways to motivate adolescents to stay in HIV care. In partnership with youth, we developed an intervention to address their social and financial pressures in order to promote adherence. Methods A human-centered design approach was utilized to engage adolescents in the initial design of the intervention. Through random sampling, 72 adolescents ages 12–19 were then recruited from two clinics in Rwanda for the pilot study. Adolescents participated in three monthly peer-led life skills trainings at clinics and received financial incentives via mobile money upon clinic attendance and demonstration of suppressed viral load. Semi-structured interviews were then conducted with adolescents, healthcare workers, and caregivers to understand their experiences with the intervention. Results Participants responded favorably to the intervention because of the psychosocial, financial, and health benefits it provided. Caregivers felt that adolescents’ moods, attitudes, and overall well-being improved over time. Adolescents used funds to purchase school supplies and save for investments, thus mitigating their financial burdens. Additionally, we learned that logistical challenges such as SIM card registration and mobile phone access must be considered for scale-up of the intervention. Conclusions To our knowledge, this is the first intervention designed in partnership with youth in sub-Saharan Africa aimed at removing financial barriers to ART adherence. The findings suggest that involving youth in the design of programs, providing them with financial incentives, and training them to use and invest their money wisely has a positive effect on them and their families. Thus, to improve adherence to ART and retention in care among HIV-positive youth, it is critical to address their socioeconomic and psychosocial needs.

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Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya

AIDS Care ◽

10.1080/09540121.2018.1500995 ◽

2018 ◽

Vol 30 (12) ◽

pp. 1477-1487 ◽

Cited By ~ 12

Author(s):

Jill M. Hagey ◽

Xuan Li ◽

Jill Barr-Walker ◽

Jeremy Penner ◽

Julie Kadima ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Scoping Review ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan

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Adults Receiving HIV Care Before the Start of Antiretroviral Therapy in Sub-Saharan Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182a61e8d ◽

2013 ◽

Vol 64 (5) ◽

pp. 455-463 ◽

Cited By ~ 11

Author(s):

Mathieu Bastard ◽

Nathalie Nicolay ◽

Elisabeth Szumilin ◽

Suna Balkan ◽

Elisabeth Poulet ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan

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Screening tools for HIV-associated neurocognitive disorders among adults living with HIV in sub-Saharan Africa: A scoping review

AAS Open Research ◽

10.12688/aasopenres.12921.2 ◽

2019 ◽

Vol 1 ◽

pp. 28 ◽

Cited By ~ 1

Author(s):

Patrick N. Mwangala ◽

Charles R. Newton ◽

Melanie Abas ◽

Amina Abubakar

Keyword(s):

South Africa ◽

Diagnostic Accuracy ◽

Psychometric Properties ◽

Neurocognitive Disorders ◽

Screening Tools ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan ◽

Living With Hiv ◽

Hiv Associated Neurocognitive Disorders

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify clinically important changes in cognitive functioning and allow for early interventions. However, HAND detection in routine clinical practice has never been reported in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy. Methods: We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA. Results: We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for mild forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity). Conclusions: This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new HAND screening tools in SSA.

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Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from President's Emergency Plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.010442 ◽

2011 ◽

Vol 22 (11) ◽

pp. 621-627 ◽

Cited By ~ 27

Author(s):

T D Moon ◽

J R Burlison ◽

M Blevins ◽

B E Shepherd ◽

A Baptista ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Linkage To Care ◽

Routine Data ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Hiv Care ◽

Emergency Plan ◽

Art Initiation ◽

Rural Africa ◽

Sub Saharan

Summary Many countries in sub-Saharan Africa have made antiretroviral therapy (ART) available in urban settings, but the progress of treatment expansion into rural Africa has been slower. We analysed routine data for patients enrolled in a rural HIV treatment programme in Zambézia Province, Mozambique (1 June 2006 through 30 March 2009). There were 12,218 patients who were ≥15 years old enrolled (69% women). Median age was 25 years for women and 31 years for men. Older age and higher level of education were strongly predictive of ART initiation (P < 0.001). Patients with a CD4+ count of 350 cells/μL versus 50 cells/μL were less likely to begin ART (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.16-0.23). In rural sub-Saharan Africa, HIV testing, linkage to care, logistics for ART initiation and fears among some patients to take ART require specialized planning to maximize successes. Sustainability will require improved health manpower, infrastructure, stable funding, continuous drug supplies, patient record systems and, most importantly, community engagement.

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Screening tools for HIV-associated neurocognitive disorders among adults living with HIV in sub-Saharan Africa: A scoping review

AAS Open Research ◽

10.12688/aasopenres.12921.1 ◽

2018 ◽

Vol 1 ◽

pp. 28 ◽

Cited By ~ 1

Author(s):

Patrick N. Mwangala ◽

Charles R. Newton ◽

Melanie Abas ◽

Amina Abubakar

Keyword(s):

South Africa ◽

Diagnostic Accuracy ◽

Psychometric Properties ◽

Neurocognitive Disorders ◽

Screening Tools ◽

Sub Saharan Africa ◽

Hiv Care ◽

Sub Saharan ◽

Living With Hiv ◽

Hiv Associated Neurocognitive Disorders

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify subtle changes in cognitive functioning and allow for early interventions. However, HAND detection is rarely done in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy.Methods:We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA.Results:We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for moderate forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity).Conclusions:This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new tools to make them sensitive and specific enough to identify both severe and moderate forms of HAND in SSA.

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