scholarly journals Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status

2020 ◽  
Author(s):  
Christine Kelly ◽  
Willard Tinago ◽  
Dagmar Alber ◽  
Patricia Hunter ◽  
Natasha Luckhurst ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Arterial Stiffness ◽  
Socioeconomic Factors ◽  
Low Income ◽  
Immune Activation ◽  
Communicable Diseases ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Non Communicable Diseases ◽  
Living With Hiv

BackgroundNon-communicable diseases (NCDs) are increased amongst people living with HIV (PLWH) and are driven by persistent immune activation. The role of socioeconomic status (SES) in immune activation amongst PLWH is unknown, especially in low income sub Saharan Africa (SSA), where such impacts may be particularly severe.MethodsWe recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2 and 42 weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models.ResultsOf 279 PLWH, the median (IQR) age was 36 (31-43) years and 122 (44%) female. Activated CD8 T-cells increased from 70% amongst those with no education to 88% amongst those with a tertiary education (p=0.002); and from 71% amongst those earning less than 10 USD/month to 87% amongst those earning between 100-150 USD/month (p=0.0001). Arterial stiffness was also associated with higher SES (car ownership p=0.003, television ownership p=0.012 and electricity access p=0.029). Conversely, intermediate monocytes were higher amongst those with no education compared to a tertiary education (12.6% versus 7.3%; p=0.01) and amongst those earning less than 10 USD/month compared to 100-150 USD/month (10.5% versus 8.0%; p=0.08). Water kiosk use was protective against T cell activation (p=0.007), as well as endothelial damage (MIP1β, sICAM1 and sVCAM1 p=0.047, 0.026 and 0.031 respectively).ConclusionsSocioeconomic risk factors for persistent inflammation amongst PLWH in SSA differ depending on the type of inflammatory pathway. Understanding these pathways and their socioeconomic drivers will help identify those at risk and target interventions for NCDs. Future studies assessing drivers of inflammation amongst PLWH should include an SES assessment.Key pointsWhat is already known?Persistent immune activation drives an increased risk of non-communicable diseases amongst people living with HIV. The aetiology of persistent immune activation amongst PLWH is complex and includes microbial translocation, subclinical co-infection and continued low level HIV viral replication. However, the contribution of socioeconomic factors has not previously been investigated, and may be especially relevant amongst those living in low income settings.What are the new findings?The contribution of socioeconomic factors to persistent inflammation differs according to the type of inflammatory pathway. PLWH with higher socioeconomic status are at increased risk of T cell activation and arterial stiffness, perhaps as a result of more sedentary lifestyles. Conversely, evidence of innate immune activation is seen amongst those with lower socioeconomic status. Water kiosk use is associated with a favourable inflammatory profile.What do the findings imply?The phenotype of chronic immune activation amongst PLWH in a low-income sub-Saharan Africa setting differs according to socioeconomic status. We recommend incorporation of socioeconomic factors into future studies assessing the relationship between chronic inflammation and non-communicable diseases amongst HIV populations.

scholarly journals Inflammatory pathways amongst people living with HIV in Malawi differ according to socioeconomic status

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256576
Author(s):  
Christine Kelly ◽  
Willard Tinago ◽  
Dagmar Alber ◽  
Patricia Hunter ◽  
Natasha Luckhurst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Arterial Stiffness ◽  
Immune Activation ◽  
Tertiary Education ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Socioeconomic Risk ◽  
Socioeconomic Risk Factors

Background Non-communicable diseases (NCDs) are increased amongst people living with HIV (PLWH) and are driven by persistent immune activation. The role of socioeconomic status (SES) in immune activation amongst PLWH is unknown, especially in low-income sub-Saharan Africa (SSA), where such impacts may be particularly severe. Methods We recruited Malawian adults with CD4<100 cells/ul two weeks after starting ART in the REALITY trial (NCT01825031), as well as volunteers without HIV infection. Clinical assessment, socioeconomic evaluation, blood draw for immune activation markers and carotid femoral pulse wave velocity (cfPWV) were carried out at 2- and 42-weeks post-ART initiation. Socioeconomic risk factors for immune activation and arterial stiffness were assessed using linear regression models. Results Of 279 PLWH, the median (IQR) age was 36 (31–43) years and 122 (44%) were female. Activated CD8 T-cells increased from 70% amongst those with no education to 88% amongst those with a tertiary education (p = 0.002); and from 71% amongst those earning less than 10 USD/month to 87% amongst those earning between 100–150 USD/month (p = 0.0001). Arterial stiffness was also associated with higher SES (car ownership p = 0.003, television ownership p = 0.012 and electricity access p = 0.029). Conversely, intermediate monocytes were higher amongst those with no education compared to a tertiary education (12.6% versus 7.3%; p = 0.01) and trended towards being higher amongst those earning less than 10 USD/month compared to 100–150 USD/month (10.5% versus 8.0%; p = 0.08). Water kiosk use showed a protective association against T cell activation (p = 0.007), as well as endothelial damage (MIP1β, sICAM1 and sVCAM1 p = 0.047, 0.026 and 0.031 respectively). Conclusions Socioeconomic risk factors for persistent inflammation amongst PLWH in SSA differ depending on the type of inflammatory pathway. Understanding these pathways and their socioeconomic drivers will help identify those at risk and target interventions for NCDs. Future studies assessing drivers of inflammation in HIV should include an SES assessment.

scholarly journals Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil

2013 ◽  
Vol 16 (2) ◽  
pp. 432-443 ◽  
Author(s):  
Joanna d’Arc Lyra Batista ◽  
Maria de Fátima Pessoa Militão de Albuquerque ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Demócrito de Barros Miranda-Filho ◽  
Heloisa Ramos Lacerda de Melo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Socioeconomic Factors ◽  
Low Income ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Heavy Alcohol ◽  
Factors Associated ◽  
Risk Of Death ◽  
Living With Hiv ◽  
Hiv Aids

Introduction: Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. Objective: To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. Methods: A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. Results: The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. Conclusions: It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases.

scholarly journals Setting up a nurse-led model of care for management of Hypertension and Diabetes Mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

2019 ◽  
Author(s):  
Marthe Marie Frieden ◽  
Blessing Zamba ◽  
Nisbert Mukumbi ◽  
Patron Titsha Mafaune ◽  
Brian Makumbe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Low Income ◽  
Descriptive Study ◽  
Communicable Diseases ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Income Country ◽  
Model Of Care ◽  
Non Communicable Diseases ◽  
Low Income Country

Abstract Background In light of the increasing burden of non-communicable diseases on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context adapted cost effective service delivery models are now required as a matter of urgency. Multiple models have thus been trialled across Africa with varying degrees of success. Zimbabwe is a low-income country with unique socio-economic challenges but similar dual disease burden of infectious chronic diseases such as HIV and non-communicable diseases. We aim to describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in a rural context of a low-income country from July 2016 to June 2019.Methods A descriptive study based on a conceptual framework successfully applied in the roll-out of antiretroviral therapy in Manicaland Province, Zimbabwe. Attempting to mirror the HIV experience, we describe the key enablers in the design and implementation of the model: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system.Results 11 out of 51 health facilities were selected in Chipinge district, of which nine were primary health care (PHC) clinics and two were hospitals. DM/HTN services were set up and integrated into the general out-patient department or pre-existing HIV clinics. In one hospital, an integrated chronic care clinic was established. Through structured intensive mentoring, including simplified protocols, nurses in seven PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM/HTN patients. Overall, more than 3000 patients were registered in a dedicated recording system and offered education. Free medication with differentiated periodic refills and regular monitoring of blood pressure and/or blood glucose with the use of glycosylated haemoglobin were provided.Conclusion Our experience shows that it is feasible to implement nurse-led decentralized integrated DM/HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process.

scholarly journals Setting up a nurse-led model of care for management of Hypertension and Diabetes Mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

2020 ◽  
Author(s):  
Marthe Marie Frieden ◽  
Blessing Zamba ◽  
Nisbert Mukumbi ◽  
Patron Titsha Mafaune ◽  
Brian Makumbe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Low Income ◽  
Communicable Diseases ◽  
Hiv Prevalence ◽  
Lessons Learned ◽  
Sub Saharan Africa ◽  
Model Of Care ◽  
Integration Of Care ◽  
Non Communicable Diseases ◽  
Design And Implementation

Abstract Background In the light of the increasing burden of non-communicable diseases on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are required urgently. Multiple models have been trialled across Africa with varying degrees of success. Zimbabwe is a low-income country with unique socio-economic challenges and a dual disease burden of infectious chronic diseases such as HIV and non-communicable diseases. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe from July 2016 to June 2019. Programme design and implementation We used a conceptual framework successfully applied in the roll-out of antiretroviral therapy in Zimbabwe. Mirroring the HIV experience, we describe key enablers in the design and implementation of the model: decentralization of services, integration of care, simplification of guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. DM and HTN services were set up in 9 primary health care (PHC) facilities and two hospitals in Chipinge district, and integrated into the general out-patient department or pre-existing HIV clinics. In one hospital, an integrated chronic care clinic (ICCC) emerged. We provided mentoring for staff using simplified protocols, and patient education. Free medication and monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose and manage DM and HTN patients, and 3094 patients were registered. Major lessons learned include: the value of POC devices in the management of diabetes; the pressure on services due to added caseload, exacerbated by the availability of free medications; and the importance of leadership in successful programme implementation. Conclusion Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.

scholarly journals Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda

1970 ◽  
Vol 19 (4) ◽  
pp. 3181-3189
Author(s):  
Juvenal Biraguma ◽  
Eugene Mutimura ◽  
José M Frantz
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Communicable Diseases ◽  
Health Concern ◽  
People Living With Hiv ◽  
Modifiable Risk Factors ◽  
Diabetes Research ◽  
Non Communicable Diseases ◽  
Increased Risk ◽  
Living With Hiv

Background: Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes. Research has revealed that there is a relationship between knowledge of NCD risk factors and risk perceptions in the general population. Therefore, an assessment of PLHIV’s NCD risk factors knowledge is quite critical, to design effective NCD prevention programmes.Objective: To assess the level of knowledge of modifiable risk factors for NCDs and its associated factors among adults living with HIV in Rwanda.Methods: A cross-sectional quantitative design was used to collect the data. The study targeted PLHIV who visited the out-patients’ public health centres in three purposively selected provinces of Rwanda. The knowledge assessment questionnaire relating to risk factors for chronic diseases of lifestyle was used to collect the data. Data were analysed using SPSS version 23.Results: Of the 794 respondents, 64.6% were women, and the mean age was 37.9 (±10.8) years. The results revealed that the majority of the respondents (65.0%) had low levels of knowledge about NCD risk factors, while some (35.6%) were of the opinion that they had a low risk of contracting NCDs. Good knowledge was significantly associated with high educational status, a low CD4+ cell count (< 350 cells/mm3) and normotension.Conclusion: The current study findings highlight the need for comprehensive health education, to raise awareness of non-communicable diseases’ risk factors for adults living with HIV in Rwanda.Keywords: Non-communicable diseases, Risk factors, HIV infection, Knowledge, Rwanda.

scholarly journals Once The Eldery, Now The Youth : Epidemiological Study Of Non-Communicable Diseases Among Children Under 15 Years Of Age In Yaoundé-Cameroon

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Blaise Nguendo Yongsi
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Disease Burden ◽  
Medical Condition ◽  
Communicable Diseases ◽  
Sub Saharan Africa ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Primordial Prevention ◽  
Sub Saharan

Background: In sub-Saharan Africa, communicable diseases have long been among the most prominent contributors to disease burden. However, like most low-income and middle-income countries across the globe, countries in sub-Saharan Africa are experiencing a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles featuring an increasing predominance of chronic, non-communicable diseases (NCDs). Objective : The main objective of this study is to investigate the magnitude of non-communicable chronic diseases at the Chantal Biya Foundation in Yaoundé. Design and participants: This is an institution-based and cross-sectional study conducted from january to december 2018. Participants were in and out patients who visited the institution and whose a medical condition was clearly diagnosed. Results : Of the 643 medical records, leading causes of visit were infectious diseases (51.1%), followed by NCDs (48.9%). Diagnosed NCDs range from sickle cell disease (5.7%), injuries (9.8%), cardiovascular diseases (12.0%), to cancers (25.0%). Conclusion There is a significant burden of NCDs among adolescents in Yaoundé. Then, interventions for primordial prevention (ie, actions to inhibit the emergence of NCD risk factors) and primary prevention (ie, actions on existing NCD risk factors), as well as educational programmes on leading modifiable behavioural risk factors and metabolic risk factors are crucial.

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