scholarly journals Extending access to care across the rural US south: Preliminary results from the Alabama eHealth programme

2018 ◽  
Vol 25 (5) ◽  
pp. 301-309
Author(s):  
Kriti M Jain ◽  
Prashanth Bhat ◽  
Cathy Maulsby ◽  
Alexandria Andersen ◽  
Tomas Soto ◽  
...  
Keyword(s):  
Missing Data ◽  
Antiretroviral Therapy ◽  
Rural Areas ◽  
Formative Evaluation ◽  
Social Innovation ◽  
People Living With Hiv ◽  
Viral Loads ◽  
Innovation Fund ◽  
Set Up ◽  
Hiv Continuum Of Care

Purpose Using a mixed-methods formative evaluation, the purpose of this study was to provide a broad overview of the Alabama eHealth programme set-up and initial patient outcomes. The Alabama eHealth programme uses telemedicine to provide medical care to people living with HIV in rural Alabama. It was led by a community-based organisation, Medical Advocacy and Outreach (MAO), and supported by AIDS United and the Corporation for National Community Service’s Social Innovation Fund with matching support from non-federal donors. Methods We conducted and transcribed in-depth interviews with Alabama eHealth staff and then performed directed content analysis. We also tracked patients’ ( n = 240) appointment attendance, CD4 counts, and viral loads. Findings Staff described the steps taken to establish the programme, associated challenges (e.g., costly, inadequate broadband in rural areas), and technology enabling this programme (electronic medical records, telemedicine equipment). Of all enrolled patients, 76% were retained in care, 88% had antiretroviral therapy and 75% had a suppressed viral load. Among patients without missing data, 96% were retained in care, 97% used antiretroviral therapy and 93% had suppressed viral loads. There were no statistically significant demographic differences between those with and without missing data. Conclusions Patients enrolled in a telemedicine programme evaluation successfully moved through the HIV continuum of care.

scholarly journals Expression of Inflammatory Markers RANK, MMP-9 and PTHrP in Chronic Apical Periodontitis from People Living with HIV Undergoing Antiretroviral Therapy

2020 ◽  
Vol 9 (11) ◽  
pp. 3611
Author(s):  
Marcio Francisco Pereira ◽  
Fabio Ramoa Pires ◽  
Luciana Armada ◽  
Dennis Carvalho Ferreira ◽  
Florence Carrouel ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Inflammatory Markers ◽  
Apical Periodontitis ◽  
Histopathological Diagnosis ◽  
People Living With Hiv ◽  
Viral Loads ◽  
Parathyroid Hormone Related Protein ◽  
Rank Matrix ◽  
Significant Difference ◽  
Living With Hiv

To compare the expression of the receptor activator of nuclear factor-kappa B (RANK), matrix metalloproteinase 9 (MMP-9) and parathyroid hormone-related protein (PTHrP) in primary chronic apical periodontitis lesions (CAPLs) between people living with HIV (PLWHIV) undergoing antiretroviral therapy (ART) and HIV- individuals, 32 CAPLs (16 lesions from each group) were submitted to histopathological and immunohistochemical analyses and compared between groups. The majority of the PLWHIV group had undetectable plasma viral loads (n = 13; 81.3%). The means of TCD4+ lymphocytes, exposure to HIV-1 and the time of the use of ART were 542.1 cells/mm3 (SD = 256.4), 6.3 years (SD = 2.9) and 5.0 years (SD = 2.5), respectively. Of all variables studied, only histopathological diagnosis showed a significant difference between groups (LWHIV: granuloma n = 11 (68.0%); cyst n = 5 (31.2%); HIV-: granuloma n = 15 (93.8%); cyst n = 1 (6.2%); p = 0.015). When comparing the expressions of the three inflammatory markers between the groups, no significant differences were seen. There was no difference in the expression of RANK, PTHrP and MMP-9 in primary chronic apical periodontitis lesions between PLWHIV under ART and HIV- individuals.

scholarly journals Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bahati Kasimonje ◽  
Tinei Shamu ◽  
Tinahe Mudzviti ◽  
Ruedi Luethy
Keyword(s):  
Antiretroviral Therapy ◽  
Young People ◽  
Group Intervention ◽  
People Living With Hiv ◽  
First Line ◽  
Viral Loads ◽  
Adherence Support ◽  
Adherence Counselling ◽  
Lost To Follow Up

Background: Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.Objectives: We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.Method: This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.Results: Fifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of 50 copies/mL.Conclusion: An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.

scholarly journals Retrospective trend analysis of HIV viral load suppression among antiretroviral therapy clients in Bauchi State, Nigeria

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Zainab Gambo Ibrahim ◽  
Saba’atu Elizabeth Danladi ◽  
Yusuf Abdu Misau ◽  
Shehu Yakubu Magaji ◽  
Sani Muhammad Dambam ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
General Hospital ◽  
Health Economy ◽  
People Living With Hiv ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Healthcare Facilities ◽  
Viral Loads ◽  
Public Lives

The negative effects of HIV have affected all spheres of public lives such as individual health, economy and the employment opportunity globally. The most common way to tackle the disease is the use of Antiretroviral Therapy (ART), this has proved to be an effective way to manage HIV worldwide. The use of ART has substantially suppressed the Human Immunodeficiency Virus (HIV) Viral Load (VL) and reduced the risk of HIV infection. This study evaluates the trends analysis of HIV Viral load suppression among ART Clients in Bauchi State Nigeria for the year 2017. The study used 18 healthcare facilities providing Antiretroviral Therapy (ART) in Bauchi State. The population comprises all people living with HIV/AIDS who are residents in the study area of the 18 healthcare facilities and a convenient sampling method were used. The study found that highest number of viral load suppression existed in Toro General Hospital, even though all the sample health facilities considered in the study recorded viral load suppression. The study also tested for percentage proportion of TB/HIV coinfection among people on ART with suppressed viral loads (1000c/mL) and found that in all the 18 healthcare facilities except Jama’are General Hospital, presumptive TB/HIV co-infection recorded higher proportion compare to active TB/HIV co-infection among people on ART with suppressed viral loads (1000c/mL). The study recommends that for UNAIDS target of 90-90-90 to be achieved to help end the HIV epidemics, aggressive strategies should be put in place to improve adherence to ART by patients and access to viral load monitoring should also be improved in order to detect the patients with risk of HIV.

scholarly journals Differentiated antiretroviral therapy delivery in rural Zimbabwe: availability, needs and challenges

2020 ◽  
Author(s):  
Benedikt Christ ◽  
Janneke van Dijk ◽  
Marie Ballif ◽  
Talent Nyandoro ◽  
Martina L. Reichmuth ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Rural Areas ◽  
Fast Track ◽  
Care Delivery ◽  
Waiting Times ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Linear Regression Models ◽  
Travel Costs ◽  
Art Delivery

Introduction: The traditional “one-size-fits-all” model of HIV care whereby people living with HIV (PLWH) have regular individual clinical visits does not reflect the various preferences and needs of PLWH and stretches the capacity of health facilities (HFs). Little is known about the availability and the experience of differentiated HIV care delivery in the rural areas of Zimbabwe.Methods: We used a mixed-method approach to collect data from clients and providers at 26 HFs in Zimbabwe in 2019. We collected quantitative data about antiretroviral therapy (ART) delivery and time spent at the HF during a visit from one representative healthcare providers (HCP) and a stratified sample of PLWH at each HF. We performed semi-structured interviews among HCPs and focus group discussions (FGDs) among PLWH to collect information about the implementation of differentiated ART delivery (DART) models and their experience. We performed linear regression models to assess factors associated with the time spent in the HFs. We analyzed the interviews using an inductive approach. Transcripts were coded and constricted down to themes significant to the research objectives.Results: The majority (77%) of participating HFs offered at least one of the five DART models recommended in Zimbabwe: 13 (50%) offered community ART refill group (CARG), 1 (4%) club refill, 6 (23%) family refill, and 8 (31%) fast-track refill models. Mobile outreach was not available at any participating HF. In an unadjusted linear model, PLWH enrolled in the fast-track refill model spent 0.40 (95% confidence interval (CI): 0.15-0.56) less time at the HF than PLWH on routine care, whereas PLWH in the family refill model and delegated to go to the HF spent 2.63 (95% CI 1.42-4.88) more time at the HF during visit. Confidentiality and disclosure concerns were highlighted as the major barriers affecting the implementation of DART models, together with travel costs and waiting times. HCPs reported on the challenge of excessive workloads. Fast-track refill was perceived as the most adapted DART model to meet clients’ needs, followed by CARG and family refill.Conclusions: Confidentiality, travel costs and waiting times are key elements to consider in the implementation of differentiated care in rural Zimbabwe. More implementation research is needed to support the roll-out of differentiated HIV services in that region, especially DART models addressing the needs of PLWH. Our study supports the call for personalized care at ART programs in rural Africa.

Metabolic Syndrome in HIV-patients in Antiretroviral Therapy

2020 ◽  
Vol 18 (6) ◽  
pp. 388-395
Author(s):  
Daniel Vargas-Pacherrez ◽  
Helma P. Cotrim ◽  
Leonardo Pires ◽  
Vitor Cunha ◽  
Vitor Coelho ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Antiretroviral Therapy ◽  
International Diabetes Federation ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Anthropometric Data ◽  
Cross Sectional ◽  
History Of ◽  
Family History Of Hypertension ◽  
Living With Hiv

Introduction: The global prevalence of metabolic syndrome (MS) among people living with HIV/AIDS varies from 20% to 33%. Objective: to estimate the prevalence of metabolic syndrome and associated factors in a group of HIV-infected patients on antiretroviral therapy. Methods: This is a cross-sectional study with HIV-infected patients from a reference center in Bahia, Brazil. We evaluated clinical, socio-demographic and anthropometric data. MS was defined according to the guidelines of International Diabetes Federation. Results: We evaluated 152 patients with mean age of 47.3±11.6 years, 59.2% male. The main comorbidities detected were diabetes (3.3%) hypertriglyceridemia (9.3%) and metabolic syndrome (MS,38.2%). Patients with MS were predominantly women (55.2% vs 31.9%; p=0.005), older [52.1 (10.4) vs 44.3 (11.3); p<0.001], and had overweight (74.1% vs 23.4%; p<0.001). After multivariate analysis MS remained associated with age (OR = 1.076; 95% CI: 1.030 – 1.125), female sex (OR = 2.452; 95% CI: 1.114 – 5.374) and family history of hypertension (OR = 3.678; 95% CI: 1.431 – 9.395). Conclusion: Almost half of the HIV-infected patients in Bahia presents with MS which seems to be driven by classical risk factors.

Emerging Trends in the Long-acting Antiretroviral Therapy: Current Status and Therapeutic Challenges

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajpushpa Labh ◽  
Rachna Gupta
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Drug Distribution ◽  
Antiretroviral Drugs ◽  
Current Status ◽  
People Living With Hiv ◽  
Viral Reservoirs ◽  
Emerging Trends ◽  
Gradual Development ◽  
Long Acting

: Antiretroviral drug therapy has significantly improved the prognosis and life expectancy of People Living with HIV over the years. But this progress comes with an important caveat that antiretroviral regimens generally require adherence to life-long, daily dosing, to keep viral multiplication under check. Non-adherence to such dosing leads to decreased efficacy and increased drug resistance against antiretroviral drugs. Besides, poor drug penetration to certain tissues like CNS and lymph nodes leads to build-up of viral reservoirs in these sites. To combat some of these challenges and improve patient compliance, long-acting antiretroviral drugs, are a new weapon in the arsenal, in fight against HIV. Few long acting preparations have been approved, and several others are in various clinical and preclinical stages of development. However, longacting formulations also have their share of clinical issues like limited drug distribution, long term adverse drug reactions, drug-drug interactions, and gradual development of drug resistance. Modern technological premises are being tested to mitigate some of these problems. One such promising approach involves nanotechnological methods, which are being used to develop ultra-long acting formulations and drug delivery systems, targeting tissues with residual HIV concentration. LongActing Slow Effective Release Antiretroviral Therapy aka LASER ART, also builds on nanotechnology and prodrug modifications to design preparations with tailor-made favorable pharmacokinetics and wider drug distribution. These recent advances are fueling the progression of antiretroviral therapy towards eliminating the disease.

Barriers to antiretroviral therapy adherence among prisoners in one prison in Iran

2019 ◽  
Vol 19 ◽  
Author(s):  
Behnam Farhoudi ◽  
Seyed Ahmad Seyedalinaghi ◽  
Masoud Jafarinasab ◽  
Seyed Mohammad Ghavam ◽  
Omid Dadras ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Patient Adherence ◽  
Social Stigma ◽  
Group Discussion ◽  
Life Quality ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Dramatic Improvement ◽  
Art Adherence ◽  
Opium Addiction

Background: Antiretroviral medications have improved the survival and life quality of people living with HIV and turned HIV into a chronic controllable disease. However, the success of HIV treatment depends on many factors; the patient adherence is one the most important indicators which. In this study, we explored the potential barriers to an effective adherence antiretroviral therapy (ART) among the HIV-positive prisoners of Ghezelhesar prison, Iran. Methods: To explore and identify the barriers toward ART adherence, a focus group discussion was held with six prisoners eligible for ART but rejected to be treated or did not retain on ART. The prisoners were recruited through purposive sampling method. All the words, behaviors and even body languages were precisely recorded and analyzed to reach the final results. Results: The most reported obstacles toward ART adherence were the lack of trust in effectiveness of medications and drug complications. Other reasons were inadequate nutrition, lack of amenities, social stigma, lack of economic and psychological support, misbehavior of prison staff and inadequate methadone prescription for those with opium addiction. Conclusion: Due to the results and the fact that adequate Methadone prescription for opium addiction, improving life quality and receiving emotional and medical support from staff could improve adherence to HIV medication in prisoners, comprehensive education of prisoners about their health condition along with staff education may improve the life condition of HIV infected prisoners and may cause dramatic improvement in ART adherence and prisoners health.

Dukungan sosial dan kualitas hidup orang dengan HIV/AIDS

2017 ◽  
Vol 33 (3) ◽  
pp. 147
Author(s):  
Mardia Mardia ◽  
Riris Andono Ahmad ◽  
Bambang Sigit Riyanto
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Antiretroviral Therapy ◽  
Social Life ◽  
Opportunistic Infections ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Criteria For Diagnosis ◽  
Hiv Aids

Purpose: This study aimed to determine the quality of life among people living with HIV/AIDS based on the criteria for diagnosis and other factors.Methods: This study was conducted in the VCT clinic hospital of Dr. Moewardi. The population was HIV-positive patients with antiretroviral therapy. Data collection conducted through medical records and interview to patients. Results: Out of a total of 89 respondents, 66.29% were males and 71.91% were aged between 26-45 years. We found significant correlations for diagnosis of HIV/AIDS, opportunistic infections, time since HIV diagnosis, duration of ARV therapy, social support, modes of transport, sex, age, and marital status with the quality of life. Multivariate analysis obtained by each variable showed the strongest association with the quality of life was time since diagnosis, social support and duration of ARV therapy. Conclusion: The quality of life was better for those who have been diagnosed with HIV/AIDS ≥ 32 months, with social support, and who have been undergoing antiretroviral therapy ≥ 29 months. Improved counseling in the early days of ARV therapy is necessary to always maintain the treatment and provide support for their social life.

scholarly journals The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

2021 ◽  
Author(s):  
Tiago Rua ◽  
Daniela Brandão ◽  
Vanessa Nicolau ◽  
Ana Escoval
Keyword(s):  
Positive Impact ◽  
Cost Effective ◽  
Relative Magnitude ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Continuum Of Care ◽  
Clinical Conditions ◽  
Study Designs ◽  
Living With Hiv ◽  
Payment Models

AbstractThe increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system’s financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.

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