scholarly journals “Lighten This Burden of Ours”: Acceptability and Preferences Regarding Injectable Antiretroviral Treatment Among Adults and Youth Living With HIV in Coastal Kenya

2021 ◽  
Vol 20 ◽  
pp. 232595822110005
Author(s):  
Jane M. Simoni ◽  
Kristin Beima-Sofie ◽  
George Wanje ◽  
Zahra H. Mohamed ◽  
Kenneth Tapia ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Options ◽  
Sub Saharan Africa ◽  
Hiv Stigma ◽  
Attractive Alternative ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Long Acting ◽  
Youth Living With Hiv ◽  
Living With Hiv

Background: Long-acting injectable (LAI) antiretroviral therapy (ART) may offer persons living with HIV (PLWH) an attractive alternative to pill-based treatment options, yet acceptability data remain scant, especially in sub-Saharan Africa. Methods: We conducted 6 focus group discussions with PLWH, including key stake holder groups, and analyzed data with content analysis. Results: Initial reactions to the idea of LAI-ART were often positive. The primary advantages voiced were potential to facilitate improved adherence and alleviate the burden of daily pill-taking while avoiding inadvertent disclosure and HIV stigma. Potential side effects were a particular concern of the women. Most participants preferred clinic-based administration over self-injections at home due to concerns about safety, privacy, and potential need for refrigeration. Conclusions: LAI-ART may be acceptable in Kenya, provided injections are infrequent and delivered in a clinic setting. However, HIV stigma, fear of potential side effects, and limited clinical capacity would need to be addressed.

scholarly journals Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

2021 ◽  
Vol 22 ◽  
Author(s):  
Maria Y. Charumbira ◽  
Karina Berner ◽  
Quinette A. Louw
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health System ◽  
Fall Prevention ◽  
Falls Prevention ◽  
Sub Saharan Africa ◽  
Prevention Services ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

Abstract Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

scholarly journals Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa

2019 ◽  
Vol 71 (3) ◽  
pp. 525-531 ◽  
Author(s):  
Caleb Skipper ◽  
Mark R Schleiss ◽  
Ananta S Bangdiwala ◽  
Nelmary Hernandez-Alvarado ◽  
Kabanda Taseera ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Opportunistic Infections ◽  
Survival Rates ◽  
Hazard Ratio ◽  
Sub Saharan Africa ◽  
Persons Living With Hiv ◽  
Median Plasma ◽  
Sub Saharan ◽  
Immunodeficiency Syndrome ◽  
Living With Hiv

Abstract Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Conclusions Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). Clinical Trials Registration NCT01075152.

The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana

2020 ◽  
Author(s):  
Adobea Y Owusu ◽  
Mabel Teye-kau ◽  
Eric Y Tenkorang
Keyword(s):  
Sub Saharan Africa ◽  
Housing Conditions ◽  
Hiv Status ◽  
Policy Makers ◽  
Stability And Change ◽  
Housing Stability ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Depth Interviews

Summary Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

scholarly journals Assessing Women Caregiving Role to People Living With HIV/AIDS in Nigeria, West Africa

SAGE Open ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 215824401769201 ◽  
Author(s):  
Ekaete Francis Asuquo ◽  
Josephine B. Etowa ◽  
Margaret I. Akpan
Keyword(s):  
Quality Care ◽  
Treatment Options ◽  
Family Members ◽  
Sampling Technique ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Caregiving Roles ◽  
Living With Hiv ◽  
Hiv Aids

HIV/AIDS scourge remains high in most countries of sub-Saharan Africa such as Nigeria, which is home to about 3.3 million HIV positive individuals and represents the second largest burden of HIV/AIDS care, treatment and demand worldwide after South Africa. Anti-retroviral treatment options though a welcome development, has increased the number of people living with this chronic illness, and most of them depend on family members for physical and emotional support. Traditional gender norms in Nigeria ensure that legitimately, women and girls are the first options for caregiving roles. This mandatory role has in turn imposed psychosocial disruption in the lives of female family members in Calabar, Nigeria. This descriptive study utilized convenient sampling technique, Zarit Burden Interview scale and semistructured questionnaires for data collection (260 respondents), and data analyses were achieved using SPSS16.0. The study showed that a significant ( p < .05) proportion of women (91%) were involved in providing care, including children from 10 years and above. Caregivers had minimal social support which increased the burden they experienced. The need for policy that recognizes and supports female caregivers (“silent cornerstone”) to reduce burden and ensure high quality care of people living with HIV/AIDS (PLWHA) in Nigeria is advocated.

scholarly journals Factors Influencing Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State Southeast Nigeria

2019 ◽  
pp. 1-8
Author(s):  
C. P. Igweagu ◽  
O. H. Chime ◽  
O. C. Ekwueme
Keyword(s):  
Health Education ◽  
Sub Saharan Africa ◽  
Limiting Factors ◽  
People Living With Hiv ◽  
Factors Influencing ◽  
Persons Living With Hiv ◽  
Enugu State ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Aids

Background: The Acquired Immune – deficiency syndrome (AIDS) is a terminal illness caused by a retrovirus known as the Human Immune-deficiency virus (HIV). HIV/AIDS is a leading cause of death in sub-saharan Africa. Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa with 1.9 million people living HIV in 2018. Antiretroviral therapy (ART) has significantly reduced morbidity and mortality, prolonged life expectancy and improved quality of life among people living with HIV/AIDS infection (PLWHA). To be most effective ART requires a near perfect level of adherence. Poor adherence compromises treatment effectiveness, leading to treatment failure and development of drug resistance. Non-adherence is also characterized by increased morbidity, mortality and great economic loss. This study assessed the effect of health education on factors influencing adherence to ART among PLWHAs in Enugu State. Methodology: A health education intervention was carried out among 312 persons living with HIV/AIDS receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy. A structured questionnaire was used to collect data from 312 people living with HIV/AIDS (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey. Results: Knowledge of supportive and limiting factors of adherence improved significantly among the study group than the controls post-intervention (P<0.001). The factors that facilitated adherence included follow-up visits, adequate information education/counseling and supportive relationships. The limiting factors were drug side-effects, forgetfulness, finance and travel time to clinic. Conclusion: Health education improved knowledge of supportive factors of ART adherence among PLWHAs in Enugu State, and this should be promoted.

scholarly journals Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa (Preprint)

2017 ◽  
Author(s):  
Brian Rice ◽  
Andrew Boulle ◽  
Stefan Baral ◽  
Matthias Egger ◽  
Paul Mee ◽  
...  
Keyword(s):  
Local Level ◽  
Clinical Care ◽  
Routine Data ◽  
Sub Saharan Africa ◽  
Data Systems ◽  
Persons Living With Hiv ◽  
Sentinel Events ◽  
Sub Saharan ◽  
Living With Hiv ◽  
New Phase

UNSTRUCTURED The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts.

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