Association Between HIV Infection and Cancer Stage at Presentation at the Uganda Cancer Institute

Purpose The HIV epidemic has contributed to the increasing incidence of cancer in sub-Saharan Africa, where most patients with cancer present at an advanced stage. However, improved access to HIV care and treatment centers in sub-Saharan Africa may facilitate earlier diagnosis of cancer among patients who are HIV positive. To test this hypothesis, we characterized the stage of cancer and evaluated the factors associated with advanced stage at presentation among patients in Uganda. Methods We conducted a retrospective analysis of adult patients with any of four specific cancers who presented for care in Kampala, Uganda, between 2003 and 2010. Demographic, clinical, and laboratory data were abstracted from the medical record, together with the outcome measure of advanced stage of disease (clinical stage III or IV). We identified measures for inclusion in a multivariate logistic regression model. Results We analyzed 731 patients with both AIDS-defining cancers (cervical [43.1%], and non-Hodgkin lymphoma [18.3%]), and non–AIDS-defining cancers (breast [30.0%] and Hodgkin lymphoma [8.6%]). Nearly 80% of all patients presented at an advanced stage and 37% had HIV infection. More than 90% of patients were symptomatic and the median duration of symptoms before presentation was 5 months. In the multivariate model, HIV-positive patients were less likely to present at an advanced stage as were patients with higher hemoglobin and fewer symptoms. Conclusion Patients with limited access to primary care may present with advanced cancer because of a delay in diagnosis. However, patients with HIV now have better access to clinical care. Use of this growing infrastructure to increase cancer screening and referral is promising and deserves continued support, because the prognosis of HIV-positive patients with advanced cancer is characterized by poor survival globally.

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HIV is associated with endothelial activation despite ART, in a sub-Saharan African setting

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000531 ◽

2018 ◽

Vol 6 (2) ◽

pp. e531 ◽

Cited By ~ 11

Author(s):

Joseph Kamtchum-Tatuene ◽

Henry Mwandumba ◽

Zaid Al-Bayati ◽

Janet Flatley ◽

Michael Griffiths ◽

...

Keyword(s):

Hiv Infection ◽

Endothelial Activation ◽

Sub Saharan Africa ◽

Intercellular Adhesion Molecule ◽

Hiv Positive ◽

Plasminogen Activator Inhibitor 1 ◽

Multivariable Logistic Regression Model ◽

Cross Sectional ◽

Sub Saharan ◽

Pai 1

ObjectiveTo study the relationship between endothelial dysfunction, HIV infection, and stroke in Malawians.MethodsUsing a cross-sectional design, we measured plasma levels of intercellular adhesion molecule-1 (ICAM-1), plasminogen activator inhibitor-1 (PAI-1), vascular endothelial growth factor (VEGF), and soluble thrombomodulin (sTM) in stroke patients and controls, stratified by HIV status. These biomarkers were measured using ELISA. After dichotomization, each biomarker was used as the dependent variable in a multivariable logistic regression model. Primary independent variables included HIV and stroke status. Adjustment variables were age, sex, hypertension, diabetes mellitus, tobacco and alcohol consumption, personal/family history of stroke, antiretroviral therapy status, and hypercholesterolemia.ResultsSixty-one stroke cases (19 HIV+) and 168 controls (32 HIV+) were enrolled. The median age was 55 years (38.5–65.0) for controls and 52 years (38.0–73.0) for cases (p = 0.38). The median CD4+ T-cell count was 260.1 cells/mm3 (156.3–363.9) and 452 cells/mm3 (378.1–527.4) in HIV-infected cases and controls, respectively. HIV infection was independently associated with high levels of ICAM-1 (OR = 3.6, 95% CI: 1.3–10.6, p = 0.018) in controls but not in stroke cases even after excluding patients with a viral load >1,000 RNA copies/mL (OR = 4.1, 95% CI: 1.3–13.1, p = 0.017). There was no association between the clinical profiles of HIV-positive controls or HIV-positive stroke and high levels of PAI-1, VEGF, and sTM.ConclusionsHIV infection is associated with endothelial activation despite antiretroviral treatment. Our findings underscore the need for larger clinical cohorts to better understand the contribution of this perturbation of the endothelial function to the increasing burden of cardiovascular diseases in sub-Saharan Africa.

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Mapping evidence on adolescents’ HIV-positive status disclosure in sub-Saharan Africa: a protocol for a scoping review

Systematic Reviews ◽

10.1186/s13643-020-01546-9 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Patience Adzordor ◽

Clement Avoka ◽

Vitalis Bawontuo ◽

Silas Agbesi ◽

Desmond Kuupiel

Keyword(s):

Hiv Infection ◽

Scoping Review ◽

Keyword Search ◽

Sub Saharan Africa ◽

Hiv Positive ◽

People Living With Hiv ◽

Sub Saharan ◽

Living With Hiv ◽

Status Disclosure ◽

Hiv Aids

Abstract Background Sub-Saharan Africa (SSA) homes most of the people living with HIV/AIDS in the world. Adolescents/young people are a vulnerable population and at high risk of HIV infection. Identifying and bridging the research gaps on the disclosure of HIV-positive status among adolescents, particularly to their sexual partners, is essential to inform appropriate policy planning and implementation towards preventing HIV transmission. This study will aim to explore literature and describe the evidence on HIV-positive status disclosure among adolescents in SSA. Methods The framework provided by Arksey and O’Malley’s framework and improved by Levac and colleagues will be used to conduct a scoping review. A keyword search for relevant literature presenting evidence on HIV-positive status disclosure among adolescents in SSA will be conducted in CINAHL, PubMed, Science Direct, Google Scholar, and SCOPUS. Date limitations will be removed, but Boolean terms “AND” and “OR” as well as Medical Subject Headings terms will be included where possible and syntax modified to suit the database during the search. Additional relevant articles will be sought from the reference lists of all included studies using a snowballing method. Two reviewers will independently screen the articles at the abstract and full-text screening phases in order to reduce bias and improve the reliability of this study’s findings. A tabular form will be developed using Microsoft Word and piloted for data extraction. Thematic content analysis will be conducted, and a narrative summary of all relevant outcomes reported. Quality appraisal of the included studies for this proposed study will be performed utilizing the recent mixed methods appraisal tool. Discussion The evidence produced by this review may help inform policy and strategies to reduce the incidence of HIV infection among adolescents and improve social support for adolescents living with HIV/AIDS in SSA. It may also reveal literature gaps to guide future researches to further inform HIV policies for adolescents in SSA. Platforms such as peer review journals, policy briefs, and conferences will be used to disseminate this study’s findings.

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Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16050728 ◽

2019 ◽

Vol 16 (5) ◽

pp. 728

Author(s):

Saria Hassan ◽

Alexis Cooke ◽

Haneefa Saleem ◽

Dorothy Mushi ◽

Jessie Mbwambo ◽

...

Keyword(s):

Care Delivery ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Initiation Rate ◽

Hiv Services ◽

Art Initiation ◽

Care Integration ◽

Therapy Strategy ◽

Sub Saharan

There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.

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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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Toward the integration of comprehensive mental health services in HIV care: An assessment of psychiatric morbidity among HIV-positive individuals in sub-Saharan Africa

AIDS Care ◽

10.1080/09540121.2013.763892 ◽

2013 ◽

Vol 25 (9) ◽

pp. 1193-1198 ◽

Cited By ~ 8

Author(s):

Andrew T. Olagunju ◽

Olasimbo A. Ogundipe ◽

Adebayo R. Erinfolami ◽

Abiola A. Akinbode ◽

Joseph D. Adeyemi

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Psychiatric Morbidity ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Sub Saharan

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Growing Up with HIV/AIDS

Childhood Studies ◽

10.1093/obo/9780199791231-0213 ◽

2019 ◽

Author(s):

Stephanie Shiau ◽

Lindsey Reif

Keyword(s):

High Risk ◽

Hiv Infection ◽

Hiv Infections ◽

Pediatric Hiv ◽

Sub Saharan Africa ◽

Hiv Care ◽

Close Monitoring ◽

Sub Saharan ◽

Pediatric Hiv Care ◽

Living With Hiv

Largely due to increased success in prevention of mother-to-child transmission, new HIV infections among children globally have declined by 47 percent since 2010, from 300,000 in 2010 to 160,000 in 2016. However, the epidemic continues. In 2016 2.1 million children under fifteen years old were estimated to be living with HIV globally, with 85 percent living in sub-Saharan Africa. Without access to HIV care and antiretroviral therapy (ART), infants and younger children living with HIV are at high risk for mortality, with a mortality rate of about 30 percent by the first year of life and 50 percent by their second year. Therefore, prompt diagnosis and adherence to effective ART is critical. Early infant diagnosis is becoming more widely available globally, allowing for earlier identification of infection close to birth and opportunities to start treatment early in infants and the potential for cure strategies. With effective treatment, pediatric HIV infection has been transformed from a fatal disease to a lifelong chronic disease. Much of pediatric HIV care focuses on co-morbidities related to long-term HIV infection and its treatment. In addition, children living with HIV require close monitoring as they age into adolescence, a high-risk period when they navigate mental, physical, and emotional development. As adolescents become independent from parents or guardians and face choices regarding relationships, sexual behavior, and alcohol and drug use, they are at high risk for poor adherence to ART.

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The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review

Global Mental Health ◽

10.1017/gmh.2020.18 ◽

2020 ◽

Vol 7 ◽

Author(s):

A.S. Dessauvagie ◽

A. Jörns-Presentati ◽

A.-K. Napp ◽

D.J. Stein ◽

D. Jonker ◽

...

Keyword(s):

Mental Health ◽

Associated Factors ◽

Mental Health Problems ◽

Health Problems ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Hand Search ◽

Sub Saharan

Abstract Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10–19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30–50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.

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Hematologic alterations and early mortality in a cohort of HIV positive African patients

PLoS ONE ◽

10.1371/journal.pone.0242068 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242068

Author(s):

Fausto Ciccacci ◽

Francesca Lucaroni ◽

Roberto Latagliata ◽

Laura Morciano ◽

Elisa Mondlane ◽

...

Keyword(s):

Nutritional Status ◽

Hiv Infection ◽

Blood Count ◽

Cd4 Count ◽

Sub Saharan Africa ◽

Hiv Care ◽

Full Blood Count ◽

First Year ◽

Treatment Naïve ◽

Sub Saharan

Introduction Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality. Material and methods We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 –December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model. Results On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn’t be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL. Conclusions Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.

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