scholarly journals Delivering Cervical Cancer Screening and Treatment to Women Living With Human Immunodeficiency Virus

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 227s-227s
Author(s):  
A. Kaneza ◽  
D. Uwimana ◽  
R. Mbonyindavyi
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Vulnerable Populations ◽  
Cancer Information ◽  
Operational Experience ◽  
Resource Limited Settings ◽  
Women Living With Hiv ◽  
Resource Limited ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Background: More than 80% of cervical cancer cases happens in the developing world. The same trend is seen in Burundi, where cervical cancer is the first gynecological cancer and the leading cause of female cancer deaths. In addition to this, Burundi presents high human immunodeficiency virus (HIV) prevalence rate. It is believed that there were 2200 new diagnosed clients in 2016. In spite of this, not all people can have access to desired services due to financial and geographical barriers. To increase access to cervical cancer information and screenings in resource-limited settings, Association Burundaise pour le Bien Etre Familiale (ABUBEF) introduces visual inspection of the cervix with acetic acid (VIA) and Lugol’s Iodine (VILI) plus cryotherapy to vulnerable populations, especially women living with HIV. Aim: To provide VIA/VILI and cryotherapy to women living with HIV in resource-limited settings. Methods: ABUBEF also conducted a training to ensure health providers can independently carry out VIA/VILI and cryotherapy. ABUBEF organized a campaign to raise people's awareness and deliver services to vulnerable populations. Results: Seventeen doctors were trained to perform VIA/VILI. They can also confidently make diagnosis and provide relevant treatment, such as cryotherapy or referral. 337 women were screened during the campaign and 4 of them received positive VIA/VILI results (1.1%). For women living with HIV, the VIA/VILI positivity rates was 4% and 2 of them presented suspicious cervical cancer lesions. All clients received essential treatments. This can be cryotherapy or be referred to specialists for further evaluation and cancer treatment. Conclusion: According to ABUBEF’s operational experience, VIA/VILI and cryotherapy is feasible in resource-limited settings. It is also noticed that women living with HIV has higher VIA/VILI-positive rate and even cancer lesions.

Human Papillomavirus Vaccination Prior to Loop Electroexcision Procedure Does Not Prevent Recurrent Cervical High-grade Squamous Intraepithelial Lesions in Women Living With Human Immunodeficiency Virus: A Randomized, Double-blind, Placebo-controlled Trial

2020 ◽  
Author(s):  
Cynthia Firnhaber ◽  
Avril Swarts ◽  
Vuyokazi Jezile ◽  
Masango Mulongo ◽  
Bridgette Goeieman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
High Grade ◽  
Double Blind ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv ◽  
Intraepithelial Lesions

Abstract Background Women living with human immunodeficiency virus (HIV), especially in sub-Saharan Africa, are at high risk for cervical high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. These women have high HSIL recurrence rates after loop electroexcision procedure (LEEP). Retrospective studies suggest that human papillomavirus (HPV) vaccination improves response to treatment of cervical HSIL. Methods We performed a double-blind, randomized clinical trial enrolling 180 women living with HIV in Johannesburg, South Africa, diagnosed with cervical HSIL by colposcopic biopsy. Women received quadrivalent HPV vaccine or placebo (1:1) at entry, week 4, and week 26. LEEP was performed at week 4. Colposcopic-directed biopsies and cervical cytology were performed at weeks 26 and 52. The primary endpoint, cervical HSIL by histology or cytology at either week 26 or 52, was compared between arms using χ 2 analysis. Results Participant characteristics included median age of 39 years and median CD4 count 489 cells/μL, and 94% had HIV suppression. One hundred seventy-four women completed the vaccine/placebo series and had evaluable results at week 26 or 52. The proportion experiencing the primary endpoint was similar in the vaccine and placebo groups (53% vs 45%; relative risk, 1.18 [95% confidence interval, .87–1.6]; P = .29). HSIL recurrence was associated with a LEEP biopsy result of HSIL and detection of HSIL at the margins of the LEEP sample. Conclusions This study did not support HPV vaccination to prevent recurrent HSIL after LEEP in women living with HIV. Recurrent HSIL was high despite virologic suppression. Improved treatments are needed for HSIL to reduce the burden of cervical cancer among women living with HIV.

scholarly journals Distal Sensory Peripheral Neuropathy in Human Immunodeficiency Virus Type 1–Positive Individuals Before and After Antiretroviral Therapy Initiation in Diverse Resource-Limited Settings

2019 ◽  
Vol 71 (1) ◽  
pp. 158-165 ◽  
Author(s):  
Alyssa C Vecchio ◽  
Christina M Marra ◽  
Jeffrey Schouten ◽  
Hongyu Jiang ◽  
Johnstone Kumwenda ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Peripheral Neuropathy ◽  
Antiretroviral Therapy ◽  
People Living With Hiv ◽  
Older Individuals ◽  
Resource Limited Settings ◽  
Sensory Peripheral Neuropathy ◽  
Resource Limited ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract Background Distal sensory peripheral neuropathy (DSPN) is a complication of human immunodeficiency virus (HIV). We estimate DSPN prevalence in 7 resource-limited settings (RLSs) for combination antiretroviral therapy (cART)–naive people living with HIV (PLWH) compared with matched participants not living with HIV and in PLWH virally suppressed on 1 of 3 cART regimens. Methods PLWH with a CD4+ count <300 cells/mm3 underwent standardized neurological examination and functional status assessments before and every 24 weeks after starting cART. Matched individuals not living with HIV underwent the same examinations once. Associations between covariates with DSPN at entry were assessed using the χ2 test, and virally suppressed PLWH were assessed using generalized estimating equations. Results Before initiating cART, 21.3% of PLWH had DSPN compared with 8.5% of people not living with HIV (n = 2400; χ2(df = 1) = 96.5; P < .00001). PLWH with DSPN were more likely to report inability to work [χ2(df = 1) = 10.6; P = .001] and depression [χ2(df = 1) = 8.9; P = .003] than PLWH without DSPN. Overall prevalence of DSPN among those virally suppressed on cART decreased: 20.3%, week 48; 15.3%, week 144; and 10.3%, week 192. Incident DSPN was seen in 127 PLWH. Longitudinally, DSPN was more likely in older individuals (P < .001) and PLWH with less education (P = .03). There was no significant association between cART regimen and DSPN. Conclusions Although the prevalence of DSPN decreased following cART initiation in PLWH, further research could identify strategies to prevent or ameliorate residual DSPN after initiating cART in RLSs.

scholarly journals Delivering Cost-Effective Cervical Cancer Screening Package to Women Living With Human Immunodeficiency Virus By Reproductive Health Uganda

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 146s-146s
Author(s):  
A. Kyarimpa
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Cancer Screening ◽  
Reproductive Health ◽  
Cervical Cancer Screening ◽  
Cost Effective ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Background and context: Uganda has one of the highest cervical cancer incidences in the world. Over 80% late diagnosis compounds the challenge. It is evident that women living with human immunodeficiency virus (HIV) have a higher prevalence of precancer lesions and have limited access to cervical cancer knowledge and relevant services especially women living with HIV, who are poor and marginalized. This results in a gap for first-line defense to cervical cancer. To bridge the gap and deliver services, Reproductive Health Uganda (RHU) introduced cost-effective “see and treat”, single visit approach (SVA), using combined visual inspection with acetic acid (VIA) and cryotherapy. Aim: To promote single visit approach in cervical cancer screening program in selected HIV clinics and assess the feasibility. Strategy: • Collaborate with HIV clinics, which enroll and provide counseling and services to women living with HIV • Integrate SVA into the current services package in HIV clinics and outreaches to break geographic barriers • Train RHU and public health clinic staff to perform VIA and cryotherapy if needed • Enable SVA in public antiretroviral therapy (ART) clinics through partnerships • Awareness creation through group health education and individual counseling Program: The project implemented in three high HIV prevalence rate districts targeted women 25-49 years of age. Partnered with public ART clinics and arranged training to ensure midwives and nurses in RHU and public health facilities are able to carry out VIA and cryotherapy if needed. Announcements and appointment posters were pinned up on the facility notice board providing details of dates and service package. RHU used this opportunity to promote contraception and STIs management. Health education and counseling session were conducted. Trained peer support mothers mobilized women seek cervical cancer screening when doing HIV follow-up. Quarterly support supervision, QOC assessments and DQAs were conducted to ensure quality and reliability of results and reports. Outcomes: Acceptability of cervical cancer screening was high. The project increased general awareness among rural community members, where cancer is generally stigmatized and associated with a lot of myths. Knowledge, skills and competencies of 54 midwives to screen for and treat with cryotherapy was built. 23,713 women were screened, with average VIA positivity rate 8%-11% across project districts. 98% of cryotherapy-eligible women treated during the same visit. Referral to Ugandan cancer institute was established to ensure timely cancer therapy. Integration and acceptability of family planning increased among women attending ART clinics. What was learned: With appropriate demand creation, acceptability of SVA was good among women attending the ART clinics, SVA is cost-effective and feasible. Integration of SRH package of services helps leverage resources. Strategic partnerships are critical in strengthening public–private partnership in services provision.

scholarly journals Human Immunodeficiency Virus-associated Neurocognitive Impairment in Diverse Resource-limited Settings

2018 ◽  
Author(s):  
Kevin R Robertson ◽  
Hongyu Jiang ◽  
Johnstone Kumwenda ◽  
Khuanchai Supparatpinyo ◽  
Christina M Marra ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Neurocognitive Impairment ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Immunodeficiency Virus

Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes

2019 ◽  
Vol 9 (2) ◽  
pp. 228-231 ◽  
Author(s):  
N Nashid ◽  
S Khan ◽  
M Loutfy ◽  
J MacGillivray ◽  
M H Yudin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Case Series ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Breastfed Infants ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract The reduction in human immunodeficiency virus (HIV) transmission through breastmilk with maternal combination antiretroviral therapy (cART) has led many pregnant women living with HIV and healthcare providers to question exclusive formula feeding in resource-rich settings. Here, we describe cART prophylaxis in 3 breastfed infants whose mothers had sustained virologic suppression; all 3 of these infants remained uninfected.

scholarly journals Calcaneal Quantitative Ultrasonography and Urinary Retinol-Binding Protein in Antiretroviral-Treated Patients With Human Immunodeficiency Virus in Uganda: A Pilot Study

2020 ◽  
Vol 222 (2) ◽  
pp. 263-272
Author(s):  
Cecilia Costa ◽  
Silvia Scabini ◽  
Arvind Kaimal ◽  
William Kasozi ◽  
Jessica Cusato ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Binding Protein ◽  
Retinol Binding Protein ◽  
Tubular Dysfunction ◽  
Mineral Density ◽  
Resource Limited Settings ◽  
Quantitative Ultrasonography ◽  
Resource Limited ◽  
Immunodeficiency Virus

Abstract Background Data on bone health and renal impairment in people with human immunodeficiency virus (HIV) in resource-limited settings are limited. The primary aim of this study was to investigate the potential role of calcaneal quantitative ultrasonography (QUS) in predicting bone mineral density (BMD) reduction in a population of Ugandan HIV-infected  individuals receiving long-term antiretroviral therapy; the secondary end point was to assess the prevalence of proximal tubular dysfunction and the correlation between elevated urinary retinol-binding protein–urinary creatinine ratio (uRBP/uCr) and reduced BMD. Methods We conducted a cross-sectional study at the Infectious Diseases Institute, Kampala, Uganda. We included 101 HIV-infected adults who had been receiving continuous antiretroviral therapy for ≥10 years and had undergone dual-energy x-ray absorptiometry (DXA) during the previous 12 months. All patients underwent calcaneal QUS evaluation and urine sample collection. Results DXA BMD measurements were significantly associated (P < .01) with calcaneal speed of sound, broadband ultrasound attenuation, and QUS index. Forty-seven individuals (47%) had abnormal uRBP/uCr values. A significant inverse correlation was observed between uRBP/uCr and DXA T scores (lumbar [P = .03], femoral neck [P < .001], and total hip [P = .002]). Conclusions Calcaneal QUS results showed a moderate correlation with DXA outputs. The identified high prevalence of subclinical tubular impairment also highlights the importance of expanding access to tenofovir disoproxil fumarate–sparing regimens in resource-limited settings.

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