scholarly journals HIV viraemia during pregnancy in women receiving preconception antiretroviral therapy in KwaDukuza, KwaZulu-Natal

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Vuyokazi Ntlantsana ◽  
Richard J. Hift ◽  
Wendy P. Mphatswe
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Antenatal Care ◽  
Viral Suppression ◽  
Healthcare Facility ◽  
Reproductive Age ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Sustained Viral Suppression ◽  
Kwazulu Natal

Background: Preconception antiretroviral therapy (PCART) followed by sustained viral suppression is effective in preventing mother-to-child transmission of HIV. The rates of persistent and transient viraemia in such patients have not been prospectively assessed in South Africa.Objectives: We determined the prevalence of transient and persistent viraemia in HIV-positive women entering antenatal care on PCART and studied variables associated with viraemia.Methods: We performed a prospective cross-sectional observational study of HIV-positive pregnant women presenting to a primary healthcare facility in KwaZulu-Natal. All had received at least 6 months of first-line PCART. Viral load (VL) was measured, patients were interviewed, adherence estimated using a visual analogue scale and adherence counselling provided. Viral load was repeated after 4 weeks where baseline VL exceeded 50 copies/mL.Results: We enrolled 82 participants. Of them, 59 (72%) pregnancies were unplanned. Fifteen participants (18.3%) were viraemic at presentation with VL > 50 copies/mL. Of these, seven (8.5%) had viral suppression (VL < 50 copies/mL), and eight remained viraemic at the second visit. Adherence correlated significantly with viraemia at baseline. Level of knowledge correlated with adherence but not with lack of viral suppression at baseline. Socio-economic indicators did not correlate with viraemia. No instances of vertical transmission were observed at birth.Conclusions: Approximately 20% of women receiving PCART may demonstrate viraemia. Half of these may be transient. Poor adherence is associated with viraemia, and efforts to encourage and monitor adherence are essential. The rate of unplanned pregnancies is high, and antiretroviral therapy programmes should focus on family planning needs of women in the reproductive age group to prevent viral non-suppression prior to pregnancy.Keywords: Preconception Antiretroviral Therapy; HIV; Viraemia; Antenatal Care; Adherence.

scholarly journals Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242817
Author(s):  
Jessica E. Long ◽  
Barbra A. Richardson ◽  
George Wanje ◽  
Kate S. Wilson ◽  
Juma Shafi ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Viral Suppression ◽  
Hiv Positive ◽  
Art Adherence ◽  
Detectable Viral Load ◽  
Harmful Alcohol

Background Excessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs. Methods A prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Results This analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7–15) in 14.3%, harmful alcohol use (AUDIT 16–19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63–1.92) or late ART refill (aRR 1.13, 95%CI 0.82–1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42–3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84–3.71). Conclusions In this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.

scholarly journals Depression symptoms, HIV testing, linkage to ART, and viral suppression among women in a high HIV burden district in KwaZulu-Natal, South Africa: A cross-sectional household study

2020 ◽  
pp. 135910532098204
Author(s):  
Kaymarlin Govender ◽  
Dick Durevall ◽  
Richard G Cowden ◽  
Sean Beckett ◽  
Ayesha BM Kharsany ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Hiv Testing ◽  
Viral Suppression ◽  
Hiv Positive ◽  
Depression Symptoms ◽  
Cross Sectional ◽  
Lower Odds ◽  
Hiv Positive Women ◽  
Kwazulu Natal

Achieving the UNAIDS 90-90-90 targets by 2020 is contingent on identifying and addressing mental health challenges that may affect HIV testing and treatment-related behaviors. This study is based on survey data from KwaZulu-Natal, South Africa (2014–2015). HIV positive women who reported higher depression scores had a lower odds of having tested previously for HIV (15–25 years: AOR = 0.90, 95% CI [0.83, 0.98]; 26–49 years: AOR = 0.90, 95% CI [0.84, 0.96]). Because HIV testing behavior represents a gateway to treatment, the findings suggest mental health may be one challenge to attaining the UNAIDS 90-90-90 targets.

scholarly journals Asymptomatic Leishmania infection in HIV-positive outpatients on antiretroviral therapy in Pernambuco, Brazil

2021 ◽  
Vol 15 (1) ◽  
pp. e0009067
Author(s):  
Diego Lins Guedes ◽  
Alda Maria Justo ◽  
Walter Lins Barbosa Júnior ◽  
Elis Dionísio da Silva ◽  
Samuel Ricarte de Aquino ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Endemic Area ◽  
Agglutination Test ◽  
Leishmania Infection ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Cross Sectional ◽  
Endemic Areas ◽  
The Impact

Background Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients. Methods We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive. Results A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection. Conclusions A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.

scholarly journals Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009–December 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suleiman Bello Abdullahi ◽  
Olayinka Rasheed Ibrahim ◽  
Abdulkadir Baba Okeji ◽  
Rabilu Iliyasu Yandoma ◽  
Ibrahim Bashir ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Treatment Success ◽  
Tertiary Care ◽  
Cd4 Count ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
First Line ◽  
Tertiary Care Centre ◽  
Cross Sectional

Abstract Background Human Immuno-Deficiency Virus (HIV) remains one of the world’s significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. Methods This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients’ care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. Results Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts  ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20–40) vs 19,989 (3311–110,340) cp/ml in virally suppressed, and unsuppressed  respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. Conclusions Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.

scholarly journals Contraceptive practices amongst HIV-positive women on antiretroviral therapy attending an ART clinic in South Africa

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Ezekiel E. Oni ◽  
Andrew Ross ◽  
Stephan Van der Linde
Keyword(s):  
Antiretroviral Therapy ◽  
Contraceptive Use ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Hiv Positive ◽  
Hiv Status ◽  
Cross Sectional ◽  
Factors Associated ◽  
Hiv Positive Women ◽  
Desire For A Child

Background: Effective contraceptive practices amongst HIV-positive women of reproductive age have been shown to reduce mother-to-child transmission of HIV by preventing unplanned pregnancies. However, most antiretroviral therapy (ART) programmes focus on treatment,neglecting comprehensive contraceptive services. This results in a high frequency of pregnancies amongst HIV-positive women attending the ART clinic of a regional hospital north of Durban.Objectives: This research aimed to explore contraceptive use amongst HIV-positive women attending an ART clinic by determining, (1) prevalence of contraceptive use, (2) pregnancy rate, (3) contraceptive preferences and (4) factors associated with contraceptive use.Methods: In this observational, analytical, cross-sectional study of 420 women, aged 15to 49 years, participants were selected by systematic random sampling. They completed standardised questionnaires.Results: Of all participants, 95% of the participants used contraception. Factors associated with contraceptive practice were knowledge of HIV status 292 (72.8%), health worker advice 84 (20.9%), and spousal insistence 33 (8.2%). Of the 130 women (31%) who had fallen pregnant whilst on ART, 73 (56.2%) said that the pregnancy had been unplanned, whilst 57 (43.8%) had wanted to fall pregnant because of: partner’s insistence (45.6%), desire for a child (36.8%),desire to conceal HIV status (15.8%), not wanting to die childless (5.3%), and death of aprevious child (1.8%).Conclusion: Contraceptive use amongst these women was high but the number of pregnancies is a cause for concern. Information regarding contraceptive use should therefore be providedat all ART clinics.

scholarly journals Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys

2020 ◽  
Author(s):  
Clara Pons-Duran ◽  
Mireia Llach ◽  
Charfudin Sacoor ◽  
Sergi Sanz ◽  
Eusebio Macete ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Intermittent Preventive Treatment ◽  
Preventive Treatment ◽  
Malaria Prevention ◽  
Reproductive Age ◽  
Cluster Sampling ◽  
Household Surveys ◽  
Cross Sectional ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.

scholarly journals Determinants of Antenatal Care Attendance among Pregnant Women Living in Endemic Malaria Settings: Experience from the Democratic Republic of Congo

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Célestin Ndosimao Nsibu ◽  
Célestin Manianga ◽  
Serge Kapanga ◽  
Esther Mona ◽  
Philippe Pululu ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Male Partner ◽  
First Trimester ◽  
Reproductive Age ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Republic Of Congo

Background. Antenatal care (ANC) attendance helps pregnant women to benefit from preventive and curative services.Methods. Determinants for ANC attendance were identified through a cross-sectional survey in the Democratic Republic of Congo. Sociocultural bottlenecks were assessed via focus groups discussion of married men and women.Results. In this survey, 28 of the 500 interviewed pregnant women (5.6%) did not attend ANC services and 82.4% booked over the first trimester. The first visit is positively influenced by the reproductive age (OR: 0.52, 95% CI(0.28–0.95),p<0.04), the educational level (OR: 0.41,95% CI(0.17–0.97),p<0.04), the nearby health center (OR: 0.43, 95% CI(0.2–0.92),p<0.03), and the presence of a male partner (OR: 10.48, 95% CI(2.1–52.23),p<0.001). The barriers to early booking were (i) the cost of service; (ii) the appearance or individual income; (iii) the geographical inaccessibility or distance to health facilities; (iv) social and religious prohibitions; (v) the stigmatization from other women when conceiving in the late ages or young or while still lactating (parity); (vi) the time for waiting for services.Conclusion. The early ANC attendance is delayed among poor women with little education and living alone.

scholarly journals Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246140
Author(s):  
Sarah Nabukeera ◽  
Joseph Kagaayi ◽  
Fredrick Edward Makumbi ◽  
Henry Mugerwa ◽  
Joseph K. B. Matovu
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Clinical Research ◽  
Clinical Stage ◽  
Research Centre ◽  
Hiv Positive ◽  
Factors Associated ◽  
Art Initiation ◽  
Stage 4

Background While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. Method This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0–14 years) were randomly selected from existing medical records and data on children’s socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. Results The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5–9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10–14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. Conclusion Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.

scholarly journals Cost of Ante-natal Care among Health Insurance (HI) Enrollees and Out-of-Pocket (OOP) Payers accessing Maternal Healthcare Services in a Tertiary Health Institution in Southwest Nigeria

2021 ◽  
Vol 9 (2) ◽  
pp. 11-22
Author(s):  
Taofeek Adedayo Sanni
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Healthcare Services ◽  
Reproductive Age ◽  
P Value ◽  
Maternal Healthcare ◽  
Cross Sectional ◽  
Health Institution ◽  
Total Cost ◽  
Southwest Nigeria

Maternal Mortality Remains A Leading Cause Of Death Among Women Of Reproductive Age Group. This Study Determined The Cost Of Antenatal Care Among Health Insurance (HI) Enrollees And Out-Of-Pocket (OOP) Payers Accessing Maternal Healthcare Services In A Tertiary Health Institution In Southwest Nigeria. A Comparative Cross-Sectional Study Was Carried Out Among 380 Women (190 HI Enrollees And 190 OOP Payers) Attending Antenatal Care Services In A Tertiary Health Institution In Southwest Nigeria Using A Systematic Random Sampling Technique. Data Was Gathered Using An Interviewer-Administered Semi-Structured Questionnaire And Analyzed Using IBM SPSS Version 23. Chi-Square And Binary Logistic Regression Were Used To Assess The Association Between Dependent And Independent Variables And A P-Value Of <0.05 Was Taken As Significant. The Overall Mean Age Of Respondents In This Study Was 33.8 ± 5.0 Years (HI Group: 34.1 ± 4.9 Years And OOP Group: 33.6 ± 5.0 Years). The Mean Total Cost Of Antenatal Care (ANC) Is Lesser For HI Enrollees (₦5,095.2 ± 1,753.1 Equivalent To $13.3 ± 4.6) As Compared With OOP Payers (₦15,050.6 ± 5,548.9 Equivalent To $39.6 ± 14.6). Predictors And Enablers For HI Uptake Are Marital Status, Family Size, Level Of Education, Occupation, Appropriate And Quality HI Package, And Trust In The HI Scheme. It Was Concluded That The Total Cost Of Antenatal Care Is Lower Among The Health Insurance Enrollees Than The Out-Of-Pocket Payers. Therefore, Interventions To Increase Awareness And Designing More Enticing HI Packages Are Recommended.

scholarly journals FACTORS AFFECTING UTILIZATION OF ANTENATAL CARE SERVICES IN SANA'A CITY, YEMEN

2017 ◽  
Vol 17 (3) ◽  
pp. 1-14
Author(s):  
Seham Othman ◽  
Taha Almahbashi ◽  
Alabed Ali A. Alabed
Keyword(s):  
Antenatal Care ◽  
Signs And Symptoms ◽  
First Trimester ◽  
Health Problems ◽  
Reproductive Age ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Danger Signs ◽  
Care Services ◽  
Mother Education

Antenatal care is a vital part of primary healthcare that is known to improve maternal and newborn outcomes. The aim of this study was to identify the factors affecting utilization of antenatal care services for women in reproductive age in Yemen. This cross-sectional community-based study was conducted in six districts of Sana’a City, Yemen. Data were collected from 460 mothers who gave birth in the past six months via face-to-face interviews at home between September to December 2010. Only 54% of mothers were found to have made four or more antenatal care visits. Almost two third of participants made their first visit during their first trimester due to presence of health problems and did not follow up when they became healthy during pregnancy. Reasons for not receiving antenatal care services due to absence of health problems, high cost of antenatal care services, long waiting time, and poor staff attitude. Sixty percent of participants were unaware of the danger symptoms of common health problems in pregnancy. The significant factors affecting utilization of antenatal services were mother education, residence place, age at first pregnancy, gravida, parity, occurrence of pregnancy without planning, and number of live children (P<0.05). The factors affecting the number of visits were mother education, place of residence, and husband work were (P<0.05). Future healthcare activities should focus on improving women’s awareness of the importance of antenatal care even in the absence of noticeable health problems and lack of education about the common danger signs and symptoms of pregnancy.

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