scholarly journals Causes of Hospitalization and Predictors of Mortality among Adult HIV Positive Patients at the Benue State University Teaching Hospital, Makurdi

2020 ◽  
pp. 88-97
Author(s):  
Patrick Ojojarumi Echekwube ◽  
Emmanuel Uzodimma Iwuozo ◽  
Helen Sagay
Keyword(s):  
Substance Use ◽  
Pulmonary Tuberculosis ◽  
Short Duration ◽  
Opportunistic Infections ◽  
Scale Up ◽  
University Teaching ◽  
Hiv Care ◽  
Hiv Positive ◽  
Predictors Of Mortality ◽  
Male Sex

Introduction: HIV/AIDS is one of the leading causes of morbidity and mortality worldwide. In Africa, opportunistic infections are the leading causes of morbidity among HIV patients and there is need to establish the causes of morbidity and/or mortality among the patients in our environment. Methods: This was a retrospective study in which the case files of adult HIV positive patients admitted from January 2018 to December 2018 were retrieved. Their socio-demographic profile, HIV stage at admission, outcomes and other relevant information were extracted. The Center for Disease Control staging for HIV was used for the study. Results: A total of 94 patients were enrolled into the study. At admission, most of the patients, 57(61%) were in CDC Stage B while the remaining patients were in stage C. Pulmonary tuberculosis was responsible for most of the admissions. The total number of deaths were 27 giving a mortality ratio of 28.7%; 9 (33%) of them were in stage B and the remaining 18 (67%) were in stage C. The predictors of mortality were male sex, short duration of admission, substance use and referral from non-specialist centres. Conclusion: The major disease cause of morbidity among PLHIV in Makurdi is Pulmonary Tuberculosis. Male sex, substance use, referral from non-specialist centres and short duration of admission were significant predictors of mortality. All stakeholders involved in HIV care should intensify efforts at early HIV diagnosis, scale up HAART where necessary and implement task shifting at non-specialist centres to improve treatment outcomes.

scholarly journals Accessing antiretroviral therapy for children: Caregivers' voices

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.

scholarly journals Status of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara University Teaching Hospital in Southwestern Uganda

2021 ◽  
Vol 8 ◽  
pp. 204993612110424
Author(s):  
Israel Kiiza Njovu ◽  
Benson Musinguzi ◽  
James Mwesigye ◽  
Kennedy Kassaza ◽  
Joseph Turigurwa ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Clinical Features ◽  
Fungal Pathogens ◽  
Study Participant ◽  
University Teaching ◽  
Blue Staining ◽  
Hiv Positive ◽  
Fungal Culture ◽  
Cross Sectional Survey ◽  
Cross Sectional

Background: Pulmonary mycoses are important diseases of the respiratory tract caused by pulmonary fungal pathogens. These pathogens are responsible for significant morbidity and mortality rates worldwide; however, less attention has been paid to them. In this study we determined the prevalence of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara Regional Referral Hospital. Method: This was a hospital based cross sectional survey. Sputum samples were collected from each study participant. For each sample, the following tests were performed: Sabouraud dextrose agar for fungal culture, GeneXpert for Mycobacteria tuberculosis (MTB) and potassium hydroxide for fungal screening. Filamentous fungal growth and yeasts were further examined with lactophenol cotton blue staining and germ tube respectively. Results: Out of 113 study participants, 80 (70.7%) had pulmonary fungal pathogens whilst those with pulmonary tuberculosis numbered five (4.4%). Candida albicans [21 (22.58%)] and Aspergillus species [16 (17.20%)] were the pathogens most identified among others. Two (1.7%) TB GeneXpert positive participants had fungal pathogens isolated from their sputum samples. We established a prevalence of 57 (71.3%) for pulmonary fungal pathogen (PFP) isolates, three (60.0%) for MTB in HIV positive patients and 18 (22.5%) for PFP, and zero (0.0%) for MTB in HIV negative patients. On the other hand, two (100%) HIV positive patients had both PFP isolates and MTB. Conclusion: Our findings highlight the diversity of neglected pulmonary fungal pathogens whose known medical importance in causing pulmonary mycoses cannot be overemphasised. Therefore this presents a need for routine diagnosis for pulmonary mycoses among TB suspects and set-up of antimicrobial profile for pulmonary fungal isolates to support clinical management of these cases.

scholarly journals The Unique Challenges Facing HIV-Positive Patients Who Smoke Cigarettes: HIV Viremia, Art Adherence, Engagement in HIV care, and Concurrent Substance Use

2014 ◽  
Vol 19 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Conall O’Cleirigh ◽  
Sarah E. Valentine ◽  
Megan Pinkston ◽  
Debra Herman ◽  
C. Andres Bedoya ◽  
...  
Keyword(s):  
Substance Use ◽  
Hiv Care ◽  
Hiv Positive ◽  
Art Adherence ◽  
Engagement In Hiv Care

scholarly journals High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018–2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Auxilia Muchedzi ◽  
Mulamuli Mpofu ◽  
Fungai H. Mudzengerere ◽  
Moses Bateganya ◽  
Tarirai Mavimba ◽  
...  
Keyword(s):  
Large Scale ◽  
Scale Up ◽  
Age Groups ◽  
Hiv Care ◽  
Hiv Positive ◽  
Chi Square ◽  
Innovative Strategy ◽  
Mobile Testing ◽  
Self Testing ◽  
The Difference

Introduction: HIV self-testing (HIV-ST) is an innovative strategy to increase HIV case identification. This analysis shares the outcomes of HIV-ST implementation within the Zimbabwe HIV Care and Treatment (ZHCT) project for the period October 2018–March, 2020.Materials and Methods: We extracted HIV-ST data for the period October 2018 to March 2020 from the project database and assessed (1) the proportion of reactive HIV-ST results; (2) the concordance between reactive HIV-ST results against rapid confirmatory HIV tests using Determine™ and Chembio™ in parallel; and (3) the monthly contribution of HIV-ST to total HIV positive individuals identified within project. The Chi-square test was used to assess for statistical differences in HIV positivity between age groups, by sex and district; as well as the difference in HIV positivity between the HIV-ST and index and mobile testing strategies.Findings: Between October 2018 and March 2020, the ZHCT project distributed 11,983 HIV-ST kits; 11,924 (99.8%) were used and 2,616 (21.9%) were reactive. Of the reactive tests, 2,610 (99.8%) were confirmed HIV positive giving a final positivity rate of 21.9%, and a concordance rate of 99.8% between the HIV-ST results and the confirmatory tests. Proportion of reactive results differed by age-groups (p < 0.001); with the 35–49 years having the highest positivity rate of 25.5%. The contribution of HIV-ST to total new positives increased from 10% in October 2018 to 80% at the end of March 2020 (p < 0.001). Positivity rates from HIV-ST were significantly different by age-groups, sex and district (p = 0.04). Additionally, index and mobile testing had a higher positivity rate compared to HIV-ST (p < 0.001).Conclusion: The ZHCT project has successfully scaled up HIV self-testing which contributed significantly to HIV case finding. Countries should consider using the lessons to scale-up the intervention which will contribute in reaching under-served and undiagnosed populations.

Ocular manifestations in tuberculosis cases with HIV in Nepal

2019 ◽  
Vol 11 (2) ◽  
pp. 130-137
Author(s):  
Subash Bhatta ◽  
D. N. Shah ◽  
Meenu Choudhary ◽  
Ajit Thakur ◽  
Nayana Pant
Keyword(s):  
Pulmonary Tuberculosis ◽  
Opportunistic Infections ◽  
Retinal Vasculitis ◽  
University Teaching ◽  
Ocular Tissue ◽  
Ocular Involvement ◽  
Extra Pulmonary Tuberculosis ◽  
Cd4 Counts ◽  
Ocular Manifestations ◽  
Extra Pulmonary

Introduction: TB has seen resurgence associated with HIV. Tuberculosis can affect any ocular tissue. The association of HIV with TB is supposed to increase the incidence and plethora of ocular manifestations in tuberculosis. Objectives: To study the various ocular manifestations seen in tuberculosis patients with associated HIV infection. Material and Methods: This hospital based, cross sectional descriptive study was conducted in Tribhuvan University, Teaching Hospital, Maharajgunj, Nepal and Geta Eye Hospital, Kailali from 2010 to 2015. Diagnosed cases of pulmonary and extra pulmonary tuberculosis with HIV co infection were evaluated for ocular manifestations after excluding other opportunistic infections. Results: Of 70 cases eligible for the study, extra pulmonary tuberculosis was seen in60% of the cases. 5 patients (7.1 %) had ocular manifestations. CD4 counts were <50/mm3 in 3 cases. Ocular involvement was seen in the form of choroidal granulomas, papillitis, cranial nerve palsy, retinal vasculitis and central serous chorioretinopathy. Conclusion: This study demonstrated that ocular involvement is a frequent finding in cases with tuberculosis and HIV. Ocular findings are more common in cases with lesser CD4 counts. As ocular tuberculosis can be visually devastating, we recommend regular ocular evaluation of all patients with HIV and systemic tuberculosis.

scholarly journals “I Want to Get Better, But…”: Identifying the Perceptions and Experiences of People Who Inject Drugs With Respect to Evolving Hepatitis C Virus Treatments

2020 ◽  
Author(s):  
Trevor Goodyear ◽  
Helen Brown ◽  
Annette J. Browne ◽  
Peter Hoong ◽  
Lianping Ti ◽  
...  
Keyword(s):  
Substance Use ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Hiv Care ◽  
Treatment Motivation ◽  
Hcv Treatment ◽  
Opioid Agonist

Abstract Background: The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018.Methods: Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n=56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results: The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co40 morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with interferon-based treatment and uncertainty regarding treatment eligibility negatively, influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs 46 with other substance use related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions: These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peerled care that responds to power differentials.

scholarly journals Comparison of a DNA based PCR method with conventional methods for the detection of M. tuberculosis in Jos, Nigeria

2009 ◽  
Vol 3 (06) ◽  
pp. 470-475 ◽  
Author(s):  
Agatha Ani ◽  
Silvanis Okpe ◽  
Maxwell Akambi ◽  
Emeka Ejelionu ◽  
Bitrus Yakubu ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
University Teaching ◽  
Hiv Positive ◽  
Smear Microscopy ◽  
Hiv Status ◽  
Clinical Specimens ◽  
Resource Limited ◽  
Pcr Method ◽  
Polymerase Chain ◽  
Conventional Methods

Background: To achieve early diagnosis and effective treatment of pulmonary tuberculosis, simple and sensitive methods that enhance the detection of Mycobacterium tuberculosis (M. tuberculosis) from clinical specimens are needed. This study compared the effectiveness and suitability of an insertion sequence (IS 6110) based polymerase chain reaction (PCR) assay with conventional methods for the detection of M. tuberculosis from clinical specimens in a resource-limited setting. Methods: Sputa from 101 HIV-positive patients and 40 clinical specimens (sputa, gastic wash out, ascitic fluid, pleural fluid and cerebrospinal fluid) collected from children (HIV status unknown), all suspected for pulmonary tuberculosis at the Jos University Teaching Hospital, Jos, (JUTH) Nigeria, were examined by Ziehl Neelsen (ZN) smear microscopy, Lowenstein Jensen’s (LJ) egg-based culture, and PCR methods for the detection of M. tuberculosis. Results: Mycobacteria was detected in 45/101 (44.6%) of the specimens from the HIV-positive patients and comprised of 6% ZN+culture+PCR+, 4% ZN-culture+PCR-, 16% ZN-culture+PCR+ and 19% ZN-culture-PCR+. Twenty-two of forty (55%) children were positive with 0% smear microscopy; 4/40 (10%) culture+PCR+; and 18/40 (45%) culture-PCR+. The sensitivity and specificity of the PCR for the HIV-positive patients were 85% and 74% respectively against 23% and 100% for ZN smear microscopy. Conclusion: The IS6110 PCR is a rapid and sensitive method that is specific for the M. tuberculosis complex group. It is simple in our experience and increased the detection of M. tuberculosis from the specimens examined. We suggest its use for the detection of M. tuberculosis in high TB and HIV burden areas.

scholarly journals “I want to get better, but…”: identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Trevor Goodyear ◽  
Helen Brown ◽  
Annette J. Browne ◽  
Peter Hoong ◽  
Lianping Ti ◽  
...  
Keyword(s):  
Substance Use ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Hiv Care ◽  
Treatment Motivation ◽  
Hcv Treatment ◽  
Opioid Agonist

Abstract Background The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018. Methods Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n = 56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to: being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with Interferon-based treatment and uncertainty regarding treatment eligibility, negatively influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials.

scholarly journals Contraception Choice among HIV-Positive Women Utilizing Family Planning Services Integrated with HIV Care at the Antiretroviral Therapy Clinic of Jos University Teaching Hospital, Nigeria

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Halima Sule ◽  
Mark Gyang ◽  
Tinuade Oyebode ◽  
Margaret Tersoo
Keyword(s):  
Family Planning ◽  
Antiretroviral Therapy ◽  
Teaching Hospital ◽  
University Teaching ◽  
Hiv Care ◽  
Hiv Positive ◽  
Family Planning Services ◽  
Infected Woman ◽  
Hiv Positive Women ◽  
The Impact

Transmission of Human Immunodeficiency Virus from a pregnant HIV-infected woman to her unborn child is one of the ways through which new HIV infections can be acquired. Utilization of contraceptives among HIV-positive women can prevent unintended pregnancies, and the use of dual methods reduces the risk of transmission of sexually transmitted infections including HIV, hence the need to support contraception in them. This study sought to describe the various choices of contraception used by women accessing family planning services integrated with the antiretroviral therapy facility of Jos University Teaching Hospital. In a retrospective study, relevant information was extracted from the records of all women who had sought contraception in the Family Planning unit of the facility from 1st March 2019 – 29th February 2020. The data obtained was analysed using EPI info 7 statistical software. Results: A total of 137 records were reviewed. The most frequent choice of contraception was hormonal implants (61.3%), while the least frequent choice was using condoms alone (1.5%). Less than half (46.7%) of them used dual contraception. Secondary and tertiary educational status, as well as disclosure of HIV-positive status to partner were significantly associated with utilization of dual contraceptive methods (P value =0.0010 and 0.0245 respectively; Odds ratio =5.8199 and 4.3307 respectively). Conclusion: Integration of family planning services with HIV care as a strategy for the prevention of unintended pregnancy is promoted in this facility but there is need to improve the uptake particularly of dual method of contraception. There is also need for inclusion of IUCD in the choices of contraception offered as this method is highly effective, long lasting and has been proven to be safe in well selected HIV patients. Furthermore, screening the clients to identify unmet needs and implementing strategies to meet those needs would enhance the impact of family planning.

scholarly journals “I want to get better, but…”: Identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments

2021 ◽  
Author(s):  
Trevor Goodyear ◽  
Helen Brown ◽  
Annette J. Browne ◽  
Peter Hoong ◽  
Lianping Ti ◽  
...  
Keyword(s):  
Substance Use ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Scale Up ◽  
Hiv Care ◽  
Treatment Motivation ◽  
Hcv Treatment ◽  
Opioid Agonist

Abstract Background: The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) – a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access – continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018.Methods: Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n=56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. Results: The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with interferon-based treatment and uncertainty regarding treatment eligibility negatively, influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. Conclusions: These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials.

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