A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients

One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34–51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.

Assessment of the factors affecting practice towards HIV/AIDS among in-School Youth in the West Guji Zone, South Ethiopia, 2021

Back Ground: Human immune deficiency virus was a worldwide pandemic, yet there is no proven medicine and vaccine to cure or prevent it. Prevention is only the mainstay solution to control the spread of the virus among high-risk young populations. Young peoples were at the greatest risk of HIV because of several influencing factors like: maturity-related physiological, emotional changes, sexuality, peer pressure, economical problem, and knowledge gaps concerning HIV. Therefore, continuously assessing prevention practice towards HIV among vulnerable young populations is relevant to yield necessary intervention.Methods and materials: Health care facility-based cross-sectional study design took place from December 01/2020 To January 01/2021. The multistage sampling technique was used in this study and a total of 615 participants were enrolled in the study. A self-administered questionnaire technique was employed to collect the data. The data was cross-checked before entered into Epi-Data version 4.4.3.1 and exported to SPSS Statistics Version 25 for analysis. Descriptive and inferential statistics were needed in the study. Bivariate logistic regression was done to check the association between dependent and independent variables. Variables that had association at p< 0.25 were entered into a multivariate logistic regression model to obtain an adjusted odds ratio. Statically significance cut point settled at p < 0.05 with 95% confidence intervals. Results: Out of the 615 students, 586 were completed the questionnaires in which 95.3% of respondents rate. The overall scores of poor knowledge, unfavorable attitude, and unsafe practice concerning HIV in the current study were 25.1%, 27.5%, and 24.2%. Of all study subjects; 38.7% were undifferentiated HIV from AIDS and 20.1% of them were wrongly reported as HIV/AIDS was a curable disease. Slightly more than half 51.5%, 28.2%, and 19.3% of the respondents were misbelieved that HIV transmitted by mosquito bit, eating food cooked by HIV positive person, and handshaking respectively. Voluntarily counseling and testing service was not utilized by (34.8%) respondents and 139(23.7%) were sexually active. Early initiation of sex at age < 15 years old was reported by 70(50.4%) and the mean of first sex was (15.68 + 2.13SD). Females were 71.6% time more likely protect from HIV AOR = 0.284, 95% CI = 0.18-0.43), Age group 15-19 (AOR = 4.69, 95%CI =2.33-9.42), singles in marital status (AOR= 7.03, 95%CI =3.19-15.52), Visiting sexual related video (AOR= 0.202, 95CI = 0.11-0.38) and sharing sharp (AOR= 0.089, 95%CI = 0.04-1.21) were factors significantly associated with practice towards HIV. Conclusion: Misconception on ways of HIV transmission and misbelieves towards people living with HIV, Knowledge, and practice gap were identified in this study. HIV risk behavior such as drinking alcohol, vising sexual-related videos, sharing sharp materials practiced by some of the study participants. Therefore, continuous and age-appropriate youth-friendly health services emphasized risk behavior reduction and delay in early initiation of sexual intercourse must be given to youth. Furthermore, training focused on HIV, ways of transmission, and how to prevent it must be given by the concerned bodies to step up the students’ knowledge, attitude and practice. Additionally, all stakeholders including health care institutions, education institutions, and mass-medias give strong concern to alleviate misconceptions around HIV/AIDS particularly in this time of the COVID-19 pandemic.

Active TB infection and its associated factors among HIV-1 infected patients at Jimma medical center, Southwest Ethiopia

Background Human immune deficiency virus (HIV) increases the susceptibility to primary infection or reinfection and the risk of tuberculosis (TB) reactivation for patients with latent TB. There was no current report on the rate of active TB infection among HIV-1 infected patients in our teaching and referral hospital. Therefore, this study was aimed to determine the prevalence and factors associated with active TB infection among HIV-1 infected patients. Methods Hospital-based retrospective cross-sectional study was conducted at the Anti-Retroviral Therapy (ART) chronic follow-up clinic. Systematic random sampling was used to include the patients. A structured questionnaire was used to collect data. Data were analyzed using SPSS version 25. Descriptive statistics were used to describe the findings and multivariate logistic regression was performed to identify factors associated with active TB infection. Result 150 HIV-1 infected patients (female 54.7%) were included. The median (interquartile range, IQR) age of the patients was 33.5 (25.7, 40.0) years. Twenty-six (17.3%) of the patients had developed active TB infection, which was independently associated with the WHO clinical stage III and IV (AOR: 9.67, 95% confidence interval (CI); 2.21–42.37), p = 0.003). The use of isoniazid preventive therapy (IPT) (AOR: 0.123, 95CI; 0.034–0.44, p = 0.001) and having good adherence to ART medications (AOR: 0.076, 95CI; 0.007–0.80, p = 0.032) was associated with the reduced risk of active TB infection among HIV-1 infected patients. Conclusions Advanced WHO clinical stages increased the risk of active TB infection, while the use of IPT and good adherence to ART medications reduced the risk of active TB infection. Therefore, patients with advanced WHO clinical stage should be screened for TB infection, and starting IPT for the candidate patients should be strengthened to reduce the burden of active TB incidence. ART medication adherence should also be supported.

Impact of Chronic HIV Infection on SARS-CoV-2 Infection, COVID-19 Disease and Vaccines

Purpose of Review The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has developed into a global pandemic that affect the health of hundreds of millions worldwide. In particular, SARS-CoV-2 infection in people with chronic human immune deficiency virus (HIV) infection is of concern, due to their already immunocompromised status. Yet, whether and how the immunological changes brought about by HIV will affect the immune responses against SARS-CoV-2 acute infection and impact the effectiveness of vaccines remain unclear. We discuss the intersection of COVID-19 in HIV-infected individuals. Recent Findings People living with HIV (PLWH) may be at increased risk of severe SARS-CoV-2 mediated disease complication due to functional impairment of the immune system and persistent inflammation, which can be ameliorated by antiretroviral therapy. Importantly, limited data suggest that current approved vaccines may be safe and efficacious in PLWH. Summary To address remaining questions and supplement limited experimental evidence, more studies examining the interplay between HIV and SARS-CoV-2 through their impact on the host immune system are required.

The Nerve Growth Factor IB-like Receptor Nurr1 (NR4A2) recruits CoREST transcription repressor complexes to silence HIV following proviral reactivation in microglial cells

Human immune deficiency virus (HIV) infection of microglial cells in the brain leads to chronic neuroinflammation, which is antecedent to the development of HIV-associated neurocognitive disorders (HAND) in the majority of patients. Productively HIV infected microglia release multiple neurotoxins including proinflammatory cytokines and HIV proteins such as envelope glycoprotein (gp120) and transactivator of transcription (Tat). However, powerful counteracting silencing mechanisms in microglial cells result in the rapid shutdown of HIV expression to limit neuronal damage. Here we investigated whether the Nerve Growth Factor IB-like nuclear receptor Nurr1 (NR4A2), which is a repressor of inflammation in the brain, acts to directly restrict HIV expression. HIV silencing was substantially enhanced by Nurr1 agonists in both immortalized human microglial cells ( hµglia ) and induced pluripotent stem cells (iPSC)-derived human microglial cells (iMG). Overexpression of Nurr1 led to viral suppression, whereas by contrast, knock down (KD) of endogenous Nurr1 blocked HIV silencing. Chromatin immunoprecipitation (ChIP) assays showed that Nurr1 mediates recruitment of the CoREST/HDAC1/G9a/EZH2 transcription repressor complex to HIV promoter resulting in epigenetic silencing of active HIV. Transcriptomic studies demonstrated that in addition to repressing HIV transcription, Nurr1 also downregulated numerous cellular genes involved in inflammation, cell cycle, and metabolism, thus promoting HIV latency and microglial homoeostasis. Thus, Nurr1 plays a pivotal role in modulating the cycles of proviral reactivation by cytokines and potentiating the proviral transcriptional shutdown. These data highlight the therapeutic potential of Nurr1 agonists for inducing HIV silencing and microglial homeostasis and amelioration of the neuroinflammation associated with HAND.

Time to Develop and Predictors for Incidence of Tuberculosis among Children Receiving Antiretroviral Therapy

Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 ( IQR = ± 19 ) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) ( AHR = 2.5 ; 95% CI, 1.4-4.7, P < 0.021 ), being severely stunted ( AHR = 2.9 : 95% CI, 1.2-7.8, P < 0.03 ), and having low hemoglobin level ( AHR = 4.0 ; 95% CI, 2.1-8.1, P < 0.001 ) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.

AIDS-Defining Opportunistic Illnesses in Qatar, 2000-2016 : A Cohort Study

Background Human immune deficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981. Globally, since introduction of antiretroviral therapy, AIDS related death felt by more than 25% between 2005 &2011. Also, HIV related opportunistic infections (OIs) are less common, especially with use of prophylaxis to prevent such infections (3). We aim in this study to assess the incidence of HIV infection and related OIs in Qatar for 17-year period, and assess the spectrum of these infections, risk factors and treatment outcome. Methods retrospective cohort study for all HIV infected patients registered in Qatar from 2000-2016. Incidence of HIV infection and related opportunistic illness was calculated per 100000 population. Demographic and Clinical characteristic were compared between two groups of patients with and without opportunistic illness. Results of 167 cases with HIV infection 54 (32.3%) of them had opportunistic illness. The average incidence rate of HIV infection over 17 years is 0.69 per 100000 population, and the incidence rate for opportunistic illness is 0.27 per 100000 population, figure1. The most common opportunistic illness is pneumocystis jirovecii pneumonia (PCP) 25% of cases, followed by CMV retinitis 7.2%, Tuberculosis 5.4%, Toxoplasmosis 4.2% and less than 2% for Kaposi sarcoma, lymphoma and cryptococcal infection.

Bag of Features (BoF) Based Deep Learning Framework for Bleached Corals Detection

Coral reefs are the sub-aqueous calcium carbonate structures collected by the invertebrates known as corals. The charm and beauty of coral reefs attract tourists, and they play a vital role in preserving biodiversity, ceasing coastal erosion, and promoting business trade. However, they are declining because of over-exploitation, damaging fishery, marine pollution, and global climate changes. Also, coral reefs help treat human immune-deficiency virus (HIV), heart disease, and coastal erosion. The corals of Australia’s great barrier reef have started bleaching due to the ocean acidification, and global warming, which is an alarming threat to the earth’s ecosystem. Many techniques have been developed to address such issues. However, each method has a limitation due to the low resolution of images, diverse weather conditions, etc. In this paper, we propose a bag of features (BoF) based approach that can detect and localize the bleached corals before the safety measures are applied. The dataset contains images of bleached and unbleached corals, and various kernels are used to support the vector machine so that extracted features can be classified. The accuracy of handcrafted descriptors and deep convolutional neural networks is analyzed and provided in detail with comparison to the current method. Various handcrafted descriptors like local binary pattern, a histogram of an oriented gradient, locally encoded transform feature histogram, gray level co-occurrence matrix, and completed joint scale local binary pattern are used for feature extraction. Specific deep convolutional neural networks such as AlexNet, GoogLeNet, VGG-19, ResNet-50, Inception v3, and CoralNet are being used for feature extraction. From experimental analysis and results, the proposed technique outperforms in comparison to the current state-of-the-art methods. The proposed technique achieves 99.08% accuracy with a classification error of 0.92%. A novel bleached coral positioning algorithm is also proposed to locate bleached corals in the coral reef images.

Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.