The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana

2020 ◽  
Author(s):  
Adobea Y Owusu ◽  
Mabel Teye-kau ◽  
Eric Y Tenkorang
Keyword(s):  
Sub Saharan Africa ◽  
Housing Conditions ◽  
Hiv Status ◽  
Policy Makers ◽  
Stability And Change ◽  
Housing Stability ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Depth Interviews

Summary Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

scholarly journals Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

2021 ◽  
Vol 22 ◽  
Author(s):  
Maria Y. Charumbira ◽  
Karina Berner ◽  
Quinette A. Louw
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health System ◽  
Fall Prevention ◽  
Falls Prevention ◽  
Sub Saharan Africa ◽  
Prevention Services ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

Abstract Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

scholarly journals Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa

2019 ◽  
Vol 71 (3) ◽  
pp. 525-531 ◽  
Author(s):  
Caleb Skipper ◽  
Mark R Schleiss ◽  
Ananta S Bangdiwala ◽  
Nelmary Hernandez-Alvarado ◽  
Kabanda Taseera ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Opportunistic Infections ◽  
Survival Rates ◽  
Hazard Ratio ◽  
Sub Saharan Africa ◽  
Persons Living With Hiv ◽  
Median Plasma ◽  
Sub Saharan ◽  
Immunodeficiency Syndrome ◽  
Living With Hiv

Abstract Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Conclusions Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). Clinical Trials Registration NCT01075152.

scholarly journals “Lighten This Burden of Ours”: Acceptability and Preferences Regarding Injectable Antiretroviral Treatment Among Adults and Youth Living With HIV in Coastal Kenya

2021 ◽  
Vol 20 ◽  
pp. 232595822110005
Author(s):  
Jane M. Simoni ◽  
Kristin Beima-Sofie ◽  
George Wanje ◽  
Zahra H. Mohamed ◽  
Kenneth Tapia ◽  
...  
Keyword(s):  
Side Effects ◽  
Treatment Options ◽  
Sub Saharan Africa ◽  
Hiv Stigma ◽  
Attractive Alternative ◽  
Persons Living With Hiv ◽  
Sub Saharan ◽  
Long Acting ◽  
Youth Living With Hiv ◽  
Living With Hiv

Background: Long-acting injectable (LAI) antiretroviral therapy (ART) may offer persons living with HIV (PLWH) an attractive alternative to pill-based treatment options, yet acceptability data remain scant, especially in sub-Saharan Africa. Methods: We conducted 6 focus group discussions with PLWH, including key stake holder groups, and analyzed data with content analysis. Results: Initial reactions to the idea of LAI-ART were often positive. The primary advantages voiced were potential to facilitate improved adherence and alleviate the burden of daily pill-taking while avoiding inadvertent disclosure and HIV stigma. Potential side effects were a particular concern of the women. Most participants preferred clinic-based administration over self-injections at home due to concerns about safety, privacy, and potential need for refrigeration. Conclusions: LAI-ART may be acceptable in Kenya, provided injections are infrequent and delivered in a clinic setting. However, HIV stigma, fear of potential side effects, and limited clinical capacity would need to be addressed.

scholarly journals Factors Influencing Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State Southeast Nigeria

2019 ◽  
pp. 1-8
Author(s):  
C. P. Igweagu ◽  
O. H. Chime ◽  
O. C. Ekwueme
Keyword(s):  
Health Education ◽  
Sub Saharan Africa ◽  
Limiting Factors ◽  
People Living With Hiv ◽  
Factors Influencing ◽  
Persons Living With Hiv ◽  
Enugu State ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Aids

Background: The Acquired Immune – deficiency syndrome (AIDS) is a terminal illness caused by a retrovirus known as the Human Immune-deficiency virus (HIV). HIV/AIDS is a leading cause of death in sub-saharan Africa. Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa with 1.9 million people living HIV in 2018. Antiretroviral therapy (ART) has significantly reduced morbidity and mortality, prolonged life expectancy and improved quality of life among people living with HIV/AIDS infection (PLWHA). To be most effective ART requires a near perfect level of adherence. Poor adherence compromises treatment effectiveness, leading to treatment failure and development of drug resistance. Non-adherence is also characterized by increased morbidity, mortality and great economic loss. This study assessed the effect of health education on factors influencing adherence to ART among PLWHAs in Enugu State. Methodology: A health education intervention was carried out among 312 persons living with HIV/AIDS receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy. A structured questionnaire was used to collect data from 312 people living with HIV/AIDS (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey. Results: Knowledge of supportive and limiting factors of adherence improved significantly among the study group than the controls post-intervention (P<0.001). The factors that facilitated adherence included follow-up visits, adequate information education/counseling and supportive relationships. The limiting factors were drug side-effects, forgetfulness, finance and travel time to clinic. Conclusion: Health education improved knowledge of supportive factors of ART adherence among PLWHAs in Enugu State, and this should be promoted.

scholarly journals Myocardial Fibrosis among ART-treated Persons Living with HIV in South Africa

2020 ◽  
Author(s):  
S R Shuldiner ◽  
L Y Wong ◽  
T E Peterson ◽  
J Wolfson ◽  
S Jermy ◽  
...  
Keyword(s):  
Heart Failure ◽  
South Africa ◽  
Myocardial Fibrosis ◽  
Sub Saharan Africa ◽  
Absolute Difference ◽  
Central Feature ◽  
Hiv Status ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
Cmr Imaging

Abstract Background Heart failure is a prominent cardiovascular disease manifestation sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons living with HIV (PWH) in South Africa (SA). Methods Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by HIV status were made using linear and logistic regression, adjusted for age, sex, and hypertension. Findings 134 PWH and 95 uninfected completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared to controls, PWH had greater myocardial fibrosis by extracellular volume fraction (ECV; absolute difference 1.2%; 95%CI 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (&gt;125 pg/mL; OR 2.4; 95%CI: 1.0-6.0). Among all PWH, an elevated NT-proBNP levels was associated with higher ECV (3.4% higher; 95%CI: 1.3-5.5). Interpretation HIV disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

scholarly journals Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa (Preprint)

2017 ◽  
Author(s):  
Brian Rice ◽  
Andrew Boulle ◽  
Stefan Baral ◽  
Matthias Egger ◽  
Paul Mee ◽  
...  
Keyword(s):  
Local Level ◽  
Clinical Care ◽  
Routine Data ◽  
Sub Saharan Africa ◽  
Data Systems ◽  
Persons Living With Hiv ◽  
Sentinel Events ◽  
Sub Saharan ◽  
Living With Hiv ◽  
New Phase

UNSTRUCTURED The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts.

scholarly journals Alcohol use during pregnancy in Rakai, Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256434
Author(s):  
Adriane Wynn ◽  
Dorean Nabukalu ◽  
Tom Lutalo ◽  
Maria Wawer ◽  
Larry W. Chang ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Pregnant Women ◽  
Partner Violence ◽  
Sub Saharan Africa ◽  
Hiv Status ◽  
Cross Sectional ◽  
The Past ◽  
Catholic Religion ◽  
Sub Saharan ◽  
Living With Hiv

Introduction Antenatal alcohol use is linked to adverse maternal and neonatal outcomes. Uganda has one of the highest rates of alcohol use in sub-Saharan Africa, but the prevalence of antenatal alcohol use has not been reported in the Rakai region. Methods We used cross-sectional data from pregnant women in the Rakai Community Cohort Study between March 2017 and September 2018. Using bivariate and multivariable analyses, we assessed associations between self-reported antenatal alcohol use and sociodemographic characteristics, intimate partner violence (IPV), and HIV status. Results Among 960 pregnant women, the median age was 26 years, 35% experienced IPV in the past 12 months, 13% were living with HIV, and 33% reported alcohol use during their current pregnancy. After adjusting for marital status, education, smoking, and HIV status; Catholic religion (AOR: 3.54; 95% CI: 1.89–6.64; compared to other), bar/restaurant work (AOR: 2.40; 95% CI: 1.17–4.92; compared to agriculture), >one sex partner in past year (AOR: 1.92; 95% CI: 1.17–3.16), a partner that drank before sex in past year (AOR: 2.01; 95% CI: 1.48–2.74), and past year IPV (AOR: 1.55; 95% CI: 1.14–2.11) were associated with antenatal alcohol use. Conclusion We found that alcohol use during pregnancy was common and associated with religion, occupation, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and IPV experience. More research is needed to understand the quantity, frequency, and timing of antenatal alcohol use; and potential impacts on neonates; and to identify services that are acceptable and effective among pregnant women.

scholarly journals Accuracy of self-reported HIV testing history and awareness of HIV-positive status among people living with HIV in four Sub-Saharan African countries

2020 ◽  
Author(s):  
Yiqing Xia ◽  
Rachael M. Milwid ◽  
Arnaud Godin ◽  
Mare-Claude Boily ◽  
Leigh F. Johnson ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Latent Class ◽  
Latent Class Models ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Hiv Status ◽  
African Countries ◽  
Sub Saharan ◽  
Living With Hiv

Background: In many countries in Sub-Saharan Africa, self-reported HIV testing history and awareness of HIV-positive status from household surveys are used to estimate the percentage of people living with HIV (PLHIV) who know their HIV status. Despite widespread use, there is limited empirical information on the sensitivity of those self-reports, which can be affected by non-disclosure. Methods: Bayesian latent class models were used to estimate the sensitivity of self-reported HIV testing history and awareness of HIV-positive status in four Population-based HIV Impact Assessment surveys in Eswatini, Malawi, Tanzania, and Zambia. Antiretroviral (ARV) metabolites biomarkers were used to identify persons on treatment who did not accurately report their status. For those without ARV biomarkers, the pooled estimate of non-disclosure among untreated persons was 1.48 higher than those on treatment. Results: Among PLHIV, the sensitivity of self-reported HIV testing history ranged 96% to 99% across surveys. Sensitivity of self-reported awareness of HIV status varied from 91% to 97%. Non-disclosure was generally higher among men and those aged 15-24 years. Adjustments for imperfect sensitivity did not substantially influence estimates of of PLHIV ever tested (difference <4%) but the proportion of PLHIV aware of their HIV-positive status was higher than the unadjusted proportion (difference <8%). Conclusions: Self-reported HIV testing histories in four Eastern and Southern African countries are generally robust although adjustment for non-disclosure increases estimated awareness of status. These findings can contribute to further refinements in methods for monitoring progress along the HIV testing and treatment cascade.

Epidemiology and the Spread of HIV

2017 ◽  
Author(s):  
Philip Bolduc ◽  
Navix Order ◽  
Emily Colgate
Keyword(s):  
United States ◽  
The United States ◽  
Sub Saharan Africa ◽  
Heterosexual Transmission ◽  
Persons Living With Hiv ◽  
The Us ◽  
Sub Saharan ◽  
Sex With Men ◽  
Prevention Methods ◽  
Living With Hiv

Worldwide, approximately 36 million people are infected with HIV. The number of new infections has been declining in most geographic areas including sub-Saharan Africa due to a larger number of persons receiving antiretroviral therapy (ART) and the uptake of new prevention methods. Prevalence in many areas has either stabilized or gradually increased due to prolonged survival. The US epidemic has remained stable, with approximately 1.2 million persons living with HIV. There are fewer AIDS deaths and approximately 40,000–50,000 new infections yearly, leading to an overall increase in HIV prevalence in the United States. Globally, most new infections are via heterosexual transmission, with more than half of new infections occurring in women. In Europe and the United States, the largest number of new infections is occurring in men who have sex with men. Due to the progressive uptake of ART, mother-to-child transmission has declined significantly throughout the world.

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