Gaps in the continuum of care among people living with HIV in Afghanistan

Background Afghanistan adopted a “test and treat” strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. Methods We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. Results Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35–44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. Conclusion Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.

Treatment Literacy of People Living with HIV (PLHIV) in Government Healthcare Facilities in Malaysia

Background: Treatment literacy is a significant factor in the management of health and care of people living with HIV (PLHIV). Therefore, the aim of this study was to determine the level of treatment literacy among PLHIV in selected government facilities. Methods: A cross-sectional study was undertaken from July to August 2020 in five government hospitals and six government health clinics in Malaysia. A validated self-administered questionnaire encompassing six items about treatment literacy was used to assess the knowledge of PLHIV. This survey was conducted via web-based platform. Results: Overall, 1173 PLHIV participated in this study. The major finding in this study was that 90.0% of PLHIV were currently on treatment and aware of their antiretroviral therapy (ART) regime. Majority of PLHIV (74.0%) also stated that they know the frequency of receiving their viral load test. Conclusion: The study found a high level of treatment literacy among PLHIV in selected government facilities in Malaysia. Key words: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), people living with HIV (PLHIV), antiretroviral therapy (ART)

Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon

Background: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. Objective: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influ- encing return to care. Method: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemo- graphic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance ap- proved by CBCHS-IRB. Results: A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. Conclusion: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered ap- proaches like multiplying proxy ART pick points, devolving stable clients to community ARV model. Keywords: ART interruption; attrition; return to care; predictors; motivating factors; Cameroon.

Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon

Background: Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. Objective: We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influ- encing return to care. Method: We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemo- graphic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance ap- proved by CBCHS-IRB. Results: A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. Conclusion: Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered ap- proaches like multiplying proxy ART pick points, devolving stable clients to community ARV model. Keywords: ART interruption; attrition; return to care; predictors; motivating factors; Cameroon.

Patient and provider characteristics associated with retention in HIV medical care and viral suppression among in care patients in Hawaii

The percentages of retention in care and viral suppression among persons living with HIV (PLWH) in the United States from 2015 to 2018 were far below the 2020 national goals. This study aims to examine disparities in retention in care and viral suppression. The study population included PLWH diagnosed through 2016, residing in Hawaii at year-end 2016 and 2017, and who were in care in 2017 defined as having ≥1 CD4/viral load tests in 2017. Care providers were categorized as “very frequent” (≥50 patients), “frequent” (25–49 patients), “occasional” (10–24 patients), and “infrequent” (<10 patients). Among the 1752 patients included, 28.0% were not retained in care in 2017 (i.e., <2 CD4/VL tests performed at least 3 months apart), of whom 89.2% had only a single viral load test. Patients receiving care from the “infrequent” group of providers were less likely to be retained in care (adjusted odds ratio (aOR) = 0.48; 95% CI = 0.33, 0.69) or virally suppressed (aOR = 0.39; 95% CI = 0.24, 0.63), than patients receiving care from the “very frequent” group of providers. Percentages of three-year (2016–2018) in care and viral suppression were lowest among patients receiving care from “infrequent” care providers. Patients <45 years old were less likely to be retained in care (aOR = 0.53; 95% CI = 0.41, 0.68) or be virally suppressed (aOR = 0.59; 95% CI = 0.40, 0.86) than those 45 years or older. Patients of multiple races were less likely to be virally suppressed than whites (aOR = 0.38, 95% CI = 0.23, 0.64). Establishing a long-term relationship with an experienced HIV provider appears beneficial to achieve sustainable viral suppression and provision of uninterrupted HIV medical care.

Multicenter Evaluation of the Cepheid Xpert® HBV Viral Load Test

Accurate measurement of the hepatitis B virus (HBV) DNA is important for the management of patients with chronic HBV infection. Here, the performance of the Xpert® HBV Viral Load test (Xpert HBV Viral Load) versus the Roche COBAS® Ampliprep/COBAS® TaqMan® system (CAP/CTM HBV) HBV test v2.0 was evaluated. From September 2017 to December 2017, a total of 876 prospectively collected or archived serum or EDTA plasma specimens from subjects chronically infected with HBV were tested using the Xpert HBV Viral Load and the CAP/CTM HBV v2.0 assays. Of the 876 specimens tested, 560 were within the quantitative range of both assays. The agreement between the two methods was 90.0%. No difference in plasma or serum samples was observed. Deming regression analysis showed a good correlation of the Xpert HBV Viral Load assay with the CAP/CTM HBV v2.0 assay. The Bland–Altman analysis showed a good agreement between the results of the Xpert HBV Viral Load assay and the CAP/CTM HBV assay, with a mean difference (±1.96 standard deviation) of 0.0091 ± 0.3852 Log IU/mL. Comparing the two assays, only nineteen specimens (2.1%) had a difference greater than 1.96 times the standard deviation. The Xpert® HBV Viral Load test is suitable for monitoring patients with HBV infection and is useful in diagnostic settings.

ROLE OF MODERN TECHNOLOGY FOR TREATMENT OF HCV

HCV is the main reason of the liver disease and worldwide it is one of the major issues of health due to its development into cirrhosis, failure and cancer of liver. The transference of HCV is mainly through the parental but people who use drug like intravenous are also at greatest threat. The life cycle of HCV is now understood in a more precise way due to extensive studies. Due to more understanding of this virus there is establishment of more effectual antiviral medications and also diagnostic devices. Test of nucleic acids are suggested for the validation of active HCV. Serology tests are suggested for the groups that are at the greatest risk. Earlier for the standard medications of HCV interferon (IFN-a) and ribavirin are used. Later FDA approved a number of drugs such as harvoni, simeprevir and boceprevir etc. for the proper treatment of HCV. Antiviral medications will be utilized to treat the infections of HCV. In the management of certain severe viral infection, therapeutic option has improved in a better way. There is need of follow-up and careful consideration as well as there are many new technologies that have developed for the quantitative measurement of viral genome concentration in the body fluid of patients. Initially this measurement led to important insight in the viral infection pathogenesis as well as these test also revolutionized natural history of HCV. In addition viral load test are pure tool for research, these are used in routine viral diagnosis. Viral load test are used in clinical virology for diagnosis and prognosis of patient’s.

ASSESSMENT OF CD4 CELL COUNT AND VIRAL LOAD TEST IN HIV – INFECTED ADULTS

Introduction – CD4 cell count is an indicator of immune function in PLHIV and key determinant for the need of opportunistic infection prophylaxis. Viral load test is used to diagnose acute HIV infection, guide treatment choices and monitor response to ART. Since there have not been many studies on this topic, this study was done to assess the use of both CD4 cell count and viral load in the monitoring HIV/AIDS progression. Aim & objective – To assess the CD4 cell count and viral load in HIV- infected adults. Methods – This was a retrospective study, conducted on 197 patients receiving ART, from July 2018 to June 2019. CD4 cell count was done by BD FACS count system and viral load test was done by Real – time PCR. Results –The mean baseline CD4 cell count was 233.46 cells/mm3 while mean latest CD4 cell count was 371.67 cells/mm3. The mean baseline viral load was 230926.20 copies/ml. Of the 197, 12 underwent both baseline viral load (mean 394499.92 copies/ml) and latest viral load (mean 226389.83 copies/ml). The paired differences of Latest – Baseline CD4 cell count is <0.001 i.e. significant & Latest – Baseline viral load is 0.323 i.e. not significant. Conclusion – This study concludes CD4 cell count is simple, convenient and shows significant prognosis results, while viral load testing is a cumbersome and inconvenient method, and does not show effective prognosis. Hence, in Indian scenario set- up CD4 cell count is better than viral load test.

Evaluation of the Zimbabwe HIV Case Surveillance Pilot Program, 2019 (Preprint)

BACKGROUND Zimbabwe has a high burden of HIV, with an estimated 1.3 million people living with the virus and an HIV prevalence and incidence of 13.8% and 0.48%, respectively (2017 Spectrum estimates). In 2017, the Zimbabwe Ministry of Health and Child Care (MOHCC) developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) Person-centred HIV patient monitoring (PM) and case surveillance guidelines. As the case surveillance guidelines were new, lessons learned from field implementation experiences were intended to inform the development of HIV case surveillance implementation guidance and tools. OBJECTIVE At the end of the pilot phase, the Ministry of Health and Child Care (MOHCC) commissioned an evaluation to inform further steps. METHODS Two districts, Umzingwane in Matabeleland South Province and Mutare in Manicaland Province were commissioned to run the CS pilot from August 2017 to December 2018. During this period, 1602 people living with HIV (PLHIV) newly diagnosed with HIV were reported in the CS system, while other HIV sentinel events, including ART initiation and first viral load test, were routinely reported. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the following CS system features: design and operations, performance, usefulness, sustainability and scalability. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two pilot districts. RESULTS The HIV CS system was adequately designed for Zimbabwe’s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. The system was used at the health facility level to track the HIV positive clients in their catchment area; all facilities that were visited were aware of what is happening to their clients. Almost all respondents believed that the country can roll out the HIV CS system to all facilities with partner support. CONCLUSIONS The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning with all facilities in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays. Lessons learned from the provincial roll out can be used for a nationwide scale-up.