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Georgina N. Odaibo, Oluwatoyin A. Babalola, Onoja M. Akpa, Foluke A. Fasola, Abayomi Odetunde, Biobele Brown, Nanfisat A. Alamukii, Chinedum P. Babalola, Adeyinka G. Falusi
World Journal of AIDS, Volume 11, pp 101-119; https://doi.org/10.4236/wja.2021.113009

Abstract:
Aim: This study was designed to determine the prevalence of HBV, HCV and HIV infections among individuals with Sickle Cell Disease (SCD) in Ibadan, southwestern Nigeria. Methodology: In this case-control study, 1017 patients with SCD and 1017 age and gender matched controls were enrolled from 6 health facilities and some communities in Ibadan, southwestern Nigeria. Blood samples were tested for the presence of HIV, HBV and HCV infections. Structured questionnaire was used to capture participants’ information and data analyzed using descriptive statistics, McNemar Chi-square/Fishers exact test. Results: Blood transfusion was significantly more common among SCD cases [566 (55.7%)] than controls [54 (5.3%)], while history of vaccination was higher in the control group (p = 0.001). The overall prevalence of HIV [2 (0.2%) vs 11 (1.1%)], HBV [58 (5.7) vs 66 (6.5%)] and HCV [10 (1.0) vs 22 (2.2%)] was lower among SCD cases than controls, respectively, although significantly different only in HCV infection (p = 0.048). All three infections were significantly higher in adults than in children. Co-infection was found only in four of the participants, all of whom were SCD patients. Conclusion: The prevalence of HIV, HBV and HCV infection among SCD patients indicates an improvement in the transfusion safety measures in the region. The prevalence of HBV and HCV found in this study is still relatively high when compared with reports from some other regions. There is a need for continued surveillance and subsidized cost of drugs for treatment of these infections, especially for SCD patients who already have a compromised immunity.
Ibrahim Jahun, Mustapha Mukhtar, Aminu Yakubu, Musa Zakirai, Bamidele Moyosola, Ahmad Aliyu, Abdulrazaq G. Habib, Gambo Aliyu
World Journal of AIDS, Volume 11, pp 71-83; https://doi.org/10.4236/wja.2021.112007

Abstract:
Introduction: With an estimated 1.8 million People Living with HIV (PLHIV), Nigeria’s HIV response is still heavily donor dependent. However, with anticipated decline in donor funding for HIV/AIDS program as the country takes ownership of the program, understanding financing options for PLHIV is important. One of such financing options is affordability of out-of-pocket payments (OOP) for anti-retroviral drugs (ARV) by PLHIV. We assessed affordability of OOP payments for ARVs in Kano State, North-Western Nigeria. Methods: Four Hundred and sixty-nine PLHIV receiving donor-supported-free ARV in Kano, North Western Nigeria were systematically selected and interviewed during routine clinic visits. Affordability for ARV was assessed by a combination of variables including willingness and financial means to incur extra expense for full dose of ARV based on landing and distribution cost of 8.3 USD (about 3,000 NGN) per month dose. Results: Four hundred and sixty-nine respondents were interviewed. Of those, 72 (15.4%, 95% CI: [13.2 - 19.7]) can afford ARV OOP on monthly base. The proportion of males able to pay 3,000 NGN (8.3 USD) or more OOP for ARVs was not different from that of women (15.5% versus 15.2%). Attending school, education level, employment, monthly income and wealth have all been found to be associated with willingness and ability to pay for monthly dose of ARV OOP (p < 0.0001). Conclusion/recommendation: Majority of PLHIV in Kano State may not afford ARV OOP in the event of withdrawal of supports by international donors. Innovative sustainable financing mechanisms from domestic resources are needed for HIV program sustainability.
N. Lyons, W. Samaroo Francis, J. Edwards, O. Lavia
World Journal of AIDS, Volume 11, pp 50-59; https://doi.org/10.4236/wja.2021.112005

Abstract:
Objective: To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. Design and Methods: Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. Results: During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. Conclusion: Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.
Nkechinyere Elizabeth Harrison, Kenneth Ejiofor Oruka, Uzoamaka Concilia Agbaim, Olutunde Ademola Adegbite, Nathan Anelechi Elvis Okeji
World Journal of AIDS, Volume 11, pp 25-40; https://doi.org/10.4236/wja.2021.111003

Abstract:
Introduction: The prevention of mother-to-child transmission (PMTCT) plays a major role in limiting the number of children being infected by HIV. There is dearth of studies that explored the knowledge of HIV transmission and PMTCT among women living with HIV. Methods: This was a cross-sectional, descriptive study of HIV-positive mothers receiving medical care at the adult antiretroviral therapy (ART) clinic, 68 Nigeria Army Reference Hospital Yaba. A pre-tested structured questionnaire was used to collect information from the subjects concerning their socio-demographic, knowledge of HIV transmission and mother-to-child transmission of HIV and preventive measures. SPSS v23 was used for data analysis. Results: Out of the 374 participants, 282 (75.4%) were aware that HIV can be transmitted to an unborn baby from the positive mother. Of these, 240 (85.1%) were well-informed that increase mother’s viral load can increase the chances of mother-to-child transmission. 268 (95%) understood that giving of antiretroviral drugs during and after pregnancy can lower transmission risk, while 254 (90.1%) saw the use of breast milk substitutes as another prevention strategy. There was statistically significant association between the respondents’ knowledge of PMTCT and their husbands’/partners’ awareness of their HIV status. Conclusion: In conclusion, our study demonstrated a good knowledge of HIV transmission, MTCT and PMTCT among women who were receiving ART in our centre. Disclosure is a significant factor found to be associated with PMTCT knowledge. More studies can also explore if the observations in our study with women living with HIV will be comparable in similar population in different settings.
H. N. Fomundam, A. R. Tesfay, S. A. Mushipe, H. T. Nyambi, A. K. Wutoh
World Journal of AIDS, Volume 11, pp 60-70; https://doi.org/10.4236/wja.2021.112006

Abstract:
Background: Patients medical records are used to document care processes for communication amongst healthcare workers for continued patient management. Incomplete or inaccurate documentation can adversely affect the quality of patients’ care, leading to medication and treatment errors, increased morbidity, and mortality. Quality documentation in medical records is therefore an essential component of optimal healthcare and facilitates an individual’s continuity of care. This study aimed to assess the quality of documentation of clinical data through the review of the accuracy and completeness of clinical records among newly diagnosed HIV-positive persons. The study is a sub analysis of a prospective longitudinal study that followed a cohort of 12,413 persons who were newly diagnosed with HIV infection. Severe limitations in retrieving reliable information and data became an obstacle to our research and led the study team to conduct medical records documentation and data audit to verify the accuracy and completeness of the data for newly diagnosed HIV positive persons. Methods: A cross-sectional study was conducted using routine data generated from 75 randomly selected newly diagnosed HIV positive persons aged 12-years-old and above between June 1, 2014 and March 31, 2015 in 36 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts of South Africa (Gert Sibande, uThukela and City of Johannesburg). Results: Significant differences in the accuracy and completeness of clinical records were observed between data generated through the self-assessment by the facility managers and data primarily collected through review of the patients’ clinical stationery and facility registers. 80% of the newly diagnosed HIV positive persons were not documented as screened for tuberculosis (TB) on the clinical chart and 69% of newly diagnosed clients were not clinically staged (WHO staging). Furthermore, 80% of newly diagnosed HIV positive persons’ follow up visit dates were not documented in the patient’s clinical chart. Completeness of the data elements on the case record forms ranged from as low as 26% to a maximum of 66%. It was noteworthy that all the clients’ information documented in HIV counselling and testing registers, continuum of care registers and clinical charts were only partially completed. Conclusion: Each of the health care facilities under study had some significant gaps in medical records documentation of clinical data on newly diagnosed HIV positive persons. Data and information accuracy and completeness were a serious challenge in most facilities during the period under investigation. Of interest was the inconsistency of data recorded in the HCT registers, continuum of care and clinical charts of individual patients. This is a major impediment to HIV/AIDS comprehensive care.
Tegan Mosugu
World Journal of AIDS, Volume 11, pp 120-142; https://doi.org/10.4236/wja.2021.113010

Abstract:
Objectives: This paper seeks to examine the history of HIV/AIDS in Nigeria while presenting a clear picture of some of the issues that exist in service delivery. Lastly, this paper explores how an evidence-based management approach offers an effective set of tools to HIV/AIDS organizations. Methods: Content analysis and a qualitative desk review of the literature. Results: Findings from this paper reveal that through the use of evidence-based management, preconceived notions can be challenged so as to yield a diversity of thought and a more people-centered approach to public health delivery. This paper also shows that in the Nigerian setting, an evidence-based management framework can be a transformative tool in ensuring that key populations can receive critical care and treatment in the long run despite the uncertainty that might exist when it comes to funding and resources. Conclusions: Evidence-based management is a rigorous framework that can be used for understanding how a multitude of factors can position an organization to achieve its theory of change, which in turn can lead to sustainable impact in the long run. Incorporating the use of evidence in everyday organizational behavior involves not only looking at the manner in which data is aggregated, but also how it is disseminated. In order to ensure that the evidence is not manipulated, nonprofit organizations are often viewed as being best suited for collecting evidence since they are not heavily plagued by systemic corruption and political tides, compared to their government counterparts.
Shaheda Viriyathorn, Saranya Sachdev, Yaowaluk Wanwong, Walaiporn Patcharanarumol, Viroj Tangcharoensathien
World Journal of AIDS, Volume 11, pp 85-100; https://doi.org/10.4236/wja.2021.113008

Abstract:
Background: The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. Methods: A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. Results: HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. Conclusion: Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.
Elon Warnow Isaac, Ayomikun Ajani, Abubakar Joshua Difa, John Tunde Aremu, Oyeniyi Christianah Oluwaseun, Muhammad Danlami Hassan
World Journal of AIDS, Volume 11, pp 1-14; https://doi.org/10.4236/wja.2021.111001

Abstract:
Background: The adult ART (antiretroviral therapy) programme started in Nigeria in 2002. After many years of ART in the country, the National implementation plan for the scale up of viral load testing was launched in 2016. Viral load estimation is the most important indicator of ART response. Aim: To describe viral suppression in adults on the HIV ART programme Material & methods: Viral load blood samples of 9450 adults on highly active antiretroviral therapy living with HIV from 4 states within Nigeria were analyzed for HIV RNA in Polymerase Chain Reaction laboratory of the Federal Teaching Hospital, Gombe between December 2017 and December 2019. Results: Males were 2577/9450 (27.3%) and 6873 (72.7%) females. Adults aged 26 - 45 years constituted 69.5% (6572). Viral load test was primarily routine in 96.3% (9098). ART was AZT/3TC/NVP in 52.5% (4962); TDF/3TC/EFV in 46.3% (4375). 48.3% (4568/9450) adults had received HAART for 1 - 5 years; 7.4% (699) for 6 months but 10 years. The most recent CD4 count before viral load request was ≥1000/μL in 6.5% (612) of adults; 500 - 999/μL in 38.6% (3651); 350 - 499 μL in 23.2% (2195) and 1000 c/ml in 22.8% (587/2577) males and 23.0% (1580/6873) females. Of adults aged 19 - 25 years, 28.4% (211/743) had viral load >1000 c/ml; 23.5% (1544/6572); 20.0% (294/1473); 17.8% (93/523) and 18.0% (25/139) aged 26 - 45 years, 46 - 55 years; 56 - 65 years and >65 years also had viral load >1000 c/ml (p value 1000 c/ml in 26.0% (182/699) of adults on HAART for 6 months - 1 year and 21.3% (975/4568) after receiving HAART for 1 - 5 years. 24.9% (885/3551) and 19.8% (125/632) adults had viral load > 1000 c/ml after receiving HAART for 6 - 10 and >10 years respectively. (p value < 0.001) Conclusion: Over all viral suppression of 77% in our study is high but fell below the WHO threshold of 90%. ART programme in Nigeria requires strengthening.
Jamie Yoon, David S. Chung, Michelle Kim, Kunmin Kim, Sang Heon Lee, Tae Youn Kim, Hark Joon Lee, Seog In Moon, Jooheon Park, Paul S. Chung, et al.
World Journal of AIDS, Volume 11, pp 15-24; https://doi.org/10.4236/wja.2021.111002

Abstract:
Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with HIV in 2016, with 24,000 HIV-related deaths. The Option B+ program, first implemented in Malawi, aimed to initiate ART for all pregnant women, regardless of their CD4 cell count or disease stage. This study serves to analyze and assess the effectiveness of Option B+ retention, in relation to the facilitation of how various social and cultural barriers were handled. A literature review of 29 publications was conducted. Careful evaluation of various studies indicates that although there is a myriad of reasons explaining low levels of retention, the women who were at the highest risk for low retention were young pregnant women who were treated on the same day of HIV-diagnosis. Solutions focused around women and their partners or communities showed promising evidence of success in increasing adherence, as these strategies likely provided women reliable social and emotional support to address major barriers to retention such as a lack of support from male partners, ineffective education from healthcare workers, or stigma towards their HIV disclosure statue.
Erick N. Kamangu, Ben I. Bulanda, Idriss M. Mwanaut, Simplice K. Makoka, Gauthier K. Mesia
World Journal of AIDS, Volume 11, pp 41-49; https://doi.org/10.4236/wja.2021.112004

Abstract:
Background: The ultimate goal of AntiRetroViral Treatments (ART) is to achieve complete immune restoration and lasting viral suppression in the infected patient. In order to ensure the efficacy, safety and accessibility of antiretroviral drugs (ARVs), it is recommended that they should be prescribed according to national guidelines; which are evolving with the various recommendations of the World Health Organization (WHO) and the arrival of newer, more effective and safer molecules. Objective: The objective of this study was to assess the rational use of Antiretrovirals in patients treated in Kinshasa before the use of Dolutegravir within the national program in order to assess the correct use of these molecules. Methods: This work is a descriptive cross-sectional study to assess the rational use of first-line ARVs among People Living with HIV (PLHIV) in different Centers of Treatment (ATCs) in Kinshasa before the introduction of Dolutegravir. The records of patients on ARVs were randomly and rationally selected in 12 different ATCs for HIV in Kinshasa according to three centers per district in the period from June to September 2018. Information on use and consumption of ARVs, compliance with guidelines, change of therapeutic combination as well as their reasons were consulted for the present study. Results: 507 files of PLHIV were collected in the various ATCs. 274 (54.1%) were from female patients. The most represented age group was 26 to 35 years with 192 patients (37.9%). The mean duration of first-line treatment for all patients included was 16.30 ± 5.85 months. The most widely used combination of ARVs overall was TDF + 3TC + EFV at 45.4%. 305 (60.2%) PLHIV kept the same first-line treatment molecule throughout the treatment period with an average treatment duration of 12.9 ± 2.77 months. The most common combination found in this population was TDF + 3TC + EFV (69.2%). 202 (39.8%) PLHIV changed treatment molecule yet respecting the first-line combinations. The average duration of treatment for those who changed molecules was 21.43 ± 7.25 months. Before the change, 112 (55.5%) of these patients were using the ZDV + 3TC + EFV combination. After switching, 105 (52%) of the patients used the TDF + 3TC + NVP combination. The first reason for changing molecules was its unavailability (53.3%) in the ATCs. Conclusion: Although some banned molecules are still available in some treatment centers, the guidelines on first-line treatments are respected in different centers in Kinshasa.
Jean Yaovi Daho, Badirou Aguemon, Pascal Hinnakou
World Journal of AIDS, Volume 10, pp 128-140; https://doi.org/10.4236/wja.2020.102011

Abstract:
Evaluation of the effectiveness of the mother-to-child HIV Prevention Program, in Benin in 2016 reported a national rate of 6.7%. The Region of Couffo, within 12 Regions (departments) in the country, had the highest rate of transmission, which was 16.1%. The study aimed to determine transmission rate during pregnancy and delivery as well as the factors associated with it. This is a retrospective and analytical study based on a sample of seventy (70) babies born to HIV-infected mothers in 2016 in Couffo. Key findings showed, there is a perinatal transmission of five percent (5%) and the factors associated with this transmission are: delay in carrying out first antenatal visits at the health facility, low frequency of visits performed versus number requested and appropriate time, poor health condition of mothers during pregnancy, absence or late start of antiretroviral care and treatment during pregnancy, irregular intake of intermittent presumptive treatment at sulfadoxine-pyrimethamine to prevent malaria, a short antiretroviral therapy (less than three months) for mothers before delivery and the default in cleaning mother’s genital tract with betadine after the woman’s water broke.
Guosheng Su, Lihua Qin, Lida Mo
World Journal of AIDS, Volume 10, pp 149-157; https://doi.org/10.4236/wja.2020.102013

Abstract:
More than 90% of HIV-positive children come from mother-to-child transmission, so mother-to-child interdiction is the main measure to prevent AIDS in children. Relevant data show that the incidence of mother-to-child transmission of HIV usually fluctuates between 15% and 50% without intervention. Standardized and effective comprehensive intervention can reduce the transmission rate of mother to child to less than 1%. At present, it is believed that mother-to-child transmission of AIDS can be blocked by comprehensive intervention, and its mechanism has been clearly studied. Combined with highly effective antiviral treatment, safe labor and artificial feeding, the mother to child transmission rate can be reduced to less than 1%. However, due to the effect of drugs on mother-to-child transmission of AIDS may lead to some changes in the main biochemical indicators of mother-to-child, there is no systematic analysis of the viral load, T lymphocyte subsets and major biochemical indicators of HIV/AIDS pregnant women before and after maternal-to-child transmission. In this study, the viral load, T lymphocyte subsets and major biochemical indicators of HIV/AIDS pregnant women before and after maternal-infant blockade were dynamically analyzed. It is hoped that this study will help to observe the basic physical fitness and disease development of pregnant women with HIV/AIDS during pregnancy, to provide a strong basis for the treatment and evaluation of maternal-infant blockade of HIV/AIDS pregnant women, and to establish a complete set of laboratory indicators to understand the body status of pregnant women at all stages to minimize the probability of fetal transmission, which will make good economic and social benefits.
Bonniface Oryokot, Yunus Miya, Barbara Logose, Eunice Ajambo, Abraham Ignatius Oluka, Charles Odoi, Bernard Michael Etukoit, Levicatus Mugenyi, Kenneth Mugisha
World Journal of AIDS, Volume 10, pp 94-106; https://doi.org/10.4236/wja.2020.102008

Abstract:
Introduction: Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. Method: Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. Results: The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. Conclusion: The use of quality improvement in addressing gaps in HIV service delivery is highly effective.
Ottop F. Manyi, Assob N. Jules Clement, Mbu R. Enow, Ngowe N. Marcelin
World Journal of AIDS, Volume 10, pp 36-45; https://doi.org/10.4236/wja.2020.101004

Abstract:
Background: At enrolment into antenatal care, socio-demographic data of HIV infected pregnant women and lactating mothers are usually collected with little or no analysis done on them. This study was aimed to describe the socio-demographic profiles of naive to antiretroviral therapy (ART) HIV-infected pregnant women in the East region of Cameroon and to link this to retention in order to optimize the implementation of the prevention of mother-to-child transmission (PMTCT) interventions. Methods: A descriptive prospective study that lasted from February 2018 until February 2019 in three catchment health facilities in the East region for the recruitment and follow-up of participants who were consented HIV-infected pregnant women naive to ART. Socio-demographic, treatment compliance and adherence data were obtained by healthcare providers who were trained using a standard questionnaire that was conceived, tested and adapted for the study. Data were analyzed using Graph Prism (Graph pad 6.0, San Diego, USA). The Fisher exact and Chi-squared tests were used to establish the associations and independence between different variables at statistical significance level of p Results: A total of seventy (70) women were enrolled with age range varying between 15 and 40 years with a mean age of 26.5 ± 6.2 years. Loss-to-follow-up (LTFU) was observed among 17 women (24.29%). The Muslim religion, education below secondary level and the profession of housewife were significantly associated with LTFU at p = 0.01, p p = 0.0053, respectively. For participants who were retained until study endpoint, having secondary level of education or above and a profession other than housewife had a significant association (p = 0.0063), as well as being a Christian. Conclusion: Loss to follow-up in PMTCT program was associated with Muslim religion, primary level of education and the housewife occupation.
Elon Warnow Isaac, Alfred Annabi Massa, Suraj Abdulkarim, Ayomikun Ajani, Christiana Oyeniyi
World Journal of AIDS, Volume 10, pp 1-14; https://doi.org/10.4236/wja.2020.101001

Abstract:
There are significant variations in PMTCT programme implementation in the country. Biennial serosentinel survey among pregnant women attending antenatal clinics provides estimates of HIV and for monitoring the epidemic. The objective of this work was to compare HIV prevalence trend using National ANC HSS data and PMTCT programme data in Gombe state over the last 10 years. Methodology: Cross-sectional comparative study. The HIV prevalence among pregnant women in Gombe State obtained from Gombe State PMTCT programme data from 2004-2014 was compared with the National Biennial sentinel survey for HIV in pregnant women attending ANC in the state over the same period. Results: Women tested for HIV during ANC in Gombe state increased from 4689 in 2004 to 74,737 in 2014. 447,732 women were cumulatively tested for HIV with a positivity rate of 2.1% (9543). ANC HIV positivity rates from PMTCT programme data witnessed a decline from 8.2% (385/4689) in 2004 to 0.6% (497/74,737) in 2014. Conversely, the National biennial HIV sero-prevalence sentinel survey reports for Gombe state in 2005, 2006, 2008, 2010, 2012 and 2014 were 4.9%, 4.4%, 4.0%, 4.2%, 4.1% and 3.4% respectively. The state PMTCT data showed a significant decline in HIV positivity rates among women, paralleled by increased testing, whereas the national sero-prevalence survey averaged 4.2%. Conclusion: While routine yearly Gombe state PMTCT programme data showed a declining HIV trend, biennially conducted seroprevalence in the state was consistent over the period. Implications are unclear to us; accurate estimation of HIV prevalence is a prerequisite for planning.
Jiman He
World Journal of AIDS, Volume 10, pp 195-199; https://doi.org/10.4236/wja.2020.103017

Abstract:
According to current guidelines, exposing mucous membrane to blood and body fluids of HIV infected people is risk of transmission. About 30% - 80% of HIV infected people have at least one oral manifestation. The most frequently occurring oral manifestations (pseudomembranous candidiasis, linear gingival erythema, etc.) give rise to bleeding either spontaneously or after stimulation, and strenuous stirring during oral sex and deep-mouth kissing increase risk of bleeding from oral manifestations, exposing oral and genital mucous membrane of partners to the blood. However, current guidelines assert that there’s little to no risk of getting HIV from oral sex and deep-mouth kissing. These guidelines are conflict with each other, suggesting potential problems with current prevention strategies which are based on the guidelines. After discussing existing data on animals, lesbians, young peoples, and occupational exposures, this paper suggests oral sex and deep-mouth kissing are risk factors when one partner has HIV-associated oral bleeding manifestations, and the number of infections associated with oral sex and deep-mouth kissing is significant. Current guidelines on HIV risk factors should be reevaluated urgently, and new studies should be undertaken with an open mind to explore risk factors.
Tran Chi Thanh, Pham Duc Trinh, Nguyen Duc Thanh, Linus Olson, Mattias Larsson
World Journal of AIDS, Volume 10, pp 186-194; https://doi.org/10.4236/wja.2020.103016

Abstract:
HIV/AIDS is still an important public health issue in Vietnam and other developing countries. In Vietnam, Community-based organizations (CBOs) were officially considered as the key partners to approach vulnerable groups at high risks of HIV infection since 2010. Funds for HIV/AIDS prevention and control are facing difficulties due to rapid reduction by international organizations, while domestic funding has not yet met the demand, especially funding for prevention and communication activities. Our study aimed to assess the fundraising capacity of several CBOs in Ho Chi Minh City, Vietnam and analyze the challenges that they are facing now and in future in their work of HIV/AIDS management for community. The 03 typical and representative CBOs (G3VN, Smile and Strong Ladies) were chosen in our cross-sectional descriptive study. The electronic questionnaire was about fundraising reports over 3 years (2017-2019), organization structure (staff, mission, strategies) and the advantages and disadvantages in fundraising. Funds received over the year increased in total, but unstable in each projects. To have more funds, CBOs must invest time and money to have professional staff in fundraising and writing proposals. To meet requirement and survive, some CBO shifted to social enterprises and faced many difficulties in laws when being treated like profit companies. In Vietnam context, the key challenges which affect the role of funding are including: 1) Legal status; 2) Small scale; 3) Capacity of fundraising (finding calls, writing competence proposals); 4) Fewer funds on HIV/AIDS. In future, we should pay attention in scaling up and building fundraising capacity for CBOs in order to help them in applying for international funds in community projects or even in HIV/AIDS research for CBOs, social enterprises in the context of funds for nation-level phased out of Vietnam.
H. N. Fomundam, A. R. Tesfay, S. A. Mushipe, H. T. Nyambi, A. Larsen, M. Cheyip, G. Aynalem, A. K. Wutoh
World Journal of AIDS, Volume 10, pp 107-118; https://doi.org/10.4236/wja.2020.102009

Abstract:
Background: South Africa is experiencing the worst HIV-driven tuberculosis (TB) epidemic in the world. More than 300,000 new cases of active TB are reported in the country each year with 60% co-infected with HIV. Isoniazid preventive therapy (IPT) is a key public health intervention for the prevention of TB among people living with HIV (PLHIV) and is recommended as part of a comprehensive HIV and AIDS care strategy. However, program data suggests that coverage of IPT service to be very low. This study aims to assess IPT initiation rate among newly diagnosed HIV-positive persons in three high HIV-burden districts of South Africa. Methods: A cross-sectional study was conducted using routine data generated from pre-ART and ART programs in 35 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts with a mix of urban and rural settings. TB screening and IPT initiation status was assessed within a window period of one-year post HIV diagnosis. Initiation rate of IPT services among newly diagnosed HIV-positive persons was assessed. The chi-squared test was used to determine whether there was a significant difference in the proportion of newly diagnosed HIV-positive persons who were initiated on IPT by sex, age group, pregnancy status, health facility, district and location of facility. Results: We identified 12,413 newly diagnosed HIV patients aged 12-years-old and above between June 1, 2014 and March 31, 2015. TB screening was not conducted among 33% of newly diagnosed HIV-positive persons to rule out or confirm the presence of active TB. IPT was initiated in 42.2% of known IPT-eligible HIV-positive persons. Initiation of IPT services was lower in younger patients aged 12 to 20-years-old compared to older patients. The proportion of pregnant women who were initiated on IPT was higher compared to the proportion in non-pregnant women (51.0% and 40.1% respectively; P Conclusion: This analysis shows that initiation rate of IPT services among newly diagnosed HIV positive persons was low in the 35 participating facilities during the period under investigation. There was variability in IPT initiation rates across the facilities included in this study and among different sub-groups of the study sample. This study has identified specific population groups and geographic settings that should be targeted by programs to improve IPT services. There is a need to identify factors that contributed to the low initiation rate of IPT services among young HIV positive persons, women with unrecorded pregnancy status and in facilities located in inner city of Johannesburg. Customized interventions tailored to the specific needs of facilities and population groups should be instituted to strengthen uptake of IPT services.
Ben Ilunga Bulanda, Berry Ikolango Bongenya, Adawaye Chatte, Elvis Tshunza Kateba, Jean-Yves Debels Kabasele, Médard Okonda Omakoy, Divine Chuga, Christian Tshibumbu, Idriss Mwanaut, Erick Ntambwe Kamangu
World Journal of AIDS, Volume 10, pp 80-93; https://doi.org/10.4236/wja.2020.102007

Abstract:
The Human Immunodeficiency Virus (HIV) has a diversity that is equal to the complexity of its management. The group M (Major) is the dominant group in Sub-Saharan Africa and its distribution is very heterogeneous; the diversity of the virus is more heterogeneous in this region than elsewhere in the world which follows a complex and specific algorithm because of geographical positions and countries. This distribution is very dynamic, evolving and unpredictable. This review aimed to expose the specifics of the HIV Type 1 epidemic in Central Africa, in terms of the different molecular variants of HIV published for the region compared to the geographic location. Both Type 1 and Type 2 of HIV are prevalent in sub-Saharan Africa due to distinct geographical contexts. HIV-2 is mainly documented in West and Central Africa, particularly in Cameroon, Guinea-Bissau, Gambia, Senegal, Ivory Coast and Burkina-Faso however HIV-1 infection is widely distributed across the continent. The HIV-1 epidemic in Sub-Saharan Africa is dominated by the Group M. The different subtypes respect a certain geographical distribution across the continent. West Africa is dominated by subtype A, East and South Africa are dominated by subtype C, while Central Africa is dominated by strains A, C, D, F, H, J, CRF01-AE and CRF02-AG. This review is the first to present de molecular diversity of HIV-1 in metropolitan cities in all central African countries. The Circulating Recombinant Form (CRF02_AG) and subtypes A and G are present in all Central African countries and are also the most commonly encountered; followed by the subtypes D, F, G, C, B, J, K and several Circulating Recombinant Forms that are not represented in all Central African countries.
Selly Ba, Ndeye Diama Ba, Lamanatou Sembene, Thierno Souleymane Baal Anne, Habibatou Dia, Jean Louis Ndiaye, Ndeye Mery Dia Badiane, Cheikh Tidiane Ndour
World Journal of AIDS, Volume 10, pp 23-35; https://doi.org/10.4236/wja.2020.101003

Abstract:
Background: Optimizing antiretroviral therapy is an essential step to reach the 90 - 90 - 90 targets. Despite tremendous progress made for antiretroviral treatment (ART) to be accessible in countries with limited resources, health care providers continue to face challenges due to the under-optimization of ART due to therapeutic failures and poor retention. Objectives: To determine the prevalence of adverse therapeutic outcomes in a decentralized health care center and to determine associated factors. Patients and Methods: This is a cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years and over, on first line antiretroviral treatment (ART), monitored onsite from February 1st to December 31st, 2018. A data collection form was completed from medical records (clinical, immuno-virological, therapeutic and evolutionary). Data were also collected from interviews with patients for additional socio-demographic information including the level of HIV knowledge. Data were captured and analyzed using EPI 2002 and R software. Proportions were compared using the chi -square and Fisher tests and logistic regression. A value of p Results: 331 patients were enrolled with HIV-1 profile in 89% of the cases. A proportion of 55% was married and 98% came from the rural area. 80% were either not or poorly educated. The median of age was 44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV status, and more than half had a low knowledge of HIV transmission. At baseline, 56% were symptomatic at WHO stage 3 or 4. They had severe immunosuppression with a median CD4 count of 217 ± 187 cells/mm3; the viral load was detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor (NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of the cases. The median duration of follow-up was estimated at 60 ± 43 months. The prevalence of adverse therapeutic outcomes was 36% (119 patients). The proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic outcomes were associated with the age less than 25 years (p = 0.007) and with a late diagnosis (CD4 T cells at baseline less than 200 cell/mm3, p = 0.02). Conclusion: These results suggest the need to make new therapeutic classes available for first-line treatment and to promote actions improving retention in care.
Francisco Martins Do Vale, Catarina Abrantes, Maria Lima, Maria Isabel Casella, Telma Azevedo, , José Poças
World Journal of AIDS, Volume 10, pp 15-22; https://doi.org/10.4236/wja.2020.101002

Abstract:
Background: Human immunodeficiency virus (HIV) type 2 infection is predominantly found in West African nations, and approximately 1 - 2 million people are thought to be infected. HIV-associated nephropathy (HIVAN) occurs in about 7% of patients with HIV-1 infection and is one of the most important causes of end-stage renal disease in this population. The only reported case of HIVAN related to HIV-2 infection was described by Izzedine et al. (2006). Aim: The aim of this paper is to report a case of HIVAN in an HIV-2-infected patient, a rarely described condition. Case presentation: We describe a case of a 40-year-old HIV-2-infected female from Angola hospitalized following a six-month history of fever, fatigue, anorexia and weight loss. Laboratory data revealed anaemia, leukopenia and renal dysfunction with nephrotic range proteinuria. Renal biopsy was performed, revealing findings consistent with HIVAN. Also, a presumed diagnosis of ganglionic tuberculosis was established. Conclusion: The slow progression of HIV-2 disease could explain the low frequency of this condition, however, more studies should be carried out for a better understanding of HIV-2 pathophysiology and its associated complications.
Menssah Teko, Mounerou Salou, Fifonsi A. Gbeasor-Komlanvi, Abla Ahouefa Konou, Yaovi Ameyapoh
World Journal of AIDS, Volume 10, pp 159-169; https://doi.org/10.4236/wja.2020.103014

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Background: In Togo, as in all sub-Saharan countries, the burden of HIV infection remains high. The registration of new cases of Buruli ulcer every year also remains a major public health problem. Buruli ulcer (BU) is a disabling disease and the presentation of lesions is frequently severe. A feature of BU and HIV coinfection is the rarity of cases, which makes its study difficult, but, nevertheless, important to study its seroprevalence, biological data, risk factors and genetic diversity. The purpose of this study is to explore the comorbidity of Buruli ulcer and HIV by evaluating HIV seroprevalence in BU patients, assessing demographic data, reviewing biological data including CD4+ T cell count, hemoglobin levels, and viral loads, and evaluating clinical and therapeutic data. Methods: This is a cross-sectional study including only BU patients confirmed by Ziehl Neelsen staining and IS 2404 PCR. The patients were hospitalized in the National Reference Center for Tsevie. They were recovered patients and patients undergoing outpatient treatment in the Gati and Tchekpo Deve treatment centers, respectively, within the Sanitary Districts of Zio and Yoto of the Maritime Region during the period from August 2015 to March 2017. Results: The number of HIV-positive BU patients is 4 out of a total of 83 BU patients. All patients are HIV-1 positive. HIV prevalence among BU patients is 4.8% compared to 2.5% nationally and 3% at regional level. Three BU patients are seropositive out of a total of 46 female patients while one patient under 15 years is seropositive out of a total of 37 male BU patients. There are a greater proportion of female patients with BU/HIV coinfections. Half of the BU/HIV positive patients (BU/HIV+) have a CD4+ TL of fewer than 500 cells/μl and the difference is significant between those of the BU HIV- and those of the BU/HIV+ patients. Two patients have undetectable viral loads while the other two have more than 1000 copies/ml (33,000 and 1,100,000 copies/ml). Anemia is significantly present in BU/HIV+ patients with a p-value = 0.003. Half of BU patients have primary education, while three-quarters of BU/HIV+ patients have no education. All patients are either in stage I or stage II of the AIDS WHO classification. All patients are on first line ARV therapy and only ARV nucleoside reverse transcriptase inhibitors (NRTIs) are used. Conclusion: In Togo, the prevalence of HIV in BU patients, although higher, is not significantly different from that of national and regional. The relatively high CD4+ LT levels of relatively high BU HIV + patients, undetectable viral loads, and AIDS WHO stages I and II indicate good quality management. Author Summary: Buruli ulcer disease (BUD) is a mycobacterial skin disease that leads to extensive ulcerations and causes disabilities in approximately 25% of the patients. Co-infection with HIV is described by the authors through the prism of risk factors and the severity of ulcerations. Healing time is described as longer than in BU/HIV- patients. The scarcity of cases seems to be an obstacle for further study. Noteworthy are the study of cases in Benin and the study of cohort cases in Cameroon. However, no study appears to be based on the seroprevalence of this morbid association, the biological data and the antiretroviral regimens. These regimens, if poorly instituted, conflict with antimycobacterial drugs against Buruli ulcer. This study, although confronted with the particular configuration of Togo, a country with a low HIV prevalence of 2.8% national prevalence and an average of 55 cases of Buruli ulcer per year, is studying the biological aspects of co-infection HIV/BU, including seroprevalence of HIV, CD4+ LT levels, patient viral load and hemoglobin levels and ARV regimens. This study shows the need for future studies, including the study of the genetic diversity of circulating Mycobacterium ulcerans strains in Togo and the study of Buruli ulcer co-infection/HIV and tuberculosis.
Nancy J. Gálvez, Julio W. Juárez
World Journal of AIDS, Volume 10, pp 215-222; https://doi.org/10.4236/wja.2020.104019

Abstract:
Background: In an age of antiretroviral therapy, the life expectancy of children perinatally infected with Human Immunodeficiency Virus (HIV) has significantly increased. At the same time, however, pulmonary pathologies secondary to opportunistic infections have decreased thanks to increased diagnostics and access to antiretroviral therapy (ART). Despite this, in these children an immune dysregulation is maintained due to chronic infection. There is evidence that these patients have increased probability of presenting with abnormalities in pulmonary function, mainly with chronic obstructive clinical pictures (25% - 40% of perinatally infected adolescents display some anomaly in the spirometry), which predisposes them to increased risk of chronic pulmonary disease. Since lung development occurs mainly during infancy, patients perinatally infected with HIV may suffer consequences. This can be secondary to opportunistic infections, chronic inflammation due to the virus, and immunologic effects of ART, mainly in non-industrialized countries, where late diagnosis is frequent. Methodology: An analytical, observational, cross-sectional study was conducted at Roosevelt Hospital Pediatric infectious disease clinic, from January to December 2019. A sample of 76 patients was obtained, out of a population of 362 patients. A total of 62 subjects, who met the criterion of reproducibility in the spirometry, were analyzed. Results were analyzed with percentages and the association of variables using the chi-squared test (χ2). Results: A decrease in pulmonary function was found in 34% of patients, mild obstructive pattern (16%) predominating. Significant association between basal viral load greater than 100,000 cp/ml and a decrease in Forced expiratory flow 25 - 75 (FEF 25-75) (p 0.046) and in relationship between forced expiratory volume and forced vital capacity (FEV1/ FVC p = 0.024) was observed, as well as a non-statistically significant relationship between advanced clinical stage at diagnosis and decreased pulmonary function. Conclusions: The prevalence of decreased pulmonary function related to advanced clinical stage and elevated basal viral load (>100,000 cps/ml) is higher than that reported in other studies (25%) and has an influence in the long-term decrease in pulmonary function.
Gilbert Ndziessi, Axel Julius Aloumba, Darius Eryx Mbou Essie, Ange Clauvel Niama, Fresnovie Geladore Mbele, Merlin Diafouka, Ange Antoine Abena
World Journal of AIDS, Volume 10, pp 201-214; https://doi.org/10.4236/wja.2020.104018

Abstract:
Background: Viral load is the key indicator of the effectiveness of antiretroviral treatment in HIV patients. Study aimed to determine antiretroviral treatments failure rates and associated risk factors among HIV-infected adult patients in Congo. Methods: Data from the Congolese AIDS and Epidemics Control Council were combined to create a historical cohort. Patients were followed up between 2003 to 2017. Mixed logistic regression was used to identify treatment failure associated-factors. Intercooled Stata 10 (StataCorp LP, College Station, Texas, USA) software packages was used for analysis. Results: Over 14 years of follow-up, a total of 25,500 visits for 6391 adult patients were reported. Among them, 88% i.e. 22,328 visits (for a total of 6127 patients) were visits with treatment failure. In the multivariate analysis, being aged >26 years, having primary education level, being student, others nationality, unspecifiedmarital status and being worker in informal sector were found associated with a higher risk of treatment failure. Conversely, being pensioners, receiving second line therapeutic protocols and having good adherence to treatment were found significantly associated with a lower risk of treatment failure. Conclusion: Antiretroviral treatments failure among HIV-treated patients is common in Congo. Developing treatment adherence-centered interventions with focus in patients who have low socio-economic status needed to reduced treatments failure. As treatment failure is not only determined by individual factors, psychosocial supports and availability of antiretroviral drugs needs to be taken into account.
Niang Khadim, Anne Malick, Sarr Assane, Thiam Ousmane, Ndiaye Papa
World Journal of AIDS, Volume 10, pp 69-79; https://doi.org/10.4236/wja.2020.102006

Abstract:
This study aims to determine the factors related to HIV-positive status in people aged 15 to 49 years of age in the commune of Niagha in Goudomp. The study was descriptive and analytically cross-cutting and had taken place in a release of 2018. The data was collected on anonymous questionnaires and then analyzed using R software after entering with Epi 7 software. Bivariate analyses and logistical modelling have been used to investigate the factors associated with HIV status. The sample included 400 people, and a participation rate of 100% was obtained in relation to the administration of the questionnaire. For the detection of HIV infection, 318 people agreed to do so, a proportion of 79.7%. The average age of the respondents was 27.8 years with a standard deviation of 9.1 and extremes of 15 to 49 years. 21.5% of respondents were under 20 years of age, the median was 26 years. With 58.8% of women, the sex ratio (M/F) was 0.7. In this study, 11.5% of respondents did not believe in the existence of HIV infection, 92.0% were sexually active, and 40.5% had sex with casual partners. The main places for casual sex were cultural events (84.0%), weekly markets (53.1%), religious events (27.8%) and during travel (22.8%). Among them, only 20 respondents, or 12.3%, declared that they systematically protect themselves with a condom during these occasional sexual relations. This wearing of condoms was found in 20.7% of singles and 10.7% of married couples having casual sex. In this study, 60.0% of the respondents declared that they had paid for sex, although this practice is not cited in income-generating activities. Non-consensual sex was found in 6.5% of the respondents. In this study, 319 people agreed to be tested for HIV, or 79.7% of the sample. HIV infection was found in 19 people, 6.0% seroprevalence, with 16 cases of HIV 1 infection and three cases of HIV 2 infection. Several risk behaviors were found in this study. However, none of them had a statistically significant link to HIV seropositivity. The prevalence of HIV infection in Niagha common is very high compared to data from the Sedhiou region and national level. Risky sexual behaviors are found in this population with no statistically significant link to HIV. Studies with a mixed approach would be more appropriate to study these relationships.
M. W. Isichei, T. T. Selowo, D. Meshak, A. F. Ale, S. D. Peter, M. A. Misauno, A. Affi, O. Olaniru, C. O. Isichei
World Journal of AIDS, Volume 10, pp 119-127; https://doi.org/10.4236/wja.2020.102010

Abstract:
Testing for Human Immunodeficiency Virus (HIV), widely distributed in sub-Saharan Africa since it is mainly invasive but, could be non-invasive and quick also, reducing waiting time especially when required for presurgical procedures. This study determined the HIV status of patients using Urine screening test method and to compare its performance to blood-based testing methods. The routine pre and post-test counselling for HIV screening were done for all provider-initiated HIV testing using blood-based screening methods. Due to the cost and unavailability of enough urine testing kits, only patients who tested positive for HIV with blood-based methods and were scheduled for surgery or a surgical procedure were enrolled in the study. Informed consent was obtained. Paired urine and blood samples were collected at the same visit into clean universal bottles and analyzed immediately. A colloidal gold enhanced rapid immuno-chromatographic assay (Alliance Biomedical) kit for the rapid qualitative detection of antibodies to Human Immunodeficiency Virus (HIV) I and II in urine were used in comparison to the standard HIV testing of ante-cubital venous blood collected in EDTA vacutainer and analyzed using Determine (T) HIV 1 and 2 in vitro qualitative immunoassay strip, UNI GOLD rapid test kit and the Chembio HIV 1/2 STAT PAK assay strip. A total of 7568 patients were tested for routine provider-initiated HIV testing, 521 tested HIV positive. There were 105 (20.15%) males and 416 (79.85%) females, age ranged from 15 years to >80 years. Most of the surgeries performed were Caesarian section 93 (37%), Hernia 55 (22%), Lumps 48 (19%), Acute appendicitis 33 (13%), Uterine fibroids 10 (4%), Ruptured ectopic pregnancy 2 (1%) and others (Intestinal obstruction, Postoperative adhesions, Ingrown toe nails, Breast abscess, Hemorrhoids, Anal fissures etc.) 10 (4%). DETERMINE RAPID HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 502 (96.35%) tested HIV positive and 19 (3.65%) tested HIV negative. These 19 HIV negatives were re-tested with Stak Pak: 19 (100%) tested HIV positive. UNI GOLD HIV TEST METHOD USING BLOOD: A total of 521 HIV positive samples were tested, 521 (100%) tested HIV positive. URINE TESTING METHOD: A total of 251 (48.18%) of the 521 HIV positive patients were scheduled to undergo a surgical procedure. These were re-tested using the Urine testing method, 235 (93.63%) tested HIV positive while 16 (6.37%) tested negative. The blood sample of the 16 who tested negative using the Urine testing method was subjected to confirmatory test using Stat Pak and all 16 (100%) tested HIV positive. The specificity for Unigold and Determine blood testing was 100%. All three tests had a Positive Predictive Value (PPV) of 100% while the Negative Predictive Values (NPV) were 100% and 99.73% for Unigold and Determine respectively. The use of Urine HIV testing method compared well to the blood HIV testing methods and could be a better non-invasive sample method for screening of HIV/AIDS in the population especially among surgeons’ pre-surgical procedures.
M. C. O. Ezeibe, B. L. Salako, F. I. O. Onyeachonam, A. David, O. O. Aina, E. Herbertson, M. E. Sanda, I. J. Ogbonna, E. Kalu, N. U. Njoku, et al.
World Journal of AIDS, Volume 10, pp 141-148; https://doi.org/10.4236/wja.2020.102012

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In verifying antiretroviral efficacy of a Nigerian broad spectrum antiviral medicine (Antivirt®), the Nigerian Institute of Medical Research certified it safe by toxicological test on laboratory animals, before commencing treatment of three HIV/AIDS patients whose viral loads varied widely (millions, hundreds of thousands and thousands). To overcome errors associated with such wide differences in subject-classes, percentages of viral load-reductions were calculated instead of comparing their viral loads. After first month of the Antivirt®-treatment, means of ranked viral loads of the patients significantly (P ≤ 0.05) increased from 10.00 ± 7.21 to 11.30 ± 5.51 (-41.03% infection-reduction rate) instead of reducing. From second month of the trial, their viral loads started to reduce, continuously, so that their infection-reduction rates have been increasing from that -41.03%, to -38.22% in the second month; 23.98% in the third month; 31.76% in the fourth month and 64.12% after the fifth month.
Mildred R. Sebogodi, Mmampedi Huma, Mathilda M. Mokgatle, Matsontso Peter Mathebula, Maphoshane Nchabeleng
World Journal of AIDS, Volume 09, pp 167-182; https://doi.org/10.4236/wja.2019.94013

Abstract:
Background: The gap in the understanding of the context of the sexually transmitted infections (STIs) and risky behaviours among men who have sex with men (MSM) could lead to the development and implementation of inappropriate interventions, which could exacerbate the rapid spread of STIs, especially HIV, among MSM. The aim of the study was to qualitatively assess the understanding of the STIs and the risky sexual behaviours of men who have sex with men in the North-West region of Tshwane. Methods: An exploratory qualitative design was employed to assess the STIs and the risky sexual behaviour of the MSM population. The study participants were enrolled in a HPV clinical trial at MECRU, which is a clinical research unit at the Sefako Makgatho Health Sciences University. Data collection occurred from September 2016 to May 2017. A convenience sampling method was used and n = 30 participants were selected. Face-to-face in-depth interviews were conducted on MSM 18 years and older, using a semi-structured interview guide. Thematic content analysis was used for data analysis, using NVivo version 10 software. Results: The mean age of the sample was 26 years, and the age range was 18 to 44 years. All were unmarried, and all of them came from townships, rural villages and informal settlements in the vicinity of the clinical research unit. The high-risk behaviours noted among the majority of the MSM in this study were having multiple sexual partners and exchanging partners, alcohol abuse, inconsistent condom-use, having unprotected anal sex, and having transactional sex. There was a high level of knowledge of STIs in the heterosexual population with poor understanding of STIs affecting MSM through anal sex. Most of the MSM played a female or bottom role, which made them vulnerable because they could not successfully negotiate condom use, and they reported that they sometimes accepted gifts or money in exchange for anal sex. Conclusion: The study concludes that the MSM in this study had casual sex, and are involved in sex work without practising safe sex. There is a need for health promotion on STIs and risky behaviours among MSM in communities as well as in health facilities for MSM in the North-West region of Tshwane.
Christiana Asiedu, Evans Opoku Agyemang, Emmanuel Appiah Agyei
World Journal of AIDS, Volume 09, pp 183-194; https://doi.org/10.4236/wja.2019.94014

Abstract:
Background: The prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) is paramount in safeguarding the lives of unborn children and young babies. The study sought to examine the knowledge and attitudes of expectant mothers towards HIV screening and testing in the Jachie-Pramso Community of the Ashanti Region. Methods: The study adopted a descriptive survey approach as its research design. The population of the study comprised 158 expectant mothers who were registered and attended regular antenatal care sessions at the community hospital. The census approach to sampling was adopted for the study. A structured questionnaire was used as the tool for data collection. Chi-square and descriptive statistics were used to analyse the data. Results: The findings from the study indicated that awareness level of HIV and its related issues were high among expectant mothers. It was also found that attitude of healthcare workers, community members and sexual partners are the main factors that prevent expectant mothers from patronising voluntary counselling and testing (VCT) services. It was generally, recommended that intensive educational programmes be instituted to sensitize both healthcare workers and the general public on discriminative behaviours. Conclusion: Most of the expectant mothers have knowledge of HIV and attitudes of the expectant mothers towards VCT of HIV were positive. The healthcare facility and its professionals may consider training the expectant mothers so they can act as snow-ballers in the dissemination of relevant health education and coerce other expectant mothers in the community to participate in the VCT and HIV programmes.
Harriet Ntalasha, Jacob R. S. Malungo, Sonja Merten, Annie N. Phiri, Simona J. Simona
World Journal of AIDS, Volume 09, pp 49-69; https://doi.org/10.4236/wja.2019.92005

Abstract:
Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some people living with HIV still abandon treatment. This study explores patient-related factors that influence adherence to the life prolonging drugs. It is hoped that such information would be useful in enhancing adherence so as to achieve the goal of ART. This information is critical considering irrefutable evidence that non-adherence to Anti-Retroviral Therapy (ART) can lead to drug resistance and consequently, transmission of drug resistant HIV. Drug resistant HIV is not only expensive to handle, but can lead to increased morbidity, mortality and increased incidence of HIV cases particularly, for a low income country like Zambia. Methods: This paper uses data from a large mixed method study which was conducted in a rural setting. The study explored how patient-related factors influence people living with HIV in continuing taking of medication. The paper, therefore, discusses the major reasons reported by HIV infected people on ART for either being able to consistently take their medication or failing to do so. Results: Both limiting and facilitating factors were identified as influencing adherence. Among the facilitators identified were one having a reminder, feeling better after being on ART, seeing someone on ART recover, desire to live longer and disclosure of one’s positive status. The limiting factors included forgetting to take medication, non-recovery while on treatment for some time and drug fatigue. A significant association was found between adherence treatment and one having a reminder, desire to live longer and seeing someone on ART get better. Conclusion: While facilitators enhanced adherence, the barriers prevented or discouraged people on ART from continuing taking AIDS medicines as prescribed by their health care providers. In order to avoid drug resistance and other public health implications, such as transmission of drug resistant HIV virus and deaths, there is need to address these patient-related barriers.
N. E. Harrison, O. A. Adegbite, C. U. Agbaim, O. Nwaiwu, K. E. Oruka
World Journal of AIDS, Volume 09, pp 129-141; https://doi.org/10.4236/wja.2019.93010

Abstract:
Background: Female condom (FC) has efficiently challenged the increased risk for sexually transmitted infections (STI)/HIV, unwanted pregnancy and promoted self-protection and autonomy among females. However, despite being provided free of charge, the researchers have not observed satisfactory level of demand for FC by the HIV-positive clients at our facility. This study sought to establish the determinants or deterrent factors to the uptake and the use of FC among HIV-infected female clients in an Army hospital, Lagos. Method: A cross-sectional descriptive design was used and 340 interviewees were selected for the survey. Analyses were completed using Epi InfoTM version 7.2.1.0. Association between variables of interests was established using Chi-square. Result: Mean age of the participants was 37.91 ± 8.33 years while the median age was 37. Greater proportion was married (50.5%), business women (55.5%), had at least school certificate (90.1%), and had regular sexual partner (84.4%). Only 69.8% disclosed their status to their sexual partners, while 79.5% in turn were informed of their partners’ HIV status. Being in marital union, younger age and being aware of partner’s HIV status were significantly associated with HIV disclosure (p
William De Martini, Roksana Rahman, Eduvie Ojegba, Emily Jungwirth, Jasmine Macias, Frederick Ackerly, Mia Fowler, Jessica Cottrell, , Sulie L. Chang
World Journal of AIDS, Volume 09, pp 142-160; https://doi.org/10.4236/wja.2019.93011

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Antiviral drugs currently on the market primarily target proteins encoded by specific viruses. The drawback of these drugs is that they lack antiviral mechanisms that account for resistance or viral mutation. Thus, there is a pressing need for researchers to explore and investigate new therapeutic agents with other antiviral strategies. Viruses such as the human immunodeficiency virus (HIV) alter canonical signaling pathways to create a favorable biochemical environment for infectivity. We used Qiagen Ingenuity Pathway Analysis (IPA) software to review the function of several cellular kinases and the resulting perturbed signaling pathways during HIV infection such as NF-κB signaling. These host cellular kinases such as ADK, PKR, MAP3K11 are involved during HIV infection at various stages of the life cycle. Additionally IPA analysis indicated that these modified host cellular kinases are known to have interactions with each other especially AKT1, a serine/threonine kinase involved in multiple pathways. We present a list of cellular host kinases and other proteins that interact with these kinases. This approach to understanding the relationship between HIV infection and kinase activity may introduce new drug targets to arrest HIV infectivity.
M. C. O. Ezeibe, N. K. Aneke, T. N. Obarezi, F. Onyeachonam, M. E. Sanda, I. J. Ogbonna, E. Kalu, U. N. Njoku, M. Udobi, O. E. Ekundayo, et al.
World Journal of AIDS, Volume 09, pp 161-166; https://doi.org/10.4236/wja.2019.93012

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HIV/AIDS is an immune deficiency disease, caused by an RNA virus (positively charged pathogen). It is still being regarded as mysteriously incurable but in Nigeria many patients have been cured (they became HIV-antibody and antigen negative) by exploiting electrostatic attraction between pathogens and opposite electrical charges that are on Nanoparticles of Medicinal synthetic Aluminum-magnesium silicate (MSAMS) and by using antioxidants to relieve oxidative stress. To confirm the cure, as permanent, a patient (adult male) whose CD4 count increased (P
Fehmida Visnegarwala, Glory Alexander, Ram Babu
World Journal of AIDS, Volume 09, pp 23-32; https://doi.org/10.4236/wja.2019.91003

Abstract:
PLHIV have decreased economic productivity both due to direct and indirect causes. Data from developed countries have shown that at the societal level, high costs ART are offset by increased productivity. We hypothesized that post-ART the SES would improve regardless of the baseline SES and will be sustained over time. Our objective was to perform a comprehensive SES evaluation pre/post ART initiation using an ambispective cohort study design. We used Indian household-specific SES validated tool, with score of 76 being affluent, along with clinical, ART adherence data at median of 6 and 18 months post ART, and compared using paired t-tests. Among 140 persons started on ART, with a median follow up of 22 months, 118 had Pre-ART SES data, of these: 57% were women; median age was 38 years; 67% were married; 89 (78%) had heterosexual sex as HIV risk; 40 (34%) had major OI and/or TB at presentation. Reported self-occupation was: skilled labourers 41 (35%); 12 (10%) unskilled labourers; 27 (23%) housewives; 26 (22%) pro-fessionals/blue collar job; 1 student, 10 unemployed. The median pre-post ART CD4 cell counts were: 187 and 454 cells/cumm (P < 0.01); median body weight pre-post ART was 54 and 57 kg (P < 0.01); 97% of the participants were 100% adherent. The mean Pre-ART total SES score was 37.06 (+/-10.2); and Post-ART SES score 40.62 (+10.1 P < 0.001) and these results were sustained over time and remained significant even when only monthly income was considered. Our data show a significant impact of ART on SES in a sustained manner in a developing world setting, which has policy level implications.
Reinhard H. Dennin, Arndt Sinn
World Journal of AIDS, Volume 09, pp 33-48; https://doi.org/10.4236/wja.2019.92004

Abstract:
This article addresses issues regarding the transmission of HIV; without the combination antiretroviral treatment (cART), HIV causes a fatal outcome of those infected in most cases. First, legal issues: For years, controversial discussions have dealt with the subject of the legal classification of HIV infection, such as “… criminalization of HIV exposure might limit access to and uptake of HIV prevention services…” Based on the rule of law of a constitutional state, we explain the legal principles that serve to protect the legal rights of its citizens. The state has to protect its citizens from harm by other people. The prosecution and conviction of a specific person for a proven HIV infection are legal. Therefore, general decriminalization of HIV infection would undermine the right of thereby harmed citizens to compensation. Second, HIV prevention strategies: Based on the Test and Treatment Strategy (TASP)1, controlled studies were undertaken to find out which framework conditions could improve their benefit. We outline concepts that can help to curb the still ongoing spread of HIV: By providing early HIV diagnosis and ongoing HIV care services as part of updated education and prevention campaigns. Also, concerted, comprehensive campaigns are required to demonstrate further impacts of HIV infection: Both on the quality of life of infected individuals due to the development of non-communicable diseases and the increasing burden to societies as a whole.
Parvine Basimane Bisimwa, Dieudonné Bihehe Masemo, Andre Bulabula Nyandwe Hamama, Théophile Kashosi Mitima, Aline Kusinza Byabène, Tony Akilimali Shindano, Sioban Harlow, Jean Paulin Mbo Mukonkole, Narcisse Patrice Komas, Jean Bisimwa Nachega
World Journal of AIDS, Volume 09, pp 105-117; https://doi.org/10.4236/wja.2019.93008

Obiyo Nwaiwu, Folasade A. Olatunde, Nkechinyere E. Harrison, , Oludaisi A. Oduniyi
World Journal of AIDS, Volume 09, pp 70-84; https://doi.org/10.4236/wja.2019.92006

Abstract:
Background: Over 90% of infection in children is acquired through mother to child transmission (MTCT). Nevirapine’s efficacy, safety and affordable cost make it the most preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) for paediatric prophylactic use in resource limited settings. There are very few studies on pediatric adherence to antiretroviral prophylaxis, especially in very young infants. The objective of the study was to evaluate the adherence to nevirapine for prevention of mother to child transmission (PMTCT) amongst infants of HIV positive mothers in the first 6 weeks of life. Methods: This was a questionnaire based prospective cross-sectional multicenter study initiated in July 2015 and concluded in December 2017. The study was carried out at the Aids Prevention in Nigeria (APIN/HIV) human immunodeficiency paediatric clinics of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State, 68 Nigerian Army Reference Hospital Yaba (68NARHY) Lagos, Nigeria and the Holy Family Catholic Hospital, Festac Town, Amuwo Odofin, Lagos State. Nevirapine adherence, in infants of 0 - 6 weeks was measured by maternal verbal reports. Results: Eighty-one (81) infants receiving nevirapine within the age of 0 - 6 weeks completed the study. Majority of the infants started treatment at birth (32%) and after 4 weeks (31%). 54% of the 81 respondents do not miss or skip their doses while 46% of respondents skip doses. Majority of the respondents 18 (49%) missed their doses for 24 - 48 hours while 25% missed their doses because they were away from home and 23% ran out of pills. 85.2% took ≥95% of the prescribed medications (good or high adherence ), 8.2% took 80% - 95% of doses (moderate adherence) while 6.2% took 0.05). Conclusions: The adherence rates found in this study are comparable to other studies in developing countries. But these rates are still low for good clinical outcomes. Different levels of adherence were documented with the majority having good or high adherence. Not all of the infants started treatment at birth and Institutional delivery should be encouraged to improve early initiation of prophylaxis. The finding of patients with low adherence rates among the study population calls for intensification of counselling on adherence and should continue to be an integral part of prevention of mother to child transmission. Improved access to antiretroviral agents and improved care delivery systems are important.
Mariam M. Mirambo, Benson R. Kidenya, , Emmanuel Mkumbo, Awadh Mujuni, Kennedy J. Mmanga, Japhet J. Mwihambi, Shimba Henerico, Carolyne A. Minja, Stephen E. Mshana
World Journal of AIDS, Volume 09, pp 1-10; https://doi.org/10.4236/wja.2019.91001

Abstract:
Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections have been a major public health problem. HIV patients with HBV and HCV infection are at high risk of liver diseases which is associated with increased mortality. This study aims at determining the prevalence of hepatitis B surface antigen (HBsAg), HCV antibodies and HBV antibodies (anti-HBsAg) among HIV seropositive adults attending care and treatment clinic at Sengerema district hospital in Mwanza, Tanzania. A cross-sectional hospital based study was conducted between February and March 2017 among 243 HIV adult patients at Sengerema designated district hospital, Mwanza, Tanzania. Socio-demographic and other relevant information were collected using pre-tested questionnaires. Detection of HBsAg and HCV antibodies was done by commercial rapid immunochromatographic test while the detection of anti-HBsAg was done using enzyme linked immunosorbent assay. Data were analyzed by using STATA version 13. The median age of the study participants was 43, interquartile range (IQR): 37 - 51 years. The majority 172 (70.8) of study participants were female and the majority (88%) of participants had CD4 count of greater than 200 counts/μl. The prevalence of HBsAg, HCV antibodies and anti-HBsAg were 26/243 (10.7%, 95% confidence interval [CI]: 7 - 14), 20/243 (8.2%, 95% CI: 4.7 - 11.6) and (100/243) 41.2%, 95% CI: 35 - 47, respectively. Co-infection with HCV (OR: 4.45, 95% CI: 1.51 - 13.21, P = 0.007) was independenlty found to predict HbsAg positivity. History of blood transfusion (OR: 2.34, 95% CI: 1.08 - 5.06, P = 0.028) was significantly associated with anti-HBsAg among HIV infected individuals while, the rate of anti-HBsAg was found to decrease by 2.02 IU/L in a year increase in age. About one tenth of HIV infected individuals are co-infected with HCV and HBV with more than one third being positive for anti-HBsAg. There is a paramount need to emphasize the need for regular screening and proper management of these patients to reduce associated complications in resource limited countries where these infections are common.
Richard Bahizire Riziki, Sylvie Mutonda Mwangaza, Théo Mitima Kashosi, Bienfait Mitima Misuka, Freud Muciza Bayunvanye, Tharcisse Mateso Kakulibo, Jean Paul N’Sibula Bisimwa, Jean Lambert Mandjo Aholoma, Philippe Bianga Katchunga
World Journal of AIDS, Volume 09, pp 11-22; https://doi.org/10.4236/wja.2019.91002

Abstract:
Background: It has been well-established that a program to fight HIV can accomplish the same results with noncommunicable diseases (NCDs). Such a strategy has not yet been the subject of a trial in the Democratic Republic of the Congo (DRC). The aim of this study was to test the feasibility of HIV concurrent and respectively other chronic infectious and NCDs in the general population of South Kivu. Methods: Between 1 December 2016 and 15 January 2017, HIV, hepatitis B, high blood pressure (HBP) and diabetes mellitus (DM) were tested in the general adult population ≥ 15 years, respectively, in the towns of Bukavu and Uvira, and the rural areas Nyangezi and Walungu, on World AIDS Day 2016. Previous screening of these diseases has been sought, but the association between them was modeled in a multiple logistic regression. Results: Among the three thousand eight hundred and sixty-three (3863) adult subjects > 15 years (52.1% of men) tested voluntarily, the previous screening and prevalence were 33.8% and 1.2% respectively for HIV, 1.3% and 8.3% for hepatitis B, 18.2% and 25.1% for HBP and 9.5% and 4.8% for DM. The acceptance rate for current screening was significantly higher (p < 0.0001) for HIV (97.5%) than for HBP (84.6%) as well as DM (64.6%). Finally, age ≥ 60 years (adjusted OR = 1.74; p = 0.01), HBP (adjusted OR = 1.82; p = 0.004) and above all HIV (adjusted OR = 3.94; p = 0.008) showed an independent effect on the likelihood of DM. Conclusion: This study did more HIV testing than screens for other diseases. Finally, these problems can be managed (at a reasonable cost) with a view similar to the objectives of the World Health Organization (WHO).
, Kwaku Opoku-Ameyaw, Francis Kwame Bukari, Bashiru Mahama, Jerry John Amaasende Akooti
World Journal of AIDS, Volume 09, pp 85-104; https://doi.org/10.4236/wja.2019.92007

Abstract:
Knowledge on individual’s HIV/AIDS status provides a tool to reduce or avoid HIV transmission, spread and mortalities due to HIV-related illness. However, most people still do not know their HIV status because they are not willing to test for HIV/AIDS due to various reasons. Hence the aim of this paper is to investigate the effects of various risk factors that are likely to influence decision to ever test for HIV/AIDS. The data used in this paper were obtained from the Ghana Demographic and Health Survey (n = 1828 observations and 32 risk factors). We applied the Chi-Square test statistic and the logistic regression model to the data in order to study the effects of these risk factors on one’s decision to ever test for HIV. STATA version 14.1 and R version 3.5.2 were used to carry out the statistical analyses. Generally, the results show that education, especially higher education significantly (OR = 0.53, 95% = 0.230, 0.837) increases the likelihood to ever test for HIV. Also, the younger the age groups the higher the effect and significance in the likelihood to ever test for HIV. We found that HIV-TB co-infection (OR = 0.53, 95% = 0.165, 0.893), use of condom anytime one has sex (OR = 0.31, 95% = 0.054, 0.573), wealth index (OR = 0.46, 95% = 0.137, 0.791), awareness of HIV transmission during child-delivery, number of partners significantly affect HIV testing. Those with many partners are less likely (OR = -0.26, 95% = -0.504, -0.007) to ever test for HIV and those who know that healthy person may have HIV are more likely (OR = 0.41, 95% = 0.137, 0.679) to ever test for HIV. Age is the common significant risk factor of ever tested for HIV across the 10 regions in Ghana. Resources should be allocated for more education on these significant risk factors in order to help in the fight against HIV-Health related issues.
Nwanna Uchechukwu Kevin
World Journal of AIDS, Volume 09, pp 118-128; https://doi.org/10.4236/wja.2019.93009

Abstract:
Introduction: In Uganda, Human Immunodeficiency Virus (HIV) was first reported at Kasensero landing site in Rakai district, in the South Western region in 1982. The district has continued to experience high HIV rates at 12% compared to the national average of 7.3% with relatively higher vertical transmission rates. Objective: The purpose of this study was to determine the individual determinants of adherence to feeding guidelines for infants born to HIV positive mothers in Rakai District, Uganda. Methodology: A descriptive cross-sectional study design was used with a sample size of 138 respondents and employing quantitative method of enquiry. A non-probability sampling strategy called consecutive sampling was used to sample the mothers with HIV. Data were analyzed using SPSS to generate descriptive and bivariate analysis data. Results: Individual determinants found to have a statistically significant influence to feeding guidelines for infants born to mothers living with HIV were: Age (X2 = 45.967, P-value = 0.000), Number of children (X2 = 93.069, P-value = 0.000), Number of children given birth to since diagnosis (X2 = 18.604, P-value = 0.000), income per month (X2 = 50.477, P-value = 0.000), ever had breast complication (X2 = 15.039, P-value = 0.000), disclosure of HIV status (X2 = 10.740, P-value = 0.001), quantity of breast milk produced (X2 = 10.637, P-value = 0.0005) and whether mothers attended antenatal care services (X2 = 38.613, P-value = 0.000). Conclusion: Age, Number of Children, Number of Children given birth to since diagnosis, breast complications, disclosure of HIV status, quantity of breast milk produced and utilization of antenatal care services were found to have an association with the adherence to feeding guidelines among HIV positive mother and this was statistically significant. Recommendation: General improvement of socio-economic status of the mothers should be done and be given priority so that in turn it will enable the women to adequately focus on maintaining optimum and the health of their children.
Adebola A. Adejimi, Ajibola Olagunoye, Adeyemi Amuda, Olubukola Alawale, Oluwatoyin Adeola-Musa, Abayomi Adenekan, Akin Oyebade, Mosur Bello, Michael Olugbile, Olusegun Adeoye, et al.
World Journal of AIDS, Volume 09, pp 195-213; https://doi.org/10.4236/wja.2019.94015

Abstract:
Orphans and Vulnerable Children (OVC) and their families face many challenges but there are opportunities to provide care and support programmes for them in their communities. This paper presents the achievements and implications of HIV Programme Development Project (HPDP) funded by World Bank on care and support services for OVC in Osun State, Nigeria. Eight Civil Society Organisations (CSOs) were engaged by Osun State Agency for the Control of AIDS (OSACA) as part of HPDP to provide care and support services for OVC between year 2013 and 2015. Using reporting tools, data collected by the CSOs were entered into District Health Information System 2 (DHIS2) platform and analysed using Microsoft Excel. In addition, Key Informant Interviews (KII) were conducted among the selected CSOs, OVC and the caregivers who were beneficiaries of HPDP in Osun State, Nigeria. A total of 12,353 OVC were reached and about half of them were female. There was an increase in the trends of number of OVC seen and the support services provided from the year 2013 to 2015. Of the 12,353 OVC that benefitted from this programme, 1905 (15.4%) received health care services, 5383 (43.6%) received nutritional services, 5317 (43.0%) received educational services and 9861 (79.8%) were provided with psychosocial support services. About 503 (4.1%) of the OVC received economic strengthening services while 270 (2.2%) of household heads were provided with economic support. However, 3 OVC were lost to follow-up, 14 OVC voluntarily withdrew from the project and 6 OVC died. The FGD and KII revealed that the project was very impactful in transforming the lives of the OVC. Programmes for children orphaned and made vulnerable by HIV/AIDS will contribute to the achievement of HIV/ AIDS prevention and control efforts. The HIV/AIDS free generation can be built by responding to the physical, social and mental needs of these children and their families in their communities. There is a need to scale-up this programme.
Julio Werner Juárez Lorenzana, María Luisa Navarro Gómez, Andrea Palma
World Journal of AIDS, Volume 08, pp 63-75; https://doi.org/10.4236/wja.2018.83006

Abstract:
Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information; 10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory; cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.
, , Stephen Umaru, Lincoln Egbo, Felicia Okolo, , Alash’Le Abimiku
World Journal of AIDS, Volume 08, pp 160-176; https://doi.org/10.4236/wja.2018.84012

Abstract:
Background: Retention in clinical trials is critical for the accumulation of data over time and retaining enough power for comprehensive analysis. We document for the first time the retention rates and factors associated with retention among a cohort of HIV exposed seronegative (HESN) person in a discordant relationship. Understanding these factors will provide valuable cues for maintaining high retention rates in future HIV biomedical prevention studies in this cohort. Aim: We aimed to document retention rates and associated factors relevant in conducting future HIV prevention studies using a cohort of HIV exposed sero-negative individuals. Method: We conducted a prospective cohort study to enroll HESN persons in discordant relationship based on established inclusion criteria that includes: Established sero-discordance with at least 3 months in the relationship; above 18 years and willingness to be followed up. Relevant ethical approvals were obtained. Following informed consent at enrollment, standardized questionnaires on risk behavior and factors that may affect retention were administered at enrollment and during the 2 years follow-up. This was spread over 10 follow-up visits to mimic phase a 2b HIV vaccine clinical trial follow up and duration. In addition, clinical examinations were done and samples collected for safety lab during the follow up visits. Estimation of CD4 and viral load was also done for the HIV+ partners of HESN study participants. Results: Six hundred and sixty HESN persons were screened and 534 (81%) enrolled (i.e. month 0) and followed up. There was a decline in retention from 96% at month 1 (visit 1) to 78% at month 24 (Visit 10). Sharpest drop out from the study occurred at month 1 (20%) and month 15 (14%) follow-up visits. Inability to reach study participants, unwillingness of study participants to continue study, and mortality of the HIV+ partners of HESN participants were the commonest reasons for participant study termination. Furthermore, no or low level of formal education, (AOR 2.79; 95% CI 1.29 - 6.02, p = 0.06), being unemployed (AOR 1.96; 95% CI 1.18 - 3.29, p CI 1.16 - 2.91, p Conclusion: Retention rates decline especially during month 1 (visit 1) and month 15 (visit 7) mainly due to participants’ inability to locate study participants and death of HIV+ partners of HESN enrollees. One unexpected finding from our study is that those who were more consistent in their use of condom were more likely to stay in the study. This is a possible indication of commitment or an incentive for giving free condoms at study visits. This is encouraging for combined biomedical prevention strategies where consistent condoms use is desired. On the other hand, factors such as unemployment, poor formal education and never/occasional condom use were predictors of study drop out. Retention strategies should consider these barriers and predictors of drop out as exclusion criteria in preparation for future HIV biomedical prevention trial.
, Lucy Baden
World Journal of AIDS, Volume 08, pp 119-136; https://doi.org/10.4236/wja.2018.84010

Abstract:
This paper introduces the online Sociometrics Social, Behavioral, and Health Sciences Library, an exciting new science-based resource for HIV/AIDS researchers, health educators, and clinicians. The over 400 products in the Sociometrics Library supplement the online publications—journal articles, books, reports, monographs—that have been the focus of scientific research libraries and publishers to date, both printed and online. Examples of the innovative science-based products that serve as the library’s content include: Evidence-based interventions and programs (EBIs/EBPs) that evaluation research has shown to be effective in preventing HIV or its risky social and behavioral antecedents; primary research data and survey instruments; and interactive, multimedia training tools and courses to build HIV professionals’ capacity to implement EBPs with fidelity and to cooperate with evaluators in the assessment of their effectiveness. A Scientist Expert Panel has guided and will continue to guide product selection and acquisition, ensuring the collection’s continuing technical merit, research utility, and relevance for practice and policy. The Sociometrics Library aims to become the dominant online source of behavioral and social science-based HIV research by-products, operationally sustainable and able to stay up-to-date both from a technological and scientific perspective.
Andrea Palma, Julio W. Juarez
World Journal of AIDS, Volume 08, pp 1-10; https://doi.org/10.4236/wja.2018.81001

Abstract:
Background: The infection with HIV has been related to neurological disorders that are very frequent, since this virus crosses the blood-brain barrier and enters the CNS, thus affecting its neurological development. About 50% - 90% of infected patients, with an average age of onset from 19 months to 3 years old may present some types of neurological alteration during the course of the disease. Currently in Guatemala, there are no researches that show changes in the neurodevelopment of patients infected with HIV. Objective: To identify neurodevelopment of pediatric patients infected with the HIV, taking into consideration clinical and epidemiological characteristics. Materials and Methods: Fifty-six patients, who were under 8 years and 6 months of age, that met the inclusion criteria (confirmed diagnosis of HIV), were evaluated through neurodevelopment test (Bayley Test and McCarthy’s Scale) during the months of May and June of 2016. Results: Within the neurodevelopment evaluation, it was discovered that between 36% and 54% of evaluated patients that were 3 years and 6 months to 8 years and 6 months old, presented alterations in more than one area of neurodevelopment, correlating it with studies performed in other countries with 30% - 70% of neurological affection. Conclusions-All infected patients have alterations in more than one area of neurodevelopment. The most affected areas of neurodevelopment were the verbal, numerical and cognitive areas.
, , Zhenyuan Du
World Journal of AIDS, Volume 08, pp 137-159; https://doi.org/10.4236/wja.2018.84011

Abstract:
The ongoing spread of HIV after sobering news about the goal “End of AIDS” is not encouraging, apart from regional differences. We focus on the consequences of the two essentially failed HIV prevention strategies in certain countries. The first failed because the correct messages concerning preventive behavior did not reach the required levels of target populations to interrupt HIV infection chains. There was a lack of appropriate framework conditions for the target populations to engage in the required scale. The additional biomedical strategy “Treatment as Prevention” didn’t achieve the breakthrough as was hoped. The consequences thereof affect the financial burden on societies, which can take several decades. We draw attention to the unbalanced principles of proportionality to which governments are committed, but which are practiced in favor of those vulnerable people; these people abuse their autonomy and contribute to the further spread of HIV at the expense of financial burdens, social and medical care systems; this behavior is tolerated, although the transmission of HIV is mostly preventable. We point to extreme tendencies, such as the chem-sex settings, whose unswayable participants engage in indirect violence against the societies. Another possible consequence of the still uncontrolled spread of HIV is the potential for HIV to increase its virulence.
Harriet Ntalasha, Simona J. Simona, Felicitas Moyo, Jairous Miti, Ireen Kabembo, Eliphas Machacha, Mundia Libati, Emily Ng’Andu, Aurick Mubita
World Journal of AIDS, Volume 08, pp 37-52; https://doi.org/10.4236/wja.2018.81004

Chiranjeev Bhattacharjya, Giridhar Pathak, Tulika Goswami Mahanta, Y. Manihar Singh, Ranjanjyoti Deka, Mitali Sen, Alok Kr. Deb
World Journal of AIDS, Volume 08, pp 21-36; https://doi.org/10.4236/wja.2018.81003

Abstract:
Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years; 2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately; and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.
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