The effects of oral clefts on hospital use throughout the lifespan

Background

Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority.

Methods

We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched.

Results

The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme.

Conclusions

The review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS.     

Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa

INTRODUCTION: In order to assess the health outcomes of the South African public sector antiretroviral treatment (ART) programme, it is important to gain a better understanding of the complex relationship between ART and the multidimensional construct quality of life (QoL). Because of the gap between supply and demand, equity issues arise concerning the provisioning of ART. OBJECTIVE: The aim of this paper is to examine how and to what extent public sector ART is related to the physical and emotional health of people living with HIV/AIDS (PLWHA). METHODS: The stratified random sample consisted of 371 AIDS patients on ART or medically certified for ART, but still awaiting treatment. A model of the relationships between patient characteristics (age and gender) and socio-economic position (educational level, income, type of dwelling, number of rooms), ART duration, and physical and emotional QoL was tested using structural equation modelling. RESULTS: Patients with a higher personal income (beta = .19, P < .05) and a larger dwelling (beta = .45, P < .01) were significantly more likely to enter the programme at this early stage. The model showed that the initial months of ART have been associated with significant improvements in the physical QoL (beta = .21, P < .01). Furthermore, patients on ART reported significantly higher levels of emotional well-being than patients awaiting treatment (beta = .10, P < .01). Finally, the results indicate that ART is not only directly associated with emotional QoL, but is also indirectly associated with emotional QoL via the mediating variable physical QoL (beta = .30, P < .01). CONCLUSIONS: The study suggests that the poorest of the poor are not the first beneficiaries of the public programme. Most importantly, the present findings demonstrate the positive physical and emotional health outcomes of the first 6 months of ART in the Free State, South Africa.     

Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents

SETTING:Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV.OBJECTIVES:To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents’ perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months’ post-HIV diagnosis.DESIGN:We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes).RESULTS:Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers.CONCLUSION:This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.     

2016—2018年广东省艾滋病抗病毒治疗者首年死亡率分析

  目的  了解广东省2016-2018年新接受抗逆转录病毒治疗(antiretroviral therapy, ART)的感染者/艾滋病患者(简称HIV/AIDS患者)治疗首年死亡率变化趋势, 比较与探索"广东艾滋病社区综合防治研究项目"广州市示范区、广州市非示范区及广东省其他市的HIV/AIDS患者死亡率差异及原因, 为AIDS死亡防控工作提供依据。  方法  基于国家艾滋病抗病毒治疗信息系统与《中国死因监测数据集》, 分析2016-2018年在广州市第八人民医院新接受ART的HIV/AIDS患者, 治疗首年死亡率和标准化死亡率比(standardized mortality ratio, SMR); 采用Cochran-Armitage趋势检验分析2016-2018年各年新接受治疗患者的治疗相关指标的变化趋势; 采用Cox回归探索不同地区HIV/AIDS患者治疗首年死亡率差异的原因。  结果  2016-2018年共6 447名HIV/AIDS患者新接受ART, 广州市示范区、广州市非示范区和广东省其他市的患者分别为976、3 921和1 550人; 期间死亡152人。2016-2018年广州市示范区患者的治疗首年死亡率下降79.7%, 广州市非示范区患者死亡率下降趋势不明显, 广东省其他市患者死亡率上升18.8%;经标化后, 三组现住址患者的SMR均呈现下降趋势。三组患者的早治疗率随开始治疗年份增加而增加, 但是仅广州市的患者疗效随年份增加改善显著。Cox回归结果显示在校正不同地区患者的基线特征以及项目实施过程中控制效果良好的因素后, 三组现住址患者死亡率差异均无统计学意义(均有P>0.05)。  结论  项目实施下, 广州市HIV/AIDS患者治疗首年死亡率得到控制, 特别是示范区患者首年死亡率在2018年下降至较低水平, 但广东省其他市患者死亡率相对较高且可用较差的基线特征与治疗相关指标解释。对于在广州市接受治疗且居住在广东省其他市的HIV/AIDS患者, 掌握疗效较差原因, 积极促进早治疗以提高ART疗效是降低这部分患者首年死亡率的关键。     

Philani Plus (+): A Mentor Mother Community Health Worker Home Visiting Program to Improve Maternal and Infants�� Outcomes

Pregnant mothers in South African townships face multiple health risks for themselves and their babies. Existing clinic-based services face barriers to access, utilization, and human resource capacities. Home visiting by community health workers (CHW) can mitigate such barriers. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting intervention program for maternal and child nutrition by integrating content and activities to address HIV, alcohol, and mental health. Pregnant Mothers at Risk (MAR) for HIV, alcohol, and/or nutrition problems in 24 neighborhoods in townships in Cape Town, South Africa (n?=?1,239) were randomly assigned by neighborhood to an intervention (Philani Plus (+), N?=?12 neighborhoods; n?=?645 MAR) or a standard-care control condition of neighborhood clinic-based services (N?=?12 neighborhoods; n?=?594 MAR). Positive peer deviant ??Mentor Mother?? CHWs are recruited from the township neighborhoods and trained to deliver four antenatal and four postnatal home visits that address HIV, alcohol, nutrition, depression, health care regimens for the family, caretaking and bonding, and securing government-provided child grants. The MAR and their babies are being monitored during pregnancy, 1 week post-birth, and 6 and 18 months later. Among the 1,239 MAR recruited: 26% were HIV-positive; 27% used alcohol during pregnancy; 17% previously had low-birthweight babies; 23% had at least one chronic condition (10% hypertension, 5% asthma, 2% diabetes); 93% had recent sexual partners with 10% known to be HIV+; and 17% had clinically significant prenatal depression and 42% had borderline depression. This paper presents the intervention protocol and baseline sample characteristics for the ??Philani Plus (+)?? CHW home-visiting intervention trial.     

Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects

After a decline in enthusiasm for national community health worker (CHW) programmes in the 1980s, these have re-emerged globally, particularly in the context of HIV. This paper examines the case of South Africa, where there has been rapid growth of a range of lay workers (home-based carers, lay counsellors, DOT supporters etc.) principally in response to an expansion in budgets and programmes for HIV, most recently the rollout of antiretroviral therapy (ART). In 2004, the term community health worker was introduced as the umbrella concept for all the community/lay workers in the health sector, and a national CHW Policy Framework was adopted. We summarize the key features of the emerging national CHW programme in South Africa, which include amongst others, their integration into a national public works programme and the use of non-governmental organizations as intermediaries. We then report on experiences in one Province, Free State. Over a period of 2 years (2004--06), we made serial visits on three occasions to the first 16 primary health care facilities in this Province providing comprehensive HIV services, including ART. At each of these visits, we did inventories of CHW numbers and training, and on two occasions conducted facility-based group interviews with CHWs (involving a total of 231 and 182 participants, respectively). We also interviewed clinic nurses tasked with supervising CHWs. From this evaluation we concluded that there is a significant CHW presence in the South African health system. This infrastructure, however, shares many of the managerial challenges (stability, recognition, volunteer vs. worker, relationships with professionals) associated with previous national CHW programmes, and we discuss prospects for sustainability in the light of the new policy context.     

"Life is still going on": reproductive intentions among HIV-positive women and men in South Africa

This article reports on qualitative research investigating HIV positive individuals' reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not receiving ART. Being HIV positive modified but did not remove reproductive desires, and diversity existed in reproductive intentions. Some HIV positive individuals wished to avoid pregnancy. Fears of partner and infant infection and having a previously infected baby were important factors deterring some individuals from considering having children. There was also strongly perceived community disapproval associated with HIV and reproduction. Strong desires to experience parenthood, mediated by prevailing social and cultural norms that encouraged childbearing in society more broadly, were reported by others. Motherhood was an important component of married women's identity and important for women's social status. Family, husbands' and societal expectations for childbearing were important influences on women's reproductive intentions, for some counterbalancing HIV as a factor discouraging reproduction. There was evidence that prevention of perinatal transmission programs in combination with ART may alter women and men's attitudes in favour of childbearing. Most HIV positive women had not discussed their reproductive desires and intentions with health care providers in HIV care or general health services because of anticipated negative reactions. The few who had done so perceived the counselling environment to be mostly unsupportive of open discussion on these issues. The findings highlight the need for explicit policies recognizing reproductive rights and choice. They support the need for health counselling and service interventions that advance safer and healthier reproductive options for HIV positive individuals in this region of the world which is experiencing a generalised and advanced HIV/AIDS pandemic.     

‘My biggest fear was that people would reject me once they knew my status…’: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg,South Africa

Stigma is not a new concept; however, it remains highly significant in the context of HIV/AIDS in South Africa. There is wide consensus that HIV/AIDS‐related stigma compromises the well‐being of people living with the disease. This paper is part of a larger study that seeks to understand the social and cultural complexity related to the provision and outcomes of antiretroviral therapy (ART) in South Africa. It explores and analyses how patients on ART perceived and experienced stigma and how it has shaped their behaviour towards, as well as their understanding of the epidemic. The data have been collected by means of in‐depth face‐to‐face interviews, conducted between June and November 2007, with a sample of 44 patients in an HIV/AIDS clinic in a resource‐limited setting in Johannesburg, South Africa. The findings reveal that the level of felt and anticipated stigma is intense and affects all dimensions of living with HIV/AIDS, particularly disclosure and treatment. Stigma permeates the experience of HIV‐positive people on ART who participated in this study. The intensity of HIV/AIDS‐related stigma can threaten to compromise the value of ART, thus impacting on the daily lives of people living with HIV/AIDS (PLWHA). This study suggests that three decades into the epidemic, stigmatisation remains a core feature of the patient experience of HIV/AIDS. In the clinic in which this research was conducted, HIV/AIDS was regarded as a chronic condition increasingly manageable by ongoing access to ART. However, this approach was not shared by many family members, neighbours and employers who held highly stigmatised views.     

Community-Based Diabetes Community Health Worker Intervention in an Underserved Chicago Population

The Community Health Worker (CHW) model has been used to combat disparities in healthcare access by utilizing community members as healthcare liaisons to promote improved community health. CHW interventions have been effective in improving diabetes management. This case study reports on a low-intensity CHW intervention in a predominantly Hispanic and non-Hispanic Black population in two Chicago neighborhoods: North Lawndale and South Lawndale. CHWs conducted door-to-door outreach and, for individuals with self-reported type 2 diabetes, offered home visits at baseline and one-year follow-up to provide diabetes education, create an individual management strategy, and refer to clinic-based support services. During 2012, 459 participants were enrolled, with 343 completing follow-up visits in 2013 (75 % retention). The mean HbA1c decrease was 0.5 %. At follow-up, participants were less likely to be depressed, to forget to take their diabetes medications, and were more likely to report higher social support and score higher on an assessment of diabetes knowledge. Patients who were younger, Hispanic, had uncontrolled diabetes, and had lower levels of diabetes self-care at baseline demonstrated increased odds of a significant HbA1c decrease with the intervention than patients without these characteristics. This study demonstrates the effectiveness of a home-based, low-intensity CHW intervention in medically underserved communities, and identifies population groups who might benefit the most from future similar CHW interventions.     

安徽省艾滋病抗病毒治疗病人生活质量与社会支持典型相关分析

目的了解接受抗病毒治疗的艾滋病病人的生活质量和社会支持现况及其相关性。方法采用简明健康调查量表（the MOS item short from health survey,SF-36）和社会支持评定量表（social science research solutions,SSRS）对选定人群进行生活质量和社会支持的调查及典型相关分析。结果抗病毒治疗艾滋病病人生活质量和社会支持得分均低于一般人群（均有P〈0.05）。病人社会支持与生活质量之间存在典型相关关系（F=7.48,P〈0.001）。反映生活质量的第一典型变量V1主要由心理健康和情绪角色限制决定;反映社会支持的第一典型变量W1主要由主观支持和对支持的利用度决定。结论抗病毒治疗艾滋病病人生活质量差,社会支持水平低。病人获得的主观支持越多或对支持的利用度越高,则其心理健康状况越好;越少或越低,则由情感问题所造成的职能限制越大。     

A review of ICT systems for HIV/AIDS and anti-retroviral treatment management in South Africa

Telemedicine and e-health systems have been proposed as a support tool, to monitor and evaluate HIV/AIDS management strategies. The aim of the present study was to provide an overview of telemedicine and e-health systems for HIV/AIDS in South Africa as a basis for developing an e-health toolkit for anti-retroviral treatment (ART). An initial literature review and a subsequent interactive networking approach were chosen to identify telemedicine and e-health systems, projects and services for HIV/AIDS and ART facilities in low-resource settings and under-served areas. The literature review produced little useful information. In contrast, the face-to-face interviews and the focus group discussions provided useful information about projects and systems which had not been published. The meetings involved 1 - 5 people per session, about 30 people in total. The review showed that there were some plans for telemedicine and e-health implementation in South Africa. However, there was no all-inclusive ICT-based system in place for AIDS treatment there. With the exception of the major health information systems and electronic patient record systems, none of the telemedicine and e-health systems identified in the review were ready to be deployed across the country as a whole.     

The emergence of community health worker programmes in the late apartheid era in South Africa: An historical analysis

There is re-emerging interest in community health workers (CHWs) as part of wider policies regarding task-shifting within human resources for health. This paper examines the history of CHW programmes established in South Africa in the later apartheid years (1970s–1994) – a time of innovative initiatives. After 1994, the new democratic government embraced primary healthcare (PHC), however CHW initiatives were not included in their health plan and most of these programmes subsequently collapsed. Since then a wide array of disease-focused CHW projects have emerged, particularly within HIV care.     

“They (ARVs) are my life, without them I’m nothing”—experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa

This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.     

Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda

Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR?=?0.29, 95% CI?=?0.13–0.65, p?=?.002) and a 4.52 times higher mortality hazard rate (adjusted HR?=?4.52, 95% CI?=?1.20–17.09, p?=?.026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients.     

湖南省252例艾滋病患者抗病毒治疗效果及耐药分析

目的了解湖南省艾滋病患者接受国家免费抗病毒治疗的效果,分析治疗依从性及治疗后产生耐药的情况。方法对衡阳市接受国家免费抗病毒治疗时间超过6个月,且年龄为18岁以上在治的艾滋病患者进行问卷调查,并采集抗凝全血,检测CD4＋T淋巴细胞和病毒载量,对病毒载量〉1 000拷贝/ml的标本做HIV耐药基因型检测分析。结果共调查252名艾滋病患者,接受抗病毒治疗6个月以后,71.83%的患者坚持服药,无漏服;91.27%的患者CD4＋T淋巴细胞计数比治疗前增加,80.95%的患者CD4＋T淋巴细胞计数与治疗前比增加了50个/μl以上;病毒载量完全抑制的比例为71.03%;13名患者发生耐药,耐药发生率为5.16%,对核苷类反转录酶抑制剂（NRTIs）和非核苷类反转录酶抑制剂（NNRTIs）耐药发生率分别为3.97%和5.16%,对NRTIs和NNRTIs两类药物均发生耐药的比例为3.97%。结论湖南省接受艾滋病抗病毒治疗患者总体疗效显著,少数患者出现耐药值得关注。     

Who is accessing public-sector anti-retroviral treatment in the Free State,South Africa? An exploratory study of the first three years of programme implementation

Background

Although South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008. However, longitudinal studies of who is accessing the South African public-sector ART programme are scarce. This study therefore had one main research question: who is accessing public-sector ART in the Free State Province, South Africa? The study aimed to extend the current literature by investigating, in a quantitative manner and using a longitudinal study design, the participants enrolled in the public-sector ART programme in the period 2004-2006 in the Free State Province of South Africa.

Methods

Differences in the demographic (age, sex, population group and marital status) socio-economic (education, income, neo-material indicators), geographic (travel costs, relocation for ART), and medical characteristics (CD4, viral load, time since first diagnosis, treatment status) among 912 patients enrolled in the Free State public-sector ART programme between 2004 and 2006 were assessed with one-way analysis of variance, Bonferroni post-hoc analysis, and cross tabulations with the chi square test.

Results

The patients accessing treatment tended to be female (71.1%) and unemployed (83.4%). However, although relatively poor, those most likely to access ART services were not the most impoverished patients. The proportion of female patients increased (P < 0.05) and their socio-economic situation improved between 2004 and 2006 (P < 0.05). The increasing mean transport cost (P < 0.05) to visit the facility is worrying, because this cost is an important barrier to ART uptake and adherence. Encouragingly, the study results revealed that the interval between the first HIV-positive diagnosis and ART initiation decreased steadily over time (P < 0.05). This was also reflected in the increasing baseline CD4 cell count at ART initiation (P < 0.05).

Conclusions

Our analysis showed significant changes in the demographic, socio-economic, geographic, and medical characteristics of the patients during the first three years of the programme. Knowledge of the characteristics of these patients can assist policy makers in developing measures to retain them in care. The information reported here can also be usefully applied to target patient groups that are currently not reached in the implementation of the ART programme.

     

Providing support to caregivers and self-care

The evolution of HIV/AIDS care has resulted in a wide range of caregivers who work out of public and private hospital facilities, nongovernmental organizations (NGOs) and community-based facilities. Others are volunteers and community health and social workers based at facilities or community sites. Many caregivers are family members or part of a client's close social network. Additionally, people living with HIV/AIDS (PHA) themselves engage in self-care and provide support to other PHA through support groups. In the best-case scenario the services of these caregivers are sometimes provided free of charge at one site by a specialized NGO. In many cases, however, a person wishing to gain access to care and social services may need an understanding how the systems and procedures of various institutions operate. Many PHA are unprepared for the administrative, financial, and legal barriers that they may encounter. To cope with this need, a new type of support service called the "buddy" system has emerged. Buddies are individuals who are less directly involved with, but who know about HIV/AIDS, the services available and the rights of PHA. A buddy is close enough for the PHA to approach, has sufficient time to devote to him/her and can be asked almost everything. The article on the Rio de Janeiro Buddy Project provides an example of a project for gay men in Brazil. In other parts of the world where the buddy system is non-existent, the PHA must often rely on support provided by family and friends.     

我国530例既往不安全有偿供血感染艾滋病病毒者生存分析

目的 探讨既往不安全有偿供血感染艾滋病病毒(HIV)者生存时间及其影响因素.方法 采用回顾性队列研究方法,从山西、山东、湖北、吉林4个省以典型抽样方式选取8个县(区),选择所有2006年1月24日前发现并确认既往不安全有偿采血(浆)者中HIV感染者和艾滋病(AIDS)患者病例,收集其感染、发病、死亡等信息及影响因素.结果 530例病例中,HIV感染者196例(37.0%);AIDS患者334例(63.0%),其中168例(50.3%)抗病毒治疗;152例(29.0%)死亡.在530例患者从感染到观察终点平均观察(10.1±1.8)年中.166例未治疗AIDS患者平均生存时间9.1年(95%CI:9.1～9.4),8年生存率52.0%;而168例已治疗AIDS患者平均生存时间12.1年(95%CI:11.9～12.3),12年生存率80.0%;在抗病毒治疗3年中,治疗者平均生存时间比未治疗者延长而死亡风险降低12.2倍.AIDS患者平均生存时间在性别、年龄、地区、是否高效抗逆转录病毒治疗(HAART)、治疗前基线CD4+ T淋巴细胞水平上存在差异,多因素COX回归分析表明抗病毒治疗是AIDS患者生存首要保护因素(HR=13.3,P=0.00),治疗前基线CD4+T淋巴细胞＜50个/μl的AIDS患者治疗中死亡风险高(HR=10.9,P=0.00).结论 AIDS患者生存时间受到诸多因素影响,但是HAART干预是延长AIDS患者生存时间和降低AIDS患者死亡风险的首要保护措施.     

人血清白蛋白与艾滋病抗病毒疗效关系的病例对照研究

目的 探索抗病毒治疗后人血清白蛋白水平（human serum albumin,HSA）与抗病毒疗效的关系。方法 收集抗病毒治疗半年以上的病毒学失败HIV/AIDS患者,以性别、年龄、抗病毒治疗时间和治疗方案等条件按1∶1配对收集病毒学抑制成功的对照组患者,采用条件logistic回归分析。结果 根据匹配条件共获得178对患者,男性占66.29%,女性占33.71%。在未调整变量前,OR为0.764（95%CI 0.696 - 0.838）。调整基线HSA、基线CD4+T淋巴细胞和治疗24周后CD4+T淋巴细胞后,OR为0.780（95%CI 0.703 - 0.866）,HSA与抗病毒疗效存在负关联,高HSA可能为抑制病毒血症的保护因素。在一线方案AZT/3TC/EFV、TDF/3TC/EFV和AZT/3TC/NVP也发现HSA与抗病毒疗效存在负关联,而在二线方案TDF/3TC/LPVr、AZT/3TC/LPVr未发现此现象。结论 抗病毒治疗失败与低血清白蛋白水平有关,HIV/AIDS患者在临床治疗过程中,应加强血清白蛋白的监测。     

AIDS treatment and mental health: Evidence from Uganda

Increased access to antiretroviral therapy (ART) in developing countries over the last decade is believed to have contributed to reductions in HIV transmission and improvements in life expectancy. While numerous studies document the effects of ART on physical health and functioning, comparatively less attention has been paid to the effects of ART on mental health outcomes. In this paper we study the impact of ART on depression in a cohort of patients in Uganda entering HIV care. We find that 12 months after beginning ART, the prevalence of major and minor depression in the treatment group had fallen by approximately 15 and 27 percentage points respectively relative to a comparison group of patients in HIV care but not receiving ART. We also find some evidence that ART helps to close the well-known gender gap in depression between men and women.