HIV/AIDS患者合并精神障碍研究进展

艾滋病病毒(HIV)感染者/艾滋病(AIDS)患者(简称HIV/AIDS患者)合并精神障碍极大地加重了个人和社会的疾病负担,影响生活质量.而精神障碍与HIV感染之间的病理生理学和相互影响机制、依从性、共病模式、药物相互作用等尚不完全清楚,给干预、治疗及管理带来了巨大挑战.本文基于现有的最新证据,对HIV/AIDS患者合...     

Paediatric HIV and neurodevelopment in sub-Saharan Africa: a systematic review

Objective  To determine the degree of motor, cognitive, language and social-emotional impairment related to HIV infection in children living in sub-Saharan Africa (SSA).
Methods  Literature searches using MEDLINE and PsycINFO. Additionally, the reference lists of previous reviews were checked to ensure that all eligible studies were identified. Cohen's d, a measure of effect size, was computed to estimate the level of impairment.
Results  Six reports met the inclusion criteria. In infancy a consistent delay in motor development was observed with a median value of Cohen's d  =   0.97 at 18 months, indicating a severe degree of impairment. Mental development showed a moderate delay at 18 months, with a median value d  =   0.67. Language delay did not appear until 24 months of age, d  =   0.91. Less clear findings occurred in older subjects.
Conclusion  Although HIV has been shown to affect all domains of child functioning, motor development is the most apparent in terms of severity, early onset, and persistence across age groups. However, motor development has been the most widely assessed domain while language development has been less vigorously evaluated in SSA, hence an accurate quantitative estimate of the effect cannot yet be made.     

HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review

Female sex workers (FSW) living with HIV in sub-Saharan Africa have poor engagement to HIV care and treatment. Understanding the HIV care and treatment engagement experiences of FSW has important implications for interventions to enhance care and treatment outcomes. We conducted a systematic review to examine the HIV care experiences and determinants of linkage and retention in care, antiretroviral therapy (ART) initiation, and ART adherence and viral suppression among FSW living with HIV in sub-Saharan Africa. The databases PubMed, Embase, Web of Science, SCOPUS, CINAHL, Global Health, Psycinfo, Sociological Abstracts, and Popline were searched for variations of search terms related to sex work and HIV care and treatment among sub-Saharan African populations. Ten peer-reviewed articles published between January 2000 and August 2015 met inclusion criteria and were included in this review. Despite expanded ART access, FSW in sub-Saharan Africa have sub-optimal HIV care and treatment engagement outcomes. Stigma, discrimination, poor nutrition, food insecurity, and substance use were commonly reported and associated with poor linkage to care, retention in care, and ART initiation. Included studies suggest that interventions with FSW should focus on multilevel barriers to engagement in HIV care and treatment and explore the involvement of social support from intimate male partners. Our results emphasise several critical points of intervention for FSW living with HIV, which are urgently needed to enhance linkage to HIV care, retention in care, and treatment initiation, particularly where the HIV prevalence among FSW is greatest.     

Obesity and its health impact in Africa: a systematic review

Abstract

Obesity and its association with co-morbidities in Africa are on the rise. This systematic review examines evidence of obesity and its association with co-morbidities within the African continent. Comparative studies conducted in Africa on adults 17 years and older with mean body mass index (BMI) ≥ 28 kg/m² were included. Five electronic databases were searched. Surveys, case–control and cohort studies from January 2000 to July 2010 were evaluated. Of 720 potentially relevant articles, 10 met the inclusion criteria. Prevalence of obesity was higher in urban than rural subjects with significant increases in obesity rates among women. Inflammatory marker levels were significantly elevated among Africans compared with Caucasians. The co-relationship between obesity and chronic diseases was also highlighted. This systematic review demonstrates that while obesity remains an area of significant public health importance to Africans, particularly in urban areas, there is little evidence of proper diagnosis, treatment and/or prevention.     

Caregiver alcohol use and mental health among children orphaned by HIV/AIDS in South Africa

Research in the developed world suggests that parental alcohol use negatively impacts child mental health. However, little research has examined these relations among children in the developing world and no studies to date have done so in the context of AIDS-orphanhood. Therefore, the present study tested the interactive effect of AIDS-orphan status with caregiver alcohol use on child mental health. The sample included 742 children (51.2% female; M_{age ?}=?9.18; age range: 7–11 years; 29.8 AIDS-orphans; 36.8% orphaned by causes other than AIDS; 33.4% non-orphaned) recruited from Mangaung in the Free State Province of South Africa. Child mental health was assessed via child self-report, caregiver, and teacher reports; and caregiver alcohol use via self-report. Path analyses, via structural equation modeling, revealed significant direct effects for AIDS-orphan status on caregiver-reported child mental health; and for caregiver alcohol-use problems on teacher-reported child mental health. However, the interaction effect of AIDS-orphan status with caregiver alcohol use did not reach significance on all three reports of child mental health problems. These results suggest that orphan status and caregiver alcohol use may independently relate to mental health problems in children and that the effects of both should be considered in the context of the mental health needs of children in AIDS-affected countries.     

Understanding culture and HIV/AIDS in sub-Saharan Africa

Early in the study of HIV/AIDS, culture was invoked to explain differences in the disease patterns between sub-Saharan Africa and Western countries. Unfortunately, in an attempt to explain the statistics, many of the presumed risk factors were impugned in the absence of evidence. Many cultural practices were stripped of their meanings, societal context and historical positioning and transformed into cofactors of disease. Other supposedly beneficial cultural traits were used to explain the absence of disease in certain populations, implicitly blaming victims in other groups. Despite years of study, assumptions about culture as a cofactor in the spread of HIV/AIDS have persisted, despite a lack of empirical evidence. In recent years, more and more ideas about cultural causality have been called into question, and often disproved by studies. Thus, in light of new evidence, a review of purported cultural causes of disease, enhanced by an understanding of the differences between individual and population risks, is both warranted and long overdue. The preponderance of evidence suggests that culture as a singular determinant in the African epidemic of HIV/AIDS falls flat when disabused of its biased and ethnocentric assumptions.     

Integrated delivery of HIV and tuberculosis services in sub-Saharan Africa: a systematic review

Tuberculosis is a major cause of morbidity and mortality in people with HIV and about a quarter of HIV-related deaths are attributed to tuberculosis. In this Review we identify and synthesise published evidence for the effectiveness and cost-effectiveness of eight integrated strategies recommended by WHO that represent coordinated delivery of HIV and tuberculosis services. Evidence supports concurrent screening for tuberculosis and HIV, and provision of either co-trimoxazole during routine tuberculosis care or isoniazid during routine HIV care and at voluntary counselling and testing centres. Although integration of antiretroviral therapy into tuberculosis care has shown promise for improving health outcomes for patients, evidence is insufficient to make conclusive claims. Evidence is also insufficient on the accessibility of condoms at tuberculosis facilities, the benefits of risk reduction counselling in patients with tuberculosis, and the effectiveness of tuberculosis infection control in HIV health-care settings. The vertical response to the tuberculosis and HIV epidemics is ineffective and inefficient. Implications for policy makers and funders include further investments in implementing integrated tuberculosis and HIV programmes with known effectiveness, preferably in a way that strengthens health systems; evaluative research that identifies barriers to integration; and research on integrated strategies for which effectiveness, efficiency, and affordability are not well established.     

Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVE: To systematically review studies of male circumcision and the risk of HIV-1 infection in men in sub-Saharan Africa, and to summarize the findings in a meta-analysis. DESIGN: A meta-analysis of observational studies. METHODS: A systematic literature review was carried out of studies published up to April 1999 that included circumcision as a risk factor for HIV-1 infection among men in sub-Saharan Africa. A random effects meta-analysis was used to calculate a pooled relative risk (RR) and 95% confidence interval (CI) for all studies combined, and stratified by type of study population. Further analyses were conducted among those studies that adjusted for potential confounding factors. RESULTS: Twenty-seven studies were included. Of these, 21 showed a reduced risk of HIV among circumcised men, being approximately half that in uncircumcised men (crude RR = 0.52, CI 0.40-0.68). In 15 studies that adjusted for potential confounding factors, the association was even stronger (adjusted RR = 0.42, CI 0.34-0.54). The association was stronger among men at high risk of HIV (crude RR = 0.27; adjusted RR = 0.29, CI 0.20-0.41) than among men in general populations (crude RR = 0.93; adjusted RR = 0.56, CI 0.44-0.70). CONCLUSION: Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.     

Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review

Disclosure of one's HIV status can help to improve uptake and retention in prevention of mother-to-child transmission of HIV services; yet, it remains a challenge for many women. This systematic review evaluates disclosure rates among pregnant and postpartum women in sub-Saharan Africa, timing of disclosure, and factors affecting decisions to disclose. PubMed and EMBASE databases were searched to identify relevant studies published between January 2000 and April 2014. Rates of HIV serostatus disclosure to any person ranged from 5.0% to 96.7% (pooled estimate: 67.0%, 95% CI: 55.7%–78.3%). Women who chose to disclose their status did so more often to their partners (pooled estimate: 63.9%; 95% CI: 56.7%–71.1%) than to family members (pooled estimate: 40.1; 95% CI: 26.2%–54.0%), friends (pooled estimate: 6.4%; 95% CI: 3.0%–9.8%), or religious leaders (pooled estimate: 7.1%; 95% CI: 4.3%–9.8%). Most women disclosed prior to delivery. Decisions to disclose were associated with factors related to the woman herself (younger age, first pregnancies, knowing someone with HIV, lower levels of internalized stigma, and lower levels of avoidant coping), the partner (prior history of HIV testing and higher levels of educational attainment), their partnership (no history of domestic violence and financial independence), and the household (higher quality of housing and residing without co-spouses or extended family members). Interventions to encourage and support women in safely disclosing their status are needed.     

Seasonal influenza epidemiology in sub-Saharan Africa: a systematic review

Acute respiratory infection (ARI) is a leading cause of mortality worldwide, of which influenza is an important cause that can be prevented with vaccination. We did a systematic review of research published from 1980 to 2009 on seasonal influenza epidemiology in sub-Saharan Africa to identify data strengths and weaknesses that might affect policy decisions, to assess the state of knowledge on influenza disease burden, and to ascertain unique features of influenza epidemiology in the region. We assessed 1203 papers, reviewed 104, and included 49 articles. 1-25% of outpatient ARI visits were caused by influenza (11 studies; mean 9·5%; median 10%), whereas 0·6-15·6% of children admitted to hospital for ARI had influenza identified (15 studies; mean 6·6%; median 6·3%). Influenza was highly seasonal in southern Africa. Other data were often absent, particularly direct measurement of influenza incidence rates for all ages, within different patient settings (outpatient, inpatient, community), and for all countries. Data from sub-Saharan Africa are insufficient to allow most countries to prioritise strategies for influenza prevention and control. Key data gaps include incidence and case-fatality ratios for all ages, the contribution of influenza towards admission of adults to hospital for ARI, representative seasonality data, economic burden, and the interaction of influenza with prevalent disorders in Africa, such as malaria, HIV, and malnutrition.     

Risk factors for HIV/AIDS in a low HIV prevalence site of sub-Saharan Africa

We conducted a hospital-based survey on prevalence and risk factors of HIV-1/2 and other viral infections in Zanzibar archipelago. Blood samples, socio-demographic and behavioural data were collected from 2697 patients. The overall HIV prevalence was 2.9%. About 1.4%, 2.1%, 4.2% of antenatal clinic (ANC) attendees and 2.1%, 3.7%, 5.3% of blood donors were, respectively, HIV-Abs-, HTLV-Abs- and HBs-Ag-positive; 5.5% of blood donors were HCV-affected. Co-infections were rare. Exactly 3.4% of the children aged 6-10 years were HIV-positive. People aged 26-35 years [adjusted odds ratio (AOR) 4.4, 95% CI (confidence interval) 1.72-11.22; P = 0.002], illiterate subjects (AOR 3.6, 95% CI 1.65-7.98; P = 0.001) mobile workers (AOR 7.0, 95% CI 1.41-34.62; P = 0.02) and previously operated patients (AOR 1.9, 95% CI 1.02-3.66; P = 0.04) were at higher risk for HIV/AIDS. Any of the examined factors were associated with hepatitis B virus, hepatitis C virus and human T lymphotropic virus type 1/2 transmission. HIV/AIDS prevention strategies must primarily be addressed to traditional high-risk groups and secondarily to unsafe health care procedures in relatively preserved sub-Saharan areas.     

Epidemiology of health and vulnerability among children orphaned and made vulnerable by HIV/AIDS in sub-Saharan Africa

The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and it is projected that by 2010, 18 million African children under the age of 18 are likely to be orphans from this single cause (UNICEF, 2005, The state of the Worlds Children: Childhood under threat. New York: UNICEF). Results from a Kellogg funded OVC project (Skinner et al., 2004, Definition of orphaned and vulnerable children. Cape Town: HSRC) supported the construct that the loss of either or both parents would indicate a situation of likely vulnerability of children. A key problem in the literature on the impact of orphanhood on the well-being of children, families and communities, is that the focus of assertions and predictions is often on the negative impact on 'AIDS orphans', or households. There are hardly any studies that compare the experiences of orphans with non-orphans. This paper thus attempts to fill that gap. It uses epidemiological data to explore the epidemiology of health and vulnerability of children within the context of AIDS in sub-Saharan Africa. Because of data limitations, only the following aspects are examined: (i) orphan status; (ii) household structure (in particular, grandparent headedness and female-headedness); (iii) illness of parents; (iv) poverty; and (v) access to services, especially schooling, health, social services. While recognizing the limitations of the analysis, data presented in this paper indicates that orphans in sub-Saharan Africa are more vulnerable than non-orphans. The authors conclude with some suggestions for policy makers and programme implementers, highlighting the importance of focusing on interventions that will have maximum impact on the health and well-being of children.     

Social and cultural aspects of HIV and AIDS in West Africa: A narrative review of qualitative research

With the increasing focus on the role of social aspects of the HIV epidemic in sub-Saharan Africa, the need for an overview of existing research dealing with such issues has become more urgent. The objective of this article is to provide a thematic overview of existing qualitative research on HIV and AIDS in the West African region and to analyze the main research findings in order to identify possible gaps and recommend new research themes to inform future research-based interventions. The analysis is based on a total of 58 articles published from 2001 to 2009 in English or French identified through a literature search in seven scientific, bibliographical databases. Searches included terms related to qualitative studies combined with various terms related to HIV/AIDS. The results of this narrative review show that there was a geographical concentration on Nigeria, Ghana, Burkina Faso and Côte d'Ivoire and a strong urban bias, with most studies taking place in the capital cities of these countries. The majority of the studies focused on women or women and men; only four articles dealt exclusively with men, of which only two were on men who have sex with men. The main study groups were people living with HIV, young people or female sex workers. Sexual risk-taking and stigmatization were the themes that were most prominently explored in the articles we reviewed. We conclude that research needs to be strengthened in relation to the analysis of experiences with antiretroviral therapy and the non-optimal access to treatment in West Africa. Also, more research is needed on men and their exposure to HIV/AIDS, as well as on the role of concurrent partnership in the spread of HIV.     

Youth as research fieldworkers in a context of HIV/AIDS

What are the strengths and limitations of using out-of-school youths as researchers in a study of the relationships among young people of the same group? While youth-to-youth research approaches have increased in both popularity and practice, our understanding of the processes and mechanisms underlying the successes or failures of ‘peer researchers’ is still developing. The study addresses the question through qualitative research, drawing on observations of the process of training out-of-school youths as research fieldworkers, reflections on the interviews with respondents, and focus group discussions with the young fieldworkers. We found striking advantages to using fieldworkers who are close in their characteristics to that of respondents: these included ready access to respondents, the immediate use of language appropriate to the respondents, and an ability to swiftly establish rapport. We also observed striking limitations: the peer researchers struggled with the wish of some respondents to establish supportive friendships with them, they lacked the authority of an academic researcher, and they sometimes resorted to false promises in attempts to get cooperation. The main conclusion drawn is that, in principle, using youths as peer researchers is neither better nor worse than using professional researchers, but each approach can produce its own challenges and possibilities.