Antiretroviral treatment among co-infected tuberculosis patients in integrated and non-integrated facilities

Background: South Africa has the second worst tuberculosis-human immunodeficiency virus (TB-HIV) syndemic in the world: in 2011, the TB-HIV co-infection rate was estimated at 65%. Integration of TB and HIV health-care services was implemented to increase antiretroviral treatment (ART) uptake among eligible patients.Aim: To evaluate whether integrated TB and HIV facilities had better ART uptake among eligible patients compared to non-integrated facilities.Methods: A cross-sectional study using routine TB programme data from January to December 2010. ART eligibility was defined as a CD4+ cell count <350 cells/μl.Results: Respectively 2761 (86.8%) and 3611 (84.7%) patients were eligible for ART at integrated and non-integrated facilities (P < 0.001). The proportion of patients started on ART at integrated facilities did not differ significantly from that of non-integrated facilities (35.9% vs. 37.1%, P = 0.340), but the proportion with unknown HIV status (31.8% vs. 24.5%, P < 0.001) and unknown CD4+ cell count (40.9% vs. 30.4%, P < 0.001) did.Conclusion: Integration of TB and HIV services in the Free State (2009–2010) was not associated with improved ART uptake. The reasons why are not clear. Of concern are the high proportions of unknown HIV status and CD4+ cell count results, especially at integrated facilities, and the small proportion of patients on ART, which may indicate poor implementation of integration.     

云南省3县TB/HIV患者结核病知识知晓率及影响因素分析

目的分析云南省TB/HIV患者的流行特征和结核病知识知晓率及其影响因素,为进一步加强云南省结核病健康促进和健康教育工作提供理论依据。方法对2010年1月—2012年6月期间218名TB/HIV患者进行结核病知识知晓率的问卷调查。统计分析采用单因素分析和Logistic回归分析。结果调查对象结核病知识综合得分为（8.23±2.01）分。职业（χ2=22.515）、婚姻状况（χ2=50.110）、患者来源（χ2=6.378）、住院治疗（χ2=3.915）、管理方式（χ2=4.579）及抗病毒治疗（χ2=11.342）各组间差异均有统计学意义（P均〈0.05）。Logistic回归分析显示,影响结核病知识综合得分的因素有患者来源（Waldχ2=6.277,P=0.02）和抗病毒治疗（Waldχ2=10.678,P〈0.001）。结论云南省TB/HIV患者结核病核心信息总知晓率为82.29%,高于全国结核病防治知识80%的目标。应根据不同地区、不同人群的特点,针对性的制作各种不同的宣传材料,积极宣传结核病的防治知识。     

Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry,South India

Setting:

Puducherry, a district in South India with a low prevalence of human immunodeficiency virus (HIV) infection (<1% among antenatal women).

Objectives:

1) To estimate the proportion of patients with known HIV status who were HIV-positive, 2) to describe the demographic and clinical characteristics of patients with unknown HIV status among presumptive TB patients, and 3) to assess the additional workload at HIV testing centres.

Design:

In this cross-sectional study, consecutive presumptive TB patients attending microscopy centres for diagnosis during March–May 2013 were asked if they knew their HIV status. Patients with unknown HIV status were offered voluntary counselling and HIV testing.

Results:

Of 1886 presumptive TB patients, HIV status was ascertained for 842 (44.6%); 28 (3.3%) were HIV-positive. The uptake of HIV testing was significantly higher in younger age groups, males, residents of Puducherry and smear-positive TB patients. The median increase in the number of clients tested for HIV per day per testing centre was 1 (range 0–6).

Conclusion:

The uptake of HIV testing was low. HIV prevalence was higher among presumptive TB patients than in antenatal women, and as high as in TB patients. With minimal increase in workload at HIV testing centres, HIV testing could be implemented using existing resources.     

Fertility intentions among HIV-infected,sero-concordant couples in Nyanza province,Kenya

Research in sub-Saharan Africa has shown significant diversity in how HIV influences infected couples' fertility intentions. Supporting HIV-infected, sero-concordant couples in sub-Saharan Africa to make informed choices about their fertility options has not received sufficient attention. In-depth interviews were conducted among 23 HIV-positive, sero-concordant married couples in Kenya, to better understand how HIV impacted fertility intentions. HIV compelled many to reconsider fertility plans, sometimes promoting childbearing intentions in some individuals but reducing fertility plans among most, largely due to fears of early death, health concerns, stigma, perinatal HIV transmission and financial difficulties (particularly in men). Preferences for sons and large families influenced some couples' intentions to continue childbearing, although none had discussed their intentions with healthcare providers. Additional support and services for HIV-infected, sero-concordant couples are needed. Family planning counselling should be tailored to the unique concerns of HIV-infected couples, addressing perinatal transmission but also individual, couple-level and socio-cultural fertility expectations. Community-level programmes are needed to reduce stigma and make HIV-infected couples more comfortable in discussing fertility intentions with healthcare providers.     

Breakthrough TB among people living with HIV on TB preventive therapy

BACKGROUND:Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.METHOD:This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.RESULTS:Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4–16).CONCLUSION:Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.     

广州市2019年新报告HIV/AIDS病例确诊后30天内接受抗病毒治疗分析

目的评价广州市"发现即治疗"实施情况,分析相关影响因素,为进一步优化HIV/AIDS病例管理提供科学依据。方法通过艾滋病防治基本信息模块,收集广州市2019年新报告的HIV/AIDS病例信息,采用单因素和多因素logistic回归,分析HIV/AIDS病例确诊后30天内开始治疗的相关影响因素。结果 2019年广州市新报告HIV/AIDS病例确诊后30天内接受抗病毒治疗1 185例,占71.6%。与确诊后30天内未治疗的病例相比,确诊后30天内接受抗病毒治疗的病例女性较多[aOR(95%CI):1.61(1.08～2.39)](男性作为参照),已婚有配偶的比例高[aOR(95%CI):1.51(1.04～2.17)](未婚作为参照),文化程度高,初中[aOR(95%CI):1.58(1.08～2.30)],高中或中专[aOR(95%CI):2.24(1.49～3.37)],大专及以上[aOR(95%CI):2.66(1.74～4.08)](小学及以下作为参照),同性传播的比例高[aOR(95%CI):1.45(1.10～1.92)](异性传播作为参照),自愿检测发现的比例高[aOR(95...     

山东省艾滋病抗病毒治疗病毒学评价

[目的]评价山东省艾滋病抗病毒治疗病毒学效果。[方法]对山东省2012年6月30日前治疗满6个月的艾滋病病人,使用荧光实时定量PCR（NucliSensEasyQ）进行病毒载量检测,使用流式细胞学技术进行CD4＋T淋巴细胞计数。[结果]925例艾滋病病人中,826例病毒载量结果〈400cp／ml,病毒抑制率为89．30％;99例载量结果〉400cp／ml病人中,28例出现了病毒反弹,1例为持续性低水平病毒血症,CD4＋T淋巴细胞计数均值为312个／mm3,14例出现了机会性感染。54例采用二线抗病毒治疗方案的病人,病毒抑制率为81．48％。[结论]山东省艾滋病抗病毒治疗病毒抑制效果良好。     

中国2014年新报告HIV感染者与配偶离异或分居情况及其相关因素分析

目的 分析HIV感染者与配偶离异或分居情况及相关因素。方法 收集国家艾滋病综合防治信息系统2014年新报告、年满18周岁且已婚有配偶的HIV感染者的信息,根据确证阳性后1年内配偶变化情况分为“离异或分居”和“已婚有配偶”。应用logistic回归分析感染者与配偶离异或分居的相关因素。结果 共有31 708个已婚有配偶HIV感染者纳入分析,有22.5%（7 134/31 708）确证阳性后1年内离异或分居。81.6%（25 864/31 708）感染者的配偶1年内进行了HIV抗体检测,其中10.0%（2 599/25 864）离异或分居;18.4%（5 844/31 708）感染者的配偶1年内未进行HIV抗体检测,其中有77.6%（4 535/5 844）离异或分居。多因素logistic回归分析显示,配偶未检测的感染者中,≥46岁（46~岁：OR=1.28,95%CI：1.03~1.58;61~岁：OR=1.83,95%CI： 1.41~2.37）、汉族（OR=1.56,95%CI：1.34~1.83）、高中及以上文化程度（OR=1.55,95%CI：1.27~1.90）、非农民或民工（OR=1.34,95%CI：1.17~1.54）、注射吸毒（OR=1.33,95%CI：1.03~1.71）和同性传播途径感染（OR=1.49,95%CI：1.20~1.86）、无子女（OR=2.35,95%CI：1.78~3.09）,离异或分居的比例较高。配偶已检测的感染者中,≥61岁（OR=1.32,95%CI：1.12~1.56）、汉族（OR=1.27,95%CI：1.13~1.44）、高中及以上文化程度（OR=1.26,95%CI：1.11~1.43）、非农民或民工（OR=1.37,95%CI：1.25~1.51）、同性传播途径感染（OR=1.38,95%CI：1.25~1.54）、无子女（OR=1.48,95%CI：1.27~1.71）,离异或分居的比例较高。结论 我国已婚有配偶HIV感染者确证阳性后存在一定比例的离异或分居,不同特征的感染者确证阳性后离异或分居的比例不同,为减少已发现感染者的传播,需要采取针对性的干预措施。     

安徽省某市结核病人中HIV感染状况分析

目的了解安徽省某市结核病人中HIV感染情况,为制定结核病和艾滋病双重感染防治对策提供科学依据。方法对新登记人项的1212例结核病人用酶联免疫法进行HIV初筛试验,初筛阳性者进行免疫印迹法确认试验进行确认,并进行流行病学调查。结果1212例结核病人检出HIV感染者4例（其中死亡1例）,感染率为0．33％,其中健在的3例中,2例男性,1例女性;民工2例,农民1例,平均年龄为（34．00±10．44）岁,传播途径均为性传播。结论结核病人中HIV感染率高于一般人群,应在结核病人群中加强艾滋病的宣传教育和行为干预。     

HIV感染者合并肺结核的研究

目的探讨HIV感染者合并肺结核的情况、CD4细胞计数及HIV感染诊断时间与合并肺结核诊断时间的关系,为防治提供科学依据。方法将109例HIV感染者按HIV感染诊断时间分为短期、中期、长期3组,分析各组合并肺结核比率、CD4细胞均数,以及与HIV感染诊断时间和肺结核诊断时间的关系。结果 3组HIV感染者中,短期合并肺结核鲜见,中期少量,长期最多(经χ2检验,P﹤0.001);CD4细胞均数短期最高,中期次之,长期最低(经方差分析,P﹤0.001);CD4细胞均数与HIV感染诊断时间、肺结核诊断时间负相关,HIV感染诊断时间与肺结核诊断时间相关性高(经相关性分析,P﹤0.01)。结论 HIV感染者不同时期合并肺结核比率及CD4细胞均数差异有统计学意义,CD4细胞均数与HIV感染诊断时间和合并肺结核诊断时间密切负相关。     

2016—2020年湖南省新报告成年HIV/AIDS病例抗病毒治疗及时性及影响因素分析

目的 分析2016—2020年湖南省新报告的成年HIV/AIDS病例及时入组抗病毒治疗的情况,了解湖南省实现“发现即治疗”工作实施情况,探索影响工作开展的相关因素。方法 对2016—2021年1月中国疾病预防控制中心艾滋病防治基本信息系统的湖南省随访管理数据和抗病毒治疗管理数据进行分析,了解不同年份间抗病毒治疗及时情况及可能的影响因素。结果 31 635例新报告成年HIV/AIDS病例中,男女比例3.54∶1;中位年龄48(33,60)岁,未婚/离异占54.17%,农民占55.11%,异性性传播占77.31%。2016—2020年总体及时入组抗病毒治疗率为61.85%,入组治疗中位时间20 d,及时治疗率从2016年的51.65%上升到2020年67.91%(χ²_趋势=550.060,P<0.001)。女性(OR=1.228,95%CI:1.150～1.311)、检测咨询来源病例(OR=1.169,95%CI:1.104～1.237)更易及时治疗;婚姻状况未婚(OR=0.792,95%CI:0.749～0.837)、职业为工人(OR=0...     

Decline in national tuberculosis notifications with national scale-up of antiretroviral therapy in Malawi

From 2000 to 2012, Malawi scaled up antiretroviral therapy (ART) from <3000 to 404 905 persons living with HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome), representing an ART coverage of 40.6% among those living with HIV. During this time, annual tuberculosis (TB) notifications declined by 28%, from 28 234 to 20 463. Percentage declines in annual TB case notifications were as follows: new TB (26%), recurrent TB (40%), new smear-positive pulmonary TB (19%), new smear-negative pulmonary TB (42%), extra-pulmonary TB (19%), HIV-positive TB (30%) and HIV-negative TB (10%). The decline in TB notifications is associated with ART scale-up, supporting its value in controlling TB in high HIV prevalence areas in sub-Saharan Africa.     

Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US

Despite an overall decrease in numbers of tuberculosis (TB) cases in the US, the proportion of extrapulmonary TB cases has increased. The study objective was to determine the most important predictors of all-cause mortality among patients with extrapulmonary TB. A retrospective chart review of adult extrapulmonary TB cases registered between 01/1995 and 12/2001 at Grady Memorial Hospital (a 1,000 bed, public inner-city hospital in Atlanta) was performed. Risk factors for death within 12 months after diagnosis of extrapulmonary TB were identified in multivariate analysis using log-binomial regression model. A total of 212 cases of extrapulmonary TB were identified; 100 (47%) were HIV-infected. The majority of patients were male (68%) and African-American (84%); mean age was 40 years. The most common sites of extrapulmonary TB were: lymph node (26%), pleural (21%), disseminated (20%), and central nervous system (CNS) or meningeal (16%). All-cause mortality rate in patients with extrapulmonary TB was 15% (21% among HIV-seropositive and 9% among HIV-uninfected patients, p = 0.02). In multivariate analysis, independent predictors of mortality included disseminated disease (PR = 4.66, 95% CI 1.93–11.24) and CNS/meningeal extrapulmonary TB (PR = 4.29, 95% CI 1.78–10.33), controlling for HIV infection. Extrapulmonary TB continues to be a persistent problem in the inner city and is associated with high mortality rates, especially among HIV-infected. Disseminated disease and the presence of CNS/meningeal TB are associated with poor prognosis.     

Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana

Tuberculosis (TB) remains a major cause of mortality despite availability of effective chemotherapy. This study was performed to identify contributing factors for poor outcome during anti-tuberculosis treatment at a teaching hospital chest clinic. Medical records of registered patients treated for TB between 1 January and 31 December, 2009 were reviewed and abstracted for demographic, clinical and outcome data. Risk factors for mortality during therapy were assessed using bivariate and multivariate logistics approaches. Of 599 patients, 355 (58.9%) completed therapy and/or were cured, 192 (32.1%) died, and 39 (6.5%) defaulted. In multivariate analysis, independent risk factors for mortality included pulmonary cases for which sputum smear status was unknown (odds ratio [OR] 13.7; 95% confidence interval [CI] 6.0, 31.4), HIV coinfection (OR, 3.6; 95% CI 2.4, 5.4), disseminated TB (OR, 2.2; 95% CI 1.0, 4.9), TB meningitis (OR, 2.8; 95% CI 1.5, 5.3), not having a treatment supporter (OR, 2.0; 95% CI 1.3, 3.1), and low body weight (OR, 11.0; 95% CI 3.1, 38.6). Not having a treatment supporter (OR, 3.2; 95% CI 1.6, 6.6) and HIV coinfection (OR, 2.4; 95% CI 1.2, 5.2) were also independently associated with treatment default. Our findings suggest that enhanced measures to reduce mortality and default in TB patients with HIV coinfection, disseminated or meningeal disease and those who have no treatment supporters may help improve treatment outcomes in Ghana.     

心理干预对新确诊HIV/AIDS患者接受抗病毒治疗意愿的影响

目的　探讨心理干预对新确诊HIV/AIDS患者接受抗病毒治疗意愿的影响。方法　随机抽取2014年12月30日—2018年12月30日在我中心新确诊的HIV/AIDS患者240例作为研究对象,采用随机数表法分为实验组和对照组各120例,实验组实施心理干预,对照组实施常规护理干预,对比2组患者干预前后心理健康变化及抗病毒治疗意愿。结果　新确诊HIV/AIDS患者抑郁发生率为59.58%,焦虑发生率为59.17%;干预后,2组患者抑郁自评量表（self-rating depression scale, SDS）、焦虑自评量表（self-rating anxiety scale, SAS）得分和抑郁、焦虑发生率均比干预前显著降低（P均＜0.05）,且干预后实验组SDS、SAS得分和抑郁、焦虑发生率均显著低于对照组（P均＜0.05）;干预后,实验组接受抗病毒治疗人数比例（97.5%）显著高于对照组（85.0%）,差异有统计学意义（χ2=11.742,P=0.001）。结论　心理干预能提高新确诊HIV/AIDS患者抗病毒治疗的意愿,值得临床采纳推广。     

2010年全国新报告HIV/AIDS病例接受规范化随访及效果分析

目的 分析2010年全国新报告HIV/AIDS病例（HIV/AIDS）接受规范化随访的效果。方法 使用艾滋病综合防治数据信息系统截至2015年12月31日的病例报告历史卡片和随访定时数据库,筛选出2010年新报告的病例,对其在2010-2015年期间接受规范化随访的情况进行分析,通过安全性行为比例、成功转介抗病毒治疗比例以及死亡情况等指标的变化评估随访效果。结果 2010年新报告、年龄≥14周岁的HIV/AIDS共40 335例,其中,男性占70.4%,汉族占72.0%,25～44岁年龄组占56.7%,小学及以下文化程度者占62.3%,未婚者占53.9%;异性传播、注射吸毒和同性传播分别占65.8%、15.0%和11.7%。40 335例HIV/AIDS每年接受规范化随访的比例逐年上升,趋势 χ²检验结果差异有统计学意义（χ²=3 749.77,P<0.01）;接受随访干预后,发生危险性行为的比例明显下降,2011-2015年安全性行为比例均>90%（趋势 χ²=16 971.98,P<0.01）,但从同一病例角度,其接受全程规范化随访期间安全性行为比例为86.1%;符合抗病毒治疗标准的病例当年成功转介治疗的比例从2010年的56.5%上升到2015年的83.2%,呈现明显的上升趋势（趋势 χ²=2 504.86,P<0.01）,注射毒品感染的HIV/AIDS接受抗病毒治疗的比例较低（2015年为64.7%）;HIV/AIDS病死率从2010年新报告时的12.4%下降到2015年的2.4%（趋势 χ²=4 935.89,P<0.01）。结论 实施规范化随访后,HIV/AIDS采取安全性行为的比例和及时转介接受抗病毒治疗的比例逐年上升,病死率有所降低。     

中国2011―2020年新报告HIV/AIDS短期内死亡特征及风险因素

目的  了解中国新报告HIV/AIDS短期内死亡(诊断后一年内的死亡)的流行病学特征、时间趋势和相关影响因素, 为制定降低HIV/AIDS病死率相关政策提供依据。方法  数据来源于中国疾病预防控制信息系统, 对2011-2020年新报告的15岁及以上的HIV/AIDS短期内死亡情况进行分析, 采用Joinpoint回归模型分析短期内死亡比例随时间变化趋势, 采用多因素logistic回归分析模型和无序多分类logistic回归分析模型探讨HIV/AIDS短期内死亡的影响因素。结果  新报告HIV/AIDS在诊断后一年内死亡的比例为10.68%。2011-2015年新报告HIV/AIDS短期内死亡比例呈快速下降趋势, 年度变化百分比(annual percentage change, APC)(%, 95%CI)为-9.95(-11.29~-8.59)。多元logistic回归分析模型分析结果显示, 男性[OR (95% CI)= 1.60(1.57~1.63)]、年龄≥30岁[30~ < 45岁年龄组: OR (95% CI)=1.89(1.83~1.95);45~ < 60岁年龄组: OR (95% CI)=2.73(2.64~2.81);≥60岁年龄组: OR (95% CI)=4.39(4.25~4.53)]、初中及以下文化程度[OR (95% CI)=1.59(1.55~1.63)]、感染途径为异性性传播[OR (95% CI)=1.81(1.76~1.86)]和注射毒品[OR (95% CI)=1.86(1.77~1.96)]、通过医疗机构[OR (95% CI)=3.33(3.23~3.43)]和自愿咨询检测[OR (95% CI)=2.13(2.06~2.20)]发现、首次CD4⁺T淋巴细胞计数 < 200个/mm³[OR (95% CI)=4.83(4.75~4.92)]和未在30 d内启动抗病毒治疗[OR (95% CI)=2.69(2.64~2.74)]的感染者短期内死亡风险相对较高。无序多分类logistic回归分析模型分析结果提示, 相较于非短期内死亡感染者, 诊断后一年内不同时间段死亡的风险因素基本一致。结论  中国HIV/AIDS诊断后短期内死亡比例较高, 应继续加强扩大检测, 促进早发现、早治疗, 持续巩固HIV防治工作, 降低HIV/AIDS病死率。     

HIV感染者及艾滋病患者检测发现晚的原因调查分析

了解1998—2022年上海市嘉定区人类免疫缺陷病毒（HIV）感染者和艾滋病（AIDS）病例（简称“HIV/AIDS患者”）晚发现情况及其影响因素,为制定AIDS防控政策提供参考依据。

通过全国AIDS综合防治信息系统收集1998—2022年嘉定区新报告的HIV/AIDS患者信息。采用logistic回归对晚发现影响因素进行分析。

共报告HIV/AIDS患者809例,晚发现324例,总体晚发现率为40.1%。1998—2015年晚发现率总体呈下降趋势,2015年达29.5%,但2016—2018年有上升趋势,2016—2022年平均晚发现率为34.9%。晚发现患者平均年龄（44.8±14.6）岁,>50岁年龄组晚发现率为57.7%,占总晚发现患者数的35.8%。多因素分析显示,>30岁年龄组（OR=1.37~3.50）晚发现率均高于21~30岁年龄组;性病门诊（OR=2.23,95%CI：1.42~3.49）和其他临床就诊（OR=2.75,95%CI：1.88~4.01）患者晚发现率均高于自愿咨询检测（VCT）门诊患者。

嘉定区HIV/AIDS患者晚发现率较高。要注重对>50岁人群的AIDS宣传干预,充分发挥VCT门诊平台作用,医疗机构要重视就诊者HIV检测工作,以便及早发现人群中潜在的HIV/AIDS患者。