Correlates of HIV infection among people visiting public HIV counseling and testing clinics in Mpumalanga, South Africa

Background

HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. Factors associated with HIV infection in VCT clients have not been well characterized in South Africa.

Objectives

A case-control study was carried out to determine the association between socio-demographic and HIV risk variables and HIV infection among people visiting HIV counseling and testing centers in two districts in Mpumalanga province, South Africa. Cases (n=1093) and controls (n=1162) were compared by socio-demographics, exposure to substances, and risky behaviours that predispose them to HIV infection.

Results

In multivariable analysis, having children, having been diagnosed with a a sexually transmitted infection (STI) in the past three months, not having had oral sex in the past three months, lack of condom use consistency in the past three months, and lack of HIV behavioural skills enactments were significantly associated with HIV positive status.

Conclusion

HIV risk behaviour was found to be a significant risk factor for HIV infection in the study population. There is urgent need for health education to bring about behavioural changes to reduce HIV infection in the community.     

Ocular manifestations in paediatric HIV/AIDS patients in Mulago Hospital,Uganda

Background

In Uganda the prevalence of HIV averages 12% as was reported to the STD/AIDS control surveillance unit. In Uganda there are approximately 30,000 HIV infected infants per year. The burden of HIV disease is high in Uganda and patients present with ocular complications. However, there is paucity of information and knowledge concerning ocular manifestations in the paediatric HIV/AIDS population and how they may differ from those of adults.

Objectives

To describe the ocular manifestations of HIV/AIDS infection in an African paediatric population. Generally the study will record the external ocular manifestations seen but specifically to document the intra-ocular lesions, in particular the retinal changes associated with paediatric HIV/AIDS.

Design

A cross-sectional hospital based study.

Setting

The study was conducted at the Paediatric Infectious Disease Clinic at Upper Mulago Hospital, in Kampala, Uganda.

Patients

Patients are those with positive HIV sero status, with or without symptoms and signs of AIDS.Parents/caretakers of the children were interviewed to obtain the socio-demographic data of the patients and a general physical as well as an ophthalmic examination were conducted to document any ocular problems.

Results

A total of 158 HIV -infected children were examined. The overall rate of ophthalmic involvement was 35%. The most common finding was a non-purulent conjuctivitis, observed in 12% of the patients, followed by perivasculitis of the peripheral retinal vessels, in 12 % of patients and molluscum contagiosum.     

Brucella sero-prevalence and modifiable risk factors among predisposed cattle keepers and consumers of un-pasteurized milk in Mbarara and Kampala districts,Uganda

Background

Brucellosis is an important zoonotic disease in developing countries yet it is often not recognized, goes unreported and does not attract public health action by these governments including Uganda.

Objective

To estimate the sero-prevalence and assess modifiable risk factors associated with Brucella seropositivity in cattle keepers and consumers of unpasteurized milk in Uganda.

Methods

One group comprised of 161 individuals randomly selected from households living on farms that had Brucella sero-positive cattle and/or goats in Mbarara District from an earlier survey; the second group comprised of 168 randomly selected individuals attending an HIV voluntary counseling and testing clinic in Kampala District. Sera samples were tested using Rapid Plate Agglutination Test, Standard Tube Agglutination Test and cELISA.

Results

The sero-prevalence of brucellosis among exposed cattle keepers in Mbarara and consumers of unpasteurised milk in Kampala Districts was 5.8% (95%CI: 3.3%, 8.3%) and 9% (95%CI: 13.3%, 4.7%), respectively. Consumption of unboiled milk was significantly (p=0.004) associated with seropositivity in Mbarara District. There was no association between sero-positivity with age, sex and awareness of human brucellosis.

Conclusion

Human brucellosis is prevalent among livestock rearing communities and consumers of unpasteurised milk. The continued consumption of unboiled milk is a major health risk.     

Zero prevalence of parasites associated with oral lesions of HIV infected and AIDS patients in South Western Uganda

Background

Despite paucity of information regarding oral lesions with parasitic etiology, parasitic diseases continue to be problematic among impoverished and immunocompromised individuals in developing countries.

Objective

To determine the prevalence of parasites in the oral lesions of Ugandan HIV infected and AIDS patients, in South Western Uganda.

Methods

Adult HIV/AIDS positive patients attending The AIDS Support Organization Clinics in South Western Uganda with oral lesions were recruited for this study. Standard parasitological methods (direct microscopy, saline and iodine wet preparations, Giemsa-Romanosky staining of smears and culture) were adopted in analysis of randomly collected six hundred and five samples (469 from females; 136 from males) for parasites.

Results

No ova, cyst, trophoziotes, lava or segment of parasites were seen in the oral lesions identified among the studied population.

Conclusion

Parasites were absent and therefore may not be implicated as etiologic microbial agents of observed oral lesions associated with HIV infected and AIDS patients living in South Western Uganda     

Hepatitis B infection is highly endemic in Uganda: findings from a national serosurvey

Background

Infant immunization against hepatitis B began in Uganda in 2002.

Objective

To determine the baseline prevalence of hepatitis B virus (HBV) infection and explore risk factors.

Methods

A hepatitis B prevalence study was nested in the 2005 national HIV/AIDS serobehavioural survey. Demographic characteristics and risk factors were explored by questionnaire. One third of blood specimens (n=5875) from adults aged 15 to 59 years were tested for hepatitis B core antibodies (HBcAb); positive specimens were tested for hepatitis B surface antigen (HBsAg).

Results

HBcAb was present in 52.3% (95% CI: 51.0–53.6) of adults, and HBsAg in 10.3% (9.5–11.1). By 15–19 years of age, 40.0% had been infected with HBV. Prevalence of both markers was significantly higher across northern Uganda, in rural areas, among the poor and least educated, and in uncircumcised men. Other independent predictors of infection were age, ethnic group, occupation, number of sex partners, and HIV and HSV-2 status.

Conclusion

Hepatitis B virus infection is highly endemic in Uganda, with transmission occurring in childhood and adulthood. More than 1.4 million adults are chronically infected and some communities disproportionately affected. The hepatitis B infant immunization programme should be sustained and catch-up vaccination considered for older children.     

Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda

Background

Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions.

Objectives

The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients.

Methods

This was a repeated cross-sectional survey (October–November 2005 and March–April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions.

Results

Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting.

Conclusions

The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.     

Neurosyphilis masquerading as hemiparesis and Jacksonian epilepsy in an HIV positive patient: a case report

Background

Neurosyphilis is a common but often missed disease worldwide, mainly because it has many manifestations making its diagnosis difficult. It is often missed among HIV patients as the search for other co-infections such as toxoplasmosis often overshadows its consideration.

Objectives

To describe one of our cases of neurosyphilis in HIV, raise awareness about the reality of neurosyphilis in Africa and share our experiences in diagnosis and management of the disease.

Methods

A 40 year old, HIV positive female was admitted with a 2 month history of left sided facial and limb weakness followed by delirium, aphasia and Jacksonian epilepsy. She underwent clinical and laboratory evaluation.

Results

On examination she had a maculo-papular rash and left sided paresis. Rapid Plasma Reagin(RPR) was reactive(titre 1:16). Treponema Pallidum Haemoaggluttination Assay(TPHA) was also reactive. Cerebrospinal fluid (CSF) analysis revealed: protein 56 mg per dl, glucose 71 mg per dl, cells 14 per high power field (predominantly lymphocytes). The VDRL on the CSF was positive. The CD4 cell count was 320 per ml. She was treated with intravenous penicillin G, 4 mega-units 6 hourly for 14 days, with a very good response.

Conclusion

Neurosyphilis still occurs in Uganda. It should be considered in all patients with neurological/ophthalmic illness, including those with HIV. Most cases respond well to intravenous penicillin G.     

Screening for hepatitis C among HIV positive patients at Mulago Hospital in Uganda

Background

In industrialized countries with more resources, it is recommended that HIV infected patients should be screened for hepatitis C virus (HCV) on entry into the health care system. Implementation of these guidelines in a country like Uganda with limited resources requires some modification after taking into account the prevailing circumstances. These include the prevalence of HCV in HIV positive patients and the cost of HCV testing.

Objective

The objective of the study was to estimate the prevalence of HCV in HIV positive patients.

Methods

This was a cross sectional study among HIV positive outpatients in Mulago hospital. HCV screening was done using anti-HCV Enzyme Immuno Assay (Roche Diagnostics)

Results

Between October 2003 and February 2004, one hundred and twenty two HIV positive patients were enrolled into the study with a mean age of 33.9 years. There were more females 81 (66.4%) than males. Only 4 patients had anti-HCV, giving an estimated HCV prevalence of 3.3%.

Conclusion

In view of the low HCV prevalence found in our study and similar studies and considering the high cost of HCV screening, routine HCV testing cannot be recommended among all HIV positive patients in our health care settings with limited resources. We recommend that HCV screening be limited to investigating HIV positive patients with features suggestive of liver disease in order to identify HCV as a possible cause.     

Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya

Objectives

To describe the development, cost effectiveness and implementation of a PDA based electronic system to collect, verify and manage data from a multi-site study on HIV/AIDS stigma and pregnancy in a rural, resource-poor area.

Methods

We worked within a large prevention of mother-to-child-transmission (PMTCT) program in nine rural health facilities to implement a PDA-based data collection system and to study the feasibility of its use in a multisite HIV research study in rural Kenya. The PDAs were programmed for collecting screening and eligibility data, and responses to structured interviews on HIV/AIDS stigma and violence in three local languages.

Results

Between November 2007 and December 2008, nine PDAs were used by Clinic and Community Health Assistants to enrol 1,270 participants on to the PMTCT program. Successes included: capacity-building of interviewers, low cost of implementation, quick turnaround time of data entry with good data quality, and convenience.

Conclusion

Our study demonstrated the feasibility of utilizing PDAs for data collection in a multi-site observational study on HIV/AIDS stigma conducted in remote rural health facilities in Kenya. However, appropriate and frequent data backup protocols need to be established and paper forms are still needed as backup tools in resource-poor settings.     

Condom use at first and latest sexual events among young people: evidence from a rural and peri-urban setting in Uganda

Background

Condom use remains low among young people despite high prevalence of HIV, STIs, and unplanned pregnancy in Uganda.

Objectives

This paper presents patterns of condom use at first and latest sexual events and associated factors.

Methods

The data were obtained from 445 sexually active unmarried people aged 15–24 from one peri-urban and another rural district. Stratified multi-stage cluster sampling technique was applied. Logistic regression was used to identify factors associated with condom use at each of the two sexual events, while multinomial logistic regression was used to establish factors correlated with condom use at both first and last sex.

Results

Factors associated with condom use at each event were residence in the peri-urban district and higher education attainment. Factors correlated with condom use at both first and last sex were residence in peri-urban district (p<0.001) and being in school (p<0.01). Alcohol consumption and age at first sex were only significant at one event.

Conclusions

Some factors that influence condom use at first sex are different from those that affect condom use at latest sexual event. Prevention programmes against STIs, HIV and unplanned pregnancies among young people focus more on rural areas and those with minimal or no education.     

Sero-prevalence of herpes simplex type 2 virus (HSV-2) and HIV infection in Kampala,Uganda

Background

Prevalence of herpes simplex type 2 virus (HSV-2) is high worldwide. Previous studies in Uganda were rural or in women. We estimated age and sex-specific sero-prevalence of HSV-2 in Kampala, Uganda.

Methods

Using two-stage random sampling stratified on population density, a survey of persons 15–65 years was conducted. Type-specific serological tests for HSV-2, HSV-1(HerpeSelect2 and 1 ELISA), HIV (Rapid tests and ELISA), syphilis (RPR and TPHA) were done. Additional prevalence analysis included post-stratification weighting on the Uganda 2002 Census gender distribution.

Results

Among 1124 persons, HSV-2 prevalence was 58% (95% CI: 55, 60), HSV-1; 98% (95% CI: 97.6, 99.1), HIV; 17.7% (95% CI: 14.8, 19.2) and syphilis; 1.7% (95% CI: 1.4, 1.9). Weighted HSV-2 prevalence was 53.8% (Women; 63.8%, men; 43.2%), similar to unweighted data. Weighted HIV prevalence was 20.7% in women, 8.6% in men. Of 165 HIV infected persons, 85.4% had HSV-2. Risk factors for HSV-2 were being a woman (OR 2.0; 95% CI: 1.42, 2.78), age (OR 3.3; 95% CI: 2.43, 4.53), education (OR 1.70; 95% CI: 1.34, 2.34) and HIV (OR 4.5; 95% CI: 2.70, 7.50).

Conclusion

Prevalence of HSV-2 and HIV was high especially in women. Syphilis was rare. Awareness of herpes was low. Interventions in young people are needed.     

Opportunities and barriers for implementation of integrated TB and HIV care in lower level health units: experiences from a rural western Ugandan district

Background

As countries with a high burden of TB and HIV roll out integrated TB/HIV care, there is need to assess possibility of lower level health units treating TB to provide integrated TB/HIV care.

Objective

To determine barriers and opportunities for provision of integrated TB/HIV care in lower level health units offering TB treatment in Mbarara district, Uganda.

Methods

Conducted key informant interviews, interviewed health workers and observed services offered.

Results

22 health units were assessed and 88 health workers were interviewed. Of the 18 health units mandated to offer laboratory services, 55.6% and 38.9% were able to offer rapid HIV-testing and ZN staining respectively. Understaffing, lack of capacity to diagnose HIV and TB, lack of guidelines to inform care options of TB/HIV co-infected patients and insufficient knowledge and skills among health workers towards provision of integrated TB/HIV care were mentioned as barriers to provision of integrated TB/HIV services.

Conclusion

To offer integrated TB/HIV services at lower level health units currently offering TB stand alone services, there is need to address gaps in knowledge and skills among health workers, laboratory diagnostics, staffing levels, medical supplies and infrastructure.     

Health seeking behaviour and challenges in utilising health facilities in Wakiso district,Uganda

Background

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.

Objectives

To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.

Methods

The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.

Results

While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants'' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.

Conclusions

There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.     

Malaria and HIV co-infection and their effect on haemoglobin levels from three health-care institutions in Lagos,southwest Nigeria

Background

Malaria and human immunodeficiency virus (HIV) are two major infections with enormous public health consequence. Together, they are endemic in many developing countries with anaemia being the most frequent haematological consequence of the infections.

Objectives

To determine the prevalence of malaria and HIV co-infection as well as anaemia among selected patients from three health-care institutions in Lagos, Nigeria.

Methods

A cross-sectional study of 1080 patients was carried out to determine the prevalence of malaria and HIV co-infection as well as anaemia. Blood sera from each of the patients were screened for malaria parasites, HIV-1 and HIV-2 using Giemsa stain, Cambridge Biotech Recombigen HIV-1/HIV-2 rapid device, respectively while haemoglobin estimation was performed using cyanmethemoglobin method.

Results

Our data showed that the total number of malaria infected patients were significantly higher in HIV sero-positive patients 47.7% (31/65) when compared with their HIV sero-negative counterparts 25.8% (262/1015) P = 0.047. The result also revealed that 25.8% (8/31) of the patients co-infected with malaria and HIV had anaemia as compared to 11.1% (29/262) infected with malaria alone. Multivariable logistic regression analysis showed that patients with dual infection of malaria and HIV were twice likely to be anaemic than those infected with malaria alone [adjusted OR 2.4, 95% CI, 1.3 to 2.7, P = 0.014].

Conclusions

Our data indicated a higher prevalence of malaria in HIV infected patients and also revealed that patients co-infected with malaria and HIV were more likely to be anaemic.     

Evidence-based monitoring and evaluation of the faith-based approach to HIV prevention among Christian and Muslim youth in Wakiso district in Uganda

Background

The Islamic Medical Association of Uganda, has been implementing the faith-based approach to HIV prevention without baseline data on expected positive outcomes.

Objectives

To establish evidence-based baseline data on expected positive outcomes of the faith-based approach to HIV prevention.

Methods

A cross-sectional study of 15–24 year-old youths was analyzed for significant associations between HIV infections, risky behaviors, and religiosity

Results

HIV prevalence was 3.6% among Christians and 2.4% among Muslims. Abstaining from sex among teenagers was at 54% for Christians and 58% for Muslims. Being faithful in marriage among males was at 41% for Christians and 34% for Muslims and among females it was 65% for Christians and 69% for Muslims. Praying privately was associated with lower HIV infections and was observed among 60% of Christians. Sujda, the hyperpigmented marker of regular prayers on the forehead of Muslims was associated with lower HIV infections and observed in 42% of them. Ever drank alcohol was associated with higher HIV prevalence and observed in 52% of Christians and 17% of Muslims. Male circumcision rates were 15% for Christians and 98% for Muslims.

Conclusion

A sero-behavioral-religiosity survey can provide evidence-based data for monitoring and evaluation of the faith-based approach to HIV prevention.     

Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi

Objectives

To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women''s perceptions towards selected potential HIV prevention efforts

Design

Cross sectional, questionnaire-administered study

Setting

Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi

Subjects

A total of 321 pregnant women attending ante-natal clinics

Results

Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse.

Conclusion

Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.     

The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda

Background

Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples.

Methods

A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.

Results

Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction

Conclusions

HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.     

HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: challenges in the diagnosis and management

Background

Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit.

Objectives

To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/AIDS co-infection in TB diagnosis and treatment in western Kenya.

Methods

In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain''s GenoType^® Mycobacterium CM and GenoType^® Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-Gold™ test and positives confirmed with the enzyme linked immunosorbent assay.

Results

A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%.

Conclusion

A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya.     

Changes in body weight,C-reactive protein,and total adiponectin in non-obese women after 12 months of a small-volume,home-based exercise program

OBJECTIVE:

Our objective was to evaluate the effects of small-volume, home-based exercise combined with slight caloric restriction on the inflammatory markers C-reactive protein and adiponectin.

METHODS:

In total, 54 women were randomly assigned to one of two groups for exercise intervention: the control or home-based exercise groups. Weight, waist and hip circumferences, and inflammatory markers were measured at baseline and after 6 and 12 months. Women allocated to the home-based exercise group received a booklet explaining the physical exercises to be practiced at home at least 3 times per week, 40 minutes per session, at low-to-moderate intensity. All participants received dietary counseling aimed at reducing caloric intake by 100-300 calories per day, with a normal distribution of macro-nutrients (26-28% of energy as fat). Clinicaltrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01206413","term_id":"NCT01206413"}}NCT01206413

RESULTS:

The home-based exercise group showed a significantly greater reduction in weight and body mass index at six months, but no difference between groups was observed thereafter. With regard to the inflammatory markers, a greater but non-statistically significant reduction was found for C-reactive protein in the home-based exercise group at six months; however, this difference disappeared after adjusting for weight change. No differences in adiponectin were found at the 6- or 12-month follow-up.

CONCLUSION:

Small-volume, home-based exercise did not promote changes in inflammatory markers independent of weight change.