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     

Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda

Background

In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage.

Objective

To evaluate the cost effectiveness of facility- and home-based HIV VCT strategies in rural southwestern Uganda.

Methods

Data on costs and effectiveness of facility- and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective.

Results

The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5.

Conclusion

Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.     

2014-2015年天津市主动求询者HIV感染状况及影响因素分析

目的 了解天津市艾滋病自愿咨询检测门诊主动求询者的HIV感染状况及其影响因素.方法 对2014-2015年天津市艾滋病自愿咨询检测门诊主动求询者的问卷调查资料和实验室检测结果进行统计,采用SPSS 21.0对数据进行统计学分析.结果 门诊累计为24 249人提供了HIV咨询检测服务,咨询者以20-39岁为主,男女比例1.8∶1,男性HIV检出率明显高于女性.HIV阳性检出率2.0％(473/24249),梅毒阳性检出率4.6％(1119/24249).HIV检出阳性最多的是男男性行为者、有商业异性性行为史者、有非商业非固定异性性行为史者,构成比分别为51.6％(244/473)、18.8％(89/473)、13.1％(62/473).多因素分析显示,年龄、性别、文化程度、既往检测、梅毒结果和求询原因是调查对象HIV感染的影响因素.结论 应该在艾滋病高风险人群,尤其是男男同性性行为人群中加强健康教育和行为干预,开展更便利的VCT服务模式,促进高危人群主动检测.     

Attitude of Lesotho health care workers towards HIV/AIDS and impact of HIV/AIDS on the population structure

Background

The impact and management of HIV/AIDS in Lesotho in the context of disaster management was investigated.

Objectives

Lesotho health care workers'' perception on HIV/AIDS progression, whether HIV/AIDS was managed as a disaster, and the impact on the demographic profile was investigated.

Methods

The empirical investigation included a literature study, and primary and secondary data analyses. Questionnaires (n=116) determined health care workers'' perception of HIV/AIDS. Interviews with officers of Lesotho Disaster Management determined how HIV/AIDS was managed as a disaster. National population censuses and data from surveys were summarised to describe the impact of HIV/AIDS on the population structure.

Results

Respondents'' modal age group was 25 to 39 years, 28.4% viewed HIV/AIDS related deaths as very high and perceived that HIV/AIDS changed the age composition, sex and dependency ratio of the population. Although HIV/AIDS was declared a disaster, the Lesotho Disaster Management Authority only aided the National AIDS Commission. There was evidence that HIV/AIDS caused the population pyramid base to shrink, and an indentation in the active population.

Conclusion

Health care workers attributed HIV/AIDS to changing the demographic profile of Lesotho, also reflected in the population pyramid. Lesotho Disaster Management Authority played a supporting role in HIV/AIDS disaster management.     

Associations of HIV testing and late diagnosis at a Japanese university hospital

OBJECTIVES:This study was conducted to clarify the rate of late diagnosis of HIV infection and to identify relationships between the reasons for HIV testing and a late diagnosis.METHODS:This retrospective cohort study was conducted among HIV-positive patients at the Jikei University Hospital between 2001 and 2014. Patient characteristics from medical records, including age, sex, sexuality, the reason for HIV testing and the number of CD4-positive lymphocytes at HIV diagnosis, were assessed.RESULTS:A total of 459 patients (men, n=437; 95.2%) were included in this study and the median age at HIV diagnosis was 36 years (range, 18–71 years). Late (CD4 cell count <350/mm³) and very late (CD4 cell count <200/mm³) diagnoses were observed in 61.4% (282/459) and 36.6% (168/459) of patients, respectively. The most common reason for HIV diagnosis was voluntary testing (38.6%, 177/459 patients), followed by AIDS-defining illness (18.3%, 84/459 patients). Multivariate analysis revealed a significant association of voluntary HIV testing with non-late and non-very-late diagnoses and there was a high proportion of AIDS-defining illness in the late and very late diagnosis groups compared with other groups. Men who have sex with men was a relative factor for non-late diagnosis, whereas nonspecific abnormal blood test results, such as hypergammaglobulinemia and thrombocytopenia, were risk factors for very late diagnosis.CONCLUSIONS:Voluntary HIV testing should be encouraged and physicians should screen all patients who have symptoms or signs and particularly hypergammaglobulinemia and thrombocytopenia, that may nonspecifically indicate HIV infection.     

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.     

The impact of group counseling on depression,post-traumatic stress and function outcomes: A prospective comparison study in the Peter C. Alderman trauma clinics in northern Uganda

Background

The effectiveness of group interventions for adults with mental distress in post-conflict settings is less clear in sub-Saharan Africa.

Aim

To assess the impact of group counseling intervention on depression, post-traumatic stress and function outcomes among adults attending the Peter C. Alderman Foundation (PCAF) trauma clinics in northern Uganda.

Methods

631 War affected adults were enrolled into PCAF trauma clinics. Using a quasi-experimental design, assessments were conducted at baseline, at 3 and 6 months following initiation of care. Multivariate longitudinal regression models were used to determine change in depression, post-traumatic stress and function scores over time among group counseling participants and non-participants.

Results

In comparison to non-participants, participants had faster reduction in depression scores during the 6-month follow-up period [β=−1.84, 95%CI (−3.38 to −0.30), p=0.019] and faster reduction in post-traumatic stress scores during the 3-month follow-up period [β=−2.14, 95%CI (−4.21 to −0.10), p=0.042]. At 3-month follow up, participants who attended two or more sessions had faster increase in function scores [β=3.51, 95%CI (0.61–6.40), p=0.018] than participants who attended only one session.

Limitations

Selection bias due to the use of non-random samples. Substantial attrition rates and small sample sizes may have resulted in insufficient statistical power to determine meaningful differences.

Conclusion

The group counseling intervention offered in the PCAF clinics may have considerable mental health benefits over time. There is need for more research to structure, standardize and test the efficacy of this intervention using a randomized controlled trial.     

2008-2010年深圳市艾滋病自愿咨询检测结果比较分析

目的调查深圳市艾滋病自愿咨询检测（VCT）人群的社会人口学特征和感染状况,为制定预防措施提供依据。方法对2008-2010年深圳市VCT人群的调查结果进行比较分析。结果 44239名求询者接受了咨询和血清HIV抗体检测,以20～40岁青壮年为主,占82.4%;男女比例为0.89∶1,文化程度以初、高中或中专为主,占62.6%;咨询类型主要为危险性行为28948例,占65.4%;HIV阳性428例,阳性率为0.97%。2008-2010年男男性行为（MSM）感染率分别为9.2%、9.8%和14.6%。结论深圳市MSM感染率逐年升高,应加强对MSM人群的行为干预,并对高危人群进行艾滋病宣传教育。     

Religiosity for HIV prevention in Uganda: a case study among Christian youth in Wakiso district

Background

Utilization of religious institutions is one of the strategies for HIV prevention in Uganda. There is limited data on the association between religiosity and HIV infection rates.

Objective

To determine the association between religiosity and HIV prevalence rates among Christians.

Methods

An unmatched case-control study was done. Data from 106 HIV positive cases and 424 HIV negative controls between 15– 24 years were analyzed.

Results

Lower religiosity was associated with higher HIV infection rates when the following dimensions were analyzed: feeling guided by God in daily activities (odds ratio 1.90, 95%CI 1.03–3.50, p=0.035), feeling thankful for God''s blessings (odds ratio 1.76, 95%CI 1.01–3.11, p=0.042), praying privately (odds ratio 2.02, 95%CI 1.30–3.11, p=0.001), trying hard to be patient in life (odds ratio1.74, 95%CI 1.07–2.84, p=0.024) and trying hard to love God (odds ratio 1.57, 95%CI 1.01–2.42, p=0.039).Higher HIV infection rates were associated with having multiple life-time sexual partners (odds ratio 5.37, 95%CI 1.86–15.47, p<0.001), ever drinking alcohol (odds ratio 2.28, 95%CI 1.43–3.65, p<0.001) and ever using narcotics for recreation (odds ratio 2.49, 95%CI 1.14–5.44, p=0.018).

Conclusion

Lower levels of several dimensions religiosity are significantly associated with higher HIV infection rates. This data supports strengthening religiosity in HIV prevention strategies.     

Barriers to use of antiretroviral drugs in Rakai district of Uganda

Background

About 75% of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries.

Objective

To investigate the barriers to use of ART in Rakai district of Uganda

Methods

We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART, sources of information for ART, beliefs regarding ART, social support, use of alternative medicine, stigma/discrimination towards PHAs, distance to ART centres, transport costs to ART centres, waiting time, and on suggestions as how to improve the use of ART.

Results

The major barriers mentioned regarding use of ART included: inadequate mobilization, long waiting time at ART treatment centres, high cost of transport to reach ART centres, stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs.

Conclusions

Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music, dance and videos, increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care, bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS.     

Contraceptive acceptability and associated factors among young women (15–24) living with HIV/AIDS: a hospital-based study in Kampala,Uganda

IntroductionIn Uganda, over 43% of all pregnancies among young women (15–24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala.MethodsBetween February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05.ResultsContraceptive acceptability was 40.7% (95% CI: 27.6%–53.6%). Older age group (20–24 years) (aPR; 2.42, 95%CI; 1.06–5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13–1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 – 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 – 1.32, P<0.001) were significantly associated with acceptability of contraceptives.ConclusionThere is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted.     

Factors that affect HIV testing and counseling services among heterosexuals in Canada and the United Kingdom: an integrated review

Objective

To examine factors that affect the utilization of HIV testing and counseling (HTC) services among heterosexual populations in Canada and the UK.

Methods

We conducted an integrated review of published and unpublished literature (1996–September 2010) using Scopus, OVID-EMBASE, CSA illumina, CINHAL, PROQuest, Web of Science, and Google.

Results

Twenty-seven studies met the inclusion criteria. We identified and categorized the key factors into three broad categories depending on their source. Personal-related factors included socio-demographic characteristics, risk perception, illness, HIV-related stigma, level of HIV and testing knowledge, and culture. Provider-related factors included provider-recommended HIV testing, provision of culturally and linguistically appropriate services, and doctor–patient relationship. System-related factors included integrating HIV testing with other health care services, anonymity of testing services, suitability of testing venues, technical aspects of HIV testing, and funding for immigrant health services.

Conclusion

The findings from our review indicate that HTC behaviors of heterosexuals in the Canada and the UK are likely influenced by several unchangeable (socio-demographic characteristics) and amenable factors. There is need to step-up research to confirm whether these associations are causal using stronger research designs.

Practical implication

We have made several recommendations that could be used to improve existing services in Canada.     

艾滋病自愿咨询检测行为影响因素调查

目的了解大众艾滋病相关认知水平对于自愿咨询检测（VCT）的影响，为VCT的社区倡导提供依据。方法限定时段内对于自愿咨询检测门诊的求询者和整群抽取的社区居民进行包括人口学特征、艾滋病相关认知、VCT需求和行为的调查。采用描述性统计和Logistic回归对资料进行分析。结果VCT对传播途径的认知水平（Z=3．24314，P=0．0012）和公共卫生焦虑程度（Z=1．92708，P=0．0540）明显高于社区居民。对于存在感染风险者，主要影响其自愿咨询检测行为的是性别（OR=0．051，P=0．0001）、传播途径认知水平（OR=12．161，P=0．0264）、应对病毒的自我效能感（OR=3，252，P=0．0343）和流行现状焦虑（OR=1．576，P=0．0305）等。结论人口学特征对于合理检测行为的影响并非关键，在VCT社区倡导中要加强流行状况的介绍提高防治紧迫感，详细解释传播风险以提高风险自觉性，同时通过介绍HIV的防治方法以提高应对病毒的自我效能感也有助于促进自愿咨询检测。     

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.     

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.     

Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda

BackgroundMalnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients.MethodsA cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors.ResultsThe mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 – 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutritionDiscussionIn rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities.ConclusionsMalnutrition is a threat in HIV adult patients in rural communities of Uganda.     

Sexual, reproductive health needs and rights of young people with perinatally acquired HIV in Uganda

Background

Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs, children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding, new challenges have emerged in their care and support needs. The most dynamic being, their sexual and reproductive health needs and rights (SRHR).

Objectives

This paper aimed at establishing the gaps at policy, program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned.

Methods

This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives.

Results

The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet, existing policies, programs and services are inadequate in responding to their sexual and reproductive health needs and rights.

Conclusion

Against these findings, it is important, that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized.     

Interface between biomedical and traditional systems of treatment and care among HIV positive fisher folk in two fishing communities on Lake Victoria,Uganda

BackgroundFisherfolk have been identified as a key population in the HIV response in Uganda due to high HIV prevalence and low engagement in HIV services. While studies have examined lifestyles and risk, much remains to be understood about help and health seeking experiences, including the combined use of biomedical and traditional health care.ObjectiveTo examine the use of biomedical and traditional health care in two fishing communities around Lake Victoria in Uganda.MethodsExploratory, in-depth qualitative study involving semi-structured interviews with 42 HIV positive fisherfolk.ResultsPrior to HIV diagnosis, participants who described becoming ill sought different forms of help including biomedical treatment prescribed by health workers or self-prescribed; biomedical and herbal medicines together; herbal medicines only; or no form of treatment. Following HIV diagnosis, the majority of participants used ART exclusively, while a smaller number used both ART and traditional care strategies, or reported times when they used alternative therapies instead of ART. Prior to HIV diagnosis, fisherfolk''s health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. After HIV diagnosis, most resorted only to using ART.ConclusionStudy findings provide insight into how fisherfolk''s use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Efforts are needed to reach fisherfolk through everyday health seeking networks to ensure HIV is diagnosed and treated as early as possible.