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.     

HIV/AIDS and blindness

Nearly 34 million people are currently living with HIV/AIDS: ocular complications are common, affecting 50% to 75% of all such patients at some point during the course of their illness. Cytomegalovirus retinitis is by far the most frequent cause of vision loss in patients with AIDS. Although the prevalence of cytomegalovirus retinitis is decreasing in industrialized countries because of the widespread availability of highly active antiretroviral therapy, between 10% and 20% of HIV-infected patients worldwide can be expected to lose vision in one or both eyes as a result of ocular cytomegalovirus infection. Less frequent but important causes of bilateral vision loss in patients with HIV/AIDS include varicella zoster virus and herpes simplex virus retinitis, HIV-related ischaemic microvasculopathy, ocular syphilis, ocular tuberculosis, cryptococcal meningitis, and ocular toxic or allergic drug reactions. At present, most patients with HIV/AIDS in developing countries who lose their vision have a very limited life expectancy. As antiretroviral therapy makes its way to these countries, however, both life expectancy and the prevalence of blindness related to HIV/AIDS can be expected to increase dramatically.     

Measuring the impact of HIV/AIDS, heart disease and malignant neoplasms on life expectancy in the USA from 1987 to 2000

OBJECTIVES: Quantifying the impact of a disease on society is an important issue for setting priorities for better allocation of healthcare resources and for evaluating the effectiveness of prevention and control of the disease. STUDY DESIGN: The potential gains in life expectancy due to the elimination of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), heart disease and malignant neoplasms were compared for the US population by age and ethnicity from 1987 to 2000. METHODS: The potential gain in life expectancy after hypothetical elimination of cause-specific deaths is an effective indicator of measuring the impact of a disease on a population. Official age-specific mortality rates, by ethnicity, due to HIV/AIDS, heart disease and malignant neoplasms of the US population from the National Center for Health Statistics were used, and multiple decremental life tables were constructed to find the corresponding potential gains in life expectancy. RESULTS: The potential gains in life expectancy for the US population at birth by complete elimination of HIV/AIDS, heart disease and malignant neoplasms were 0.14, 3.71 and 3.06 years in 1987, respectively. In 1995, the potential gain in life expectancy due to the elimination of HIV/AIDS increased from 0.14 years in 1987 and achieved its highest value (0.41 years), whereas the elimination of heart disease and malignant neoplasms led to potential gains in life expectancy of 3.05 and 3.10 years, respectively. Since 1995, the potential gains in life expectancy at birth by eliminating deaths from HIV/AIDS and heart disease have decreased to 0.13 and 2.67 years, respectively, in 2000. However, the potential gain in life expectancy due to elimination of malignant neoplasms remained relatively stable (3.01 years in 2000). It is well known that HIV/AIDS tends to have a greater impact on people of working age, whereas heart disease and malignant neoplasms have a greater impact on people over 65 years of age. To measure the impact of these diseases on life expectancy in people of working age, a partial multiple decremental life table was constructed and the potential gains in life expectancy were computed by partial or complete elimination of various causes of death during the working years. shows the impact on life expectancy of the US working-age population by eliminating deaths from HIV/AIDS, heart disease and malignant neoplasms by race and sex groups. CONCLUSIONS: Since 1995, there has been a rapid reduction in the burden of HIV/AIDS on the life expectancy for the US population, especially for black males of working age. These results could provide useful information when evaluating public health improvements and allocating resources for future disease control programmes.     

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.     

Impact of HIV/aids epidemic on human capital development in West Africa

West Africa occupies the third position with respect to the burden of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) globally, after Southern and East Africa. About 5 million adults and children are infected with the disease in the subregion, while HIV prevalence in the general population hovers around 2% and 5%. This paper attempts to investigate the impact of HIV/AIDS epidemic on human capital development in 11 West African countries over the period 1990 to 2011. The study used a dynamic panel data modeling approach, using first difference, difference generalized methods of moment, and system generalized methods of moment estimating techniques. Four measures of HIV/AIDS and 2 human capital measures were used in the study. The findings revealed that HIV/AIDS pandemic had negative and significant impact on human capital in West Africa. However, the statistical significance was more pronounced on life expectancy (a measure of human capital), while the negative impact on school enrolment (another human capital measure) was not significant. It is therefore recommended that the spread of HIV/AIDS disease in West Africa should be effectively controlled, while the number of infected persons undergoing antiretroviral therapy in the subregion should be increased to a near 100% coverage.     

World health inequality: convergence, divergence, and development

Recent studies characterize the last half of the twentieth century as an era of cross-national health convergence, with some attributing welfare gains in the developing world to economic growth. In this study, I examine the extent to which welfare outcomes have actually converged and the extent to which economic development is responsible for the observed trends. Drawing from estimates covering 195 nations during the 1955-2005 period, I find that life expectancy averages converged during this time, but that infant mortality rates continuously diverged. I develop a narrative that implicates economic development in these contrasting trends, suggesting that health outcomes follow a "welfare Kuznets curve." Among poor countries, economic development improves life expectancy more than it reduces infant mortality, whereas the situation is reversed among wealthier nations. In this way, development has contributed to both convergence in life expectancy and divergence in infant mortality. Drawing from 674 observations across 163 countries during the 1980-2005 period, I find that the positive effect of GDP PC on life expectancy attenuates at higher levels of development, while the negative effect of GDP PC on infant mortality grows stronger.     

广西南宁1999-2014年艾滋病感染者/患者生存状况分析

目的 了解广西南宁市艾滋病患者的生存状况。方法 采用回顾性队列研究方法,收集1999-2014年南宁市发现并确诊的5155例病例,采用乘积极限法描述其生存时间,寿命表法分析其生存率,Cox比例风险模型分析其影响因素。结果 5155例患者总病死率为11.58/1000人月,截止观察终点15年生存率为55.01%,平均生存时间为114.42个月(95%CI=106.75~122.09);确诊时年龄 ≥60岁病例1533例(占总病例数29.74%);确认后半年内死亡806例(死亡病例53.66%); Cox多因素分析结果显示,性别(P<0.001,HR=0.741)、确诊时年龄(P<0.001,HR=1.111)、感染途径(P=0.037,HR=0.692)、治疗情况(P<0.001,HR=0.062)是生存时间的影响因素。结论 南宁市老年病例及晚发现病例较多,及时抗病毒治疗是延长艾滋病患者生存时间的有效手段。     

广州市黄埔区HIV/AIDS患者治疗依从性及其影响因素

目的 了解发现即治疗策略下HIV/AIDS患者抗病毒治疗依从性及影响因素。方法 以广州市黄埔区正接受抗逆转录病毒疗法（ART）的HIV/AIDS患者为研究对象进行问卷调查,调查内容包括自制问卷、多维度领悟社会支持量表和视觉模拟评分法,采用描述流行病分析方法进行分析,并采用单、多因素分析方法对治疗依从性影响因素进行分析。结果 共收集到有效问卷205份。调查对象平均（35.79 ± 10.66）岁。男性183例,占89.3%;未婚102例,占49.8%;职业为工人或农民工共93例,占45.4%;大专及以上文化程度81例,占39.5％;同性传播121例,占59.0%。ARI治疗依从性好占75.6%,其中按时服药率90%~94%占21.5%。25~39岁（OR=0.28）、工人/农民工、其他（待业、学生等）职业（OR=0.13、0.13）、最近1次CD4计数≥350、500个/μL（OR=0.34、0.13）、社会支持程度为中间支持状态（OR=0.24）的HIV/AIDS患者治疗依从性较差,认可坚持按时按量服药可以延长寿命（OR=5.15）、对随访医生服务满意（OR=3.90）的HIV/AIDS患者治疗依从性较好。结论 黄埔区HIV/AIDS患者治疗依从性一般,且受较多因素影响,应针对相关影响因素采取积极的干预措施提高ART治疗依从性。     

上海地区1153例初治艾滋病患者临床流行病学研究

目的了解上海地区艾滋病患者的基本信息以及抗反转录病毒治疗(ART)前各种机会感染的发生概率,为早发现艾滋病病毒(HIV)感染者提供参考。方法 ART前收集初治艾滋病患者年龄、婚姻状况、配偶是否感染、确诊日期、既往是否接受过ART、体重等基本信息,以及确诊机会感染和机会肿瘤、曾出现的免疫低下的临床表现以及现患机会感染和机会肿瘤等,并进行统计分析。结果 1 153例初治艾滋病患者中男性955例,女性198例,开始ART时平均年龄(39.7±12.5)岁。自述配偶也为感染者的共124例,其中45对为夫妻均在接受ART。1 153例患者平均CD4+细胞计数为(139.7±109.0)个/μl。共计1 238例次发生AIDS相关性疾病或临床表现,以消瘦最为常见358例次(31.05%),其次为持续发热252例次(21.86%)、带状疱疹208例(18.04%)。457例因各种机会感染或肿瘤住院治疗并开始ART,CD4+细胞计数为(77.8±94.3)个/μl,发生AIDS相关性疾病为1 133例次(91.52%)。696例在门诊开始ART的患者,CD4+细胞计数为(180.9±98.0)个/μl,发生过AIDS相关性疾病的例次仅为105(8.48%)。结论相当一部分患者在确诊前已经出现了免疫功能低下的表现。AIDS晚期患者(尤其是CD4+细胞计数<100个/μl)在开始ART前更可能发生各种较严重的多重机会性感染。     

The HIV/AIDS epidemic in Africa: implications for U.S. policy

Political will or commitment toward the HIV epidemic has been lacking in most African countries. Although most countries are in denial, a few have moved into recognition of the epidemic. Only two countries, Senegal and Uganda, have moved into mobilization. Ineffectiveness is judged by increasing HIV prevalence rates and declining life expectancy. Countries without active national leadership to fight the epidemic have seen deterioration in these criteria. In addition to its toll in Africa, this epidemic threatens U.S. political, economic, and security interests. Political responses to manage the risks to the United States have revolved around much increased development assistance through traditional channels and financial support for the United Nations' Global Fund to Fight AIDS, Tuberculosis, and Malaria.     

Integrating HIV management for children into the Integrated Management of Childhood Illness guidelines

The WHO/UNICEF strategy of Integrated Management of Childhood Illness (IMCI) has been adopted as a strategy for improving paediatric care in resource-poor settings. The original IMCI guidelines recommend referral of children with severe or recurrent illnesses such as those common in HIV/AIDS, however the specific identification and management was not included. In many countries, especially in sub-Saharan Africa, HIV/AIDS contributes significantly to child morbidity and mortality. There was a need to include the specific assessment and management of symptomatic HIV infection in IMCI guidelines. A draft HIV component of the IMCI guidelines was developed, which included management of symptomatic HIV cases with referral for counselling and testing, and was evaluated in South Africa. A revised version was then validated in Ethiopia and Uganda where HIV, malnutrition and malaria prevalence is different from South Africa. IMCI materials have been adapted to include an HIV component. Currently, very few children under 15 years of age receive antiretroviral therapy (ART). Chronic HIV care of children, including ART for children, has been developed within the Integrated Management of Adolescent and Adult Illness (IMAI) initiative of the WHO. Through this initiative, the WHO is assisting countries to facilitate care and treatment of children undergoing ART.     

Pentecostalism and AIDS treatment in Mozambique: creating new approaches to HIV prevention through anti-retroviral therapy

Pentecostal fervor has rapidly spread throughout central and southern Mozambique since the end of its protracted civil war in the early 1990s. In the peri-urban bairros and septic fringes of Mozambican cities African Independent Churches (AICs) with Pentecostal roots and mainstream Pentecostals can now claim over half the population as adherents. Over this same period another important phenomenon has coincided with this church expansion: the AIDS epidemic. Pentecostalism and HIV have travelled along similar vectors and been propelled by deepening inequality. Recognising this relationship has important implications for HIV/AIDS prevention and treatment strategies. The striking overlap between high HIV prevalence in peri-urban populations and high Pentecostal participation suggests that creative strategies, to include these movements in HIV/AIDS programming, may influence the long-term success of HIV care and the scale-up of anti-retroviral treatment (ART) across the region. The provision of ART has opened up new possibilities for engaging with local communities, especially Pentecostals and AICS, who are witnessing the immediate benefits of ARV therapy. Expanded treatment may be the key to successful prevention as advocates of a comprehensive approach to the epidemic have long argued.     

From advocacy to austerity: The new role of the U.S. public sector in HIV drug development and access

ABSTRACT

Whereas advocacy was once the driving force for U.S. public support for HIV drug development and access, the nation’s response to the global epidemic is now shaped by austerity. Extending past scholarship about the role of advocates and governments in support of drug development and access around the world, in this article I identify key shifts in U.S. public sector support over the past 40 years. During the early years of the AIDS epidemic, the U.S. government and civil society expedited drug development for antiretroviral therapy (ART). After the turn of the century, a new wave of advocacy expanded access for ART, including to low- and middle-income countries through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). On the heels of these accomplishments, advocates and governments set an ambitious agenda to ‘End AIDS’ by 2030. However, progress toward this goal has been limited by a new era of austerity, as demonstrated by U.S. government spending on HIV.     

Socioeconomic Factors in Adherence to HIV Therapy in Low- and Middle-income Countries

It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries.  We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middle-income countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies.Key words: Antiretroviral therapy, highly active; Education; Employment; Income; Occupations; Social class     

HIV/AIDS and economic growth: Evidence from West Africa

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the leading causes of morbidity and mortality in West Africa. Prevalence among the most productive age group in West and Central Africa stood at 1.5%, 3.4.0%, 2.5%, and 2.1% in 1990, 2000, 2010, and 2015 respectively. This study examined the effect of HIV/AIDS on economic growth in West Africa with focus on 11 countries. The augmented Solow model, rooted in the neoclassical growth theory, was used, which was operationalized using dynamic panel data modeling approach. Incidence, prevalence, number of people living with HIV/AIDS (PLWHA), and AIDS‐related deaths were used to measure HIV/AIDS. Estimations using system GMM returned statistically significant results while those of first difference and difference GMM were not. From the outcome of system GMM analysis, a percentage increase in incidence, prevalence, PLWHA, and AIDS deaths correspondingly reduced growth significantly through their effects on life expectancy by 0.15%, 0.02%, 0.004%, and 0.03%. Acquired immune deficiency syndrome deaths and PLWHA lowered economic growth through enrolment but not significantly. The import of the findings is that HIV/AIDS threatens growth through life expectancy in West Africa. Therefore, its spread in the subregion should be effectively contained while proper treatment should be provided for all infected persons.     

整合酶抑制剂在HIV感染全程管理中的应用优势

随着HIV抗反转录病毒治疗（antiretroviral therapy, ART）的研究进展，ART时机的不断提前以及ART药物的迅速发展，HIV感染者可以获得期望寿命。现在对HIV感染者的关注不仅仅在于AIDS本身，更多应该关注HIV感染者的合并症，甚至心理疾病。中华医学会发布的《艾滋病诊疗指南（2018版）》提出全程管理的概念，而整合酶抑制剂在HIV感染全程管理的多个环节中优势显著，本文就其在全程管理中的地位以及应用展开讨论。     

中国防治艾滋病30年主要成就与挑战

  目的  分析浙江省金华市男男性行为（MSM）艾滋病病毒感染者/艾滋病患者（HIV/AIDS）确证后的生存时间及其影响因素,为有效开展MSM人群艾滋病防治工作提供科学依据。  方法  采用回顾性队列研究方法,对金华市2002 — 2018年的MSM人群HIV/AIDS的生存时间及影响因素进行分析,对流行病学相关特征进行描述性分析,用寿命表法计算生存率,用Cox回归模型分析生存时间的影响因素。  结果  1 326例MSM人群HIV/AIDS中,接受抗病毒治疗1 129例（85.14 %）。1 272例完成了最终随访（95.93 %）,平均随访时间为（40.78 ± 31.26）个月,总随访时间为54 083.90个月,发生艾滋病相关死亡21例。平均生存时间为185.10（95 % CI = 177.47～192.73）个月。第1、5、10、15年生存率分别为98.53 %、98.02 %、93.12 %、93.12 %。多因素Cox回归模型分析结果显示,艾滋病死亡相关的危险因素包括未抗病毒治疗（比抗病毒治疗,HR = 22.753,95 % CI = 8.510～60.832）、确证时为AIDS（比HIV 感染者,HR = 7.820,95 % CI = 2.141～28.560）、基线CD4⁺T 淋巴细胞计数（CD4）< 250个/μL（比 ≥ 250个/μL,HR = 5.307,95 % CI = 1.425～19.759）。  结论  金华市MSM人群HIV/AIDS治疗效果好,早发现早治疗是延长MSM患者生存时间的关键,实施“扩大检测、发现就治疗”防控策略意义重大。     

1998-2015年湖北省武汉市HIV/AIDS患者死亡及生存时间分析

目的 探讨武汉市人类免疫缺陷病毒携带者/艾滋病（human immunodeficiency virus carriers/acquired immune deficiency syndrome,HIV/AIDS）患者死亡情况、生存时间及其影响因素。方法 收集武汉市1998年1月1日~2015年12月31日所管理HIV/AIDS患者的生存、死亡等信息。计算患者的全死因死亡率,应用单因素和多因素分析探讨患者生存时间的影响因素。结果 共有3 310例患者进入研究,死亡363例,全死因死亡率为4.22/100人年,平均死亡年龄为52岁。单因素分析显示,年龄、婚姻状况、文化程度、接触史、病程阶段、是否提供宣传咨询、是否提供抗机会性感染药物、是否提供关怀救助、是否患有结核、是否进行抗逆转录病毒治疗（antiretroviral therapy,ART）、基线CD4⁺细胞计数对HIV/AIDS患者生存时间有影响（均有P<0.05）;Cox比例风险模型分析显示,65~88岁年龄组、低文化、处于AIDS期、没有提供宣传咨询、患有结核、没有接受ART、基线CD4⁺细胞计数<200个/mm³者有较高的死亡风险（均有P<0.05）。结论 武汉市HIV/AIDS患者的死亡率逐年下降,ART是影响HIV/AIDS患者生存时间的重要因素,应针对性地进行干预,以进一步延长患者寿命。     

The Cultural and Community-Level Acceptance of Antiretroviral Therapy (ART) Among Traditional Healers in Eastern Cape,South Africa

The HIV/AIDS epidemic has profoundly impacted South Africa's healthcare system, greatly hampering its ability to scale-up the provision of antiretroviral therapy (ART). While one way to provide comprehensive care and prevention in sub-Saharan African countries has been through collaboration with traditional healers, long-term support specifically for ART has been low within this population. An exploratory, qualitative research project was conducted among 25 self-identified traditional healers between June and August of 2006 in the Lukhanji District of South Africa. By obtaining the opinions of traditional healers currently interested in biomedical approaches to HIV/AIDS care and prevention, this formative investigation identified a range of motivational factors that were believed to promote a deeper acceptance of and support for ART. These factors included cultural consistencies between traditional and biomedical medicine, education, as well as legal and financial incentives to collaborate. Through an incorporation of these factors into future HIV/AIDS treatment programs, South Africa and other sub-Saharan countries may dramatically strengthen their ability to provide ART in resource-poor settings.     

Basic health care package without antiretroviral therapy?

Background Antiretroviral therapy (ART) for HIV/AIDS patients has become a standard in developed countries and a generally accepted objective in developing countries. Major funding agencies, such as USAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are supporting ART programmes in developing countries as a non-negotiable element of a basic health care package. Aim Recently a few papers have challenged whether this investment is rational as ART is expensive and the long-term consequences of resistance cannot be neglected. This paper intends to contribute to this discussion from a health economic perspective. It analyses the opportunity costs, the sustainability and the ethics of ART as well as the absorption capacity of existing health care services in developing countries. Results There is no justification for the so-called “exceptionality” of HIV/AIDS. Conclusion ART might be an essential element of a basic health care package, but it should pass the same procedure as any other intervention to be included into the basic package. Financing a comprehensive health care package would require more international input—an important vision of a “Global Fund to Promote Health” as the offspring of the existing Global Fund.