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Retrospective study on the critical factors for retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa.
J Acquir Immune Defic Syndr. 2010 Sep 1;55(1):109-16
Authors: Vella V, Govender T, Dlamini S, Taylor M, Moodley I, David V, Jinabhai C
OBJECTIVE: To analyze the critical factors favoring the retention of patients under antiretroviral therapy (ART) in KwaZulu-Natal (KZN), South Africa. DESIGN AND METHODS: This retrospective study was based on the review of a representative sample of patients who began ART between March 2004 and May 2006 in 32 public sector sites and were followed up to July 1, 2007.
Extended Cox proportional hazard models were used to identify the factors which significantly influenced treatment retention during the first 2 years of treatment. Kaplan-Meyer provided the probabilities of remaining on ART if these factors were present.
RESULTS: The 2835 sampled patients corresponded to about 10% of the universe of patients under ART in the 32 sites; 929 (33%) were males, and the median age of the sampled patients was 34 (interquartile range: 28-41). The analysis identified factors that significantly decreased the probability of remaining on ART. Patients’ risk factors were initial CD4 <100 cells per microliter, lack of a telephone contact number, and being male. Sites’ risk factors were the presence of a part time (PT) versus a full time (FT) senior professional nurse, a PT versus FT doctor, and intakes of 200 or more new patients per doctor per year. The probability of remaining on ART declined significantly for each increasing level of workload, but having a FT versus a PT doctor made a significant difference only for level of workload of 200 or more new patients per year.
CONCLUSIONS: The analysis has identified the conditions influencing retention of ART patients in KZN. This has provided a method to estimate absorption capacity of the ART delivery sites, which is of added value for a sustainable expansion of the ART coverage.
PMID: 20595904 [PubMed - indexed for MEDLINE]
Antihistamines are superior to topical steroids in managing human immunodeficiency virus (HIV)-associated papular pruritic eruption.
Int J Dermatol. 2010 Jan;49(1):83-6
Authors: Navarini AA, Stoeckle M, Navarini S, Mossdorf E, Jullu BS, Mchomvu R, Mbata M, Kibatala P, Tanner M, Hatz C, Schmid-Grendelmeier P
Papular pruritic eruption (PPE) is a frequent HIV-comorbidity in tropical countries. Because of constant itching and social stigma, effective treatment is highly valued. In our HIV cohort in rural Tanzania with 12% prevalence of PPE, we have retrospectively analyzed responses to available treatments. Oral promethazine improved itching (P < 0.0058) and clinical scores (P < 0.032) significantly more than topical steroids. Disease activity did not correlate with CD4+ and CD8+ T cell counts and was independent of anti-retroviral medication. Therefore, oral antihistamines are an effective first-line treatment for PPE.
PMID: 20465620 [PubMed - indexed for MEDLINE]
Changes in knowledge and attitudes among junior secondary students exposed to the family life and HIV education curriculum in Lagos State, Nigeria.
Afr J Reprod Health. 2009 Sep;13(3):37-46
Authors: Esiet AO, Esiet U, Philliber S, Philliber WW
To address the needs of young people in Lagos State, Nigeria, for information about family life and HIV, the Lagos State Ministry of Education, in collaboration with Action Health Incorporated, began to offer the Family Life and HIV Education Curriculum in government junior secondary schools in 2003. Knowledge and attitudes were measured in a sample of 1,366 students in Lagos State, Nigeria, in November 2004, at the beginning of the school year, and again in July 2005 after receiving a year of the Family Life and HIV Education Curriculum. Students exposed to the curriculum significantly increased knowledge of sexuality and HIV, support for abstinence, and gender role equality.
PMID: 20690260 [PubMed - indexed for MEDLINE]
Treating cofactors can reverse the expansion of a primary disease epidemic.
BMC Infect Dis. 2010 Aug 23;10(1):248
Authors: Gibson LR, Li B, Remold SK
ABSTRACT: BACKGROUND: Cofactors, ‘nuisance’ conditions or pathogens that affect the spread of a primary disease, are likely to be the norm rather than the exception in disease dynamics. Here we present a “simplest-possible” demographic model that incorporates two distinct effects of cofactors: that on the transmission of the primary disease from an infected host bearing the cofactor, and that on the acquisition of the primary disease by an individual that is not infected with the primary disease but carries the cofactor.
METHODS: We constructed and analyzed a four-patch compartment model that accommodates a cofactor. We applied the model to HIV spread in the presence of the causal agent of genital schistosomiasis, Schistosoma hematobium, a pathogen commonly co-occurring with HIV in sub-Saharan Africa.
RESULTS: We found that cofactors can have a range of effects on primary disease dynamics, including shifting the primary disease from non-endemic to endemic, increasing the prevalence of the primary disease, and reversing demographic growth when the host population bears only the primary disease to demographic decline. We show that under parameter values based on the biology of the HIV/S. haematobium system, reduction of the schistosome-bearing subpopulations (e.g. through periodic use of antihelminths) can slow and even reverse the spread of HIV through the host population.
CONCLUSIONS: Typical single-disease models provide estimates of future conditions and guidance for direct intervention efforts relating only to the modeled primary disease. Our results suggest that, in circumstances under which a cofactor affects the disease dynamics, the most effective intervention effort might not be one focused on direct treatment of the primary disease alone.
The cofactor model presented here can be used to estimate the impact of the cofactor in a particular disease/cofactor system without requiring the development of a more complicated model which incorporates many other specific aspects of the chosen disease/cofactor pair. Simulation results for the HIV/S. haematobium system have profound implications for disease management in developing areas, in that they provide evidence that in some cases treating cofactors may be the most successful and cost-effective way to slow the spread of primary diseases.
PMID: 20731862 [PubMed - as supplied by publisher]
Hypertension in pregnancy among HIV-infected women in sub-Saharan Africa: prevalence and infant outcomes.
Afr J Reprod Health. 2009 Dec;13(4):25-36
Authors: Kilewo C, Natchu UC, Young A, Donnell D, Brown E, Read JS, Sharma U, Chi BH, Goldenberg R, Hoffman I, Taha TE, Fawzi WW
This analysis was performed to determine the prevalence of hypertension and association of MAP (mean arterial pressure) with birth outcomes among HIV-infected pregnant women not taking antiretrovirals. HIV-infected pregnant women, enrolled into the HPTN024 trial in Tanzania, Malawi and Zambia were followed up at 26-30, 36 weeks, and delivery. The prevalence of hypertension was <1% at both 20-24 weeks and 26-30 weeks and 1.7% by 36 weeks. A 5 mm Hg elevation in MAP increased the risk of stillbirth at 20-24 weeks by 29% (p = 0.001), 32% (p = 0.001) at 26-30 weeks and of low birth weight (LBW) at 36 weeks by 26% (p = 0.001). MAP was not associated with stillbirth at 36 weeks, LBW prior to 36 weeks, preterm birth, neonatal mortality or the risk of maternal to child transmission (MTCT) of HIV.
PMID: 20690271 [PubMed - indexed for MEDLINE]
Knowledge, attitude and practices study on reproductive health among secondary school students in Bolgatanga, upper east region, Ghana.
Afr J Reprod Health. 2009 Dec;13(4):51-66
Authors: Rondini S, Krugu JK
This study was conducted within the secondary school student population of the Bolgatanga community, in Northern Ghana, to learn about knowledge, attitude and practices of reproductive health of this adolescent student population. Both quantitative and qualitative data were collected on adolescence perception, STIs and HIV/AIDS, family planning, male-female relationship, and vulnerability to sexual violence. The data collected show a concerning low familiarity of the student population with family planning methods and HIV/AIDS transmission, which, combined with minimal contraceptive use, pose them at high risk for unwanted pregnancies and sexual infections transmission. We argue that poor infrastructures and low accessibility of these rural areas in Northern Ghana may have led to uneven distribution of reproductive health educational programs in the country, urging more programs and interventions aimed particularly at these high risk groups.
PMID: 20690273 [PubMed - indexed for MEDLINE]
[Stevens-Johnson syndrome and toxic epidermal necrolysis in a teaching hospital in Lomé, Togo: retrospective study of 89 cases]
Med Trop (Mars). 2010 Jun;70(3):255-8
Authors: Saka B, Kombaté K, Mouhari-Toure A, Akakpo S, Tchangaï-Walla K, Pitché P
OBJECTIVES: The purpose of this study was to document epidemiological features, outcomes, and aetiologies of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a teaching hospital in Lomé, Togo.
METHOD: A retrospective study of patients with SJS/TEN treated from January 2002 to April 2009 in a teaching hospital in Lomé was conducted.
RESULTS: During the study period, 89 patients were treated for SJS/TEN, i.e., SJS in 76 cases, TEN in 9, and overlapping SJS/TEN in 4. Mean age was 30.3 +/- 13.4 years and sex ratio (M/F) was 0.7. Serological testing for HIV was carried out in 75 patients and was positive in 41 (54.6%) including 36 patients with SJS, 3 with TEN and 2 with overlapping SJS/TEN. A total of 9 patients died including 4 with SJS, 4 with TEN and one with overlapping SJS/TEN. Six of the patients who died were HIV-infected. Complications included blindness in 3 cases, moderate dry eye syndrome in 1, vaginal synechiae in 2, synechiae of labial commeasures in 1, and hypertrophic scars in 1. Antibacterial sulphonamides (50.6%) were the most commonly implicated drugs followed by nevirapine (23.6%), non-steroidal anti-inflammatory drugs (5.6%), and anti-epileptic medications (3.4%).
DISCUSSION: Our results also document the high frequency of nevirapine as a new SJS/TEN cause unrelated to antibacterial sulphonamides. With increasing access to HIV medication in sub-Saharan Africa countries, practitioners should take these data into account for patient monitoring.
PMID: 20734593 [PubMed - in process]
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