A study to assess the needs of people living with HIV/AIDS reporting to an ART Center of Central India.

Effectively addressing the needs of people living with HIV/AIDS (PLHA) and providing them with adequate care and support services are an essential intervention necessary to address the problem of HIV. The current study analyzed the needs of PLHA, the support received and the support required, to help frame comprehensive and focused programs for HIV infected individuals. The study was cross-sectional in design, incorporating quantitative analysis techniques and was conducted at the Anti Retroviral Therapy (ART) Center of MGM Medical College Indore, India, from February 2009 to January 2010. A semistructured interview schedule was used to interview 420 respondents currently on ART and the data was analyzed using SPSS software. Males and females constituted 69 and 31% of the study participants, respectively. The major support received by the respondents was care and help from families and friends, free ART, medicines for opportunistic infections (OI) and monthly health check-up at the ART Center. Other support received included nutritional supplements, traveling allowance to travel to the ART Center for availing the monthly dose of ART and educational help for children. The major support required was regular availability of medicines for various OI and associated diseases at ART centers, free laboratory investigations at hospitals, educational help for children, employment opportunities, development of a vaccine, facility of households, availability of second line ART drugs at ART centers, decentralization of ART centers, strengthening of existing PLHA networks and support groups, and better and effective counseling services. Coordinated efforts by governmental, non-governmental sources and PLHA themselves will result in the development of a comprehensive package of care and support for PLHA, to cater to their needs and requirements.

Reliability and validity of dermatology life quality index: assessment of quality of life in human immunodeficiency virus/acquired immunodeficiency syndrome patients with pruritic papular eruption.

OBJECTIVE: To test the reliability and validity of dermatology life quality index (DLQI) in simplified Chinese language by assessing the quality of life (QoL) in HIV (human immunodeficiency virus)/AIDS (Acquired immunodeficiency syndrome) patients with pruritic papular eruption (PPE). METHODS: A study of simplified-Chinese-version DLQI was carried out in Henan province, China. The reliability and validity were tested by means of statistical method. Data were processed with SPSS 19.0. RESULTS: One hundred and seven subjects participated in the study and 106 (99.07%) finished the questionnaire. Eighteen patients were mildly affected; 62 were moderately affected, 24 were highly affected, and 2 were extremely affected. Reliability analysis showed that the split-half reliability coefficient of questionnaire was 0.556 and the reliability of the full test estimated with Spearman-Brown. correction was 0.7146. The Cronbach alpha was 0.673. According to validity analysis, the correlation between the scores of items and the total scores ranged from 0.208 to 0.529 (P < 0.05). Three factors were abstracted froml0 questions with the principal component analysis and the contribution rate of the 3 common factors was 59.95%. CONCLUSION: The simplified-Chinese-version DIQL is an acceptable and valid scale for HIV/AIDS patients with PPE. It can be used to evaluate the QoL of HIV/AIDS patients with PPE in China.

Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa.

There is a growing imperative to improve the coordination and collaboration of tuberculosis (TB) and HIV healthcare services in response to escalating rates of TB/HIV coinfection. Patient-specific challenges associated with the delivery of TB/HIV care have been minimally explored in this regard. As part of a larger study conducted in South Africa, this article highlights coinfected patients' experiences with TB and HIV healthcare in light of their broader social environments. Qualitative, in-depth interviews were conducted with 40 adult, coinfected patients (24 women and 16 men) and eight key-informant healthcare workers at three urban/peri-urban, ambulatory, public health clinics in the high-burden province of KwaZulu-Natal. Transcribed interviews were analyzed under a modified grounded theory approach to capture subjective meanings of healthcare experience subsequent to patients' codiagnosis with TB and HIV. Emerging analytic themes highlighted critical sociomedical constraints to TB/HIV care in relation to patients' income and employment, eligibility for social assistance and antiretroviral treatment, fears around illness disclosure, social and material support, and treatment adherence. Patients' healthcare experiences were bound by their poor access to essential resources, multiple life responsibilities, disparate gender roles, limits within the healthcare system, and the stigmatizing social symbolism of their illness. Overlapping social inequalities perpetuated coinfected patients' experiences with stigma and collectively mediated their health decisions around disclosure, adherence, and retention in medical care. The study urges a contextualized understanding of the social challenges associated with TB/HIV healthcare and helps inform more patient-sensitive and socially responsive interventions against the co-epidemic.

Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: implications for positive prevention interventions.

Effective treatment regimens for HIV infection demand very high levels of adherence and people infected with HIV are expected to adhere to safer sex and drug use practices throughout their lives. Treatment nonadherence overlaps with continued unsafe sexual practices for some people living with HIV/AIDS. The co-occurrence of nonadherence and HIV transmission risk behavior poses particular risk for the spread of drug-resistant variants of HIV. There are common correlates of both nonadherence and risk behavior, particularly substance use and depression. Interventions designed to address treatment nonadherence and those designed to reduce risk behavior also share common elements, particularly self-efficacy enhancement and behavioral skills training. The common correlates and shared intervention elements suggest that integrated intervention approaches that simultaneously address adherence and risk reduction may be feasible. Research is currently testing interventions that simultaneously increase HIV treatment adherence and reduce behaviors that risk HIV transmission.

Confidentiality or continuity? Family caregivers' experiences with care for HIV/AIDS patients in home-based care in Lesotho.

In the context of poor access to antiretroviral therapies in sub-Saharan Africa, the minimum treatment package intended to treat opportunistic infections common with HIV infection is inadequate but appealing, since it presumes universal coverage of medical care for patients living with HIV and AIDS. The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. A qualitative study using in-depth interviews with a sample of 21 family caregivers -16 females and 5 males aged between 23 and 85 years was conducted with the assistance of health personnel in two hospitals in Lesotho. Using the concept of continuity of care, this article discusses the experiences of family caregivers about home care, including their experiences of adherence to confidentiality by health care professionals and non-disclosure of AIDS as the context of illness, the circumstances under which the caregivers initiated caregiving and sought medical care, and how these factors could be stressors in caregiving. There was continuity of care where the caregivers obtained hospital support. However, when confidentiality was adhered to the caregivers were frustrated by lack of information, disrupted treatment, exclusion of their perspectives in medical care, failure to secure hospitalisation, ambiguous goals and non-responsiveness, so that continuity of care was jeopardised. Thus it can be concluded that professional-assisted disclosure benefited the patients because it facilitated continuity of care through the caregivers.

Mortality and burden of disease in a cohort of HIV-seropositive adults in Nairobi, Kenya.

The purposes of this study were to measure incidence and determine risk factors associated with opportunistic infections (OIs) and mortality among an HIV-infected cohort in Nairobi, Kenya. Three hundred and eighty-one seropositive ambulatory adults in Nairobi, Kenya were followed from 1997 to 2000 with participants visiting the clinic every two months and when acutely ill. Acute bronchitis was the most frequent diagnosis, followed by sexually transmitted infections, candida vaginitis (among women), fever, diarrhoea, pneumonia, HIV-associated skin rash, oral candidiasis and urinary tract infection. Associations between the frequency of these diagnoses including survival and sociodemographic factors and initial CD4 count were assessed. A CD4 count <200 cells/mL at recruitment was strongly associated with decreased survival (adjusted odds ratio=3.0, 95% confidence interval 1.7-5.1). These findings may help to target high-risk populations and guide OI prevention and treatment strategies including decisions regarding initiation of antiretroviral therapy in sub-Saharan Africa.

Participatory evaluation of counselling, medical and social services of The AIDS Support Organization (TASO) in Uganda.

The AIDS Support Organization (TASO) is an indigenous non-governmental organization (NGO) of HIV-infected and affected people in Uganda. TASO provides counselling, social support, medical and nursing care for opportunistic infections at 7 centres affiliated to district hospitals in Uganda. Between 1993 and 1994, the services provided by TASO were evaluated through a participatory approach between staff and clients. TASO counselling services helped clients and their families to cope with HIV and AIDS, with 90.4% of clients revealing their serostatus, and 57.2% reporting consistent use of condoms in the past 3 months. TASO was also the main source of medical care for clients with opportunistic infections in the last 6 months (63.8%). As a result of counselling, over half of the clients (56.9%) made plans for the future and 51.3% wished to make wills. There was a high level of acceptance of people living with HIV/AIDS (PWAs) by families (79%) and the community (76%). Care was provided to PWAs at home mainly by women (86.2%). TASO has demonstrated that individuals and their families are able to live positively with HIV/AIDS. Through counselling, medical care and material support to clients and their families, TASO has effected change in people's attitudes, knowledge and lifestyles. In particular, TASO has demonstrated a strong capacity to overcome four problems that haunt AIDS care in most places: (1) revealing one's HIV-serostatus to relevant others; (2) accepting PWAs in family and community; (3) seeking early treatment; and (4) combining prevention and care. In general, TASO has shown that specialized services to meet AIDS care needs can be added to existing health services at district levels. As a result of the participatory evaluation, a well-accepted monitoring system was established.

PIP: The AIDS Support Organization (TASO) is an indigenous nongovernmental organization of HIV-infected and affected people in Uganda. The organization provides counseling, social support, and medical and nursing care for opportunistic infections at seven centers affiliated with district hospitals in Uganda. TASO's services were evaluated during 1993-94 via a participatory approach involving staff and clients. The organization's counseling services helped clients and their families to cope with HIV and AIDS, with 90.4% of clients revealing their serostatus, and 57.2% reporting the consistent use of condoms during the preceding 3 months. TASO was the main source of medical care for clients with opportunistic infections during the preceding 6 months. As a result of counseling, 56.9% of clients made plans for the future and 51.3% wished to make wills. The evaluation further found a high level of acceptance of people with HIV/AIDS (PWA) by families (79%) and the community (76%). Women provided 86.2% of in-home care to PWA. TASO's experience demonstrates that individuals and their families can live positively with HIV/AIDS and that specialized AIDS care services can be readily added to existing health services at the district level.

Finding support for AIDS-related vision problems.

AIDS: The author, who has cytomegalovirus (CMV) retinitis, discusses the lack of services available to people with CMV and discusses the best means of obtaining services that do exist. It is stressed that finding a service for people with AIDS-related blindness should begin prior to total blindness so the service is already established. Joining support groups is an important step due to the severe psychological burden that comes from encroaching blindness. Support group information can be obtained by contacting Mark Thomas at (212) 337-3515. The article concludes with tips for those suddenly called upon to be the eyes for someone who is visually impaired or blind.^ieng

Problems of persons with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia.

The authors of this prospective study describe the problems of persons living with HIV/AIDS hospitalized for Pneumocystis carinii pneumonia (PCP) (N = 90) and examine how the problems change over time. Data were obtained from four sources and were classified into major problem categories. The largest mean number of problems were reported in the category of PCP. Specific psychosocial problems were more likely to be reported in the patient and nurse interviews than in the chart and intershift report. The study findings validate the physical symptoms addressed in the published care plans and guidelines for caring for patients with PCP. The study identified the limitation of using the patient record as the only data source in determining nursing care needs and emphasized the importance of the patients perspective.

Somatic care wanted by HIV-infected intravenous drug abusers: the patients' opinions and experiences.

The somatic care of HIV-infected intravenous drug abusers (IVDUs) is often combined with many problems. The addict is often an unpopular patient, but society must assume responsibility for him or her and it is important to solve care problems in an appropriate way. This study was undertaken in order to investigate what kind of care addicts want when they become somatically ill. A questionnaire was given to patients who acquired HIV infection due to intravenous drug abuse, who visited an outpatient clinic for HIV-infected patients at the Department of Infectious Disease, Huddinge Hospital, Stockholm, Sweden. A total of 72 of the original 78 questionnaires could be evaluated. Thirty respondents took part in the Stockholm Methadone Programme. The patients were asked to rank the importance of professional competence among the staff. The patients ranked competence in pain treatment highest followed by competence in somatic medical care. Lower ranked, but still perceived as important, was competence in psychiatric medical care and social welfare work. Experience in treatment of addiction was ranked as less important. It can be concluded that it is fruitful to ask IVDUs about their preferences concerning care.