Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study.

INTRODUCTION: Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS: This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS: 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS: In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.

HIV-Related Stress and Life Chaos Mediate the Association Between Poverty and Medication Adherence Among People Living with HIV/AIDS.

HIV treatment depends on high-levels of antiretroviral therapy (ART) adherence, which is severely impeded by poverty. Men and women living with HIV infection (N = 92) completed computerized interviews of demographic and health characteristics, poverty markers, stressful life events, and life chaos, as well as unannounced pill counts to determine prospective medication adherence and medical record chart abstractions for HIV viral load. Poverty markers were associated with both stressors and chaos, and the direct effects of all three factors predicted ART non-adherence. The multiple mediation model showed that accounting for stressors and chaos resulted in a non-significant association between poverty markers and ART adherence. The indirect effect of poverty markers on adherence through life chaos was significant, whereas the indirect effect of poverty markers on adherence through stressors was not significant. Factors that render HIV-related stress and create chaos offer intervention targets that are more amenable to change than poverty itself.

Current drugs for HIV-1: from challenges to potential in HIV/AIDS.

The human immunodeficiency virus (HIV) persists in latently infected CD4+T cells and integrates with the host genome until cell death. Acquired immunodeficiency syndrome (AIDS) is associated with HIV-1. Possibly, treating HIV/AIDS is an essential but challenging clinical goal. This review provides a detailed account of the types and mechanisms of monotherapy and combination therapy against HIV-1 and describes nanoparticle and hydrogel delivery systems. In particular, the recently developed capsid inhibitor (Lenacapavir) and the Ainuovirine/tenofovir disoproxil fumarate/lamivudine combination (ACC008) are described. It is interestingly to note that the lack of the multipass transmembrane proteins serine incorporator 3 (SERINC3) and the multipass transmembrane proteins serine incorporator 5 (SERINC5) may be one of the reasons for the enhanced infectivity of HIV-1. This discovery of SERINC3 and SERINC5 provides new ideas for HIV-1 medication development. Therefore, we believe that in treating AIDS, antiviral medications should be rationally selected for pre-exposure and post-exposure prophylaxis to avoid the emergence of drug resistance. Attention should be paid to the research and development of new drugs to predict HIV mutations as accurately as possible and to develop immune antibodies to provide multiple guarantees for the cure of AIDS.

Are health workers reduced to being drug dispensers of antiretroviral treatment? A randomized cross-sectional assessment of the quality of health care for HIV patients in northern Uganda.

High quality of care (QoC) for antiretroviral treatment (ART) is essential to prevent treatment failure. Uganda, as many sub-Saharan African countries, increased access to ART by decentralizing provision to districts. However, little is known whether this rapid scale-up maintained high-quality clinical services. We assess the quality of ART in the Acholi and Lango sub-regions of northern Uganda to identify whether the technical quality of critical ART sub-system needs improvement. We conducted a randomized cross-sectional survey among health facilities (HF) in Acholi (n = 11) and Lango (n = 10). Applying lot quality assurance sampling principles with a rapid health facility assessment tool, we assessed ART services vis-à-vis national treatment guidelines using 37 indicators. We interviewed health workers (n = 21) using structured questionnaires, directly observed clinical consultations (n = 126) and assessed HF infrastructure, human resources, medical supplies and patient records in each health facility (n = 21). The district QoC performance standard was 80% of HF had to comply with each guideline. Neither sub-region complied with treatment guidelines. No HF displayed adequate: patient monitoring, physical examination, training, supervision and regular monitoring of patients' immunology. The full range of first and second line antiretroviral (ARV) medication was not available in Acholi while Lango had sufficient stocks. Clinicians dispensed available ARVs without benefit of physical examination or immunological monitoring. Patients reported compliance with drug use (>80%). Patients' knowledge of preventing HIV/AIDS transmission concentrated on condom use; otherwise it was poor. The poor ART QoC in northern Uganda raises major questions about ART quality although ARVs were dispensed. Poor clinical care renders patients' reports of treatment compliance as insufficient evidence that it takes place. Further studies need to test patients' immunological status and QoC in more regions of Uganda and elsewhere in sub-Saharan Africa to identify topical and geographical areas which are priorities for improving HIV care.

New Antiretroviral Treatment for HIV.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set the global goal of ending the AIDS world epidemic by 2030. In order to end this epidemic they have established a 90-90-90 goal to be achieved by 2020, which may be problematic, especially in low- and middle-income countries. This goal includes 90% of individuals with HIV globally being diagnosed, on treatment, and virologically suppressed. Based on global estimates from 2014-2015, approximately 36.9 million individuals are living with HIV. Of those, 53% have been diagnosed with HIV, 41% are on antiretroviral therapy (ART), and 32% have viral suppression with <1000 copies/ml. Comprehensive approaches are needed to improve the number of people living with HIV (PLWH) who are diagnosed, linked, and engaged in care. Once PLWH are retained in care, treatment is key to both HIV prevention and transmission. The development and advancement of new ART is necessary to assist in reaching these goals by improving safety profiles, decreasing pill burden, improving quality of life and life expectancy, and creating new mechanisms to overcome resistance. The focus of this review is to highlight and review data for antiretroviral agents recently added to the market as well as discuss agents in various stages of development (new formulations and mechanisms of action).

Development of albumin-based nanoparticles for the delivery of abacavir.

The study was designed to prepare and evaluate albumin nanoparticles containing antiviral drug abacavir sulphate. Various batches of albumin nanoparticles containing abacavir sulphate were prepared by desolvation method. The abacavir loaded particles were characterized for their yield, percentage of drug loading, surface morphology, particle size, surface charge, pattern of in vitro drug release and release mechanism studies. Drug loading ranged from 1.2 to 5.9%w/w. The mean particle size and the surface charge were 418.2nm and -40.8mV respectively. The in vitro drug release varied between 38.73 and 51.36%w/w for 24h. The n value for Korsmeyer-Peppas was 0.425 indicating Fickian type drug release. The preliminary findings indicated that albumin nanoparticles of abacavir can be prepared by desolvation method with good yield, high drug loading and sustained release.

Simple and rapid CD4 testing based on large-field imaging system composed of microcavity array and two-dimensional photosensor.

This study presents a novel method for CD4 testing based on one-shot large-field imaging. The large-field imaging system was fabricated by a microcavity array and a two-dimensional (2D) photosensor within the desk-top-sized instrument. The microcavity array was employed to separate leukocytes from whole blood based on differences in the size of leukocytes and other blood cells. The large-field imaging system with lower side irradiation enabled acquisition of cell signatures with high signal-to-noise ratio, because the metallic substrate of the microcavity array obstructed excessive excitation light. In this setting, dual-color imaging of CD4(+) and CD8(+) T cells was achieved within the entire image area (64 mm(2)) in 2s. The practical performance of the large-field imaging system was demonstrated by determining the CD4/CD8 ratio in a few microliter of control whole blood as small as those obtained by a finger prick. The CD4/CD8 ratios measured using the large-field imaging system correlated well with those measured by microscopic analysis. These results indicate that our proposed system provides a simple and rapid CD4 testing for the application of HIV/AIDS treatment.

Entre tramas e dramas: os significados do tratamento para mulheres de camadas populares vivendo com HIV/Aids / Between storylines and dramas: the meanings of HIV/Aids treatment for lower class women

O artigo aborda os significados do tratamento para o HIV/Aids. O referencial metodológico é a pesquisa qualitativa, e o campo de estudo, o serviço de um hospital de referência da Baixada Fluminense. O grupo estudado era composto por dez mulheres vivendo com HIV/ Aids, em terapia antirretroviral (ARV). Os significados do tratamento estão relacionados: 1) ao impacto do diagnóstico; 2) ao momento do tratamento considerando as diferentes fases de convívio com a doença; 3) ao espaço (público e privado) onde se vivem preferencialmente a doença e o tratamento; 4) ao fato de se compartilhar ou não a doença e o tratamento com o parceiro; 5) à busca de outras racionalidades (religião e remédios alternativos) como contraponto às prescrições médicas; 6) ao estabelecimento ou não de um vínculo afetivo com o médico. Há uma inter-relação estreita entre cuidar-se e cuidar dos filhos, tributária do tratamento ARV. O autocuidado é, antes de tudo, afirmação da vida, o que dá a medida da saúde. Não "ceder ao lugar de doente" significa não se entregar à depressão. A doença materializa-se no corpo com o uso da medicação, mas é possível, apesar das dificuldades, conciliar a rotina com o tratamento ARV. Destaca-se a importância fundamental da variável tempo para a criação de estratégias que possibilitem a inserção da doença e do tratamento no cotidiano.

This paper discusses the psychosocial meanings of HIV/Aids treatment, using qualitative methods to assess daily operations of a reference hospital, located in Baixada Fluminense, Rio de Janeiro's outskirts. In-depth interviews were carried out with 10 women living with HIV/Aids, under antiretroviral (ARV) therapy. The meaning of treatment is related to: the impact of the diagnosis; the treatment moment, concerning different phases of living with the disease; the public and private spaces where a woman preferable lives with the disease and does her treatment; sharing or not information about the disease/treatment with partner; the search for other rationalities (religion and alternative medicine) as a counterpoint to medical prescriptions; the establishment or not of emotional inlays with the doctor. There is an interrelation of taking care of the kid(s) and taking care of themselves (referring to ARV therapy). Self-care is seen as an affirmation of life. That is what gives the person the measure of health. "Not to let the sick person take place" means keeping away from depression. The disease materializes itself in the body that uses the medication, but it is possible, even it is hard, to conciliate life routine with therapy. We highlight the fundamental importance of time for the creation of strategies that facilitate the insertion of the disease and treatment in daily life.

As diferentes facetas no tratamento do HIV/AIDS: uma análise de representações sociais de enfermeiros / The different facets in the treatment of HIV/AIDS: an analysis of nursing' social representations

O presente estudo tem como objetivo apreender e analisar as representações sociais do tratamento do HIV/AIDS para enfermeiros atuantes em um hospital de referência, localizado do município do Rio de Janeiro. Trata-se de um estudo descritivo com abordagem qualitativa, que utilizou como referencial teórico-metodológico a teoria das representações sociais. Os sujeitos do estudo foram 20 enfermeiros que atuam em um hospital público universitário da cidade do Rio de Janeiro. A coleta de dados deu-se por meio de entrevista semi-estruturada. Para análise dos depoimentos obtidos através das entrevistas utilizou-se a técnica de análise de conteúdo temática, proposta por Bardin (1977). Após a análise, emergiram nove categorias: “O tratamento medicamentoso e os determinantes de sua adesão”; “O tratamento clínico e físico”; “Ações psico-espirituais enquanto parte do tratamento”; “A abordagem terapêutica social na busca da qualidade de vida”; “Ações educativas preventivas e terapêuticas”; “A dinâmica familiar envolvida no tratamento”; “O cuidado psicossocial no diagnóstico e suas repercussões”; “O relacionamento interpessoal como parte do tratamento”; “Sentimentos do profissional que cuida”. A representação social do tratamento prestado ao portador do HIV/AIDS, identificada no presente estudo, foi construída a partir das novas necessidades apresentadas por estes pacientes, diante do caráter de cronicidade do HIV/AIDS. Observa-se que as representações sociais apreendidas apontam para uma concepção de tratamento dentro de uma perspectiva holística, e não apenas focada na doença e no corpo, apontando para o tratamento enquanto atendimento das necessidades humanas essenciais e não apenas garantia de sobrevivência.

The purpose of the present study is to apprehend and analyze the social representations of HIV/AIDS to nurses who work in a hospital of reference located in Rio de Janeiro. This is a qualitative descriptive study which used as theoretical-methodological reference the social representations theory. The study subjects were 20 nurses who work in a public university hospital in Rio de Janeiro City. The data collection was obtained by means of semi-structured interview. To analyze the statements obtained through the interviews the Technique of Analysis of Thematic Content proposed by Bardin (1977) was chosen. Nine categories emerged after analysing: “The drug treatment and the determinants of its adherence”; “The clinic and physical treatment”; “Psycho-spiritual actions while treating”; “The social therapeutic approach in the pursuit of the quality of life”; “Preventive and therapeutic educative actions”; “The family dynamics involved in the treatment”; “The psychosocial care in diagnostic and its repercussions”; “The interpersonal relationship as part of the treatment”; “The professional’s feelings who cares”. The social representation of the treatment given to HIV-positive patients identified in this study was built from the new necessities presented by these patients before the character of HIV cronicity. It is observed that the social representations apprehended point to a treatment conception within a holistic perspective, and not only focused on the disease and body, indicating the treatment while attending the essential human necessities and not only assuring the survival.