HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: The need for increasing awareness and knowledge.

BACKGROUND: As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. METHODS: A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. RESULTS: A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6-27.0) and was higher in the rural community (31.6%; 95% CI: 27.0-35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. CONCLUSION: The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.

HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: the need for increasing awareness and knowledge

As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. Methods A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. Results A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6­27.0) and was higher in the rural community (31.6%; 95% CI: 27.0­35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. Conclusion The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.

The role of agency in the implementation of Isoniazid Preventive Therapy (IPT): Lessons from oMakoti in uMgungundlovu District, South Africa.

INTRODUCTION: In response to revisions in global and national policy in 2011, six-month isoniazid preventive therapy (IPT) became freely available as a preventive measure for people living with HIV in the uMgungundlovu District of KwaZulu-Natal province, South Africa. Given a difference in uptake and completion by sex, we sought to explore the reasons why Zulu women were more likely to accept and complete IPT compared to men in an effort to inform future implementation. METHODS: Utilising a community-based participatory research approach and ethnographic methods, we undertook 17 individual and group interviews, and met regularly with grassroots community advisory teams in three Zulu communities located in uMgungundlovu District between March 2012-December 2016. FINDINGS & DISCUSSION: Three categories described women's willingness to initiate IPT: women are caregivers, women are obedient, and appearance is important. The findings suggest that the success of IPT implementation amongst clinic-utilising women of uMgungundlovu is related to the cultural gender norms of uMakoti, isiZulu for "the bride" or "the wife." We invoke the cultural concept of inhlonipho, meaning "to show respect," to discuss how the cultural values of uMakoti may conflict with biomedical expectations of adherence. Such conflict can result in misinterpretations by healthcare providers or patients, and lead some patients to fear the repercussions of asking questions or contemplating discontinuation with the provider, preferring instead to appear obedient. We propose a shift in emphasis from adherence-focussed strategies, characteristic of the current biomedical approach, to practices that promote patient agency in an effort to offer IPT more appropriately. IMPLICATIONS: Building on existing tools, namely the harm reduction model and the use of mini-ethnography, we provide guidance on how to support women to participate as agents in the decision to initiate or continue IPT, decisions which may also impact the health and choices of the family.

Validity and reliability of the tuberculosis-related stigma scale version for Brazilian Portuguese.

BACKGROUND: Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients. METHODS: The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study. RESULTS: As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%. CONCLUSION: The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context.

A disease called stigma: the experience of stigma among African men with TB diagnosis in London.

OBJECTIVES: Tuberculosis (TB) is a highly stigmatised disease. This paper sought to explore the experiences and meanings of stigma among African men with a previous TB diagnosis. STUDY DESIGN: Qualitative approach with ten men recruited from a community based organisation offering health support to the men. METHODS: In-depth semi-structured interviews. RESULTS: Men were unable to recognise TB symptoms and subsequently made late clinical presentation when they were also diagnosed with HIV. A few were diagnosed when in immigration detention centres. The experience of late diagnosis informed their understanding of the word stigma. The link between HIV and TB compounded experiences of stigma which led to depression and compromised HIV confidentiality. CONCLUSION: TB late diagnosis among the men has implications for population health. Multidisciplinary teams supporting ongoing TB education programmes should include African men's organisations, due to the close supportive links such organisations have with African men.

O autocuidado de idosos com HIV/aids: contribuições de Enfermagem / Self-care of elderly people with HIV/AIDS: nursing contributions

Pesquisa de abordagem qualitativa com o objetivo de discutir como idosos com HIV/aids realizam o autocuidado, quais as implicações para sua saúde e para o cuidado de enfermagem. Aprovada pelos Comitês de Ética em Pesquisa EEAN/HESFA e HUCFF/UFRJ, utilizou o método Grounded Theory (GT) ou Teoria Fundamentada em Dados (TFD) para guiar a coleta, análise e discussão dos dados de 25 idosos com HIV/aids, usuários do ambulatório de Doenças Infecciosas e Parasitárias do HUCFF/UFRJ. Na entrevista e pesquisa documental foram utilizados dois instrumentos: o roteiro da entrevista, com seções semiestruturada e estruturada, e a planilha de registro de informações nos prontuários. Do total de idosos entrevistados, 60% eram homens, 48% entre 60 e 64 anos, 68% heterossexuais, 32% solteiros e 32% viúvos, 84% aposentados ou pensionistas, 48% frequentaram a escola de nove (09) a onze (11) anos,e 68% informaram renda entre um (01) e três (03) salários mínimos. O tempo de diagnóstico HIV/aids variou de dois (02) a 30 anos, a idade no momento do diagnóstico de 30 a 70 anos, com 100% fazendo uso da TARV por períodos entre um (01) e 25 anos. As doenças oportunistas mais frequentes foram pneumonia, tuberculose e herpes zoster e as comorbidades foram hipertensão arterial sistêmica, diabetes mellitus e dislipidemia. A partir dos dados submetidos aos processos analíticos da TFD, emergiram 47 códigos, agrupados em oito (08) subcategorias - (1) O Mim, (2) Diagnóstico, (3) Saúde Mental, (4) Saúde Física, (5) Espiritualidade, (6) Sexualidade, (7) O Outro, (8) Preconceito - e três (03) categorias - "Idoso com HIV/aids", "Interação Social" e a categoria central "Autocuidado", ilustradas pelo diagrama de Venn. Em conclusão, dentre as demandas de cuidado físico e psicossocial de enfermagem aos idosos com HIV/aids, emergiram necessidades de instrumentalização para a adoção e sustentação do autocuidado e de fomentar a autoestima para o enfrentamento do preconceito.

Qualitative approach research with the objective to discuss how older adults with HIV/aids practice self-care, its health and nursing care implications. Approved by the EEAN/HESFA and HUCFF/UFRJ Institutional Review Boards (IRBs), used Grounded Theory (GT) or Teoria Fundamentada em Dados (TFD) to guide data collection, analysis and discussion of 25 older adults with HIV/aids, outpatients at the Infectious and Parasitic Diseases at the HUCFF/UFRJ ambulatory. Two instruments were used on the interview and documental research: the interview guide with two sections, one semi-structured and one structured, and a spreadsheet for data entry of information on patient files. From the overall number of participants, 60% were men, 48% between 60-64 years old, 68% heterosexuals, 32% single and 32% widowers, 84% were retired or received pensions, 48% attended school between nine (09) and eleven (11) years, and 68% declared income between one (01) e three (03) minimum wages. HIV/aids time of known diagnosis varied from two (02) to 30 years; age at the time of diagnosis between 30-70 years old, with 100% in use of Antiretroviral Therapy (ART) for periods varying between one (01) and 25 years long. The most frequent opportunist diseases were pneumonia, tuberculosis and herpes zoster and the comorbidities were systemic hypertension, diabetes mellitus and dyslipidemia. From the data submitted to GT analytic processes, emerged 47 codes, groups into eight (08) subcategories - (1) The Me, (2) Diagnose, (3) Mental Health, (4) Physical Health, (5) Spirituality, (6) Sexuality, (7) The Other, (8) Prejudice- and three (03) categories- "Older with HIV/aids", "Social Interaction" and the central category "Self-care", illustrated by a Venn diagram. In conclusion, among the nursing physical and psychosocial care demands of older adults with HIV/aids, emerged needs for effective support towards(i) the adoption and sustainingof self-care practices and (ii) the building up of self-esteem for coping against prejudice.

Investigación de abordaje cualitativa com el objetivo de discutir como ancianos con VIH/sida realizan el autocuidado, cuales las implicaciones para su salud y para el cuidado de enfermería. Aprobada por los Comités de Ética em Investigación EEAN/HESFA y HUCFF/UFRJ, utilizo el método Grounded Theory (GT) o Teoría Fundamentada em Datos (TFD) para conducir la recolección, análisis y discusión de los datos de 25 ancianos con VIH/sida, usuários del ambulatorio de Enfermedades Infecciosas y Parasitarias del HUCFF/UFRJ. En la entrevista e investigación documental fueron utilizados dos instrumentos: el guión de la entrevista, con secciones semiestructurada y estructurada, y una hoja de trabajo para registro de informaciones em los historiales clínicos. En la totalidad de participantes entrevistados, 60% eran hombres, 48% entre 60 y 64 años, 68% heterosexuales, 32% solteros y 32% viudos, 84% eran jubilados o pensionistas, 48% con nueve (09) a once (11) años de escolaridad, y 68% informaron renta entre una (01) y tres (03) remuneraciones mínimas. El tiempo de diagnóstico VIH/sida varió de dos (02) a 30 años, la edad en el momento del diagnóstico de 30 a 70 años, con 100% haciendo uso de la Terapia Antirretroviral (TAR) por periodos entre uno (01) y 25 años. Las enfermedades oportunistas más frecuentes fueronpulmonía, tuberculosis y herpes zóster y las comorbilidades fueron hipertensión arterial sistémica, diabetes mellitus y dislipimia. A partir de los datos sometidos a los procesos analíticos de la TFD, emergieron 47 códigos, agrupados en ocho (08) subcategorias - (1) El Mí, (2) Diagnóstico, (3) Salud Mental, (4) Salud Física, (5) Espiritualidad, (6) Sexualidad, (7) El Otro, (8) Prejuicio ­ y tres (03) categorías ­ "Anciano con VIH/sida", "Interacción Social" y la categoría central "Autocuidado", ilustradas por el diagrama de Venn. En conclusión, de las demandas del cuidado físico y psicosocial de enfermería a los ancianos con VIH/sida, emergieron necesidades de instrumentalización para la adopción y sustentación del autocuidado y de fomentar la autoestima para el enfrentamiento del prejuicio.

[Cryptococcal meningitis and neuropsychiatric consequences of HIV-infection]. / Cryptokokkenmeningitis en neuro-psychiatrische gevolgen van hiv-besmetting.

A 49-year-old African-born male was admitted to hospital with an acute psychosis. He had been treated by an internist after being found to have hiv; as a result of non-compliance over a period of about four months his cd4-count had dropped to 40. Six months earlier he had developed a cryptococcal meningitis, which left him a number of neurological and psychiatric symptoms. During his stay in hospital there had to be good collaboration with the specialist in internal medicine whose dual task was to manage the patient's dramatically low cd4-account as well as his psychosis. Cryptococcal meningitis is a risk factor for psychiatric disorders and mortality in hiv-infected persons.