Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial.

BACKGROUND: South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. METHOD: Twenty-three pregnant women with HIV (WWH), ages 18-45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. RESULTS: Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, ß = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, ß = - 13.8, t(24) = - 3.3, p < 0.005, 95% CI [- 22.50, - 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. CONCLUSION: A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.

Preventing cardiovascular disease in midlife women with HIV: An examination of facilitators and barriers to heart health behaviors.

Midlife women with HIV (WWH) are disproportionately impacted by cardiovascular disease (CVD), yet little is known about perceptions of CVD risk and the factors that influence engagement in heart health behaviors in this population. Few (if any) studies have used a qualitative approach to examine these perceptions, which has important implications for minimizing the negative impact of HIV-related noncommunicable diseases, the risk for which increases after midlife. Eighteen midlife WWH (aged 40-59) in Boston, MA, completed semistructured interviews to explore perceptions of CVD, HIV, and barriers and facilitators to healthy lifestyle behaviors. Interviews were analyzed via thematic analysis. Participants viewed heart health as important but were unaware of HIV-associated CVD risk. Facilitators included family and generational influences, social support, and access to resources. Physical symptoms, menopause, mental health challenges, and limited financial resources were barriers. Midlife WWH may benefit from tailored CVD prevention interventions that target their unique motivations and barriers to healthy behaviors.

Morphological evidence of marine adaptations in human kidneys.

Amongst primates, kidneys normally exhibiting lobulated, multipyramidal, medullas is a unique attribute of the human species. Although, kidneys naturally multipyramidal in their medullary morphology are rare in terrestrial mammals, kidneys with lobulated medullas do occur in: elephants, bears, rhinoceroses, bison, cattle, pigs, and the okapi. However, kidneys characterized with multipyramidal medullas are common in aquatic mammals and are nearly universal in marine mammals. To avoid the deleterious effects of saline water dehydration, marine mammals have adaptively thickened the medullas of their kidneys--which enhances their ability to concentrate excretory salts in the urine. However, the lobulation of the kidney's medullary region in marine mammals appears to be an adaptation to expand the surface area between the medulla and the enveloping outer cortex in order to increase the volume of marine dietary induced hypertonic plasma that can be immediately processed for the excretion of excess salts and nitrogenous waste. A phylogenetic review of freshwater aquatic mammals suggest that most, if not all, nonmarine aquatic mammals inherited the medullary pyramids of their kidneys from ancestors who originally inhabited, or frequented, marine environments. So this suggest that most, if not all, aquatic mammals exhibiting kidneys with lobulated medullas are either marine adapted--or are descended from marine antecedents. Additionally, a phylogenetic review of nonhuman terrestrial mammals possessing kidneys with multipyramidal medullas suggest that bears, elephants and possibly rhinoceroses, also, inherited their lobulated medullas from semiaquatic marine ancestors. The fact that several terrestrial mammalian species of semiaquatic marine ancestry exhibit kidneys with multipyramidal medullas, may suggest that humans could have, also, inherited the lobulated medullas of their kidneys from coastal marine ancestors. And a specialized marine diet in ancient human ancestry could, also, explain the reactivation and enumeration of corporeal eccrine sweat glands and the copious secretion of salt tears. The substantial loss of genetic variation in humans relative to other hominoid primates, combined with the apparent isolation of early Pliocene human ancestors from particular retroviruses that infected all other African primate species, may suggest that such a semiaquatic marine phase, during the emergence of Homo, may have occurred on an island off the coast of Africa during the early Pliocene.