Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.026
Filtrar
2.
BMJ Open ; 11(9): e049673, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489284

RESUMO

OBJECTIVES: In sub-Saharan Africa (SSA) where HIV burden is highest, access to testing, a key entry point for prevention and treatment, remains low for adolescents (aged 10-19). Access may be hampered by policies requiring parental consent for adolescents to receive HIV testing services (HTS). In 2013, the WHO recommended countries to review HTS age of consent policies. Here, we investigate country progress and policies on age of consent for HIV testing. DESIGN: Comprehensive policy review. DATA SOURCES: Policies addressing HTS were obtained through searching WHO repositories and governmental and non-governmental websites and consulting country and regional experts. ELIGIBILITY CRITERIA: HTS policies published by SSA governments before 2019 that included age of consent. DATA EXTRACTION AND SYNTHESIS: Data were extracted on HTS age of consent including exceptions based on risk and maturity. Descriptive analyses of included policies were disaggregated by Eastern and Southern Africa (ESA) and Western and Central Africa (WCA) subregions. RESULTS: Thirty-nine policies were reviewed, 38 were eligible; 19/38 (50%) permitted HTS for adolescents ≤16 years old without parental consent. Of these, six allowed HTS at ≥12 years old, two at ≥13, two at ≥14, five at ≥15 and four at ≥16. In ESA, 71% (n=15/21) allowed those of ≤16 years old to access HTS, while only 24% (n=6/25) of WCA countries allowed the same. Maturity exceptions including marriage, sexual activity, pregnancy or key population were identified in 18 policies. In 2019, 63% (n=19/30) of policies with clear age-based criteria allowed adolescents of 12-16 years old to access HIV testing without parental consent, an increase from 37% (n=14/38) in 2013. CONCLUSIONS: While many countries in SSA have revised their HTS policies, many do not specify age of consent. Revision of SSA consent to HTS policies, particularly in WCA, remains a priority to achieve the 2025 goal of 95% of people with HIV knowing their status.


Assuntos
Infecções por HIV , Adolescente , África ao Sul do Saara , Criança , Feminino , Infecções por HIV/diagnóstico , Humanos , Casamento , Políticas , Gravidez , Comportamento Sexual
3.
Medicine (Baltimore) ; 100(35): e27030, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477133

RESUMO

ABSTRACT: The Human Immunodeficiency Virus (HIV) seropositive prevalence among women with cervical cancer varies in different parts of the world and even within a country. This study aimed to document the prevalence of HIV infection in women with newly diagnosed cervical cancer at a secondary hospital in South Africa.This study is a retrospective review of records of 89 women who were newly diagnosed with cervical cancer between 01 June 2010 and 31 May 2013 at Pelonomi Hospital, Mangaung, South Africa. Data such as age, parity, gravidity, marital status, occupation, HIV status, CD4 count, on anti-retroviral treatment, clinical stage of disease were retrieved from the case files, the Meditech-patient record and Disa laboratory system. Data analysis was done using the SAS statistical package.HIV-seropositive prevalence was 52.4%, with the highest prevalence (91.3%) in the age group 40 years and younger. In HIV-positive women, the mean CD4 cell count was 280 cell/mm3 and 43% of them were not on anti-retroviral treatment. The majority (86%) of all patients presented with late stage disease (International Federation of Gynecology and Obstetrics Stage III and IV) when newly diagnosed with cervical cancer.This study highlights high HIV-seropositive prevalence; severe immunosuppression and late presentation of the disease in women newly diagnosed with cervical cancer. Cervical cancer screening programs need to be fully reinforced into existing HIV health care services to allow for ideal prevention and early detection of the disease. Anti-retroviral treatment needs to be prioritized for HIV-positive women.


Assuntos
Infecções por HIV/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Estudos de Coortes , Correlação de Dados , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia , Neoplasias do Colo do Útero/epidemiologia
5.
J Int Assoc Provid AIDS Care ; 20: 23259582211041260, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34488480

RESUMO

BACKGROUND: South Florida has the highest HIV rates across the country. Emergency Rooms (ERs) are optimal clinical sites for the identification of people living with HIV. We aimed to evaluate the feasibility and yield of opt-out HIV testing among ER patients in a large community healthcare system in South Florida, and determine the impact of the COVID-19 pandemic on HIV testing. METHODS: This was a retrospective study conducted in the Memorial Healthcare System, Hollywood, Florida. HIV test was offered on an "opt-out" basis to patients aged 16 years or older presenting to the ER of the Memorial Regional Hospital between July 2018 and August 2020. Number of ER visits, HIV testing offered, acceptance of HIV testing, tested positive for HIV infection and linkage to care were reviewed and analyzed. RESULTS: A total of 105,264 (53.7%) patients of 196,110 ER visits were eligible for HIV testing and 39,261 (37.3%) completed HIV testing. Of those tested, 206 (0.5%) patients tested positive, with 54 (26.2%) new infected patients and 152 (73.8%) known infected patients who had not disclosed their status. 45 (60%) of 75 patients with known HIV infections who were not engaged in HIV care were successfully relinked into care after testing, and engagement in care increased from 50.7% pre-testing to 80.3% post-testing (p = 0.001). 45 (83.3%) of 54 newly diagnosed patients were successfully linked into care. During the COVID-19 pandemic, there was a significant reduction in both the ER visits and HIV tests as compared with the pre-pandemic period (p = 0.007 and p < 0.001, respectively). CONCLUSION: An "Opt-out" HIV testing program was successfully implemented in a community hospital ERs. The use of this strategy successfully identified patients with undiagnosed HIV infection and improved their engagement in HIV care. Given the impact of COVID-19 pandemic on the testing program, new strategies should develop to reduce service disruption and maintain the progress of "Opt-out" HIV testing.


Assuntos
COVID-19 , Infecções por HIV , Planejamento em Saúde Comunitária , Serviço Hospitalar de Emergência , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV , Humanos , Programas de Rastreamento , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , SARS-CoV-2
6.
AIDS Res Ther ; 18(1): 59, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503542

RESUMO

BACKGROUND: We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy. METHODS: A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy). RESULTS: Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05). CONCLUSIONS: The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.


Assuntos
Infecções por HIV , Terapia Antirretroviral de Alta Atividade , China/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Modelos de Riscos Proporcionais , Estudos Prospectivos
7.
Trials ; 22(1): 630, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530894

RESUMO

BACKGROUND: Malawi is a low-income country in sub-Saharan Africa that has limited resources to address a significant burden of disease-including HIV/AIDS. Additionally, depression is a leading cause of disability in the country but largely remains undiagnosed and untreated. The lack of cost-effective, scalable solutions is a fundamental barrier to expanding depression treatment. Against this backdrop, one major success has been the scale-up of a network of more than 700 HIV clinics, with over half a million patients enrolled in antiretroviral therapy (ART). As a chronic care system with dedicated human resources and infrastructure, this presents a strategic platform for integrating depression care and responds to a robust evidence base outlining the bi-directionality of depression and HIV outcomes. METHODS: We will evaluate a stepped model of depression care that combines group-based Problem Management Plus (group PM+) with antidepressant therapy (ADT) for 420 adults with moderate/severe depression in Neno District, Malawi, as measured by the Patient Health Questionnaire-9 (PHQ-9) and Mini-International Neuropsychiatric Interview (MINI). Roll-out will follow a stepped-wedge cluster randomized design in which 14 health facilities are randomized to implement the model in five steps over a 15-month period. Primary outcomes (depression symptoms, functional impairment, and overall health) and secondary outcomes (e.g., HIV: viral load, ART adherence; diabetes: A1C levels, treatment adherence; hypertension: systolic blood pressure, treatment adherence) will be measured every 3 months through 12-month follow-up. We will also evaluate the model's cost-effectiveness, quantified as an incremental cost-effectiveness ratio (ICER) compared to baseline chronic care services in the absence of the intervention model. DISCUSSION: This study will conduct a stepped-wedge cluster randomized trial to compare the effects of an evidence-based depression care model versus usual care on depression symptom remediation as well as physical health outcomes for chronic care conditions. If determined to be cost-effective, this study will provide a model for integrating depression care into HIV clinics in additional districts of Malawi and other low-resource settings with high HIV prevalence. TRIAL REGISTRATION: ClinicalTrials.gov NCT04777006 . Registered on 1 March, 2021.


Assuntos
Depressão , Infecções por HIV , Adulto , Análise Custo-Benefício , Depressão/diagnóstico , Depressão/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Malaui , Ensaios Clínicos Controlados Aleatórios como Assunto , Carga Viral
9.
J Pak Med Assoc ; 71(Suppl 4)(8): S6-S10, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34469422

RESUMO

OBJECTIVE: To assess the feasibility of index testing approach to test the parents and siblings of human immunodeficiency virus (HIV)-positive children, and identify HIV-positive individuals. Methods: The study was conducted at Ratodero, Pakistan. Study participants were enrolled from September 2019 to February 2020. The list of HIV-positive persons was provided by the Sindh AIDS Control Programme. Families of 706 HIV-positive persons were approached and all of them agreed to participate. The first test was performed by trained outreach workers. All those with a reactive first test were transported to the nearest health facility for further testing and confirmation. Mothers and siblings were tested at home while additional visits were carried out to reach the fathers. RESULTS: A total of 1766 persons were tested through HIV index testing. Biological siblings accounted for 81% of the contacts. We were able to test 413/463 (89.2%) mothers, 232/413 (56.2%) fathers and 1121/1392 (80.5%) siblings. Out of these, 7 mothers (1.7%) and 22 siblings (2.0%) were confirmed to be HIV-positive, while no one was found to be positive among the fathers. The overall HIV prevalence was 1.6% (29/1766). All HIV-positive persons were guided for treatment and care. CONCLUSIONS: Results indicate that index-testing approach is feasible in Pakistan to expand HIV testing services through home visits.


Assuntos
Infecções por HIV , Criança , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV , Instalações de Saúde , Humanos , Paquistão/epidemiologia , Pais
10.
Bull World Health Organ ; 99(9): 618-626, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475599

RESUMO

Objective: To determine how often men in Malawi attend health facilities and if testing for human immunodeficiency virus (HIV) is offered during facility visits. Methods: We conducted a cross-sectional, community-representative survey of men (15-64 years) from 36 villages in Malawi. We excluded men who ever tested HIV-positive. Primary outcomes were: health facility visits in the past 12 months (for their own health (client visit) or to support the health services of others (guardian visit)); being offered HIV testing during facility visits; and being tested that same day. We disaggregated all results by HIV testing history: tested ≤ 12 months ago, or in need of testing (never tested or tested > 12 months before). Findings: We included 1116 men in the analysis. Mean age was 34 years (standard deviation: 13.2) and 55% (617/1116) of men needed HIV testing. Regarding facility visits, 82% (920/1116) of all men and 70% (429/617) of men in need of testing made at least one facility visit in the past 12 months. Men made a total of 1973 visits (mean two visits): 39% (765/1973) were as guardians and 84% (1657/1973) were to outpatient departments. Among men needing HIV testing, only 7% (30/429) were offered testing during any visit. The most common reason for not testing was not being offered services (37%; 179/487). Conclusion: Men in Malawi attend health facilities regularly, but few of those in need of HIV testing are offered testing services. Health screening services should capitalize on men's routine visits to outpatient departments as clients and guardians.


Assuntos
Infecções por HIV/diagnóstico , Instalações de Saúde/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Malaui/epidemiologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
11.
AIDS Res Ther ; 18(1): 52, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399787

RESUMO

BACKGROUND: HIV and hepatitis C virus (HCV) have shared routes of transmission among men who have sex with men (MSM). Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We evaluated factors associated with HIV and HCV testing in a behaviorally vulnerable cohort of predominantly MSM. METHODS: From June 2018 through June 2019, the BRAHMS study enrolled adults at ten German outpatient clinics that serve gender and sexual minority populations. Participants completed behavioral questionnaires that captured prior experience with HIV and HCV testing. Multivariable robust Poisson regression was used to evaluate factors potentially associated with testing in the previous 6 months. RESULTS: Among 1017 participants with median age 33 (interquartile range 28-39) years, 1001 (98.4%) reported any lifetime history of HIV testing and 787 (77.4%) reported any HCV testing, including 16 (1.6%) known to be living with HCV. Testing within the last 6 months was reported by 921 (90.6%) and 513 (50.4%) for HIV and HCV, respectively. Recent HIV testing was more common among participants with higher education level and recent HCV testing. Recent HCV testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing. CONCLUSION: Prior testing for HIV was common in this cohort, but interventions are needed to improve HCV risk stratification and access to testing. HIV testing infrastructure can be successfully leveraged to support HCV testing, but differentiated preventive care delivery is needed for some vulnerable populations.


Assuntos
Infecções por HIV , Hepatite C , Minorias Sexuais e de Gênero , Adulto , Estudos de Coortes , Estudos Transversais , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepacivirus , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Fatores de Risco
12.
Front Public Health ; 9: 653565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34354973

RESUMO

Background: The ATLAS program promotes and implements HIVST in Côte d'Ivoire, Mali, and Senegal. Priority groups include members of key populations-female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD)-and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic. Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative, and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of and the disruption of field activities. Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d'Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact. Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.


Assuntos
COVID-19 , Infecções por HIV , Profissionais do Sexo , Minorias Sexuais e de Gênero , Costa do Marfim/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Homossexualidade Masculina , Humanos , Masculino , Mali/epidemiologia , Pandemias , SARS-CoV-2 , Autoteste , Senegal/epidemiologia
13.
BMC Med Res Methodol ; 21(1): 159, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332540

RESUMO

AIM: HIV prevention measures in sub-Saharan Africa are still short of attaining the UNAIDS 90-90-90 fast track targets set in 2014. Identifying predictors for HIV status may facilitate targeted screening interventions that improve health care. We aimed at identifying HIV predictors as well as predicting persons at high risk of the infection. METHOD: We applied machine learning approaches for building models using population-based HIV Impact Assessment (PHIA) data for 41,939 male and 45,105 female respondents with 30 and 40 variables respectively from four countries in sub-Saharan countries. We trained and validated the algorithms on 80% of the data and tested on the remaining 20% where we rotated around the left-out country. An algorithm with the best mean f1 score was retained and trained on the most predictive variables. We used the model to identify people living with HIV and individuals with a higher likelihood of contracting the disease. RESULTS: Application of XGBoost algorithm appeared to significantly improve identification of HIV positivity over the other five algorithms by f1 scoring mean of 90% and 92% for males and females respectively. Amongst the eight most predictor features in both sexes were: age, relationship with family head, the highest level of education, highest grade at that school level, work for payment, avoiding pregnancy, age at the first experience of sex, and wealth quintile. Model performance using these variables increased significantly compared to having all the variables included. We identified five males and 19 females individuals that would require testing to find one HIV positive individual. We also predicted that 4·14% of males and 10.81% of females are at high risk of infection. CONCLUSION: Our findings provide a potential use of the XGBoost algorithm with socio-behavioural-driven data at substantially identifying HIV predictors and predicting individuals at high risk of infection for targeted screening.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , África ao Sul do Saara/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Aprendizado de Máquina , Masculino , Programas de Rastreamento , Gravidez
14.
BMC Infect Dis ; 21(1): 768, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34364383

RESUMO

BACKGROUND: The COVID-19 pandemic seriously threatens general public health services globally. This study aimed to evaluate the impact of the COVID-19 pandemic on the HIV care continuum in Jiangsu province, China. METHODS: Data on newly diagnosed HIV persons for analysis were retrieved from Chinas' web-based Comprehensive Response Information Management System (CRIMS) for HIV/AIDS from 2016 to 2020. We recorded data for the first 3 months (January to March, 2020) of strictly implementing COVID-19 measures from publicly available disease databases of the Jiangsu provincial Health Committee. We used seasonal autoregressive integrated moving average (SARIMA) and exponential smoothing in forecasting the parameters. Subgroup differences were accessed using Chi-square tests. RESULTS: Compared to the estimated proportions, the HIV testing rates decreased by 49.0% (919,938) in the first three months of implementing COVID-19 measures. Of an estimated 1555 new HIV diagnosis expected in the same period, only 63.0% (980) new diagnoses were recorded. According to actual data recorded during the said period, 980 positively tested persons received confirmatory tests, of which 71.4% (700) were reportedly linked to care. And only 49.5% (235) out of the expected 475 newly diagnosed HIV persons received CD4 cell count testing. Meanwhile 91.6% (208) of newly diagnosed HIV persons who received CD4 count tests reportedly initiated antiretroviral therapy (ART) compared to the 227 expected. Compared to the same period from 2016 to 2019, PLWH less than 30 years old and migrants were more likely to be affected by the COVID-19 policies. CONCLUSIONS: The COVID-19 pandemic negatively impacted HIV healthcare systems in Jiangsu, China. Further measures that can counter the impact of the pandemic are needed to maintain the HIV care continuum.


Assuntos
COVID-19 , Continuidade da Assistência ao Paciente , Infecções por HIV , Adulto , COVID-19/epidemiologia , China/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
15.
Malawi Med J ; 33(1): 65-67, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422236

RESUMO

There is a rising prevalence of Non-Tuberculous Mycobacterial (NTM) disease in sub-Saharan Africa identified on culture specimens. However, distinguishing mycobacterial colonisations from infection from identified NTMs on culture in the sub-Saharan Africa setting remains to be established. A 49-year-old man presented with the cardinal symptoms of tuberculosis (TB) in a community TB prevalence survey in Blantyre, Malawi. Mycobacteriology was atypical, prompting a line probe assay which revealed Mycobacterium avium complex (MAC) species. The epidemiology of Mycobacterium tuberculosis complex (MTBC) is better known than that of NTM. Up-scaling culture and speciation may be a solution to this gap in knowledge of the burden of disease of NTM. Like most resource-poor settings, TB culture is not routinely done in the diagnosis and management of TB in Malawi. Furthermore, the treatment of NTM is not analogous to that of MTBC. The multi-drug regimens used for NTM disease treatment includes a newer macrolide (azithromycin, clarithromycin), ethambutol, and rifamycin, and require prolonged durations of therapy aimed at facilitating clearance of the mycobacteria and minimizing the emergence of drug resistance. Clinicians must thus be aware of this rising burden of NTM disease and consider other diagnostic options to better investigate this disease in patients.


Assuntos
Antituberculosos/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Micobactérias não Tuberculosas/isolamento & purificação , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
PLoS One ; 16(8): e0256330, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34449773

RESUMO

BACKGROUND: COVID-19 has proved to have an indirect impact on essential health services in several parts of the world which could lead to increased morbidity and mortality and loss of the gains made in the past decades. There were no synthesized scientific evidences which could show the impact of COVID-19 epidemics/pandemic on essential health services in Tigray, Northern Ethiopia. Therefore, this study aimed to assess the impacts of COVID-19 epidemics/pandemic on essential health services provision in Tigray, Northern Ethiopia. METHODS: A pre-post study design was used to assess the impacts of COVID-19 on essential health services delivery in Tigray, Northern Ethiopia in the second quarter of 2020 (Post COVID-19) compared to similar quarter in 2019 (Pre COVID-19). The study focuses on five categories; namely; maternal, neonatal and child health care; communicable diseases with a focus on HIV and TB-HIV co-infection; prevention of mother to child transmission of HIV; basic emergency, outpatient, inpatient and blood bank services, non-communicable diseases and road traffic accidents (RTAs). Analysis was done using Stata version 14.0 software package. The effects of COVID-19 epidemics/pandemic were calculated taking the differences between post COVID -19 and pre COVID-19 periods and the levels of service disruptions presented using proportions. Wilcoxon sign rank test was done and a significance level of ≤0.05 was considered as having significant difference among the two quarters. RESULTS: There were significant increase in institutional delivery, delivery by Caesarian Section (CS), still birth, postnatal care within 7 days of delivery, the number of children who received all vaccine doses before 1st birthday, the number of under 5 children screened and had moderate acute malnutrition, the number of under 5 children screened and had severe acute malnutrition and children with SAM admitted for management. However, there were significant decrease in HIV testing and detection along with enrolment to antiretroviral therapy (ART) care, number of patients with cardiovascular disease (CVD) risk ≥ 30% received treatment, RTAs, total units of blood received from national blood transfusion service (NBTS) and regional blood banks, total number of units of blood transfused and emergency referral. There were no significant changes in outpatient visits and admissions. CONCLUSION: Despite commendable achievements in maintaining several of the essential health services, COVID-19 has led to an increase in under nutrition in under five children, decline in HIV detection and care, CVD, cervical cancer screening and blood bank services. Therefore, governments, local and international agencies need to introduce innovative ways to rapidly expand and deliver services in the context of COVID-19. Moreover, lower income countries have to customize comprehensive and coordinated community-based health care approaches, including outreach and campaigns. In addition, countries should ensure that NCDs are incorporated in their national COVID-19 response plans to provide essential health care services to people living with NCDs and HIV or HIV-TB co-infection during the COVID-19 pandemic period.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde , Antirretrovirais/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , COVID-19/virologia , Doenças Cardiovasculares/diagnóstico , Parto Obstétrico/estatística & dados numéricos , Etiópia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pandemias , Cuidado Pós-Natal , SARS-CoV-2/isolamento & purificação , Vacinação/estatística & dados numéricos
17.
PLoS One ; 16(8): e0256883, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34464413

RESUMO

BACKGROUND: The GeneXpert diagnostic platform from the US based company Cepheid is an automated molecular diagnostic device that performs sample preparation and pathogen detection within a single cartridge-based assay. GeneXpert devices can enable diagnosis at the district level without the need for fully equipped clinical laboratories, are simple to use, and offer rapid results. Due to these characteristics, the platform is now widely used in low- and middle-income countries for diagnosis of diseases such as TB and HIV. Assays for SARS-CoV-2 are also being rolled out. We aimed to quantify public sector investments in the development of the GeneXpert platform and Cepheid's suite of cartridge-based assays. METHODS: Public funding data were collected from the proprietor company's financial filings, grant databases, review of historical literature concerning key laboratories and researchers, and contacting key public sector entities involved in the technology's development. The value of research and development (R&D) tax credits was estimated based on financial filings. RESULTS: Total public investments in the development of the GeneXpert technology were estimated to be $252 million, including >$11 million in funding for work in public laboratories leading to the first commercial product, $56 million in grants from the National Institutes of Health, $73 million from other U.S. government departments, $67 million in R&D tax credits, $38 million in funding from non-profit and philanthropic organizations, and $9.6 million in small business 'springboard' grants. CONCLUSION: The public sector has invested over $250 million in the development of both the underlying technologies and the GeneXpert diagnostic platform and assays, and has made additional investments in rolling out the technology in countries with high burdens of TB. The key role played by the public sector in R&D and roll-out stands in contrast to the lack of public sector ability to secure affordable pricing and maintenance agreements.


Assuntos
Investimentos em Saúde , Técnicas de Diagnóstico Molecular/economia , COVID-19/diagnóstico , COVID-19/virologia , Bases de Dados Factuais , Infecções por HIV/diagnóstico , História do Século XX , História do Século XXI , Humanos , Técnicas de Diagnóstico Molecular/história , SARS-CoV-2/isolamento & purificação , Tuberculose/diagnóstico , Estados Unidos
19.
Glob Health Action ; 14(1): 1933788, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34402766

RESUMO

BACKGROUND: Despite scaling up of HIV programmes in sub-Saharan Africa, many people living with HIV (PLHIV) are unaware of their HIV status. New testing modalities, such as community-based testing, can improve test uptake, but it is uncertain whether type of testing modality affects the subsequent cascade of HIV care. OBJECTIVE: To compare linkage to care and antiretroviral treatment (ART) outcomes with regard to type of HIV testing modality. METHODS: A retrospective registry-based study was conducted at public ART clinics in an urban uptake area in Central Ethiopia. Persons aged ≥15 years newly diagnosed with HIV in 2015-2018 were eligible for inclusion. Data on patient characteristics and testing modality were analysed for associations with the following outcomes: ART initiation, retention in care at 12 months after starting ART, and viral suppression (<1000 copies/ml, recorded during the first 12 months after ART initiation), using uni- and multivariable analysis. Separate analyses disaggregated by sex were performed. RESULTS: Among 2885 included PLHIV (median age 32 years, 59% female), 2476 (86%) started ART, 1422/2043 (70%) were retained in care, and 953/1046 (92%) achieved viral suppression. Rates of ART initiation were lower among persons diagnosed through community-based testing (adjusted odds ratio [AOR] 0.44, 95% confidence interval [CI] 0.29-0.66) and among persons diagnosed through provider-initiated testing (AOR 0.65, 95% CI 0.44-0.97) compared with facility-based voluntary counselling and testing. In sex-disaggregated analyses, community-based testing was associated with lower rates of ART initiation among both women and men (AOR 0.47, 95% CI 0.27-0.82; AOR 0.39, 95% CI 0.19-0.78, respectively). No differences were found for retention in care or viral suppression with regard to test modality. CONCLUSION: Type of HIV testing modality was associated with likelihood of ART initiation, but not with subsequent treatment outcomes among persons starting ART.


Assuntos
Infecções por HIV , Teste de HIV , Adulto , Antirretrovirais/uso terapêutico , Etiópia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Estudos Retrospectivos
20.
AIDS Patient Care STDS ; 35(8): 288-307, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34375137

RESUMO

Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.


Assuntos
Infecções por HIV , Migrantes , Grupos Étnicos , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Programas de Rastreamento , Organização para a Cooperação e Desenvolvimento Econômico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...