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1.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1476-1480, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838824

RESUMO

Through the effort in nearly 40 years of Tanzania, the total number of reported cases, the prevalence of HIV/AIDS and the number of death have declined, while the number of patients receiving antiretroviral therapy has increased significantly in Tanzania. At the same time, however, there are new challenges that require more attention, such as the HIV spread to rural areas, middle and lower social classes, and female teenagers. Although the overall performance of the HIV/AIDS prevention and control response is great, there is still a need to survey the new trends of this disease at the micro-level in Tanzania. In addition, there is a necessity of interdisciplinary concern due to the prevalence of heterosexual anal sex in Tanzania.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Infecções por HIV/epidemiologia , Vigilância da População/métodos , População Rural , Síndrome de Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual , Fatores Socioeconômicos , População Suburbana , Tanzânia/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 68(47): 1089, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31851652

RESUMO

World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1).


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Saúde Global/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Aniversários e Eventos Especiais , Humanos
3.
Rev Soc Bras Med Trop ; 53: e20190086, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859940

RESUMO

INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Incidência , Masculino , Análise Espaço-Temporal
4.
Rev Soc Bras Med Trop ; 53: e20190193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859945

RESUMO

INTRODUCTION: Prevalence of human immunodeficiency virus among adolescents is increasing. This study aimed to analyze this current situation in Rio de Janeiro City. METHODS: This was a retrospective longitudinal study using secondary data from the National System of Notifiable Diseases database of cases in adolescents aged 13-19 years. RESULTS: There were 885 acquired immunodeficiency syndrome cases from 1978 to 2017 and 445 human immunodeficiency virus new cases from 2014 to 2017. Over time, sexually transmitted human immunodeficiency virus/acquired immunodeficiency syndrome cases increase. CONCLUSIONS: Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents requires novel prevention policies.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Adolescente , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , População Urbana , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 925, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666015

RESUMO

BACKGROUND: Ruili is a border city in southwest China along the heroin trafficking route. In recent decades, the city has witnessed increased in HIV transmission. The current study aims to explore the spatiotemporal trends in HIV prevalence identify and map the spatial variation and clustering of factors associated with HIV transmission through drug use and heterosexual contact transmissions at the village level from 1989 through 2016. METHODS: Geographic information system-based spatiotemporal analyses, including global and local spatial autocorrelation analyses and space-time scanning statistics, were applied to detect the location and extent of HIV/AIDS high-risk areas. RESULTS: Drug use and heterosexual contact were identified as the major transmission routes causing infection in Ruili. Results of global spatial analysis showed significant clustering throughout the city caused by transmission via drug use in the early phase of the epidemic and transmission via heterosexual contact in the late phase of the epidemic during the study period. Hotspots of transmission from drug use were randomly distributed throughout the city. However, the hotspots of transmission by heterosexual contact were located in the central area only around the Jiegao China-Myanmar land port. Space-time scanning showed that transmission from drug use clustered in the southwest area between 1989 and 1990, while transmission by heterosexual contact clustered in the central area between 2004 and 2014. CONCLUSIONS: Heterosexual contact has become the dominant mode of transmission. Interventions should focus on highly clustered area where is around the Jiegao land port.


Assuntos
Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/transmissão , Adulto , China/epidemiologia , Cidades , Análise por Conglomerados , Epidemias , Feminino , Sistemas de Informação Geográfica , Infecções por HIV/transmissão , Heterossexualidade , Humanos , Masculino , Mianmar , Prevalência , Comportamento Sexual , Análise Espaço-Temporal , Transtornos Relacionados ao Uso de Substâncias/virologia
6.
BMC Public Health ; 19(1): 1516, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718615

RESUMO

BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.


Assuntos
Viés , Mortalidade da Criança , Métodos Epidemiológicos , Infecções por HIV/mortalidade , Mortalidade Infantil , Mães/estatística & dados numéricos , Inquéritos e Questionários/normas , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Coeficiente de Natalidade , Causas de Morte , Pré-Escolar , Epidemias , Feminino , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Tanzânia/epidemiologia , Adulto Jovem
7.
Pan Afr Med J ; 33: 224, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692753

RESUMO

Introduction: Despite increasing efforts to address the reproductive health needs of persons living with Human Immuno-Deficiency Virus (HIV), a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. Currently, Ethiopia promotes integration of family planning (FP) services in to HIV chronic care. Yet the contraceptive prevalence rate among clients remains low. The objective of the study was to assess the role of socio-cultural factors on modern family planning use among HIV+ clients attending Anti-Retroviral Therapy clinics in Addis Ababa sub-cities. Methods: The study involved a facility based cross sectional survey. The ten sub cities were initially categorized/stratified into 5 based on direction (East, West, South, North and Central) and from each category one sub city was randomly selected. The total sample size was proportionally allocated to the selected health facilities according to previous monthly average client load per health center. Participants were selected using simple random sampling technique during their routine visit at the health centers. Data were collected through a semi-structured interviewer administered questionnaire. Both descriptive and inferential statistics were generated and results considered significant at 95% confidence level using STATA version 14.0. Results: Six hundred and thirty-six clients participated in the study. Majority of them were age between 30-39 years. Though majority, 607 (95.4%) participants approved the use of modern FP method, current use rate stood at 39%. Condom was the most (14.5%) commonly used single method. The odds of FP use by participants who disclosed their HIV status were almost twice that of their counterparts (AOR= 1.84; 95% CI: 1.14, 2.95). Participants who held discussion with their spouse/partners concerning FP, irrespective of the frequency had an odd of more than four when using FP than their counterparts (AO= 4.35; 95% CI: 2.69, 7.04). Conclusion: This study revealed that 6 out of every 10 HIV+ clients are not currently using FP methods. Disclosure of HIV status as well as open discussion with spouse/partner were positively associated with family planning use. These study findings call for comprehensive and client focus FP education and counseling in line with disclosure of HIV status and dialogue with spouse/partner in order to increase uptake and utilization of FP among clients. Partners have a great influence on the use and choice of FP methods, so their views are paramount.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/epidemiologia , Educação Sexual/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Preservativos/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Revelação/estatística & dados numéricos , Etiópia , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Masculino , Saúde Reprodutiva , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Adulto Jovem
8.
Rev. bioét. derecho ; (47): 93-107, nov. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184868

RESUMO

Este artículo tiene como propósito reflexionar sobre la situación de estigma y discriminación que afecta a personas con VIH/SIDA. Esto constituye una vulneración a los derechos fundamentales de estas personas y una barrera en el avance hacia la eliminación de la enfermedad. Ya que estudios realizados en diferentes países dan cuenta que las personas en esta condición se sienten discriminadas por la sociedad, y por los profesionales de la salud. Este es uno de los aspectos que ha dificultado el acceso al tratamiento, su adhesión, y educación para el cambio de conducta en los grupos de riesgo


Aquest article té com a propòsit reflexionar sobre la situació d'estigma i discriminació que afecta a persones amb VIH/SIDA. Això constitueix una vulneració dels drets fonamentals d'aquestes persones i una barrera en l'avanç cap a l'eliminació de la malaltia. Estudis realitzats en diferents països exposen que les persones en aquesta condició se senten discriminades per la societat i pels professionals de la salut. Aquest és un dels aspectes que ha dificultat l'accés al tractament, l'adhesió al mateix, i educació per al canvi de conducta en el grups de risc


This article aims to reflect on the situation of stigma and discrimination affecting people with HIV/AIDS. This constitutes a violation of the fundamental rights of these people and a barrier to progress towards the elimination of the disease. Studies carried out in different countries show that people in this condition feel discriminated against by society and by health professionals. This is one of the aspects that has hindered access to treatment, adherence, and behaviour change education in at-risk groups


Assuntos
Humanos , Ageismo/ética , Sexismo , Discriminação Social , Estigma Social , Grupos de Risco , Relações Profissional-Paciente/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Pessoal de Saúde/ética , Síndrome de Imunodeficiência Adquirida/epidemiologia , Soroprevalência de HIV , Acesso aos Serviços de Saúde/ética , Direitos Humanos
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(10): 1191-1196, 2019 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-31658515

RESUMO

The number of people living with HIV/AIDS (PLHIV), new HIV infections, and deaths due to HIV in China were estimated. These data provided evidences for the analysis on current HIV/AIDS epidemic in China, development of AIDS prevention and control strategies and public health education. However, whether the estimation results could be fully used in practice depends on appropriate interpretation. Since the differences in estimation methods and data to produce the estimates for each year, it is not suitable to directly use the estimation results of different years to conclude the HIV/AIDS epidemic trends. The 2018 estimation results indicated that the number of PLHIV is already beyond one million by the end of 2018 and would keep growing, causing much pressure of for HIV/AIDS prevention and control. With the increased burden of case management, innovative strategies are needed to reduce secondary transmission of HIV and control the aggravating spread to general population. Less than 70%, which is significantly lower than the goal of China's 13th Five-year Action plan for AIDS prevention and control. All local governments have the necessity of analyzing percentage of PLHIV who know their status, to conduct targeted strategies and measures for the improvement of HIV case finding. New HIV infection is the core indicator for HIV epidemic evaluation. The number of estimated new HIV infections is around 80 000 in 2018. It is necessary to further improve the strategy and increase the intensity to effectively reduce the new infection of HIV.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Epidemias , Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , China/epidemiologia , Infecções por HIV/prevenção & controle , Humanos
10.
Afr J AIDS Res ; 18(3): 198-204, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31575338

RESUMO

Background: South Africa has the largest HIV/AIDS epidemic globally and the largest anti-retroviral treatment (ART) programme in the world, yet HIV incidence is still chronically high in South Africa, especially in KwaZulu-Natal province (KZN). In light of this, a study was conducted to investigate the extent of challenges making the management of HIV/AIDS difficult in people living with HIV (PLWH) in KZN, South Africa. Methods: A cross-sectional study was carried out with 297 study participants living with HIV and receiving ART from three selected clinics in the Ethekwini Metro of KZN. A self-administered questionnaire assessed the challenges experienced by PLWH, their knowledge of their condition and their management thereof. One-way frequency tables were used to descriptively assess participant responses. Associations between certain demographic characteristics and responses to HIV treatment management challenges were assessed using chi-square tests, with statistical significance set at p < 0.05. Results: One-fifth of the participants (n = 60; 20.1%) were within the 18-23 age group, with over 53% (n = 158) having secondary level education. Some of the challenges cited included: difficulty in obtaining medication, mainly due to cost; side effects resulting in non-adherence; shame for taking medication in public (younger patients were more likely to feel ashamed for taking their medication in public [χ2 = 20.3, p = 0.009]); and non-disclosure of HIV-positive status to partners. We found a significant association between education and financial status and management of their condition [χ2 = 11.2, p = 0.011]. Conclusion: These findings that challenges still exist have implications for more robust programmes on education and counselling to address such challenges.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/psicologia , Terapia Antirretroviral de Alta Atividade/economia , Efeitos Psicossociais da Doença , Acesso aos Serviços de Saúde , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Epidemias , Feminino , HIV , Humanos , Masculino , Pessoa de Meia-Idade , Parceiros Sexuais , África do Sul/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
Afr J AIDS Res ; 18(3): 234-243, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31575343

RESUMO

The numbers of people infected with HIV and living with AIDS remain high in South Africa. The youth of the Northern Cape province in South Africa are a vulnerable population in this regard. However, there seems to be a dearth of rigorous evaluations of HIV and AIDS social intervention programmes targeted at the youth. This study aimed to evaluate the relevance of the content of an HIV and AIDS social intervention programme for the youth in the Northern Cape as well as to collect attendees' recommendations with regards to programme content. The data collection method comprised a group-administered questionnaire completed by youth (N = 172) who participated in the Soul City social intervention programme (SCP) implemented for the youth in the Northern Cape, and recruited through stratified random sampling. Based on specific criteria, the results showed that the SCP programme's content was relevant to the communities it served. The youth also forwarded recommendations for the programme content. Recommendations from the study include that youth support should be beyond dialogues; women's rights should be promoted within the context of HIV prevention strategies; the SCP should intensify its condom promotion efforts because it is relevant to the South African government's macro-level plan; relevant community leaders should be visited to explain the rationale for the youth's involvement in programmes; and the programme should focus more pertinently on poverty alleviation strategies.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Promoção da Saúde/métodos , Apoio Social , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Preservativos/estatística & dados numéricos , Feminino , HIV , Humanos , Masculino , Pobreza/estatística & dados numéricos , África do Sul , Inquéritos e Questionários , Populações Vulneráveis , Adulto Jovem
12.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 367-372, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631605

RESUMO

Objective: To determine the clinical epidemiological characteristics of newly reported human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)in southwestern China from 2001 to 2017. Methods: Clinical data of newly diagnosed HIV/AIDS from 2001 to 2017 in the West China Hospital of Sichuan University were reviewed and analyze. Results: A total of 1 520 228 patients were screened for HIV, including 285 983 outpatient and emergency patients and 1 234 245 inpatients. About 4 037 (0.27%) patients were confirmed with HIV/AIDS. The confirmation rate increased from 2001 to 2013, followed by a slight decline from 2014 to 2017. The male to female sex ratio of confirmed HIV/AIDS was 3.49:1 from 2001 to 2017, ranging from 1.65:1 to 5.08:1. The majority of patients were identified as Han (88.23%), had low education (58.66%), and married (54.75%). Peasants/herdsman comprised 26.33% of the patients. The proportion of young (15-29 years old), and middle-aged (≥50 years old) patients and those who were unmarried and had high education (senior high school and above) increased over time. Heterosexual transmission remained stable at about 60% while homosexual transmission increased by about 15% ( χ 2=14.436, P<0.005) since 2008. Transmissions through drug abuse( χ 2=71.633, P<0.005) and blood( χ 2=16.672, P<0.005) decreased. Of the 899 female newly reported HIV/ADIS patients, 77.20% were infected through heterosexual relationship. In comparison, of the 3 138 male patients, 61.41% were infected through heterosexual and 18.10% through homosexual relationships. Homosexual transmissions decreased with age, but heterosexual transmissions increased with age. Mother-to-child transmissions were concentrated in those between 0 and 15 years old (100%). Conclusion: Newly diagnosed HIV/AIDS cases increased over the years in the West China Hospital of Sichuan University, in particular in those of young and middle-aged, highly educated and unmarried. Heterosexual transmissions remain the main route.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , China/epidemiologia , Feminino , Infecções por HIV/transmissão , Hospitais Gerais , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto Jovem
13.
MMWR Morb Mortal Wkly Rep ; 68(37): 801, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31538632

RESUMO

National Gay Men's HIV/AIDS Awareness Day, September 27, directs attention to the impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on gay, bisexual, and other men who have sex with men (MSM). In 2017, MSM accounted for 67% of new diagnoses of HIV infection, and MSM who inject drugs an additional 3% (1).


Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Aniversários e Eventos Especiais , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia
14.
Int Health ; 11(5): 321-323, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529115

RESUMO

The low-income developing countries require increased development assistance for health (DAH) to achieve Sustainable Development Goal 3, 'Healthy Lives for All'. DAH has a proven track record. DAH expanded during 2001-2008, with significant health gains in the LIDCs, but then stopped expanding in the wake of the 2008 financial crisis. The Global Fund to Fight AIDS, TB and Malaria requires around US$31.8 billion during 2021-2023 to maintain a trajectory to end the three epidemics by 2030, yet donors have so far signaled that they are prepared to offer less than half that sum, around US$14 billion.


Assuntos
Países em Desenvolvimento/economia , Epidemias/prevenção & controle , Saúde Global/economia , Cooperação Internacional , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Humanos , Malária/epidemiologia , Malária/prevenção & controle , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Estados Unidos
15.
BMC Infect Dis ; 19(Suppl 1): 783, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31526371

RESUMO

BACKGROUND: The 2016 'Start Free, Stay Free, AIDS Free' global agenda, builds on the 2011-2015 'Global Plan'. It prioritises 22 countries where 90% of the world's HIV-positive pregnant women live and aims to eliminate vertical  transmission of HIV (EMTCT) and to keep mothers alive. By 2019, no Global Plan priority country had achieved EMTCT; however, 11 non-priority countries had. This paper synthesises the characteristics of the first four countries validated for EMTCT, and of the 21 Global Plan priority countries located in Sub-Saharan Africa (SSA). We consider what drives vertical transmission of HIV (MTCT) in the 21 SSA Global Plan priority countries. METHODS: A literature review, using PubMed, Science direct and the google search engine was conducted to obtain global and national-level information on current HIV-related context and health system characteristics of the first four EMTCT-validated countries and the 21 SSA Global Plan priority countries. Data representing only one clinic, hospital or region were excluded. Additionally, key global experts working on EMTCT were contacted to obtain clarification on published data. We applied three theories (the World Health Organisation's building blocks to strengthen health systems, van Olmen's Health System Dynamics framework and Baral's socio-ecological model for HIV risk) to understand and explain the differences between EMTCT-validated and non-validated countries. Additionally, structural equation modelling (SEM) and linear regression were used to explain associations between infant HIV exposure, access to antiretroviral therapy and two outcomes: (i) percent MTCT and (iii) number of new paediatric HIV infections per 100 000 live births (paediatric HIV case rate). RESULTS: EMTCT-validated countries have lower HIV prevalence, less breastfeeding, fewer challenges around leadership, governance within the health sector or country, infrastructure and service delivery compared with Global Plan priority countries. Although by 2016 EMTCT-validated countries and Global Plan priority countries had adopted a public health approach to HIV prevention, recommending lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and lactating women, EMCT-validated countries had also included contact tracing such as assisted partner notification, and had integrated maternal and child health (MCH) and sexual and reproductive health (SRH) services, with services for HIV infection, sexually transmitted infections, and viral hepatitis. Additionally, Global Plan priority countries have limited data on key SRH indicators such as unmet need for family planning, with variable coverage of antenatal care, HIV testing and triple antiretroviral therapy (ART) and very limited contact tracing. Structural equation modelling (SEM) and linear regression analysis demonstrated that ART access protects against percent MTCT (p<0.001); in simple linear regression it is 53% protective against percent MTCT. In contrast, SEM demonstrated that the case rate was driven by the number of HIV exposed infants (HEI) i.e. maternal HIV prevalence (p<0.001). In linear regression models, ART access alone explains only 17% of the case rate while HEI alone explains 81% of the case rate. In multiple regression, HEI and ART access accounts for 83% of the case rate, with HEI making the most contribution (coef. infant HIV exposure=82.8, 95% CI: 64.6, 101.1, p<0.001 vs coef. ART access=-3.0, 95% CI: -6.2, 0.3, p=0.074). CONCLUSION: Reducing infant HIV exposure, is critical to reducing the paediatric HIV case rate; increasing ART access is critical to reduce percent MTCT. Additionally, our study of four validated countries underscores the importance of contact tracing, strengthening programme monitoring, leadership and governance, as these are potentially-modifiable factors.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/transmissão , HIV/imunologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Saúde Reprodutiva , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Adolescente , África ao Sul do Saara/epidemiologia , Aleitamento Materno , Criança , Pré-Escolar , Busca de Comunicante , Feminino , Soropositividade para HIV , Humanos , Lactente , Lactação , Modelos Lineares , Masculino , Programas de Rastreamento , Mães/educação , Gravidez , Cuidado Pré-Natal , Prevalência , Serviços de Saúde Reprodutiva , Organização Mundial da Saúde , Adulto Jovem
16.
Przegl Epidemiol ; 73(2): 179-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385676

RESUMO

AIM: The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2017 in comparison to the changes in preceding years. MATERIALS AND METHODS: Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS: In 2017 there were 1,419 HIV cases newly diagnosed in Poland (diagnosis rate: 3.69 per 100,000), including 51 among non-Polish citizens. The frequency of newly detected HIV infections increased by nearly 8% compared to the previous year and by almost 28% compared to the median in 2011-2015 years. The total number of AIDS cases was 108 (incidence 0.28 per 100,000), and 20 people died from AIDS disease (0.05 per 100,000). New HIV diagnoses were reported mainly among people in age 20 to 39 years (69.5%) and among men (88.5%). Among cases with known transmission route, 69.5% concerned among men who had sexual contact with men (MSM). The percentage of MSM cases, similarly to heterosexual cases decrease in comparison to previous year, relatively by 5.7% and 6.4%. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by 6% percentage points in comparison with 2016 year (from 68% to 74% AIDS cases). CONCLUSION: The most HIV cases are diagnosed among MSM, so prophylactic activities are still needed in this key population. It is also need to increase the number of new cases linkage-to-care and to improve the low frequency in HIV testing rate in all population.


Assuntos
Infecções por HIV/epidemiologia , Sistema de Registros , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/transmissão , Adulto , Distribuição por Idade , Comorbidade , Feminino , Infecções por HIV/transmissão , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Distribuição por Sexo , Adulto Jovem
17.
Psychiatriki ; 30(2): 120-128, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425140

RESUMO

Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIVrelated stigma, still quite intense in Greece, is one of the most debilitating factors concerning people's living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization 'Centre for Life' during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual's life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach.


Assuntos
Síndrome de Imunodeficiência Adquirida/psicologia , Síndrome de Imunodeficiência Adquirida/terapia , Infecções por HIV/psicologia , Infecções por HIV/terapia , Psicoterapia/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Idoso , Aconselhamento/estatística & dados numéricos , Feminino , Grécia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Saúde Mental , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Autoimagem , Minorias Sexuais e de Gênero , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários
18.
BMC Med ; 17(1): 149, 2019 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-31362721

RESUMO

BACKGROUND: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. METHODS: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. RESULTS: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. CONCLUSIONS: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.


Assuntos
Infecções por HIV/mortalidade , Infarto do Miocárdio/mortalidade , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Idoso , Estudos de Coortes , Redes Comunitárias , Comorbidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/mortalidade , Estados Unidos/epidemiologia
19.
Prim Care ; 46(3): 433-445, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375191

RESUMO

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has metamorphosed in the past 40 years since the first cases were diagnosed. The advent of highly active antiretroviral treatment (HAART) transformed the disease trajectory for many patients with HIV/AIDS and transitioned the course from a terminal disease to a chronic disease model. This article reviews the epidemiology of HIV/AIDS, prognostic indicators, frailty, opportunistic infections, specific AIDS-defining malignancies and non-AIDS-defining malignancies, role of palliative care, advance care planning, and the role of HAART in patients dying of late-stage AIDS.


Assuntos
Infecções por HIV/epidemiologia , Cuidados Paliativos/organização & administração , Atenção Primária à Saúde/organização & administração , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Planejamento Antecipado de Cuidados , Fatores Etários , Fragilidade/epidemiologia , Humanos , Adesão à Medicação , Neoplasias/epidemiologia , Manejo da Dor/métodos , Prognóstico
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