RESUMO
BACKGROUND: The prevalence of tobacco use among people living with HIV (PLWH) is up to four times higher than in the general population. Unfortunately, tobacco use increases the risk of progression to AIDS and death. Individual- and group-level interventions, and system-change interventions that are effective in helping PLWH stop using tobacco can markedly improve the health and quality of life of this population. However, clear evidence to guide policy and practice is lacking, which hinders the integration of tobacco use cessation interventions into routine HIV care. This is an update of a review that was published in 2016. We include 11 new studies. OBJECTIVES: To assess the benefits, harms and tolerability of interventions for tobacco use cessation among people living with HIV. To compare the benefits, harms and tolerability of interventions for tobacco use cessation that are tailored to the needs of people living with HIV with that of non-tailored cessation interventions. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, Embase, and PsycINFO in December 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of individual-/group-level behavioural or pharmacological interventions, or both, for tobacco use cessation, delivered directly to PLWH aged 18 years and over, who use tobacco. We also included RCTs, quasi-RCTs, other non-randomised controlled studies (e.g. controlled before and after studies), and interrupted time series studies of system-change interventions for tobacco use cessation among PLWH. For system-change interventions, participants could be PLWH receiving care, or staff working in healthcare settings and providing care to PLWH; but studies where intervention delivery was by research personnel were excluded. For both individual-/group-level interventions, and system-change interventions, any comparator was eligible. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods, and used GRADE to assess certainty of the evidence. The primary measure of benefit was tobacco use cessation at a minimum of six months. Primary measures for harm were adverse events (AEs) and serious adverse events (SAEs). We also measured quit attempts or quit episodes, the receipt of a tobacco use cessation intervention, quality of life, HIV viral load, CD4 count, and the incidence of opportunistic infections. MAIN RESULTS: We identified 17 studies (16 RCTs and one non-randomised study) with a total of 9959 participants; 11 studies are new to this update. Nine studies contributed to meta-analyses (2741 participants). Fifteen studies evaluated individual-/group-level interventions, and two evaluated system-change interventions. Twelve studies were from the USA, two from Switzerland, and there were single studies for France, Russia and South Africa. All studies focused on cigarette smoking cessation. All studies received funding from independent national- or institutional-level funding. Three studies received study medication free of charge from a pharmaceutical company. Of the 16 RCTs, three were at low risk of bias overall, five were at high risk, and eight were at unclear risk. Behavioural support or system-change interventions versus no or less intensive behavioural support Low-certainty evidence (7 studies, 2314 participants) did not demonstrate a clear benefit for tobacco use cessation rates in PLWH randomised to receive behavioural support compared with brief advice or no intervention: risk ratio (RR) 1.11, 95% confidence interval (CI) 0.87 to 1.42, with no evidence of heterogeneity. Abstinence at six months or more was 10% (n = 108/1121) in the control group and 11% (n = 127/1193) in the intervention group. There was no evidence of an effect on tobacco use cessation on system-change interventions: calling the quitline and transferring the call to the patient whilst they are still in hospital ('warm handoff') versus fax referral (RR 3.18, 95% CI 0.76 to 13.99; 1 study, 25 participants; very low-certainty evidence). None of the studies in this comparison assessed SAE. Pharmacological interventions versus placebo, no intervention, or another pharmacotherapy Moderate-certainty evidence (2 studies, 427 participants) suggested that varenicline may help more PLWH to quit smoking than placebo (RR 1.95, 95% CI 1.05 to 3.62) with no evidence of heterogeneity. Abstinence at six months or more was 7% (n = 14/215) in the placebo control group and 13% (n = 27/212) in the varenicline group. There was no evidence of intervention effects from individual studies on behavioural support plus nicotine replacement therapy (NRT) versus brief advice (RR 8.00, 95% CI 0.51 to 126.67; 15 participants; very low-certainty evidence), behavioural support plus NRT versus behavioural support alone (RR 1.47, 95% CI 0.92 to 2.36; 560 participants; low-certainty evidence), varenicline versus NRT (RR 0.93, 95% CI 0.48 to 1.83; 200 participants; very low-certainty evidence), and cytisine versus NRT (RR 1.18, 95% CI 0.66 to 2.11; 200 participants; very low-certainty evidence). Low-certainty evidence (2 studies, 427 participants) did not detect a difference between varenicline and placebo in the proportion of participants experiencing SAEs (8% (n = 17/212) versus 7% (n = 15/215), respectively; RR 1.14, 95% CI 0.58 to 2.22) with no evidence of heterogeneity. Low-certainty evidence from one study indicated similar SAE rates between behavioural support plus NRT and behavioural support only (1.8% (n = 5/279) versus 1.4% (n = 4/281), respectively; RR 1.26, 95% CI 0.34 to 4.64). No studies assessed SAEs for the following: behavioural support plus NRT versus brief advice; varenicline versus NRT and cytisine versus NRT. AUTHORS' CONCLUSIONS: There is no clear evidence to support or refute the use of behavioural support over brief advice, one type of behavioural support over another, behavioural support plus NRT over behavioural support alone or brief advice, varenicline over NRT, or cytisine over NRT for tobacco use cessation for six months or more among PLWH. Nor is there clear evidence to support or refute the use of system-change interventions such as warm handoff over fax referral, to increase tobacco use cessation or receipt of cessation interventions among PLWH who use tobacco. However, the results must be considered in the context of the small number of studies included. Varenicline likely helps PLWH to quit smoking for six months or more compared to control. We did not find evidence of difference in SAE rates between varenicline and placebo, although the certainty of the evidence is low.
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Infecções por HIV , Ensaios Clínicos Controlados Aleatórios como Assunto , Abandono do Uso de Tabaco , Humanos , Infecções por HIV/complicações , Abandono do Uso de Tabaco/métodos , Qualidade de Vida , Abandono do Hábito de Fumar/métodos , AdultoRESUMO
Factors associated with prescription of smoking cessation medication (SCM), including the impact of race, have not been well described among a large population of people living with HIV (PLWH) engaged in routine clinical care. Our study investigated whether there are racial differences between African-American and White PLWH regarding SCM prescription and sought to identify other factors associated with these prescriptions at a large HIV clinic in the Southeastern United States. Among 1899 smokers, 38.8% of those prescribed SCMs were African-American and 61.2% were White. Factors associated with lower odds of SCM prescription included African-American race (AOR, 0.63 [95% CI: 0.47, 0.84]) or transferring care from another HIV provider during the study period (AOR, 0.63 [95% CI: 0.43, 0.91]). Whereas major depression (AOR, 1.54 [95% CI: 1.10, 2.15]), anxiety symptoms (AOR, 1.43 [95% CI: 1.05, 1.94]), and heavy smoking (>20 cigarettes/day) (OR, 3.50 [95% CI: 2.11, 5.98]) were associated with increased likelihood of SCM prescription. There were racial disparities in the prescription of SCM in African Americans with HIV. These findings underscore the need to increase pharmacotherapy use among African Americans to improve smoking cessation outcomes across racial groups among PLWH.
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Infecções por HIV/terapia , Abandono do Hábito de Fumar , Negro ou Afro-Americano , Humanos , Fatores Raciais , Fumantes , Sudeste dos Estados Unidos , Estados UnidosRESUMO
People living with HIV (PLWH) have a higher prevalence of smoking and are less likely to quit smoking than the general population. Few studies involving a large sample of PLWH receiving routine care have evaluated factors associated with smoking cessation. This retrospective longitudinal cohort study evaluated factors associated with smoking cessation among PLWH from 2007 to 2018. Of 1,714 PLWH smokers included in the study, 27.6% reported quitting smoking. Suppressed plasma HIV-1 RNA (<200 copies/ml) was significantly associated with an increased likelihood of smoking cessation (HRadjusted = 1.27, 95% CI [1.03, 1.58]); whereas age/10 year increments (HRadjusted = 0.12, 95% CI [0.04, 0.38]), greater length of care at the HIV clinic (HRadjusted = 0.97, 95% CI [0.94, 0.99]), lack of insurance (HRadjusted = 0.77, 95% CI [0.61, 0.99]) or having public insurance (HRadjusted = 0.74, 95% CI [0.55, 0.97)]), current substance use (HRadjusted = 0.66, 95% CI [0.43, 0.97]) and risk of developing alcohol use disorder (HRadjusted = 0.60, 95% CI [0.43, 0.84]) were associated with a reduced likelihood of quitting smoking. These findings underscore the importance of early smoking cessation intervention among PLWH. In addition, targeted smoking cessation intervention strategies are needed for groups at risk for being less likely to quit, including older patients, and those with alcohol and substance use disorders.
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Infecções por HIV/terapia , Abandono do Hábito de Fumar , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fumar/epidemiologiaRESUMO
BACKGROUND: People living with HIV (PLWH) have a high level of interest in quitting smoking, but only a small proportion have sustainable abstinence 6 months after cessation. Few investigations have focused on relapse to smoking among PLWH. In this investigation, we evaluated the prevalence of relapse after smoking cessation and the characteristics associated with smoking relapse using a retrospective, longitudinal cohort of PLWH during an eight-year observation. METHODS: All patients aged ≥19 years that reported current smoking during the study period and then reported not smoking on a subsequent tobacco use questionnaire (quitters) were eligible for the study. In addition, patients required at least one subsequent follow-up visit after quitting where smoking status was again reported to allow for assessment of relapse. A Cox proportional hazard model was fit to evaluate factors associated with smoking relapse in PLWH attending routine clinical care. RESULTS: Of the 473 patients who quit smoking in the study, 51% relapsed. In multivariable analysis, factors significantly associated with a higher likelihood of relapse were anxiety symptoms (HR = 1.55, 95% CI [1.11, 2.17]) and at-risk alcohol use (HR = 1.74, 95% CI [1.06, 2.85]), whereas antiretroviral therapy (ART) adherence (HR = 0.65, 95% CI [0.49, 0.99]) and longer time in care (HR = 0.94, 95% CI [0.91, 0.98]) were associated with a reduced likelihood of relapse after cessation. CONCLUSION: Our study underscores the high prevalence of smoking relapse that exists among PLWH after they quit smoking. Successful engagement in mental health care may enhance efforts to reduce relapse in the underserved populations of PLWH.
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Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV/epidemiologia , Transtornos Mentais/epidemiologia , Fumar/epidemiologia , Fumar/psicologia , Adulto , Alabama/epidemiologia , Feminino , Infecções por HIV/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Fatores de Risco , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricosRESUMO
BACKGROUND: In Zambia, 3.8% of young women and men aged 15-24 are HIV positive. However, like in most developing nations, HIV prevalence is higher among young women than young men (5.6% versus 1.8%). Despite the recognition of the rights of young people to sexual reproductive health (SRH) information and services, adolescent and young people (AYP) still face challenges in accessing healthcare in public health institutions including access to comprehensive knowledge on HIV/AIDs, HIV testing and contraceptives. The overall objective of the study was to collect baseline HIV, SRH and gender based violence (GBV) data at district level to inform the design of interventions targeting adolescent girls and young women (AGYW) aged 10-24 years in 20 districts of Zambia. METHODS: A cross-sectional, mixed-methods study was conducted in 20 districts of Zambia with the highest incidence of HIV. Data was collected between August and October 2022 with a total response rate of 92% (12,813/13960), constituting 5979 (46.7%) in-school and 6834 (53.3%) out-of-school participants. RESULTS: Overall, Mwinilunga, Chinsali, Chisamba and Chembe districts had the highest number of respondents, while Sinazongwe and Mungwi districts contributed the least. The overall age distribution was such that 12.6% (n = 1617) of those interviewed were aged 10 to 14 years, 35.4% (n = 4536) were aged 15-19 years, and 52.0% (n = 6660) were aged 20-24 years. The overall mean age at first sex among AGYW interviewed was 16.6 years which was broken down as follows: 16.2 years for in-school and 16.8 years for out of school. Overall, most of the respondents had first time sex with either their boyfriend (80.4%) or husband (15.6%), with 2.4% of the in-school participants reporting to have had their sexual debut in marriage compared to 21.0% among out-of-school AGYW. Prevalence of HIV was higher in the out-of-school compared to the in-school participants (5.5% vs 2.0%), Similarly, the prevalence of syphilis was higher in the out-of-school than the in-school participants (4.1% vs 1.5%). CONCLUSION: The study focused on assessing the prevalence and vulnerability of HIV, syphilis, GBV, and SRH services uptake among adolescent girls and young women, and exploring factors affecting girls' stay-in-school and re-engagement. The study found that HIV and syphilis are still significant public health problems among adolescent girls and young women in Zambia, emphasizing the need for increased efforts to prevent and manage these infections.
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Infecções por HIV , Comportamento Sexual , Sífilis , Humanos , Adolescente , Zâmbia/epidemiologia , Feminino , Estudos Transversais , Infecções por HIV/epidemiologia , Adulto Jovem , Prevalência , Sífilis/epidemiologia , Criança , Assunção de Riscos , Masculino , Adulto , Instituições AcadêmicasRESUMO
BACKGROUND: Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia. METHODS: In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment. DISCUSSION: Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.
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Infecções por HIV , Abandono do Hábito de Fumar , Envio de Mensagens de Texto , Abandono do Uso de Tabaco , Adulto , Humanos , Abandono do Hábito de Fumar/métodos , Uganda/epidemiologia , Zâmbia/epidemiologia , Dispositivos para o Abandono do Uso de Tabaco , Infecções por HIV/epidemiologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Cigarette smoking intention is a strong predictor of cigarette smoking initiation. There is limited data on predictors of cigarette smoking intentions among adolescents in developing countries. Objective: To determine factors associated with cigarettes smoking intentions among never-smoked adolescents. Methods: The study utilized the Zambia 2011 Global Youth Tobacco Survey dataset on adolescents. Results: Being in grade nine compared to grade seven (AOR 0.43, 95%CI 0.23-0.82). Having a smoking father (AOR 2.38, 95%CI 1.25-453) mother (AOR 11.77, 95%CI 4.16-33.33), or both parents (AOR 7.05, 95%CI 2.91-17.10) showed significantly higher chance of having smoking intentions than having non-smoker parents. Also, having some (AOR 1.97, 95%CI 1.12-3.47), most (AOR 5.37, 95%CI 2.82-10.25), or all (AOR 3.75, 95%CI 1.64-8.56) smoker close friend was significantly associated with smoking intention compared to having none-smoker friends. Being around others who smoked in out-door places 1-2 days (AOR 2.16, 95%CI 1.19-3.93), 5-6 days (AOR 3.21, 95%CI 1.51-6.83) and 7 days/week (AOR 2.73, 95%CI 1.41-5.30) were also associated with one's intention to smoke cigarettes compared to not being around smokers in outdoor public places 7 days/week. Conclusion: Having smoking parents, smoking friends or around people who smoke in public places were associated with cigarette smoking intentions among adolescents.
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Fumar Cigarros , Produtos do Tabaco , Feminino , Humanos , Adolescente , Intenção , Fumar Cigarros/epidemiologia , Zâmbia/epidemiologia , Instituições AcadêmicasRESUMO
Introduction: although countries in sub-Sahara Africa (SSA) show progress in implementing various forms of health insurance, there is a dearth of information regarding health insurance in settings like Malawi. Therefore, we conducted this study to determine the uptake of health insurance and describe some of the factors associated with the prevailing uptake of health insurance in Malawi using the 2019-2020 Multiple Indicator Cluster Survey (MICS). Methods: this was a secondary analysis of the 2019-2020 MICS data. Data were analysed using frequencies and weighted percentages in Stata v.17. Furthermore, since the number of persons with health insurance is very small, we were unable to perform multivariate analysis. Results: a total of 205 (1%) of the 31259 had health insurance in Malawi in 2019-2020. Of the 205 individuals who owned health insurance, 118 (47%) had health insurance through their employers while 39 (16%) had health insurance through mutual health organizations or community-based. Men had a higher uptake of health insurance than women. The residents from urban areas were more likely to have health insurance than those in rural areas. Persons with media exposure were more likely to own health insurance as compared to their counterparts. There was an increasing trend in the uptake of health insurance by wealth of the individual with the poorest being less likely to have health insurance compared to the richest. The persons with no education were least likely to have health insurance while those with tertiary education were most likely to have health insurance. Conclusion: the uptake of health insurance in Malawi was extremely low. In order to increase the uptake of health insurance, there is a need to increase insurance coverage amongst those in formal employment, and consider minimizing the geographic, economic, and demographic barriers in accessing the health insurance.
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Seguro Saúde , Pobreza , Masculino , Humanos , Feminino , Malaui , Inquéritos e Questionários , EscolaridadeRESUMO
BACKGROUND: There has been a reduction in tobacco smoking worldwide except in developing countries. Africa has the lowest prevalence of tobacco use in the world, however, the rising trends amidst the WHO FCTC implementation are worrisome as it is likely to increase the tobacco public health impact in the next decade. The study investigated factors associated with tobacco smoking among adults in Zambia. METHODS: We used secondary data extracted from the 2017 STEPS - NCDs Survey. Logistic regression was used to obtain unadjusted (UOR) and adjusted odds ratios (AOR) at 95% confidence interval (CI). RESULTS: Of the 4,301 adults who participated, 11.0% were current tobacco smokers (25.7% men and 2.27% women). Of these 75.6% and 11.9% drunk alcohol and had mental health problems, respectively. In multivariable analysis, factors significantly associated with increased odds of current tobacco smoking were older age groups of 45-59 years (AOR = 1.69; 95% CI: 1.17-2.43, p = 0.005) and 60-69 years (AOR = 2.22; 95% CI: 1.25-3.93, p = 0.006), alcohol consumption (AOR = 5.93; 95% CI: 4.44-7.91, p < 0.001), mental health problems (AOR = 2.08; 95% CI: 1.34-3.22, p = 0.001). On the other hand, female gender (AOR = 0.07; 95% CI: 0.05-0.10, p < 0.001), being diabetic (AOR = 0.52; 95% CI: 0.15-0.46, p = 0.026), education attainment; primary, secondary, and higher education (AOR = 0.65; 95% CI: 0.47-0.91, p = 0.012, AOR = 0.40; 95% CI: 0.29-0.55, p < 0.001 and AOR = 0.26; 95% CI: 0.15-0.46, p < 0.001), respectively, had reduced odds of tobacco smoking. CONCLUSIONS: Our findings underscore the high prevalence of tobacco smoking particularly in uneducated males who consume alcohol and have mental health problems. The mental health problems and alcohol consumption in this population need to be addressed in concert with smoking cessation strategies.
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Abandono do Hábito de Fumar , Fumar , Masculino , Adulto , Humanos , Feminino , Idoso , Zâmbia/epidemiologia , Prevalência , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar Tabaco , NicotianaRESUMO
Introduction: schistosomiasis is a neglected tropical disease and remains a disease of public health concern. Despite its relative importance, paucity of information on schistosomiasis in urban settings such as Ndola remains. Here, we present findings on the prevalence and factors associated with Schistosoma haematobium (S. haematobium) infections among School-going children in the Kawama in Ndola district in Zambia, an urban area in the Copperbelt Province, Zambia. Methods: we employed a cross-sectional study design among 354 school going-children between 5 and 17 years of age between November 2020 and February 2021. A Multivariate forward step-wise logistic regression model was used to determine the associations of risk factors. Adjusted odds ratios and 95% confidence intervals are reported. Results: of the 354 school-going children included in the analysis, 13.3% had S. haematobium infection. Children who swam in the stream/dam were more likely to have S. haematobium infection as compared to those who did not (aOR 6.531, 95% CI: 2.90-14.69). Conclusion: S. haematobium infection is endemic among school-going children in an urban setup of the Kawama area of Ndola City, Zambia. There is a need for targeted interventions to mitigate infections among this population.
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Schistosoma haematobium , Esquistossomose Urinária , Animais , Humanos , Prevalência , Zâmbia/epidemiologia , Estudos Transversais , Esquistossomose Urinária/epidemiologiaRESUMO
Antiretroviral treatment failure has emerged as a challenge in the management of pediatric human immunodeficiency virus (HIV) patients, especially in resource-limited countries despite accessibility to Highly Active Antiretroviral Therapy (HAART). A systematic review and meta-analysis was conducted to synthesize virological failure (VF) prevalence and ascertain its predictors in children in sub-Saharan Africa. An electronic database search strategy was conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and CINAHL. Further, manual searching was conducted on non-indexed journals. Utilizing the JASP© version 0.17.2 (2023) statistical software, a meta-analysis of pooled prevalence of VF was estimated using the standardized mean differences. Further, selection models were used to assess the risk of bias and heterogeneity. The pooled odds ratios were estimated for the respective studies reporting on predictors of VF. The overall pooled estimate of the prevalence of VF in sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 0.001), poor adherence (OR: 5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 244.2-244.47; p <0.001), exposure to the prevention of mother to child transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence documented is at variance with studies in other developing countries outside the sub-Saharan region. The high prevalence of HIV cases contrasting with the limited expertise in the management of pediatric ART patients could explain this variance.
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Terapia Antirretroviral de Alta Atividade , Transmissão Vertical de Doenças Infecciosas , Humanos , Criança , Feminino , Prevalência , Antirretrovirais , África Subsaariana/epidemiologiaRESUMO
Background: Alcohol consumption among young people in schools and communities presents a major problem of public health concern. We determined the predictors of alcohol consumption among adolescents and young adults in Lusaka, Zambia. Methods: A cross-sectional study design was adopted. A total of 196 participants took part in the quantitative study. For the qualitative part, there were 13 participants. The study used multistage and purposive sampling methods. A semi-structured questionnaire and in-depth interviews were used. Quantitative data were analysed using STATA version 14. Ordered logistic regression analysis was used to assess the actual predictors, with confidence interval set at 95% and p-value at 0.05. Qualitative data were analysed thematically. Results: The older age category (20-24) had a greater prevalence of alcohol consumption (63.3%) than the younger age category (36.7%). Age, being employed, unconducive learning environment, limited recreation and sports activities, and adult alcohol drinking culture decreased the odds of consuming alcohol. Limited parental care support increased the odds of alcohol consumption [AOR= 4.21; 95% CI: 1.32-13.45, p=0.015]. Futile alcohol regulatory measures were cited to be contributing to alcohol consumption. Conclusion: Alcohol consumption was highly prevalent among young adults aged 20-24 years. There is need for continuous sensitization on substance abuse and its adverse effects in schools and communities at large. The strengthening, reviewing and amendment of the alcohol regulatory measures and policies should be considered.
Assuntos
Consumo de Bebidas Alcoólicas , Instituições Acadêmicas , Humanos , Adolescente , Adulto Jovem , Zâmbia/epidemiologia , Estudos Transversais , Consumo de Bebidas Alcoólicas/epidemiologia , Inquéritos e Questionários , Etanol , PrevalênciaRESUMO
INTRODUCTION: Tobacco smoking is a global public health concern. It has been projected that children and young people who are alive today in developing countries will bear the most burden of tobacco-related morbidity and mortality in the near future. This study investigated the school tobacco-related curriculum and behavioral factors associated with cigarette smoking among school-going adolescents. METHODS: We accessed secondary data in a public domain collected using a cross-sectional study design. Altogether, 3377 seventh to ninth grade students were selected by stratified two-stage cluster sampling. Data were collected using a Global Youth Tobacco Survey (GYTS) Core Questionnaire. Multivariate logistic regression models were used to determine associations of school tobacco-related curriculum and behavioral factors with current cigarette smoking status. Adjusted odds ratios and their 95% confidence intervals are reported. RESULTS: Of the 2611students included in the analysis, 6.8% (7.8% of males and 5.8% of females) reported smoking cigarettes. Slightly over half of the students were taught in schools about the effects of smoking (53.6%) and the dangers of smoking (64.1%). Adolescents who had friends who smoked were more likely to smoke compared to those who did not have friends who smoked. Adolescents whose parents smoked were more likely to smoke compared to those who did not have parents who smoked. Adolescents who were not taught at school about the dangers of smoking, or were not sure about it, were more likely to smoke compared to those who were taught (AOR=1.94; 95% CI: 1.28-2.94). CONCLUSIONS: Schools play an important role in shaping smoking behavior among school-going adolescents. Based on our findings, school programs aimed at reducing cigarette smoking among school-going adolescents may achieve greater impact by implementing anti-smoking interventions that involve parents and peers in smoking prevention activities, and have a robust tobacco school curriculum.
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Introduction: There is a significant shortage of medical subspecialists in Zambia. The government of Zambia, through programmes at the Ministry of Health, spends considerable resources to send patients outside the country for subspecialist medical treatment. The objective of this analysis was to evaluate the current situation pertaining to medical subspecialty training at the University of Zambia School of Medicine (UNZASOM) and to illustrate the new programmes that are to be introduced. Methods: We collected data from formal desk reviews on the state of medical specialisation in Zambia, the UNZASOM graduation archives and patient referral records at the Ministry of Health (MoH). In addition, information on planned subspecialist programmes is presented. Results: From the first graduates in 1986up to 2019,UNZASOM produced 351medical specialists, 63 (18%) in Internal Medicine, 77 (22%) in Obstetrics &Gynaecology, 82 (23%) in Paediatrics&Child Health, 68 (19%) in General Surgery, 17 (5%) in Anaesthesia & Critical Care, 20 (6%) in Orthopaedics &Trauma and 8 (2%) in Urology. The remaining graduates were in Ophthalmology, Psychiatry, Infectious Diseases, Paediatric Surgery and Pathology contributing 1% each. To enhance medical subspecialist training at UNZASOM, new curricula for Breast Surgery, Urology, Glaucoma, Vitreo-retinalSurgery, Adult Gastroenterology, Forensic Pathology, Dermatology & Venereology, Ophthalmology, Gynaecological Oncology and Paediatric anaesthesia, Infectious Diseases, and Gastroenterology were developed. Since 2013, only 44% of patients requiring subspecialist treatment out of Zambia got assisted with the remainder still on the waiting list or having had bad outcomes. Conclusions: These programmes will provide an opportunity for accessible and affordable medical subspecialization training for Zambia and its neighbouring countries. With enhanced infrastructural support, the subspecialists will contribute toward enhanced healthcare provision and improvement in patient outcomes. They will also form a cohort of trainers to expand the space for quality training and skills building of specialists and subspecialists in the region and beyond.
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Background: There is evidence that multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.
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Compared with women and girls, proportionately fewer men and boys in sub-Saharan Africa receive HIV testing, treatment, and other services. This study determined factors associated with never testing for HIV and examined never testing as a predictor of sexual risk behavior among men in Zambia. The sample included 2,609 men aged 15 to 24 from the 2018 Zambia Demographic and Health Survey. Logistic regression results revealed that compared with men who ever tested for HIV, men who never tested were more likely to be younger, have less education, have no children, be unemployed, and belong to the low wealth bracket. They also had a higher likelihood of not using a condom at last sex but were less likely to have more than five lifetime sexual partners. HIV prevention programs can use sociodemographic characteristics to identify those who have a lower likelihood of testing for HIV. Prevention programs can use sociodemographic characteristics to develop profiles of those who may especially need to be targeted by initiatives to promote HIV testing. Awareness does not always engender behavior change; therefore, in addition to knowledge of HIV status, risk reduction should also be emphasized.
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Infecções por HIV , Preservativos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Assunção de Riscos , Comportamento Sexual , Zâmbia/epidemiologiaRESUMO
BACKGROUND: Studies comparing self-report substance use data to biochemical verification generally demonstrate high rates of concordance. We argue that these rates are due to the relatively high true negative rate in the general population, and high degree of honestly in treatment seeking individuals. We hypothesized that high risk individuals not seeking treatment would demonstrate low concordance and a high false negative rate of self-reported substance use. METHODS: A sample of 500 individuals from a smoking cessation clinical trial was assessed over 1 year. Assessments included semi-structured interviews, questionnaires (e.g. Addiction Severity Index, etc.), and urine drug screen assays (UDS). Generalized estimating equations (GEEs) were used to predict false negative reports for various substances across the study and determine the influence of substance use on the primary study outcome of smoking cessation. RESULTS: Participants demonstrated high false negative rates in reporting substances use, and the false negative rates increased as the study progressed. Established predictors of false negatives generalized to the current sample. High concordance and low false negative rates were found in self-report of nicotine use. A small but significant relationship was found in for effect of biochemically verified substance use on smoking cessation. CONCLUSIONS: Biochemical verification of substance use is needed in high risk populations involved in studies not directly related to the treatment of substance use, especially in populations with high threat of stigmatization. Testing should continue through the time period of the study for maximal identification of substance use.
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Consumo de Bebidas Alcoólicas/terapia , Ensaios Clínicos como Assunto , Fumar Maconha/terapia , Autorrelato , Fumar/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Consumo de Bebidas Alcoólicas/urina , Transtornos Relacionados ao Uso de Cocaína/terapia , Transtornos Relacionados ao Uso de Cocaína/urina , Cotinina/urina , Reações Falso-Negativas , Feminino , Humanos , Masculino , Fumar Maconha/urina , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/terapia , Transtornos Relacionados ao Uso de Opioides/urina , Fumar/urina , Abandono do Hábito de Fumar , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/urinaRESUMO
BACKGROUND: Treatment-related reductions in morbidity and mortality among human immunodeficiency virus (HIV)-positive patients have been attenuated by cigarette smoking, which increases risk of cardiovascular, respiratory, and neoplastic diseases. This study investigated factors associated with smoking status among HIV-positive patients. METHODS: This cross-sectional study included 2,464 HIV-positive patients attending the HIV Clinic at the University of Alabama at Birmingham between April 2008 and December 2013. Smoking status (current, former, never), psychosocial factors, and clinical characteristics were assessed. Multinomial logistic regression was used to obtain unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of the various factors with smoking status. RESULTS: Among HIV-positive patients (mean age 45 years, 75% male, 55% African-American), the majority reported a history of smoking (39% current and 22% former smokers). In adjusted models, patient characteristics associated with increased odds of current smoking were male gender (OR for heterosexual men, 1.8 [95% CI: 1.3-2.6]; for men who have sex with men, 1.5 [1.1-1.9]), history of respiratory diseases (1.5 [1.2-1.9]), unsuppressed HIV viral load (>50 copies/mL) (1.5 [1.1-1.9]), depression (1.6 [1.3-2.0]), anxiety (1.6 [1.2-2.1]), and prior and current substance abuse (4.7 [3.6-6.1] and 8.3 [5.3-13.3] respectively). Male gender, anxiety, and substance abuse were also associated with being a former smoker. CONCLUSIONS: Smoking was common among HIV-positive patients, with several psychosocial factors associated with current and former smoking. This suggests smoking cessation programs in HIV clinic settings may achieve greater impact by integrating interventions that also address illicit substance abuse and mental health.