Correlates of Patient Retention in HIV Care and Treatment Programs in Nigeria

Author(s):

Chinenye Ugoji, Nwanneka Okere, Patrick Dakum, Rukeme Ake-Uzoigwe, Donald Igboelina, Nicaise Ndembi, Ernest Ekong, Manhattan Charurat and William A. BlattnerPages 300-307 (8)

Abstract:

Background: Long-term retention is a crucial component of HIV care because treatment success can only be measured among retained patients. Understanding determinants of retention will inform retention strategies. We evaluated the correlates of retention in a large HIV program in Nigeria.

Methods: We reviewed quality of care data for 5320 randomly selected HIV-positive adults aged ≥15 years enrolled in 37 treatment facilities in Nigeria between 2005 and 2009. Retention was described as having one or more clinic visits in the one year (2010) review period. Patient-related correlates of retention were determined using logistic regression.

Results: 144 patients exited the program through deaths or transferrals. Of the 5176 with no documented exits, 3231 (62.4%) were retained (65.6% female; median age: 35.6 years). 2938 (75.8%) patients on ART, and 286 (23.4%) pre-ART patients were retained. Being on ART (OR=10.3, p<0.001), Age 30-60years (30 – 45 years: OR=1.36, p<0.001 and >45 – 60 years: OR=1.47, p<0.001) compared to patients <30 years; Female gender (OR=1.18, p=0.006), baseline CD4 cell count (100-350 cells/mm3: OR=1.24, p=0.006) vs <100cells/mm3 and lower WHO stage at baseline (WHO Stage IV, III, II: OR=0.50,0.51,0.77 respectively) vs Stage I were associated with retention. Among patients on ART, recent ART initiation 2008-09 (OR=1.73, p<0.001) vs 2005-07, being on ART for >6months (p<0.001) vs <6month and initiating ART on non-Stavudine based regimen (p<0.001) were also associated with retention.

Conclusion: 3 out of 4 pre-ART patients and 1-in-4 ART patients were not retained in 37HIV treatment facilities in Nigeria. These findings provide insight that enables HIV programs integrate retention strategies at all stages of the HIV care continuum.

Keywords:

Adults, ART, AIDS, HIV, loss to follow up, Pre-ART, retention.

Affiliation:

Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.

Graphical Abstract:

Read Full-Text article

Read More

Brief Messages to Promote Prevention and Detection of Sexually Transmitted Infections

Author(s):

Rocio Garcia-Retamero and Edward T. CokelyPages 408-420 (13)

Abstract:

We review the results of our research program investigating the effects of brief risk awareness interventions for sexually active young adults⎯the age group most at-risk for sexually transmitted infections (STIs). Our review examines the influence of framed messages, individual differences, and visual aids on key attitudes, behavioral intentions, and health outcomes in three extensive longitudinal studies. Our first study showed that health messages can promote self-reported condom use (screening for STIs) when the messages were framed in positive (negative) terms. This study also showed that adding visual aids to the positive and negative framed messages made them equally and highly effective for promoting self-reported behavior. Visual aids increased self-reported behavior by eliminating the effect of framing on attitudes and behavioral intentions, which in turn influenced self-reported behavior. Our second study showed that visual aids were especially helpful for reducing the effect of message framing among young adults with low numeracy and high graph literacy. Our third study showed that visual aids influenced key attitudes, behavioral intentions, and self-reported behavior as much as a validated 8-hour educational program. Overall, our research suggests that well-constructed visual aids provide simple, effective ways of communicating quantitative information about STIs to at-risk young adults. Theoretical mechanisms, public policy implications, and open questions are discussed.

Keywords:

Condom use, individual differences, message frame, numeracy, risk literacy, screening, sexually transmitted infections, visual aids, young adults.

Affiliation:

Facultad de Psicología, Universidad de Granada, Campus Universitario de Cartuja s/n, 18071 Granada, Spain.

Read Full-Text article

Read More

Effects of a Quasi-Randomized Web-Based Intervention on Risk Behaviors and Treatment Seeking Among HIV-Positive Men Who Have Sex With Men in Chengdu, China

Author(s):

Guodong Mi, Zunyou Wu, Xiaodong Wang, Cynthia X. Shi, Fei Yu, Tian Li, Linglin Zhang, Jennifer M. McGoogan, Lin Pang, Jie Xu and Keming RouPages 490-496 (7)

Abstract:

The men who have sex with men (MSM) population in China has experienced a recent increase in HIV incidence. Due to the dual stigma and discrimination towards homosexuality and HIV infection, most MSM living with HIV/AIDS are hard to reach by offline intervention initiatives. We recruited HIV-positive MSM participants in Chengdu, China and assessed whether they disclosed their HIV status to partners, motivated a partner to receive testing, used condoms consistently, or initiated antiretroviral therapy. Participants were quasi-randomized to either the intervention or control arm. The intervention group was given instructions for an online program with four modules: an information exchange website, a bulletin board system, individualized online counseling with trained peer educators, and an animation game. All participants were re-assessed at 6 months. The study enrolled 202 HIV-positive MSM. The intervention group had significant increases in disclosing their HIV status to their partners (76.0% vs 61.2%, P=0.0388) and motivating partners to accept HIV testing (42.3% vs 25.5%, P=0.0156) compared with the control group, but there were no between-group differences in receiving early treatment or using condoms consistently. We found that a web-based intervention targeting HIV-positive MSM was an effective tool in increasing the uptake of HIV testing within this high-risk population.

Keywords:

Antiretroviral therapy, behavioral intervention, China, condom usage, HIV/AIDS, HIV status disclosure, HIV testing, men who have sex with men.

Affiliation:

National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, P.R. China.

Graphical Abstract:

Read Full-Text article

Read More

Perspectives of Genome-Editing Technologies for HIV Therapy

Author(s):

Hirotaka Ebina, Peter Gee and Yoshio KoyanagiPages 2-8 (7)

Abstract:

Background: Current HIV antiretroviral therapies potently suppress virus replication and prevent patients from progressing to AIDS but are unable to completely eliminate HIV due to the existence of dormant viral reservoirs which threaten to reemerge at anytime. Recently, genome-editing technologies that can recognize specific DNA sequences, including viral DNA, are being touted as promising tools for curing HIV, owing to their specificity, ease of use, and ability to be custom designed.

Conclusion: Here, we introduce several novel strategies aimed at eradicating HIV proviruses with state-of-the-art genomeediting technologies and discuss perspectives of these approaches for curing HIV.

Keywords:

CRISPR/Cas9, genome editing, HIV, latency, provirus, TALENs, ZFNs.

Affiliation:

Laboratory of Viral Pathogenesis, Institute for Virus Research, Kyoto University, 53 Shogoinkawara- cho, Sakyo-ku, Kyoto 606-8507, Japan.

Graphical Abstract:

Read Full-Text article

Read More

Cellular Antiviral Factors that Target Particle Infectivity of HIV-1

Author(s):

Christine GoffinetPages 211-216 (6)

Abstract:

Background: In the past decade, the identification and characterization of antiviral genes with the ability to interfere with virus replication has established cell-intrinsic innate immunity as a third line of antiviral defense in addition to adaptive and classical innate immunity. Understanding how cellular factors have evolved to inhibit HIV-1 reveals particularly vulnerable points of the viral replication cycle. Many, but not all, antiviral proteins share type I interferon-upregulated expression and sensitivity to viral counteraction or evasion measures. Whereas well-established restriction factors interfere with early post-entry steps and release of HIV-1, recent research has revealed a diverse set of proteins that reduce the infectious quality of released particles using individual, to date poorly understood modes of action. These include induction of paucity of mature glycoproteins in nascent virions or self-incorporation into the virus particle, resulting in poor infectiousness of the virion and impaired spread of the infection. Conclusion: A better understanding of these newly discovered antiviral factors may open new avenues towards the design of drugs that repress the spread of viruses whose genomes have already integrated.

Keywords:

HIV-1 Nef, IFITM, interferon, interferon-stimulated genes, particle infectivity, SERINC, 90K.

Affiliation:

Institute of Experimental Virology, TWINCORE Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany

Graphical Abstract:

Read Full-Text article

Read More