Suchergebnisse

BackgroundThe peculiarity of Romanian HIV epidemic is the high number of long‐time survivors, nosocomially infected with F subtype during early childhood. Although ART is provided for free, patients from certain regions are difficult to attain viral load (VL) and HIV resistance tests.ObjectivesTo assess the durability of first‐line antiretroviral therapy (1st ART) in Romanian HIV patients.MethodsRetrospective assessment of new HIV diagnosed patients during 2005–2010, monitored every 24 weeks (wk) in HIV clinic from Galati ‐ Romania, considering demographic data, HIV transmission pattern, immunity, HIV‐RNA blood levels, co‐morbidities, 1st ART regimen and adherence according to the national protocol. The endpoint was term on loss to follow‐up, death or 96 wk of ART.Results100 new diagnosed HIV patients since 2005 received 1st ART. Characteristics of naïve patients: median age on HIV diagnostic=22.5 years old; sex ratio M/F=53/47; living area rural/urban=55/45; low literacy 26%; HIV infection pattern paediatric/ sexual/ unknown=29/61/10; advanced late presenters 51%; TB as HIV indicator 22%; VHB co‐infection 22%; baseline av. CD4Ly=171/mm3. Experience of 1st ART: 2 NRTI+EFV 38% or LPV 27% or other protease inhibitor 35%. The reasons for 58% interrupting 1st ART: 9% dead, 17% abandoned, 18% failed, 12% developed adverse events and 2% drug‐drug interactions. While 53% patients were adherent previous to endpoint, no more than 42% kept on 1st ART>96 wk and recovered immunity with av. CD4Ly=213/mm3. Poor recovery of CD4Ly<100/mm3 was acquired by 13/48 patients with available HIV‐RNA<50 c/ml in 48 wk. The main risks below 24 weeks of 1st ART are the death (p=0.005; OR=36) and the adverse events (p=0.018; OR=24). Abandon rate (p=0.016; OR=5.14) is higher over 48 weeks. Regardless of 1st ARV regimen, adherence behaviour, immunologic benefits and ART durability were comparable. Viral failure is related to non‐adherence (p=0.03; OR=4.5) and low literacy situation (p<0.001; OR=7.5). Mortality is 4.6 times higher in TB and 2 times in HBV co‐morbidities.ConclusionsOver a half of naïve HIV patients continued 1st ART less than 96 wk. 26% patients with low literacy are a vulnerable group and require individualised educational and adherence programmes. To improve the sustainability of the 1st ART in HIV patients from Galati needs to intensify the support for earlier HIV diagnostic and current virology follow‐up.

Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-AIDS) has continued to be a tremor to the health sector in Ghana. One person was first diagnosed with HIV-AIDS in the Eastern region part of Ghana in 1986. Subsequently, 41 people more were diagnosed HIV positive in the same year. The spread of this disease was tremendous to the extent that about 107, 333 and 2744 people were diagnosed by the end of the years 1987, 1988 and 1990 respectively; hence it was declared as epidemic in accordance with the status of World Health Organization (WHO). Because there is no cure for it yet, the Government of Ghana and other stakeholders have taken some interventions to reduce the spread of this epidemic. One of these interventions was the introduction of the antiretroviral therapy (ART) program in 2003 by the Ghana AIDS Commission (GAC) through the Ghana Health Service (GHS). This research was therefore purposed at the use of phase trajectories to evaluate the effect of the ART program on the HIV infections rate. The data on the number of HIV infected people per each year for the years 1986-2018 were collated from the reports given by Ghana AIDS Commission (GAC), WHO and UNAIDS published on their associate websites. The whole data set was divided into two, with data one and two illustrating the yearly number of HIV infected people for the periods before (1986-2002) and after (2003-2018) the introduction of the ART program respectively. Phase trajectory analysis was then performed on the various components of the two data sets. Hypothesis testing was finally performed on the means of the two data sets to confirm the results of the phase trajectory analysis. The various phase trajectories illustrating data one (1086-2002) indicated a tremendous yearly increase in the HIV infection rate from 1986 to 2002, while those of data two indicated a tremendous yearly decrease in the HIV infection rate from 2003 to 2018. It was further confirmed at 0.05 significant level that the average number of HIV infected people before the introduction of the ART program was greater than that after the introduction of the ART program. Hence, the ART program contributed much to the reduction of the HIV infection rate in Ghana. The nature of this study, being first in Ghana, and its findings will help in updating the Ghanaian government, citizenly and other stakeholders on the trend of HIV infection rate with the introduction of the ART program.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Thesis (D.P.A.)--National Institute of Development Administration, 2021 ; This research on social capital and access to antiretroviral therapy in Thailand was conducted using quantitative methodology. The objectives of this research were to study the relationship of social capital with the influence of antiretroviral therapy in Thailand and to analyze the benefit incidence of access to antiretroviral therapy among populations with different income levels in the national health insurance system. The data were collected on antiretroviral drug recipients in 13 medical service areas of the National Health Security Office covering all regions of Thailand. A stratified sampling method was used for a sample of 665 people. The results showed that social capital was statistically associated with access to antiretroviral therapy. Participation in bridging and bonding networks has therefore influenced the rate of HIV drug access among HIV-positive people. Government sectors should therefore promote more social capitalization processes while raising the right attitude towards people living with HIV. In the analysis of the distribution of the benefits of using government budgets to support access to antiretroviral drugs, it was found that the Universal Health Coverage (Gold Card or 30-baht for all diseases) is more beneficial for the poor (pro-poor). However, it is interesting that all groups, whether they are middle-income groups, high-income, and highest-income groups, also benefited, while the fifth (highest-income) benefited comparatively more from this privilege than others. Therefore, policymakers may review the issue of medical treatment rights and the allocation of expenditure budgets in order to distribute benefits more directly to target groups by The poor registration data was linked to the hospital data able to produce tangible results of the policy. ; [preview](https://repository.nida.ac.th/bitstream/662723737/5513/4/b212209.pdf.jpg)

The vast numbers of individuals now infected with the HIV-1 virus and its spread to all corners of the globe have been well chronicled. It is difficult to convey, however, the desperation and hopelessness of the majority of those HIV-1-infected individuals that live in regions where resources are sparse. Pursuit of the unique and complex medical and societal issues relating to the HIV pandemic is globally creating a discrete area within the field of infectious disease. The consequences of the severe immunologic compromise resulting from HIV-1 infection vary from those seen in the West, both in terms of entities and their frequency. While a number of antiretroviral distribution programs are in place, the development of guidelines that simplify antiretroviral regimens, enrollment in treatment programs, and monitoring remain difficult. Furthermore, the epidemiology, response to antiretroviral therapy, and resistance patterns of non-B sybtypes await further elucidation. The goals that have been set may be compromised by concomitant endemic diseases (such as tuberculosis and malaria), unpreventable mother-to-child transmission, malnutrition, poor sanitation, inadequate public health systems, and, especially, the lack of an adequate healthcare workforce. However, awareness of these impediments is growing. The understanding of the complex and diverse economic, political and cultural forces entwined with and driving the epidemic is evolving. Finally, the need for a long-term, multifaceted response to the broad crisis in underdeveloped nations where AIDS is but one of a number of critical elements is becoming appreciated.

OBJECTIVE: To develop guidelines for health care providers and their HIV-positive patients on the clinical use of antiretroviral agents for HIV infection. OPTIONS: Recommendations published in 1996 by an international panel. OUTCOMES: Improvement in clinical outcomes or in surrogate markers of disease activity. EVIDENCE AND VALUES: The Canadian HIV Trials Network held a workshop on Oct. 19-20, 1996, to develop Canadian guidelines that incorporate information from recent basic and clinical research. RECOMMENDATIONS: Recommendations for the use of antiretroviral drugs in HIV infection are provided for initial therapy, continuing therapy, primary infection, vertical transmission, pediatric therapy and postexposure prophylaxis. VALIDATION: The guidelines are based on consensus of the participants attending the workshop: Canadian investigators, clinicians and invited representatives from the community, government and the pharmaceutical industry. They are subject to review and updating as new information on clinical benefits is published. SPONSORS: The workshop was organized by the National Centre of the Canadian HIV Trials Network. Unrestricted educational grants were provided by 8 pharmaceutical companies. Additional support was provided from the National AIDS Strategy of Health Canada.

In sub-Saharan Africa, AIDS has become one of the leading causes of death among children under the age of five years. Yet, despite increased availability of antiretroviral therapy (ART), children have been largely ignored or excluded from treatment initiatives. While efforts to get more children on treatment are increasing, important information is lacking to guide program and policy implementation. To address these gaps, the Horizons Program and the University of Cape Town conducted a rapid situational analysis in 2005 of pediatric HIV treatment sites in South Africa. In 2003, the South African government approved a plan for a national HIV treatment program with the goal of at least one service delivery point in each district providing treatment. The government guidelines emphasized providing treatment for both adults and children and the initial effort resulted in a significant number of children initiating treatment. This research summary details what is happening on the ground to understand how children have been affected by the ART rollout and what can be done to reach the thousands more that should be on treatment.

Anecdotal data suggest that some South Africans living with HIV who receive disability grants from the state deliberately default on their antiretroviral medication in an attempt to lower their CD4 count to remain eligible for grants. No actual empirical data however exist to show that disability grants act as such perverse incentives and are a valid reason for non-adherence. This article examines some of the complexities of antiretroviral adherence in the context of a resource-constrained environment. The multitude of structural barriers, including sometimes difficult patient-doctor conversations about the renewal of disability grants, shape patients' experiences of the clinic environment and influence their adherence to care.

Objective: To analyze and list factors and monitoring techniques related to the adherence to antiretroviral treatment. Method: study of integrative review of the literature from the electronic bases LILACS and MEDLINE, conducted in April and May, 2013. Results: factors such as education level, complexity of treatment, psychological aggravating and the relationship between health professional and the user were highlighted in adherence to ART. In this context, to monitor and measure adherence to antiretroviral therapy with the use of appropriate techniques can contribute to a significant increase of these values. Conclusion: it is true that there is no gold standard to ensure ideal adhesion, however, the use of correct and combined monitoring techniques, can significantly decrease the impact of several factors that predispose the ineffective adherence to AIDS treatment.