Risultati per: Linee guida su HIV, epatite e malattie sessualmente trasmissibili.

Introduction
Chronic kidney disease (CKD) is estimated to affect about 9.1% of the global population with a substantially increased risk of the condition (6.8%–17.2%) among people living with HIV (PLWH). This increased risk is attributed to HIV infection itself, antiretroviral therapy, coexisting viral infections, non-infectious comorbidities and traditional risk factors for CKD. Predictive models have been employed in the estimation of prevalent and incident CKD risk in both PLWH and the general population. A predictive model showing an individual’s risk of prevalent and/or progression to kidney failure is useful for initiating timely interventions that prevent further worsening of kidney function. This study will systematically review published prediction models developed and/or validated for prevalent and incident CKD in PLWH, describe their characteristics, compare performance and assess methodological quality and applicability.

Methods and analysis
Studies with predictive models of interest will be identified by searching MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane library and Scopus from inception to May 2022. Title and abstract screening, full-text review and data extraction will be completed independently by two reviewers. Using appropriate tools designed for predictive modelling investigations, the included papers will be rigorously assessed for bias and applicability. Extracted data will be presented in tables, so that published prediction models can be compared qualitatively. Quantitative data on the predictive performance of these models will be synthesised with meta-analyses if appropriate.

Ethics and dissemination
The findings of the review will be disseminated in peer-reviewed journals and seminar presentations. Ethical approval is not required as this is a protocol for a systematic review.

PROSPERO registration number
CRD42021279694.

Objectives
To estimate anaemia prevalence and the associated factors among hospitalised people living with HIV (PLHIV) receiving antiretroviral therapy (ART).

Design
A cross-sectional study.

Setting
PLHIV receiving ART and hospitalised in a specialised hospital for infectious disease in Guizhou Province, Southwest China, between 1 January 2018 and 31 March 2021.

Participants
A total of 6959 hospitalised PLHIV aged ≥18 years and receiving ART were included in this study.

Primary and secondary outcome measures
Anaemia was diagnosed as a haemoglobin concentration

Objectives
Integrated early childhood development (ECD) and prevention of mother-to-child transmission (PMTCT) interventions rarely target fathers, a missed opportunity given existing research demonstrating that father involvement improves maternal and child outcomes. We aimed to explore mother’s perceptions of fathers’ buy-in to an integrated PMTCT-ECD programme, any impact the programme had on couple dynamics, and perceived barriers to fathers’ involvement in ECD activities.

Design
Qualitative study using individual in-depth interviews with mothers participating in a PMTCT–ECD programme. Interviews assessed mothers’ perceptions of father buy-in and engagement in the programme and ECD activities. Data were coded using inductive and deductive strategies and analysed using constant comparison methods in Atlas.ti V.1.6.

Setting
Four health facilities in Malawi where PMTCT services were provided.

Participants
Study participants were mothers infected with HIV who were enrolled in the PMTCT–ECD programme for >6 months.

Interventions
The PMTCT–ECD intervention provided ECD education and counselling sessions during routine PMTCT visits for mothers infected with HIV and their infants (infant age 1.5–24 months). The intervention did not target fathers, but mothers were encouraged to share information with them.

Results
Interviews were conducted with 29 mothers. Almost all mothers discussed the PMTCT–ECD intervention with male partners. Most mothers reported that fathers viewed ECD as valuable and practised ECD activities at home. Several reported improved partner relationships and increased communication due to the intervention. However, most mothers believed fathers would not attend the PMTCT–ECD intervention due to concerns regarding HIV-related stigma at PMTCT clinics, time required to attend and perceptions that the intervention was intended for women.

Conclusions
Fathers were interested in an integrated PMTCT–ECD programme and actively practised ECD activities at home, but felt uncomfortable visiting PMTCT clinics. Interventions should consider direct community outreach or implementing ECD programmes at facility entry points where men frequent, such as outpatient departments.

Objective
To assess the potential bidirectional relationship between food insecurity and HIV infection in sub-Saharan Africa.

Design
Nationally representative HIV impact assessment household-based surveys.

Setting
Zambia, Eswatini, Lesotho, Uganda and Tanzania and Namibia.

Participants
112 955 survey participants aged 15–59 years with HIV and recency test results.

Measures
Recent HIV infection (within 6 months) classified using the HIV-1 limited antigen avidity assay, in participants with an unsuppressed viral load ( >1000 copies/mL) and no detectable antiretrovirals; severe food insecurity (SFI) defined as having no food in the house ≥three times in the past month.

Results
Overall, 10.3% of participants lived in households reporting SFI. SFI was most common in urban, woman-headed households, and in people with chronic HIV infection. Among women, SFI was associated with a twofold increase in risk of recent HIV infection (adjusted relative risk (aRR) 2.08, 95% CI 1.09 to 3.97). SFI was also associated with transactional sex (aRR 1.28, 95% CI 1.17 to 1.41), a history of forced sex (aRR 1.36, 95% CI 1.11 to 1.66) and condom-less sex with a partner of unknown or positive HIV status (aRR 1.08, 95% CI 1.02 to 1.14) in all women, and intergenerational sex (partner ≥10 years older) in women aged 15–24 years (aRR 1.23, 95% CI 1.03 to 1.46). Recent receipt of food support was protective against HIV acquisition (aRR 0.36, 95% CI 0.14 to 0.88).

Conclusion
SFI increased risk for HIV acquisition in women by twofold. Heightened food insecurity during climactic extremes could imperil HIV epidemic control, and food support to women with SFI during these events could reduce HIV transmission.

Background
Hepatitis B and HIV care share health system challenges in the implementation of primary prevention, screening, early linkage to care, monitoring of therapeutic success and long-term medication adherence.

Setting
Arua regional referral hospital (RRH) and Koboko district hospital (DH), the West Nile region of Uganda.

Design
A cross-sectional hospital-based cost minimisation study from the providers’ perspective considers financial costs to measure the amount of money spent on resources used in the stand-alone and integrated pathways.

Data sources
Clinic inputs and procurement invoices, budgetary documents, open market information and expert opinion. Data were extracted from 3121 files of HIV and hepatitis B virus (HBV) monoinfected patients from the two study sites.

Objective
To estimate provider costs associated with running an integrated HBV and HIV clinical pathway for patients on lifelong treatment in low-resource setting in Uganda.

Outcome measures
The annual cost per patient was simulated based on the total amount of resources spent for all the expected number of patient visits to the facility for HBV or HIV care per year.

Results
Findings showed that Arua hospital had a higher cost per patient in both clinics than did Koboko Hospital. The cost per HBV patient was US$163.59 in Arua and US$145.76 in Koboko while the cost per HIV patient was US$176.52 in Arua and US$173.23 in Koboko. The integration resulted in a total saving of US$36.73 per patient per year in Arua RRH and US$17.5 in Koboko DH.

Conclusion
The application of the integrated Pathway in HIV and HBV patient management could improve hospital cost efficiency compared with operating stand-alone clinics.

A man in his 40s with HIV presented to the emergency department with nausea, abdominal pain, bloody stools, odynophagia, and recurrent mucosal ulcers; he was found to have pancytopenia and septic shock. What is your diagnosis?

Objective
Tuberculosis (TB) and HIV/AIDS are public health concerns in Papua New Guinea (PNG). This study examines TB and HIV/AIDS mortalities and associated sociodemographic factors in PNG.

Method
As part of a longitudinal study, verbal autopsy (VA) interviews were conducted using the WHO 2016 VA Instrument to collect data of 926 deaths occurred in the communities within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System from 2018 to 2020.
InterVA-5 cause of deaths analytical tool was used to assign specific causes of death (COD). Multinomial logistic regression analyses were conducted to identify associated sociodemographic factors, estimate adjusted ORs (AOR), 95% CIs and p values.

Result
TB and HIV/AIDS were the leading CODs from infectious diseases, attributed to 9% and 8% of the total deaths, respectively.
Young adults (25–34 years) had the highest proportion of deaths from TB (20%) and the risk of dying from TB among this age group was five times more likely than those aged 75+ years (AOR: 5.5 (95% CI 1.4 to 21.7)). Urban populations were 46% less likely to die from this disease compared rural ones although the difference was not significant (AOR: 0.54 (95% CI 0.3 to 1.0)). People from middle household wealth quintile were three times more likely to die from TB than those in the richest quintile (AOR: 3.0 (95% CI 1.3 to 7.4)).
Young adults also had the highest proportion of deaths to HIV/AIDS (18%) and were nearly seven times more likely to die from this disease compared with those aged 75+years (AOR: 6.7 (95% CI 1.7 to 25.4)). Males were 48% less likely to die from HIV/AIDS than females (AOR: 0.52 (95% CI 0.3 to 0.9)). The risk of dying from HIV/AIDS in urban population was 54% less likely than their rural counterparts (AOR: 0.46 (95% CI 0.2 to 0.9)).

Conclusion
TB and HIV/AIDS interventions are needed to target vulnerable populations to reduce premature mortality from these diseases in PNG.

Objective
Measuring access and preferences to Men who have Sex with Men focused community-based HIV testing sites (MSM-CBTS) in Côte d’Ivoire.

Design
A respondent-driven sampling telephone survey.

Setting
National survey conducted in 2018 in Côte d’Ivoire.

Participants
518 MSM aged over 18 years old.

Primary and secondary outcome measures
Knowledge, practices, satisfaction and preferences regarding MSM-CBTS. Factors associated with MSM-CTBS access or knowledge and with HIV testing venue preferences were examined.

Results
Only half of the respondents (47%) reported knowing of an MSM-CBTS. Of these, 79% had already attended one. Both knowing of and ever visiting an MSM-CBTS were significantly associated with a higher number of HIV tests performed in the past 12 months and having disclosed sexual orientation to one family member.
In terms of preferences, 37% of respondents said they preferred undifferentiated HIV testing sites (ie, ‘all patients’ HIV testing sites), 34% preferred MSM-CBTS and 29% had no preference.
Those who reported being sexually attracted to women, being bisexual and those who did not know an MSM non-governmental organisation were less likely to prefer MSM-CBTS. MSM who preferred undifferentiated HIV testing sites mentioned the lack of discretion and anonymity of community-based sites and the desire to avoid the gaze of others.

Conclusion
Community-based HIV testing is well suited for MSM who identify as homosexual and those close to the MSM community, while maintaining undifferentiated HIV testing is essential for others. Both types of activities need to be maintained and developed. Healthcare professionals in undifferentiated HIV testing sites need to be properly trained in the non-judgemental reception of MSM.

Objective
The aim of this study was to assess the prevalence of anaemia and its associated factors at the time of antiretroviral therapy (ART) initiation among HIV-infected adults at Debre Markos Comprehensive Specialized Hospital.

Methods
An institution-based retrospective cross-sectional study was conducted among 473 patients’ charts enrolled from 2014 to 2018 at Debre Markos Comprehensive Specialized Hospital. Patients’ chart numbers were selected from the computer using a simple random sampling technique. Data were entered using Epi Info V.7.2.2.6 and analysed with Stata V.14.0. Anaemia prevalence at the time of ART initiation was computed and described using frequency tables. To identify factors for anaemia, bivariate and multivariate logistic regression models were fitted. Model fitness was checked using the Hosmer-Lemeshow goodness-of-fit test.

Results
From 473 patients’ charts, 468 charts were included in the analysis, and a total of 164 anaemia cases were recorded. The overall prevalence of anaemia among HIV-infected adults at the time of ART initiation was 35.04% (95% CI: 30.84% to 39.49%). After multivariate analysis, an increased risk of anaemia was seen among males (adjusted OR (AOR)=2.45; 95% CI: 1.51 to 3.98); those not attending formal education (AOR=2.38; 95% CI: 1.12 to 5.05); those who had baseline CD4+ T cell count ≤200 cells/mm3 (AOR=4.67; 95% CI: 2.78 to 7.85); had body mass index (BMI)

Objective
To understand the sexual behaviours and HIV testing uptake of sexually experienced male college students in China.

Design
A cross-sectional study was conducted between September and November of 2020 among male college students.

Setting
Hangzhou, China.

Participants
Male students who had sexual experience in the previous year were investigated.

Outcome measures
Sexual risk behaviour was defined as having multiple sexual partners or having unprotected sex.

Results
More than half of the sexually experienced male students (556, 53.2%) had their first sexual intercourse under the age of 18 years old. Among participants, 32.82% (343/1045) had causal sex in the last 6 months; 4.21% (44/1045) had paid sex; 37.32% (390/1045) had sex with other men and had two or more sexual partners in last half year; and 33.33% (130/390) used psychoactive drugs during same-sex intercourse. Only 33.5% (350/1045) of male students had undertaken an HIV test before.

Conclusion
Male college students especially men who have sex with men were at risk because they tended to be sexually adventurous, have sex at an early age, have sex with multiple sexual partners and practice unprotected sex. Furthermore, they had a low HIV testing uptake. This highlights the importance of carrying out targeted and timely HIV risk education towards college students.

Objectives
To explore the potential use of body mass index (BMI), proteinuria and total lymphocyte count changes in predicting immunological and virological response in individuals with HIV initiated on antiretroviral treatment (ART).

Design
Prospective cohort study.

Setting
Three urban HIV care and treatment centres in Dar es Salaam.

Participants
Individuals with HIV initiating ART.

Outcome measures
HIV viral load ≥1000 copies/mL (viral non-suppression) at 6 months after ART initiation.

Results
Of 215 (out of 220 enrolled) participants who returned for evaluation at 6 months, 147 (66.8%) were women. At 6 months of follow-up, 89.4% (76/85) of participants with sustained weight gain were virally suppressed compared with 31.8% (7/22) with sustained loss, p

Introduction
Point-of-care dual tests (POCTs) for simultaneously detecting antibodies to HIV and syphilis (dual HIV-syphilis POCTs) have been developed recently and show encouraging performance compared with the reference tests in laboratory-based studies. As community-based voluntary, counselling and testing (CBVCT) services are effective providers of HIV and syphilis testing and counselling with high acceptability among men who have sex with men (MSM), the evaluation of the utility of these dual tests in CBVCT services is a high priority. This prospective cross-sectional study will conduct a clinical utility evaluation of two dual POCTs in non-clinical settings for the screening of HIV and syphilis in MSM. This master protocol outlines the overall research approach that will be used in four countries.

Methods and analysis
MSM presenting at CBVCT services participating in the study for HIV/STI screening will be enrolled. The (WHO preapproved) dual POCTs to be evaluated will be SD Bioline HIV/Syphilis Duo (Abbot) and Dual Path Platform HIV-Syphilis Assay (Chembio). Trained staff will collect a capillary blood sample using finger prick blood to perform both POCTs according the manufacturers’ instructions. An analysis of the feasibility of introducing the dual POCT for the screening of HIV and syphilis in MSM at CBVCT services will be performed, by assessing its acceptability and usability at CBVCT service among MSM users and providers.

Ethics and dissemination
This core protocol was independently peer reviewed and approved by the Research Project Review Panel (RP2) of the WHO Department of Sexual and Reproductive Health and Research and by the WHO Ethics Review Committee (ERC). The protocol has been adapted to individual countries and approved by RP2, ERC and institutional review boards at each site. Results will be disseminated through peer-reviewed journals and relevant conferences.