Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse

The pattern of infection and in vivo response to Chloroquine by uncomplicated Plasmodium falciparum malaria in northwestern Nigeria

The pattern of infection and in vivo response of uncomplicated Plasmodium falciparum malaria to Chloroquine as first line drug and Quinine, Halofantrine or Sulfadoxine-Pyrimethamine as second line medications was evaluated at nested sentinel points, including Government and Private Practices, for three consecutive months. 559 cases were evaluated of which 22.5% failed on Chloroquine therapy. The age range of P. falciparum malaria cases was 4 months to 48 years, with a mean and median age of 9.2 and 3 years, respectively. There were significantly more female patients than male. Also, ages 5 years and below accounted for 63.2% of cases and as a group had an increased risk of treatment failure with Chloroquine compared to older patients. In general, male patients also had a higher relative risk of treatment failure on Chloroquine. Patients treated in Government practices were more likely to fail than those treated in Private practices. All cases of failure to Chloroquine treatment responded to Quinine, Halofantrine or Sulfadoxine-Pyrimethamine

Socio economic and health challenges of internally-displaced persons as a result of 2012 flooding in Nigeria

Displaced people are faced with over-crowded conditions in camps with children being the most vulnerable. This is because they are faced with myriad of challenges such as poor nutrition, breakdown of health infrastructure, disease epidemics, looting and violence. Others include unprotected sex especially when separated from their families. Displaced persons are prey to a host of diseases, most of which could be prevented. In this study the socio-economic and health impacts among internally displaced persons (IDPs) following floods in Nigeria were identified. Information on social, economic and health issues obtained from 432 household heads, nursing mothers and pregnant women from 17 IDP camps in three states was analyzed using SPSS version 20.0. Majority (58%) of IDPs had their occupation as farming and as a result of the flood, 299 (69.2%) people lost their means of livelihood with a concomitant decrease in income to a mean of $35.2. Victims’ nutrition was affected, resulting 63.3 % having less to eat. Though the major source of water to the IDPs before the flood was rivers/streams and wells, there was no statistical significance (p=0.99) between the major source of water to the community even when they had access to pipe-borne water after the disaster

Adjunctive metformin for antipsychotic-induced dyslipidemia: A meta-analysis of randomized, double-blind, placebo-controlled trials

Antipsychotic-induced dyslipidemia could increase the risk of cardiovascular diseases. This is a meta-analysis of randomized double-blind placebo-controlled trials to examine the efficacy and safety of adjunctive metformin for dyslipidemia induced by antipsychotics in schizophrenia. The standardized mean differences (SMDs) and risk ratios (RRs) with their 95% confidence intervals (CIs) were calculated using the random-effects model with the RevMan 5.3 version software. The primary outcome was the change of serum lipid level. Twelve studies with 1215 schizophrenia patients (592 in metformin group and 623 in placebo group) were included and analyzed. Adjunctive metformin was significantly superior to placebo with regards to low density lipoprotein cholesterol (LDL-C) [SMD: −0.37 (95%CI:−0.69, −0.05), P = 0.02; I 2 = 78%], total cholesterol [SMD: −0.47 (95%CI:−0.66, −0.29), P \u3c 0.00001; I 2 = 49%], triglyceride [SMD: −0.33 (95%CI:−0.45, −0.20), P \u3c 0.00001; I 2 = 0%], and high density lipoprotein cholesterol [SMD: 0.29 (95% CI:0.02, 0.57), P = 0.03; I 2 = 69%]. The superiority of metformin in improving LDL-C level disappeared in a sensitivity analysis and 80% (8/10) of subgroup analyses. Metformin was significantly superior to placebo with regards to decrease in body weight, body mass index, glycated hemoglobin A1c, fasting insulin, and homeostasis model assessment-insulin resistance (P = 0.002–0.01), but not regarding changes in waist circumference, waist-to-hip rate, leptin, fasting glucose, and blood pressure (P = 0.07–0.33). The rates of discontinuation due to any reason [RR: 0.97 (95%CI: 0.66, 1.43), P = 0.89; I 2 = 0%] was similar between the two groups. Adjunctive metformin could be useful to improve total cholesterol and triglyceride levels, but it was not effective in improving LDL-C level in schizophrenia