Impact of antiretroviral therapy on fertility desires among HIV-infected persons in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral therapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIV-infected persons on HAART have different fertility desires compared to persons not on HAART, and if the knowledge about HIV transmission from mother-to-child is different in the two groups.</p> <p>Methods</p> <p>The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who were on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living in a rural area of western Uganda. The desire for future children was measured by the question in the questionnaire "Do you want more children in future." The respondents' HAART status was derived from the interviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze the relationship between HAART treatment status and the desire for future children.</p> <p>Results</p> <p>Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95% CI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant predictors for desiring more children were younger age, having a higher number of living children and male sex. Knowledge of the risks for mother-to-child-transmission of HIV was similar in both groups.</p> <p>Conclusions</p> <p>The conclusions from this study are that the HAART treatment status of HIV patients did not influence the desire for children. The non-significant association between the desire for more children and the HAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the positive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care system ensures proper training of staff and appropriate communication to those living with HIV as well as to the general community.</p

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Gender-related mortality for HIV-infected patients on highly active antiretroviral therapy (HAART) in rural Uganda

Arif Alibhai1, Walter Kipp1, L Duncan Saunders1, Ambikaipakan Senthilselvan1, Amy Kaler2, Stan Houston3, Joseph Konde-Lule4, Joa Okech-Ojony5, Tom Rubaale51Department of Public Health Sciences, 2Department of Sociology, 3Department of Medicine, University of Alberta, Edmonton, Canada; 4School of Public Health, Makerere University, Kampala, Uganda; 5Kabarole Health Department, Fort Portal, Uganda Abstract: The purpose of this study was to examine gender differences in mortality for human immunodeficiency virus (HIV) patients in rural Western Uganda after six months of highly active antiretroviral therapy (HAART). Three hundred eighty five patients were followed up for six months after initiating HAART. Statistical analysis included descriptive, univariate and multivariate methods, using Kaplan&amp;ndash;Meier estimates of survival distribution and Cox proportional hazards regression. Mortality in female patients (9.0%) was lower than mortality in males (13.5%), with the difference being almost statistically significant (adjusted hazard ratio for females 0.55; 95% confidence interval [CI]: 0.28&amp;ndash;1.07; P = 0.08). At baseline, female patients had a significantly higher CD4+ cell count than male patients (median 147 cells/&amp;mu;L vs 120 cells/&amp;mu;L; P &amp;lt; 0.01). A higher CD4+ cell count and primary level education were strongly associated with better survival. The higher CD4+ cell count in females may indicate that they accessed HAART services at an earlier stage of their disease progression than males. A borderline statistically significant lower mortality rate in females shows that females fare better on treatment in this context than males. The association between lower mortality and higher CD4+ levels suggest that males are not accessing treatment early enough and that more concerted efforts need to be made by HAART programs to reach male HIV patients.Keywords: antiretroviral treatment, gender, rural, Ugand

Enough Children: Reproduction, Risk and “Unmet Need” among People Receiving Antiretroviral Treatment in Western Uganda

In this paper, we use survey (n=87) and interview (n=30) data to investigate orientations towards future childbearing among people receiving antiretroviral treatment and their family members in western Uganda. We investigate how reproductive options are perceived, by those receiving treatment and those closest to them, and consider what these perceptions suggest about the existence of an &ldquo;unmet need&rdquo; for birth control for women with HIV. While most people say they do not wish to have more children while on treatment, this intention coexists with contradictory desires for the benefits and happiness that more children might bring. We argue that the factors influencing birth desires and outcomes are so complex and contradictory that it is virtually impossible to predict demand or uptake of birth control as more and more people with AIDS in Africa gain the ability to access antiretroviral treatments.Keywords: HAART, AIDS, fertility, contraception, Uganda, unmet needAfr J Reprod Health 2012; 16[1]:133-14

Assez d’enfants: Reproduction, risque et besoin « non satisfait » chez les gens qui suivent un traitement antirétroviral en Ouganda de l’Ouest

In this paper, we use survey (n=87) and interview (n=30) data to investigate orientations towards future childbearing among people receiving antiretroviral treatment and their family members in western Uganda. We investigate how reproductive options are perceived, by those receiving treatment and those closest to them, and consider what these perceptions suggest about the existence of an “unmet need” for birth control for women with HIV. While most people say they do not wish to have more children while on treatment, this intention coexists with contradictory desires for the benefits and happiness that more children might bring. We argue that the factors influencing birth desires and outcomes are so complex and contradictory that it is virtually impossible to predict demand or uptake of birth control as more and more people with AIDS in Africa gain the ability to access antiretroviral treatments (Afr J Reprod Health 2012; 16[1]:133-144).Dans cet article, nous nous servons des données d’enquête (n=87) et d’interview pour étudier des orientations futures envers la maternité chez les gens qui suivent un traitement antirétroviral et chez les membres de leurs membres de leurs familles en Ouganda de l’ouest. Nous étudions comment les gens qui suivent le traitement et leurs plus proches aperçoivent les options reproductives et nous considérons ce que suggèrent ces perceptions par rapport à l’existence d’un « besoin non satisfait » pour la limitation des naissances chez les femmes séropositives. Alors que la plupart des femmes disent qu’elles ne veulent pas avoir d’autres enfants pendant le traitement, cette intention coexiste avec les désirs contradictoires pour les bénéfices et la joie que peut apporter d’autres enfants. Nous soutenons que les facteurs qui influent sur les désirs pour la maternité et les conséquences sont si complexes et contradictoires qu’il est pratiquement impossible de prédire ou d’accepter la limitation des naissances au fur et à mesure que les gens séropositifs en Afrique deviennent capables d’avoir accès aux traitements antirétroviraux (Afr J Reprod Health 2012; 16[1]:133-144)

Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda

Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13–0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20–17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients

Turning the Camera Back

There is limited literature describing the methodological and pragmatic considerations that arise when conducting participatory action research utilizing Photovoice with children, particularly within sub-Saharan Africa. We provide a case example of these considerations based on a qualitative exploratory design that was conducted in June 2010 with 13 children between the ages of 12 and 18 years who were orphaned and living with HIV in a group home setting in Western Uganda. The main purpose of this study was to explore the children’s experiences while including them in a participatory way utilizing Photovoice to share their stories, define their issues, and propose their own solutions. Conducting research in another country where language and culture are different from the researchers’ can pose many unique methodological, epistemological, and ethical challenges. These issues are discussed by reflecting on the process of the study. Key lessons will also be discussed regarding the methodological and pragmatic considerations with the aim of providing new insights for researchers who want to conduct research in a cross-cultural and multilingual setting

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs.</p> <p>The research</p> <p>This intervention study aimed to; 1) assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi) of Uganda; and 2) compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda.</p> <p>Results and outcomes</p> <p>Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda’s Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated.</p> <p>Challenges and successes</p> <p>Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole’s health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the long-term feasibility and sustainability of a community-based ARV program in Uganda still remain.</p> <p>The partnership</p> <p>This project is a continuation of previous successful collaborations between the School of Public Health of Makerere University, the School of Public Health of University of Alberta, the Kabarole District Administration and the Kabarole Research and Resource Center.</p