Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC). METHODS AND FINDINGS: This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32) and decreased (AOR, 0.31; CI, 0.11-0.83) odds of non-adherence to ART. CONCLUSION: Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland.

INTRODUCTION:HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions. METHODS AND FINDINGS:This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319). CONCLUSIONS:Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function

Descriptive and bivariate factors associated with HIV infection.

<p>Descriptive and bivariate factors associated with HIV infection.</p

Factors associated with reported HIV positive status by binary logistic and multiple logistic regression among 827 respondents.

<p>Factors associated with reported HIV positive status by binary logistic and multiple logistic regression among 827 respondents.</p

Reasons for missing ART doses during the previous seven days.

<p>ART, antiretroviral therapy; Multiple responses are possible.</p

Perceptions about HIV/AIDS and ART.

<p>ART, antiretroviral therapy; OR, odds ratio; CI, confidence interval.</p

Bivariate analysis of factors associated with Non-adherence to ART.

<p>Defined as alcohol consumption at least once a month;</p><p>travel time from home to health facility expressed in hour(s); ART, antiretroviral therapy; OR, odds ratio; CI, confidence interval; 3TC = Lamivudine; TDF = Tenofovir; EFV = Efavirenz; NVP = Nevirapine; AZT = Zidovudine; LPV/r = Lopinavir/Ritonavir, D4T = Stavudine, ABC = Abacavir; DDI = Didanosine; IQR, inter-quartile range; HPGRK, Hopital Provincial General de Référence de Kinshasa; ACS/AMO Congo, Actions Communautaires Sida/Avenir meilleur pour les orphelins.</p

Factors Affecting the Decision-making of Direct Pulp Capping Procedures among Dental Practitioners:A Multinational Survey from 16 Countries with Meta-analysis

Introduction: Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians’ decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC. Methods: The questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients’ age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. Results: A tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P &lt; .001) as opposed to the clinical scenario with 2 pulp exposures (RR = 1.38, 95% CI: 1.24, 1.53; P &lt; .001). Complete caries removal was significantly preferred to selective caries removal (RR = 4.59, 95% CI: 3.70, 5.69; P &lt; .001). Among the capping materials, calcium silicate-based materials were preferred over calcium hydroxide-based materials (RR = 0.58, 95% CI: 0.44, 0.76; P &lt; .05). Conclusions: While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of calcium silicate-based materials appears to have replaced calcium hydroxide-based materials.</p

Sociodemographic characteristics of non-adherent and adherent participants on ART recruited in Kinshasa, DRC.

<p>Other: Muslim, Kimbaguist, None;</p><p>number of financial dependents; ART, antiretroviral therapy; IGA, income generating activity; OR, odds ratio; IQR, inter-quartile range; DRC, Democratic Republic of Congo.</p

Multivariate analysis of factors associated with non-adherence to ART.

<p>ART, antiretroviral therapy; OR, odds ratio; CI, confidence interval; HPGRK, Hopital Provincial General de Référence de Kinshasa; ACS/AMO CONGO, Actions Communautaires Sida/Avenir Meilleur pour les Orphelins.</p