Mental Health among People Living with HIV (PLWH) in Iran: A Policy Brief Teaser: The necessity of a Tool for Mental Health in PLWH in Iran

Depression and anxiety are the most common mental health disorders in people living with HIV (PLWH). Adherence to antiretroviral therapy (ART) is an important concern that could be significantly affected by psychological problems among PLWH. Therefore, the authors recommend using an anxiety and depression screening tool, among Iranian PLWH in HIV health care system and determine potential barriers to depression screening and effective care

A tailored mHealth intervention for improving treatment adherence for people living with HIV in Iran (HamRaah):Protocol for a feasibility study and randomised pilot trial with a nested realist evaluation

Introduction Middle East and North Africa (MENA) has a rising rate of new HIV infections and AIDS-related mortality. Consistent adherence to antiretroviral therapy (ART) leads to viral suppression, preventing HIV transmission and treatment failure. mHealth interventions can improve ART adherence by providing tailored support and directing patients to existing healthcare services. HamRaah (Persian for ‘together-in-path’) is the first mHealth-based intervention in a MENA country and is designed to improve adherence through two-way mobile messaging for people recently diagnosed with HIV in Tehran, Iran. The objectives of this pilot randomised controlled trial (RCT) are to examine the feasibility, acceptability and preliminary effectiveness of HamRaah, and to develop an explanatory theory for any observed effects through a nested realist evaluation.Methods A feasibility study and two-arm RCT of HamRaah, with an embedded realist evaluation will be conducted. Participants will be randomised 1:1 to HamRaah or routine care for a 6-month intervention. The initial effectiveness of HamRaah will be assessed through the primary outcome of self-reported ART adherence and several secondary outcomes: retention in care, CD4 count and viral suppression. A theory-driven realist evaluation framework will be used to develop an explanatory theory regarding what works, for whom, how and in what context.Ethics and dissemination The study received ethical clearance from Tehran University of Medical Sciences Ethics Committee and Oxford Tropical Research Ethics Committee People living with HIV in Tehran and key country stakeholders in HIV policy and programming have been involved in the development of HamRaah and this pilot trial. Participants will provide informed consent prior to study enrolment. The results will be disseminated to all stakeholders and presented in peer-reviewed journal publications and conferences.Trial registration number IRCT20100601004076N23; Pre-results

Atazanavir / ritonavir versus Lopinavir / ritonavir-based combined antiretroviral therapy (cART) for HIV-1 infection: a systematic review and meta-analysis

Background: This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of Atazanavir/ritonavir over lopinavir/ritonavir in human immunodeficiency virus-1 (HIV-1) infection. Methods: Clinical trials with a head-to-head comparison of atazanavir/ritonavir and lopinavir/ritonavir in HIV-1 were included. Electronic databases: PubMed/Medline CENTRAL, Embase, Scopus, and Web of Science were searched. Viral suppression below 50 copies/ml at the longest follow-up period was the primary outcome measure. Grade 2-4 treatment-related adverse drug events, lipid profile changes and grade 3-4 bilirubin elevations were used as secondary outcome measures. Results: A total of nine articles from seven trials with 1938 HIV-1 patients were included in the current study. Atazanavir/ritonavir has 13% lower overall risk of failure to suppress the virus level < 50 copies/ml than lopinavir/ritonavir in fixed effect model (pooled RR: 0.87; CI: 0.78, 0.96; P=0.006). The overall risk of hyperbilirubinemia is very high for atazanavir/ritonavir than lopinavir/ritonavir in the random effects model (pooled RR: 45.03; CI: 16.03, 126.47; P< 0.0001). Conclusion: Atazanavir/ritonavir has a better viral suppression at lower risk of lipid abnormality than lopinavir/ritonavir. The risk and development of hyperbilirubinemia from atazanavir-based regimens should be taken into consideration both at the time of prescribing and patient follow-up

Frequency of HIV Infection among Sailors in South of Iran by Rapid HIV Test

Information on the prevalence and risk factors for HIV infection among sailors is scarce. The aim of this seroprevalence study was to evaluate the frequency of HIV infection among sailors in south of Iran using rapid HIV test. The study included 400 consecutive participants in Lengeh, Shahid Rajaie, and Shahid Bahonar ports in south of Iran in May 2010. We observed only one case (0.25%) of HIV infection in this sample of sailors. While prevalence appears low at present, we recommend periodic HIV serosurveillance with detailed behavioral measures for this population in the future

An Estimation of HIV/AIDS’s Cost in the Voluntary Counseling and Testing Center of Imam Khomeini Hospital in 2010-2011

Introduction: Undoubtedly, HIV/AIDS is one of the most important emerging infectious disease in the late twentieth century; and its control is possible only with proper and organized program. To attain this goal, one of the most serious issues is the budget planning and distribution. The present study calculated the total costs of AIDS in Voluntary Counseling and Testing center of Imam Khomeini Hospital in 2010-2011.Methods: The total cost of AIDS at this center was divided into four categories: health care, training and educating, research and services. All costs for 2010-2011 were extracted and classified based on documents and bills which were found in the center.Results: According to the calculations, the center had a total of 6,603,479,058 IRR in 2010-2011, of which 49.5% (3,271,089,796 IRR) was allocated for health care expenditure, 20.3% (1,335,186,000 IRR) for research, 12.6% (834,000,000 IRR) for training and 17.6% (1,163,203,262 IRR) for services. The average expense for each person living with HIV was 2276 US dollars. The cost of treatment by drugs for each person eligible for treatment was 782 US dollars.Conclusion: The percentage of budget distribution in the center is equal to the same percentage in low and middle income countries; although, more percentage is allocated for research than the mentioned countries. Also, the expenditure spent for treatment by drugs is more than the average of the same found in low and middle income countries. Overall, the budget distribution in this center is almost in accordance with the international standards

Content Analysis of Teleconsultation Enquiries in Positive Health Club, Imam Khomeini Hospital, Tehran, Iran

Objective: With the availability of specialists and the overflowing information in public and social networks, individuals have easy access to information about HIV and AIDS. However, medical counselling and healthcare settings still have an essential role. The aim of the present study was to analyze phone enquiries directed to the Positive Club of Imam Khomeini Hospital in Tehran; this analysis was based on demographic features of participants.Design/Methodology/Approach: In this cross-sectional study, 5255 questions were extracted and coded from the Positive Club's counselling questionnaires; the coding procedure was based on Huber and Gilapsy's decimal classification. Data were processed by descriptive statistics and SPSS software.Findings: A majority of callers were men (59.43%), most callers were aged between 26 and 30 years, and HIV transmission and high-risk sexual behaviours were among frequently asked questions (47%).Originality/Value: Taking into account that most callers were concern about transmission via sexual contact (anal, vaginal, and oral) rather than injection and its related equipment, it seems reasonable to assume that HIV transmission flow may shift from shared injection equipment to high-risk sexual behaviors

How mobile health can change the contexts of living with HIV and engaging with treatment and care in Iran

Mobile health (mHealth) interventions are increasingly used to address the challenges of living with HIV and engaging with antiretroviral therapy. A wealth of evidence supports the efficacy of mHealth in supporting living with HIV. Yet, there is a dearth of evidence on how mHealth improves outcomes, which features are effective, and why these work in a particular setting. This study uses stakeholder views, including patients, providers, peer supporters, counsellors, and program directors, to conceptualize how specific mHealth features could interact with contexts of living with HIV and mechanisms that shape engagement with treatment. The study is part of an ongoing research project on engagement with HIV care in Iran. We draw on the perspectives of recently diagnosed and more treatment-experienced patients and their providers, using purposive sampling, conducting 9 focus group discussions with a total of 66 participants, in addition to 17 interviews. Our findings suggest that mHealth designs that feature provider connection, proactive care, and privacy and personalization are expected to dilute the harsh contexts of living with HIV. We build on previously identified socioecological pathways that disrupt antiretroviral therapy in Iran and find that mHealth can enhance the relation between the health system and patients. Our findings suggest that personalized mHealth features and provisions can partially mitigate the compounded impacts of harsh socioecological pathways that impede treatment success in Iran. Our social constructivist study was augmented with realist-informed analysis and could have transferability to similar contexts that trigger similar mechanisms of treatment disruption.</p

Acceptability of HIV Rapid Testing in Diverse Clinical Settings in Iran

Introduction: Rapid HIV testing in clinical settings can identify previously undiagnosed persons and link them to care, as well provide patients with knowledge of their serostatus and risk reduction counseling. We conducted a survey to characterize factors affecting the acceptance or declining of rapid HIV testing among Iranian patients.Methods: This cross-sectional survey was conducted from October 2014 to December 2014 with patients in three different health care centers (an emergency department in an urban hospital, a rural health centre, a voluntary counseling and testing centre (VCT) within Imam Khomeini Hospital, Tehran, Iran and a rural health centre). Participants completed a semi-structured face-to-face questionnaire and were tested by an HIV rapid test (Chembio Sure Check).Results: Of 222 participants, 25 participants were from the urban emergency department, 40 from the urban VCT program, and 157 from the rural health care centre. All did the rapid HIV test; all were HIV negative. HIV-related risk profiles found the urban emergency department patients more likely to have multiple partners (26%, P&lt;0.01) and history of sexually transmitted diseases (27%, P&lt;0.001) compared to VCT patients (9% and 3%, respectively) and rural clinic patients (4% and 1%, respectively). Emergency department patients were also more willing to pay for a HIV rapid test (44%, P&lt;0.01), doing a rapid self-test at home (84%,P=0.01), preferring pharmacies as a place for providing rapid tests (80%, P=0.001). Also level of participants’ awareness was considerably different between mentioned centres (median=11, 12, 10 for emergency department, VCT and rural Health care centre respectively; P=0.012).Conclusions: Increasing knowledge about HIV rapid testing, its availability, and keeping costs low can expand the desire to use the test and ultimately prevent the spread of HIV through lack of knowing one’s serostatus and lack of treatment. Emergency departments in urban Iran may be an opportunity to test persons at high risk for HIV infection