Immunization status and child survival in rural Ghana

For three decades, the Expanded Programme on Immunization (EPI) has been promoted as one of the key child health interventions in developing countries. Vaccines for six childhood diseases (diphtheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis) have been shown to be efficacious in preventing disease-specific morbidity and mortality, yet not all commentators are convinced that the EPI reduces all-cause child mortality. Numerous studies have found that measles vaccination programs substantially reduce all-cause child mortality, but recent findings from Guinea-Bissau suggest that diphtheria, pertussis, and tetanus (DPT) vaccine may increase all-cause child mortality. The present study uses five years of data from the Navrongo Demographic Surveillance System, a longitudinal population registration system in northern Ghana, to examine all-cause mortality among vaccinated and unvaccinated children under 5 years of age. The data indicate that coverage by one Bacillus Calmette-Guerin (BCG) shot, three sets of polio drops, and three DPT shots reduces mortality between ages 4 and 8 months by nearly 90 percent. Complete coverage by all EPI antigens reduces mortality between ages 9 and 59 months by 70 percent. BCG, polio, and DPT vaccines without measles vaccination reduce mortality by 40 percent. The independent reduction in mortality associated with measles vaccination is 50 percent. Our data add to a growing body of evidence that suggests that measles vaccination programs reduce all-cause mortality substantially beyond the proportion of deaths caused by measles. These results indicate a need for further research in developing countries on the all-cause mortality impact of these vaccines, in particular DPT vaccine

Intensity, Chronicity, Circumstances, and Consequences of HIV-Related Fatigue: A Longitudinal Study

HIV-related fatigue remains the most troubling complaint of seropositive people. Researchers often use tools to measure fatigue that were developed for other patient populations; thus, the measurement of fatigue specific to HIV is needed. This article describes results from the HIV-Related Fatigue Scale (HRFS) including: (a) the variability in intensity and chronicity of HIV-related fatigue, (b) the circumstances surrounding changes in fatigue, (c) the impact of fatigue on activities of daily living (ADLs), and (d) the consequences of HIV-related fatigue. We collected data every 3 months over a 3-year period from 128 people. HIV-related fatigue was chronic and did not appear to remit spontaneously; those who were the most fatigued at the beginning of the study remained the most fatigued over 3 years. Fatigue interfered more with instrumental activities of daily living than basic ADLs; it also interfered with work, family, and social life. Stress and depression increased fatigue

Demographic and Illness-Related Variables Associated With HIV-Related Fatigue

Fatigue is one of the most debilitating symptoms suffered by those with HIV infection, yet little is known about its correlates. Our primary aims are to describe the degree to which fatigue affects daily functioning and the demographic and illness-related predictors of fatigue. The sample (n = 128) was composed of primarily poor, unemployed people of color. Fatigue most often interfered with the ability to think quickly, perform household chores, exercise, work, engage in recreational activities, walk, plan activities, and think clearly. The consequences of fatigue were highest for lowered motivation, difficulty concentrating, increased drowsiness, losing patience, and interference with work, family, and social life. Multiple linear regression analyses revealed statistically significant associations of employment status, monthly income, current antidepressant use, and number of years living with HIV infection as predictors of fatigue. These must be better understood in order to develop interventions to successfully ameliorate HIV-related fatigue

Prevalence and Comorbidity of Psychiatric Diagnoses Based on Reference Standard in an HIV+ Patient Population

To study the prevalence of psychiatric comorbidity based on reference standard diagnostic criteria in patients with human immunodeficiency virus (HIV). Psychiatric illness is common in patients with HIV and has been associated with negative health behaviors and poorer clinical outcomes. Among those persons with psychiatric illness, psychiatric comorbidity (multiple simultaneous diagnoses) is associated with increased psychiatric severity and higher HIV risk behaviors

Daytime Sleepiness, Nighttime Sleep Quality, Stressful Life Events, and HIV-Related Fatigue

In this report we describe the relationships between daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue in a sample of 128 individuals; we are reporting the baseline results of a longitudinal observational study. We examined sleep using the Pittsburg Sleep Quality Index (PSQI) (a measure of the quality of nighttime sleep), and the Epworth Sleepiness Scale (ESS), (a measure of daytime sleepiness). Recent stressful life events were measured via a methodology developed in a previous 9-year HIV study. Poor nighttime sleep was significantly correlated with fatigue intensity (r = 0.46, p < 0.05), as was daytime sleepiness (r = 0.20, p < 0.05). However, in multiple regression models, the association between stress and fatigue intensity was not explained by daytime sleepiness and was only partially explained by nighttime sleep quality. Further research is needed to better elucidate these relationships

HIV Diagnoses, Prevalence and Outcomes in Nine Southern States

A group of nine states in the Southern United States, hereafter referred to as the targeted states, has experienced particularly high HIV diagnosis and case fatality rates. To provide additional information about the HIV burden in this region, we used CDC HIV surveillance data to examine characteristics of individuals diagnosed with HIV in the targeted states (2011), 5-year HIV and AIDS survival, and deaths among persons living with HIV (2010). We used multivariable analyses to explore the influence of residing in the targeted states at diagnosis on deaths among persons living with HIV after adjustment for demographics and transmission risk. In 2011, the targeted states had a higher HIV diagnosis rate (24.5/100,000 population) than the US overall (18.0/100,000) and higher proportions than other regions of individuals diagnosed with HIV who were black, female, younger, and living in suburban and rural areas. Furthermore, the targeted states had lower HIV and AIDS survival proportions (0.85, 0.73, respectively) than the US overall (0.86, 0.77, respectively) and the highest death rate among persons living with HIV of any US region. Regional differences in demographics and transmission risk did not explain the higher death rate among persons living with HIV in the targeted states indicating that other factors contribute to this disparity. Differences in characteristics and outcomes of individuals with HIV in the targeted states are critical to consider when creating strategies to address HIV in the region, as are other factors identified in previous research to be prominent in the region including poverty and stigma

Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South

A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict these experiences among HIV-infected individuals. Data from a longitudinal study of 611 HIV-infected individuals in the Southeastern US were used to examine the frequency and types of incident stress reported in a 27-month period and to determine predictors associated with 3 incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences frequently occurred among study participants, as 91% reported at least one stressful experience (median= 3.5 experiences) and 10% of study participants reported traumatic stress in any given 9-month reporting period. Financial stressors were the most frequently reported by study participants. Greater emotional distress, substance use, and number of baseline stressful experiences were significantly associated with reporting a greater number of incident stressful experiences and any traumatic experiences. Study results indicate that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors, including mental health and substance abuse that contribute to these experiences

Incident Stressful and Traumatic Life Events and Human Immunodeficiency Virus Sexual Transmission Risk Behaviors in a Longitudinal, Multisite Cohort Study

To assess the association between incident stressful life events (e.g., sexual and physical assault; housing instability; and major financial, employment, and legal difficulties) and unprotected anal or vaginal sexual intercourse (unprotected sex) among people living with HIV/AIDS (PLWHA)

Overload: Impact of Incident Stressful Events on Antiretroviral Medication Adherence and Virologic Failure in a Longitudinal, Multisite Human Immunodeficiency Virus Cohort Study

HIV-infected individuals frequently experience traumatic and stressful events such as sexual and physical assault; housing instability; and major financial, employment, and legal difficulties. Past trauma history predicts poorer medication adherence and health outcomes, yet little research has examined the influence of incident stressful experiences on antiretroviral medication adherence and treatment outcomes

Integrating depression management into HIV care in Lilongwe, Malawi: Feasibility and impact

In Malawi, as in other sub-Saharan countries, mental health care infrastructure and resources are limited. Accordingly, there is a clear need to shift the provision of mental health treatment to the primary care level. The Malawi Ministry of Health, in partnership with UNC Project-Malawi, designed a program that would integrate depression screening and management into HIV care at two public HIV clinics in Lilongwe, Malawi. The purpose of this study, conducted under Project SOAR, was to evaluate the implementation of this program and its impact on HIV and mental health outcomes