Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review

BACKGROUND: Approximately 14% of Africans infected with HIV are over the age of 50, yet few intervention studies focus on improving access to care, retention in care, and adherence to antiretroviral therapy (ART) in this population. A review of the published literature until 2012, found no relevant ART management and care interventions for older people living with HIV (OPLHIV) in sub-Saharan Africa. The aim of this systematic review is to update the original systematic review of intervention studies on OPLHIV, with a focus on evidence from sub-Saharan Africa. METHODS: We conducted a systematic review of the available published literature from 2012 to 2017 to explore behavioral and cognitive interventions addressing access to ART, retention in HIV care and adherence to ART in sub-Saharan Africa that include older adults (50+). We searched three databases (MEDLINE, EMBASE, and Education Resources Information Center) using relevant Medical Subject Headings (MeSH) terms as well as a manual search of the reference lists. No language restrictions were placed. We identified eight articles which were analyzed using content analysis with additional information obtained directly from the corresponding authors. RESULTS AND DISCUSSION: There were no studies that exclusively focused on OPLHIV. Three studies referred only to participants being over 18 years and did not specify age categories. Therefore, it is unclear whether these studies actively considered people living with HIV over the age of 50. Although the studies sampled older adults, they lacked sufficient data to draw conclusions about the relevance of the outcomes of this group. CONCLUSIONS: These findings underscore the need to increase the evidence-base of which interventions will work for older Africans on ART

Socio-demographic characteristics, maternal and fetal outcome of parturients presenting in second stage labour

Purpose: To document the socio-demographic characteristics, maternal and foetal outcome of booked patients presenting in second stage labour and compare them with those who presented in spontaneous active phase, first stage labour, delivering normally and without oxytocin augmentation. Method: Retrospective case - control study. Result: Women who presented in second stage labour were more likely to book late in pregnancy (23.01±7.55 weeks versus 20.80±7.98, p value 0.014) and attended fewer antenatal care visits (7.22±3.09 versus 8.67±2.98 p value 0.000). Higher parity (p value 0.002), lower female education (p value 0.000) and HIV positive status (10.52% versus 0.66% p value 0.000) were other factors found with late presentation in labour. The commonest reason for presentation in the second stage of labour was transportation problems (31.9%). Perineal tear was the only significant maternal outcome between the cases and control (26.3% versus 13.8%, p value 0.001). There was no significant difference in the foetal outcome between the two groups. Conclusion: Socio-demographic characteristics of patients affect their utilization of available obstetric care. Maternal and foetal outcomes were comparable in the two groups except for increased perineal tear among the cases. A multicentre prospective study is necessary to further evaluate the foetal and maternal outcome in this group of patients.Keywords: Second stage labour, first stage of labour, failed antenatal care, socio-demographic characteristics